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A whole-system approach to commissioning for sexual health

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The progress achieved in the past 30 years in sexual health, reproductive health and HIV (SHRHH) has been phenomenal.

Rapid, open access to high-quality integrated genitourinary medicine (GUM) and sexual health services, together with improved choices for people’s reproductive health, have had an enormous impact on individual and population health and wellbeing.

Concerted efforts across England have reduced under-18 conception rates by over 40% since 1998, to the lowest level since the 1960s. And HIV, once universally fatal, now has the potential to be a long-term, manageable condition.

Yet in today’s world there is absolutely no room for complacency. Rates of new, late and undiagnosed HIV infection remain unacceptably high, abortion rates reflect unmet contraception needs, and rates of sexually transmitted infections are stubbornly elevated. 

The past year has been a transformative time. The commissioning arrangements have undergone radical changes, with the aim of creating locally relevant responses to improve the sexual and reproductive health of people and populations, while increasing equity for high-cost prescribed HIV services nationally. Local authorities, clinical commissioning groups and NHS England all have some responsibility for some element of the patient pathway.  

It is clear that achieving outcome improvements and efficiency gains, requires a system-wide approach to commissioning. Progress is already being achieved in England. Those working within the system continue to evolve thinking and approaches in this unfamiliar world, and new partnerships are being forged between commissioning organisations, providers and communities.  

However, if population and individual patient outcomes are to be not just maintained but improved, it is essential that more is done. To support our partners in this essential work, Public Health England has published – Making It Work: a guide to whole-system commissioning for sexual health, reproductive health and HIV.

The guide is designed to build on already available resources, focuses on how to establish seamless, integrated care pathways through a whole system approach, and describes how this can be made to work in practice. The boundaries and interfaces between all the bodies involved in commissioning SHRHH services are explored, with advice on how to achieve effective partnership working. Considerations for delivering better value are also set out.

Fifteen case studies are included describing models of existing and emerging practice, which we hope will provide valuable insights for commissioners, providers, clinicians, patients and the public.

In launching the guide, PHE acknowledges the invaluable support of our partners in development: the LGA, NHS England, the Department of Health, the Association of Directors of Public Health and a wide range of stakeholders across the sector who contributed. The guide can be downloaded here.

Jane Anderson, expert adivser HIV, sexual and reproductive health, Public Health England. Professor Anderson is also consultant physician and director, Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust


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