Sexual health targets ‘unrealistic and underfunded’, say local medics

A committee of Hackney GPs has slammed expectations baked into a recent council contract on sexual and reproductive health as “unrealistic and underfunded”.

The Local Medical Committee (LMC) has written to an influential Town Hall body scrutinising health with a number of “concerns” about a six-month-old arrangement between Hackney Council and the City & Hackney GP Confederation, which now implements and manages the services delivered by GPs.

Medics raised a number of issues, including the expectations that three quarters of all new registrants must accept an HIV test and that 95 per cent of all women aged between 16 and 49 must be offered Long Acting Reversible Contraception (LARC) such as the coil.

The LMC said: “In the context of City & Hackney’s highly transient and diverse population, the expectations of the contract appear unrealistic.

“There is a feeling that the contract is underfunded for the large amount of work required.

“The LMC would welcome some enquiry as to the overview of sexual health service provision envisaged, and whether the budget allocations, contract demands and key performance indicator requirements are appropriate for the demands of the contract on GPs.”

The GPs also flagged worries over a move towards offering self-testing over the internet, saying it could “prejudice opportunities for individual counselling of patients potentially at risk (eg sexual assault, safeguarding and relationship issues)”.

One of the primary objectives of the contract is to improve the uptake of the fitting of the coil or the contraceptive implant, with GP prescriptions of LARC steadily dropping.

According to government figures, eight in 1,000 women received such prescriptions in 2016, just over half the London average, dropping from 15 per thousand in 2011.

Statutory sexual health functions were transferred to councils in 2013, at which time the borough had a number of different individual contracts with GP practices, with the new arrangement aiming for a “more coordinated approach”.

According to a response to the LMC’s concerns by Dr Andy Liggins, consultant in public health and lead commissioner for City & Hackney, the rationale behind the expectations around HIV testing is to encourage uptake.

The National Institute for Health and Care Excellence (NICE) recommends that people living in areas with high HIV rates be offered a test by their GP practice when registering.

Dr Liggins added: “As there is still a stigma associated with HIV, the provision of universal testing for newly registered patients could help to address this stigma and normalise HIV testing as part of improving a person’s sexual health and wellbeing.”

The public health boss also defended the high targets on the offering of the coil, the increased uptake of which could help reduce the number of unintended pregnancies.

Dr Liggins also stood by the online service for self-testing, arguing that it will reduce unneccessary clinic attendances by focusing on patients without any symptoms and has “various triggers to identify potential safeguarding issues”.

The LMC’s concerns are due to be discussed at the 4 November meeting of the Health in Hackney Scrutiny Commission.