Tools and resources for commissioners of HIV, sexual and reproductive health services to help plan and commission regional and local services.
Sexual and reproductive health is not just about preventing disease or infection. It also means promoting good sexual health in a wider context, including relationships, sexuality and sexual rights.
Sexual health services are commissioned at a local level to meet the needs of the local population, including provision of information, advice and support on a range of issues, such as sexually transmitted infections (STIs), contraception, relationships and unplanned pregnancy.
Local authorities commission comprehensive open access sexual health services (including free STI testing and treatment, notification of sexual partners of infected persons and free provision of contraception). Some specialised services are directly commissioned by integrated care systems (ICSs), and at the national level by NHS England.
Local authorities commission:
- comprehensive sexual health services including most contraceptive services and all prescribing costs, but excluding GP additionally-provided contraception
- STI testing and treatment, chlamydia screening and HIV testing
- specialist services, including young people’s sexual health, teenage pregnancy services, outreach, HIV prevention, sexual health promotion, services in schools, college and pharmacies
- most abortion services
- non-sexual-health elements of psychosexual health services
- gynaecology including any use of contraception for non-contraceptive purposes
NHS England commissions:
- contraception provided as an additional service under the GP contract
- HIV treatment and care (including drug costs for post-exposure prophylaxis following sexual exposure (PEPSE))
- promotion of opportunistic testing and treatment for STIs and patient-requested testing by GPs
- sexual health elements of prison health services
- sexual assault referral centres
- cervical screening
- specialist fetal medicine services
Across England there is considerable regional variation in how sexual health services are provided and commissioned. They vary from distinctly separate general practice and community-based contraceptive provision with hospital-based abortion and genito-urinary medicine (GUM) services, to fully integrated sexual health services in the community. The variations occur because of differences in commissioning and contractual models used in local areas.
This section brings together existing resources that commissioners can use to support the commissioning process. It is primarily aimed at people working in local authorities who are either new to sexual health or new to commissioning, or to both. It should also be useful to those who have been working in the field for some time – as a reminder of a familiar issue, a prompt about something new or a useful reference point for key important documents.
The document should be used as a reference that can be dipped into at all stages of the commissioning cycle.
A framework for sexual health improvement in England Department of Health and Social Care (DHSC) 2013
NHS long term plan The King’s Fund
Making it Work – a guide to whole system commissioning for sexual health, reproductive health and HIV Public Health England (PHE) 2015
Data and evidence
Health economics evidence resource PHE 2017
Sexual health: clinical governance DHSC 2013
C-card condom distribution schemes Brook and Public Health England 2014
Sexual health commissioning in local government Local Government Association 2015
Service standards for sexual and reproductive health Faculty of Sexual and Reproductive Healthcare (FSRH) 2016
Service standards for consultations FSRH 2020
Standards for management of STIs British Association of Sexual Health and HIV (BASHH) 2019
STI outreach standards BASHH 2016
Standards of care for people living with HIV British HIV Association (BHIVA) 2018
The care of women requesting induced abortion Royal College of Obstetricians and Gynaecologists (RCOG) 2011
National chlamydia screening programme standards (8th edition) UK Health Security Agency 2022
National Institute for Health and Care Excellence (NICE) guidelines and resources
Contraception quality standard NICE 2016
Further resources for commissioners
Various organisations provide additional information and guidance to inform the commissioning of sexual health services. These include statutory organisations, educational bodies and the voluntary sector:
- National Institute for Clinical Excellence (NICE) provides evidence-based practice, pathways and guidelines for sexual health
- British Association for Sexual Health and HIV (BASHH) champions good sexual health and provides training and workshops and information on governance and guidelines.
- British HIV Association (BHIVA) is a national advisory body to professions and other organisations on all aspects of HIV care, providing clinical guidelines and standards as well as educational events
- Faculty of Sexual and Reproductive Healthcare (FSRH) produces guidance and advice on all aspects of contraception, including service standards and clinical governance for reproductive services
- Family Planning Association has details of training courses for health professionals
- Sexwise provides information and advice about contraception, pregnancy, STIs and sexual wellbeing for public and professionals including webinars
- Brook has information for professionals about sexual health advice for young people
- National AIDS Trust has information, advice, a range of publications and useful leaflets, and also runs the English HIV and sexual health commissioners network
- Terence Higgins Trust (THT) has resources and information on sexual health and HIV for several audiences, including for teachers, health