Tools and resources for commissioners of HIV, sexual and reproductive health services to help plan and commission 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.
Responsibilities for commissioning sexual health services
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 clinical commissioning groups (CCGs), 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
- sexually transmitted infections (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 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.
HIV, sexual and reproductive health current issues bulletin
Public Health England supports commissioning of sexual health services at a regional level through 9 local centres and 4 regions (north of England, south of England, Midlands and east of England, and London).
The HIV, Sexual and Reproductive Health Current Issues Bulletin addresses ‘live issues’ and queries from those responsible for commissioning sexual health services, and providing guidance and suggestions for solutions that can be used at local levels. The bulletin also provides information for provider bodies. PHE publishes the bulletin as needed, in conjunction with the Department of Health, Local Government Association, Association of Directors of Public Health and the National Commissioners Group.
Developing service specification and contracts
These resources can help commissioners develop their services and undertake good commissioning, with clear service specifications and contracts.
- Making it work: a guide to whole system commissioning for sexual health, reproductive health and HIV is PHE’s national framework for HIV, sexual and reproductive health service commissioning in England, working with the Department of Health, Local Government Association, NHS England and Association of Directors of Public Health.
- A Framework for Sexual Health Improvement in England sets out the government’s ambitions for improving sexual health, starting with the evidence base for sexual health and HIV improvement. It provides information and support tools to enable collaborative working locally resulting in accessible services and intervention.
- Commissioning Sexual Health Services and Interventions: Best Practice Guidance for Local Authorities: This guidance is designed to help local authorities to commission high quality sexual health services for their local area.
- The Integrated Sexual Health Services: National Service Specification is to help local authorities commission integrated sexual health care and can be used alongside the non-mandatory public health services contract.
- The Public Health Services Contract 2013 to 2014 is adaptable for use for a broad range of public health services and delivery models. It provides a framework to hold providers to account for the delivery of these services to achieve improved health outcomes.
Data to help commissioners identify local needs
Health needs assessment (HNA) is a systematic way to identify the unmet health and health-care needs of a population and recommend changes to meet those unmet needs. Follow Public Health England’s good practice guide to carrying out a local sexual health needs assessment.
Local authority directors of adult social services and children’s services and the director of public health have a statutory responsibility to produce a Joint Strategic Needs Assessment (JSNA), which is a regular strategic assessment of the the current and future health and wellbeing needs of a local population. The Department of Health has published guidance explaining the duties and powers of Joint Strategic Needs Assessments bodies.
PHE’s Sexual and Reproductive Health Profiles enable local authorities, public health leads and other interested parties to monitor the sexual and reproductive health of their population, and the use of local public health systems.
STI and HIV data publication
The HIV & STI Department of Public Health England regularly releases tables, official statistics, slide sets and reports based on data collected using its various surveillance systems. The tentative publication dates are provided in the.
STI and HIV data resources
- Sexually transmitted infections (STIs): surveillance, data, screening and management
- HIV: surveillance, data and management
- Chlamydia: surveillance, data, screening and management
- National Chlamydia Screening Programme (NCSP)
- HIV and STI Web Portal (restricted access: contact your local PHE team)
Reproductive health data resources
- Sexual and Reproductive Health Profiles (PHE)
- Community contraceptive clinic data (HSCIC)
- Teen conception data (ONS)
- Abortion data for England and Wales (DH)
Sexual health data resources
- Sexual and reproductive health in England: a guide to local and national data
- Using conception data to monitor progress on teenage pregnancy
- Sexual and reproductive health profiles
- Public Health Outcomes Framework
PHE Centres can provide commissioners with local authority tailored reports, including:
- LASERs: STI and HIV intelligence for every lower tier local authority
- SOPHID (Survey Of Prevalent HIV Diagnosed): data tables described as part of HIV surveillance systems
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 Health produces guidance and advice on all aspects of contraception, including service standards and clinical governance for reproductive services
- Medfash promotes understanding and good practice across sexual, reproductive health and HIV treatment and care, promoting evidence-based service development and service delivery
- Family Planning Association has details of training courses for health professionals
- 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 professionals and social care workers