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London boroughs seek NHS funding to cover PrEP trial

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  • London councils seeking “additional funding” from NHS England to help cover costs of PrEP trial places
  • Thousands of trial places at risk unless NHS provides around £3.5m
  • Fifteen MPs and Lords’ members have written to Matt Hancock to demand “sustainable solution”

London boroughs are seeking additional funding from NHS England to help deal with cost pressures arising from trials for an HIV drug.

In February, NHS England announced an expansion to its trials for PrEP, which is a course of treatment taken by HIV-negative people to stop them from getting the infection.

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This doubled the number of places on the pre-exposure prophylaxis trial from 13,000 to 26,000, and HSJ understands London has been asked to provide 7,400 of the extra places.

NHS England first started commissioning trials in 2017, after a court said it had the power to fund it. But, while the cost of the PrEP drugs and research is being funded by the NHS, the costs of the additional sexual health appointments and testing resulting from the trials are not.

The London Sexual Health Programme, a partnership between councils which commissions the PrEP trials in 32 boroughs, has said it can cover the costs for around a third of the new trial places and would require “additional funding” from NHS England to help cover the rest, Health Service Journal reports.

The extra costs are thought to be up to £3.5m per year, and it is unclear whether the places will be provided without this funding.

A spokeswoman said: “Given public health funding from central government is decreasing, commissioners have requested additional funding from NHS England to help support this trial”.

She said the London councils “welcome” the expansion of the trial but said they “already support 50 per cent more PrEP trial places than the rest of England put together”.

The LSHP has also asked for permission for trial participants to be able to manage some of the programme requirements using an online portal rather than through face-to-face appointments. It believes this will significantly reduce the cost of funding the trial.

NHS England did not respond to HSJ when asked if it was likely to help London authorities manage the additional costs of the ongoing trial.

The local authority ask comes after a group of 15 MPs and members of the Lords wrote to health and social care secretary Matt Hancock earlier this month to demand he intervenes to resolve the standoff.

One local authority official, who is close to the process and asked not to be named, said: “We are in the realm now where PrEP needs to be routinely commissioned”. They added this would allow councils to have a conversation with central government to call for “additional finances” to fund the service development, as routinely happens when councils are called on to deliver new schemes above their usual mandate.

John Stewart, NHS England’s specialised commissioning director, said: “This expansion will help ensure the learning from the trial is robust enough to fully inform the planning of a national PrEP programme in partnership with local authorities for the future, as well as protecting more people from HIV right now.”

The trials are due to last three years.

NHS England did not respond when asked when PrEP will be routinely commissioned.

Timeline

November 2016 – NHS England loses court battle over funding the drug. It had argued councils should fund it because it is preventative. Judge decides that NHS England has “the power, if not the obligation” to fund PrEP.

April 2017 – Drug trial overseen by Public Health England due to begin, but gets delayed. NHS England accepts efficacy of PrEP but argues a trial is needed to understand the demand and impact of the drug.

October 2017 – Trial begins with 10,000 places on offer across the country. Government commits at least £10m to fund the trial and says it will last for three years.

October 2018 – First trial expansion, with a further 3,000 places offered due to unexpected popularity of medication.

February 2019 – Second trial expansion with places doubled from 13,000 to 26,000. All councils accept this apart from London which is asked to provide 15,000 of the available places

March 2019 – MPs write letter to Mr Hancock arguing he must find a “sustainable funding” solution to commission PrEP on a routine basis

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