Sexual and reproductive health must not become the 'Cinderella' service of the NHS

Publication date: 26 July 2017

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 is warning today.

The College is launching its report Time To Act, highlighting 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."

The College is calling 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 yet others by Local Authorities, causing confusion amongst healthcare professionals and patients as to how to effectively navigate the system, and unacceptable variation across the country. 

The report also highlights 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 as a time when general practice is already under intense financial strain.

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 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 Helen Stokes-Lampard, Chair of the RCGP, 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."

Dr Anne Connolly, Vice President of the Faculty of Sexual and Reproductive Healthcare (FSRH) and Clinical Champion for Women’s Health at the RCGP, said: "The healthcare system is undergoing a workforce crisis marked by a difficulty in training, recruiting and retaining staff. Women bear the brunt of this crisis, with reduced access to sexual and reproductive healthcare (SRH). These changes and reduction in access are shortsighted and have happened due to funding cuts across the system. 

"It is unreasonable to expect that primary care services which are already under considerable strain will have the skills, appointments and ability to assimilate additional service provision without extra funding, training and planning. Lack of clear, timely and consistent communication across the system is, in fact, a key challenge for the patient journey. 

"As this report shows, the consequence is that women are not receiving the contraceptive care they need, and the risk of unplanned pregnancies is increased – and this often affects our most vulnerable patients most.

 "It is vital that GPs and other healthcare professionals in primary care are given advice, sustained support and training. Women’s Health is a clinical priority for the RCGP and along with the FSRH, we will be working to develop resources to support GPs to deliver the care our patients need."

Further Information

Click here to access Time To Act 

RCGP Press office: 020 3188 7574/7575/7633
Out of hours: 0203 188 7659

Notes to editor

The Royal College of General Practitioners is a network of more than 52,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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