Sex, Lives and Red Tape

Commissioning Contraception – what has changed since 2012?

You know those moments when, completely by chance, you stumble across something which is incredibly relevant to your research?

Well yesterday I came across the Advisory Group on Contraception‘s audits on contraception and abortion commissioning in 2012 and 2014. Hopefully this will help to evidence the section I’m writing on how commissioning of contraception services have changed. Below is a short summary of the two audits, and some personal reflections.

 Contraception commissioning in 2012

  • In 2012, all sexual health services were commissioned by NHS PCTs (Primary Care Trusts) in England (n=151), of which 83% completed the audit. The audit noted large variation across commissioners regarding definition, scope and ambition of contraceptive services.
  • Strategy: 53% of responding PCTs had a strategy for reducing unintended pregnancies and abortion rates; of these a quarter restricted their strategy to teenagers.
  • Restrictions: 34% of responding PCTs had some form of restriction in place; typically restrictions to prescribing contraceptive methods or access to services. A number of PCTs reported restricting access to free emergency hormonal contraception to women under 25, for example. Abortion rates in areas with restrictions were noted to be higher, however the report does not indicate if this was a statistically significant difference.

Contraception commissioning in 2014

  • Following the Health and Social Care Act (2012) PCTs were abolished and the responsibility for sexual health service commissioning has transferred to three organisations; local authorities, clinical commissioning groups and NHS England. In 2014 the 152 upper tier and unitary councils in England were invited to participate in a second audit, of which 88% responded.
  • 35% of responding local authorities (LA) did not procure contraceptive services using a service specification.
  • 60% of responding LA reported joint commissioning arrangements across geographical boundaries.
  • Strategy: 20% of responding LA had a strategy in place for reducing unintended pregnancies. 28% reported that plans were in place to increase contraceptive uptake and improve access to contraceptive services. The map below shows whether LA have carried out a local needs assessment for contraceptive provision in the last 3 years; 31% of commissioners reported no assessment having been carried out or planned.
  • Restrictions: it was reported that “some of the restrictions in access put in place by primary care trusts have also been enacted by local authorities.”
  • Funding: the audit compared the level of reported planned spend for contraceptive services as reported to the Department for Communities and Local Government, to the level of reported spend for the same services in the audit. The results showed large inconsistencies, and much lower levels of planned spending in the audit.

Screen Shot 2014-06-19 at 13.38.05

Personal reflections…

  • It was interesting to note that the AGC obtained their information via Freedom Of Information requests. This is a clever approach to take as Freedom of Information Act (FOIA) gives anyone the right to access recorded information held by public organisations. This methodological approach may come in handy during my PhD… it’s certainly a good way to obtain good response rates! 
  • It is unclear why the 2014 audit did not invite responses from CCGs and NHS England, in order to establish a full picture of contraceptive services in England. It’s likely this was due to available resources, and the added complexity with multiple information covering the same areas. One of the concerns about the new system is the fragmentation across different organisations, and unfortunately this audit does not provide much information regarding this; this is an area which could be further researched.
  • Its somewhat unwise to directly compare the two audits as the FOI requests were not identical between audits. However it is very striking how many fewer strategies were reported to be addressing unintended pregnancies across England in 2014 compared to 2012, and how the planned allocated funding appears to have reduced across many areas.
  • It’s not too surprising that many restrictions remain in place (although this wasn’t quantified), as in many areas they will have carried over the same contracts and providers. Now that the new commissioning responsibilities are a little more established, it will be interesting to see whether any changes are planned for the next commissioning cycle (2014/15), as I would expect to see more innovative approaches and change across England proposed for next year (now that the dust of the Health and Social Care Act (2012) has somewhat settled).

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This entry was posted on June 19, 2014 by in PhD, Sexual Health, Uncategorized and tagged , , , , , , .