Poor sexual health services in general practice says new Parliamentary survey

18 October 2007

Erratic, uncoordinated and poorly planned. This is the verdict of the All-Party Parliamentary Pro-Choice and Sexual Health Group (APPG) following a survey published in a new report Delivery of Sexual Health in General Practices examining the management of sexual health services in general practices by Primary Care Trusts (PCTs) in England.

Out of the 122 PCTs [1] surveyed, results indicate that only 5% of general practices provide testing and diagnosis of sexually transmitted infections, at least 70% of women aren’t being offered the full range of contraceptive methods, and PCTs aren’t targeting services to reduce unintended pregnancies in women over the age of 18.

In reaction to these findings the APPG are making four key demands:

• PCTs must carry out regular contraceptive audits to establish what methods are being prescribed.
• PCTs must ensure an adequate number of general practices offer all fourteen methods of contraception.
• PCTs should offer greater financial incentives and resources to general practices so they can offer other sexual health services such as STI testing.
• PCTs should use contraception and abortion budgets to make services cost effective by reducing the numbers of unintended pregnancies.

According to the APPG survey, almost half (47%) of PCTs had not assessed and do not know what methods of contraception general practices in their area offer. This is despite 91% of general practices in the PCTs surveyed providing contraception. Of the 53% of PCTs who do know, availability varies significantly: only 30% of general practices provide the implant, 65% provide the IUDs/IUS with 90% providing the injection.

As 80% of women get their contraception from general practice, restricting access to the 14 contraceptive methods available is severely detrimental to women’s needs and in reality is a false economy. Research from fpa [2] shows changing contraceptive prescribing patterns saves the NHS money – some £500 million pounds over 15 years if women’s true preferences are met. Not providing women with a full choice of methods also falls well short of guidance issued from the National Institute for Health and Clinical Excellence [3].

In England, there were 335,123 newly diagnosed sexually transmitted infections in 2006 [4]. Out of the 122 PCTs surveyed only 334 (5%) of a possible 6,647 general practices provide testing and diagnosis of STIs. 89 PCTs (61%) said they do not provide STI services at all and among the 33 (27%) of PCTs that do, a postcode lottery operates. For example, in one London PCT 44 out of 48 practices provide STI testing but in a Buckinghamshire PCT only one out of 28 practices does.

Encouragingly 14 (12%) PCTs said they had STI testing services currently in development. Nevertheless, taking this into consideration only 38% of PCTs intend to or do provide services in general practice to help ease waiting times and workload pressures on genitourinary medicine clinics.

Worryingly the question ‘what percentage of conceptions end in abortion in your PCT area?’ proved impossible to answer for most PCTs. Although many PCTs had data for under-18 year olds for the Teenage Pregnancy Strategy [5] they simply were not aware of this information for women aged between 18 and 45. However, abortion affects women differently across the age groups. The abortion rate is highest among women aged 20-24 [6] whilst women in their late twenties (25–29 year olds) [7] have as many abortions as teenagers do (15–19 year olds) [8].

Commenting on the findings, Baroness Joyce Gould, Chair of the All-Party Parliamentary Pro-Choice and Sexual Health Group said:

“The approach taken by most Primary Care Trusts delivering sexual health services in general practice is erratic, uncoordinated and poorly planned. Too many PCTs are unaware what is happening on their own doorstep. The APPG is extremely concerned that PCTs across England are falling short of expectations and neglecting their duty to meet recognised standards.

“Sexual health services in general practice aren’t just a back up to specialist services. They are vital in providing healthcare for the entire community,” she continued. “Instead of harmonisation, services in general practice are developing on an ad hoc basis, out of synchronisation with the needs of people trying to use them.

“The APPG is making four key demands to dramatically improve the availability and quality of sexual health services in general practice. PCTs should use all the evidence available to them to improve sexual health in their area with the clear aim of making the situation much better,” she concluded.

-ENDS-

For further information please contact fpa’s Press Office 020 7608 5265/5264. Mobile 07958 921060.

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Note to editors

1. In March 2007, the APPG asked 152 PCTs the following questions, 122 replied giving a response rate of 80%:

• How many general practices are in your Primary Care Trust?
• How many of these general practices provide contraception as an additional service?
• Have you completed an assessment of prescribing patterns for contraceptive services from general practice using prescribing data?
• How many general practices currently provide IUDs/IUS? (those who answered yes to question 3).
• How many general practices currently provide contraceptive implants? (those who answered yes to question 3).
• How many general practices currently provide contraceptive injections? (those who answered yes to question 3).
• Do you have a locally enhanced service (LES) with general practice to provide diagnosis and treatment of sexually transmitted infections? If so how many general practices are providing it?
• What percentage of conceptions end in abortion in your Primary Care Trust area?

2. Nigel Armstrong, Caroline Davey and Cam Donaldson, The Economics of sexual health (fpa August 2005)

3. In 2005 the National Institute for Health and Clinical Excellence (NICE) published guidance recommending that women requiring contraception should be given information about and offered a choice of all methods including Long Acting Reversible Methods of Contraception (the injection, the implant, the IUD and the IUS).

4. Health Protection Agency July 2007

5. The Teenage Pregnancy Strategy is a government initiative to halve the number of conceptions to under 18s by 2010, see www.dfes.gov.uk/teenagepregnancy.

6. 55,340 women aged 20-24 had an abortion in 2006 a rate of 33 per 1,000 women. Abortion Statistics, England and Wales 2006.

7. 40,396 women aged 25-29 had an abortion in 2006 a rate of 24 per 1,000 women. Abortion Statistics, England and Wales 2006.

8. 40,244 women aged 15-19 had an abortion in 2006 a rate of 24 per 1,000 women. Abortion Statistics, England and Wales 2006.