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Joining up national commissioning for sexual and reproductive health and HIV services

Yesterday, NICE published public health guidance on contraceptive services for young people, which will be a valuable new resource for local teams looking to deliver tailored sexual health services at convenient locations for under 25s, which provide easy access to contraception moving forward.

The good news is that many of the recommendations from NICE can be implemented without additional budget. However, if gains in sexual health in this age group are to be sustained (for example, reductions in under-18 conceptions) and progress accelerated, investing time in meticulous joint working at a local level is essential.

More broadly, to deliver on the opportunities created by the transition in sexual and reproductive health and HIV commissioning arrangements over the last year,  real integration across the NHS, local authorities, those working in education, and the wider public, private, voluntary and community sectors must be achieved.

However, new opportunities are always accompanied by new challenges. A statement released this week by the Royal College of General Practitioners highlighted the potential for a drop in recognition of the important role of primary care in sexual and reproductive health service provision, risking loss of skills in this setting and increasing barriers to access for service users.

Alert to the need to support local areas negotiate this new landscape, PHE now publishes a monthly Current Issues Bulletin, addressing ‘live issues’ and queries from those responsible for commissioning and delivering sexual health services. These bulletins provide guidance and suggestions for solutions that can be used at a local level, and include information for provider bodies. Three issues have published to date, focusing on payment for patients living outside your local authority, commissioning sexual health services from primary care and HIV commissioning.  Ideas for future bulletins are welcome and can be sent to the editorial team via

PHE is also working with partner agencies on a major new piece of work, to develop a national framework for commissioning HIV, sexual and reproductive health services. The framework is intended to support commissioners in ensuring seamless local pathways for the individual accessing care, regardless of who is commissioning the service. To do this, the framework will provide:

  • practical advice and examples of existing and emerging practice to support the commissioning of services that effectively meet the needs of patients and populations
  • tools and resources to tackle some of the ‘nuts and bolts’ issues in addressing the interfaces in the system
  • ideas and mechanism to take the opportunities the new arrangements present, particularly with regards to addressing the wider determinants of health

To date MEDFASH, appointed to support the framework development, have consulted some 120 people across Local Government, NHS England, CCGs, providers and clinicians, representative bodies, patient representatives and the third sector.

Some of the key themes raised during the consultation process will be addressed by the framework, including how best to address the commissioning interfaces especially when services are being tendered and ensuring education and training continues to be an integral part of service provision.  The need to ensure the public health value of sexual health services are recognised, including building on our successes, will be reflected. The framework will also reflect the need for services to continue to meet a wide range of population needs, from accessible reproductive service for all women to highly specialised services for specific groups.

A final draft of the framework will be available for comment in April, for publication in early summer. We would encourage everyone with an interest in this area to feed in views to ensure the final framework reflects what you need. Information on how to share feedback on the draft framework will be available shortly but, in the meantime, questions can be sent to MEDFASH (, and further detail on the framework available here.

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