Sexual health must not become the ‘Cinderella’ service of the NHS, says RCGP

Years of improvement in the quality of sexual and reproductive healthcare being delivered to patients – including a halving of teenage pregnancy rates over the last decade and steadily increasing uptake rates of long acting reversible contraceptives (LARCs) – is at risk due to the bureaucratic, financial and training barriers facing GPs and practice teams, the Royal College of GPs has warned.

Speaking at the Faculty of Sexual and Reproductive Health’s Annual Scientific Meeting conference in Cardiff, RCGP chair Professor Helen Stokes-Lampard highlighted the findings of a College consultation with its 50,000-strong membership.

It found that GPs fear rates of teenage pregnancy and transmission of sexually transmitted diseases will rise – reversing current trends – as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and that health inequalities are being widened as a result.

Members particularly cited the difficulties patients living in rural areas have in accessing sexual and reproductive health services, as well as younger patients who rely on their parents for transport.

One respondent said: “Reduced numbers of specialist clinics has reduced access for our women, especially those who have cultural and social issues meaning they are unable to travel. Many GPs are feeing unsupported in their LARC fitting services and are giving up. And the young people’s services are reduced as public health withdrew the funding to provide them.”

Professor Stokes-Lampard called out the complex and fragmented way that sexual and reproductive health services are currently commissioned in England, as well as the decreasing services available in the community. As it stands, some services are commissioned by NHS England, others by clinical commissioning groups, and others by local authorities, causing confusion amongst healthcare professionals and patients as to how to effectively navigate the system, causing unacceptable variation across the country.

She also highlighted that the funding GP surgeries receive for providing patients with LARCs does not often cover costs, meaning that practices are making a loss for delivering this service at a time when general practice is already under intense financial strain.

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Responding to the consultation, one member said: “We provide a weekly LARC drop in service at our practice but struggle with maintaining funding in practices rather than centrally. For our patients, services close to home are much better suited and this has become more of an issue since the city centre service closed only leaving a service on the other side of the city.”

Another concern raised in the paper, which Professor Stokes-Lampard addressed is training – an issue that affects the whole of the UK. One respondent to the consultation, for example, said: “Many doctors providing LARC services in primary care are nearing retirement and access to training for their successors is a problem.”

Professor Stokes-Lampard said: “In this day and age, all patients have the right to be provided with sufficient information to make the choice of contraception that is right for them, and be able to access that method without having to negotiate unnecessary hurdles – and GPs and our teams have the right to be properly trained and receive adequate recompense for carrying out these services.

“As one of the most cost-effective services we provide, sexual and reproductive health must not become the ‘Cinderella’ service of the NHS, especially when it has the potential to save the NHS millions through the prevention of unwanted pregnancies and transmission of STIs, as well as playing such as vital role in helping women control their fertility and therefore their lives. So much progress has been made in this area in recent years and the service is too important to be allowed to fall into decline.”