Commissioning local HIV sexual and reproductive health services

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.

Commissioning responsibilities

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

ICSs commission:

  • most abortion services
  • sterilisation
  • vasectomy
  • 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.

Policy context

A framework for sexual health improvement in England Department of Health and Social Care (DHSC) 2013

Commissioning sexual health services and interventions: best practice guidance for local authorities DHSC 2013

NHS long term plan The King’s Fund

Commissioning responsibilities

Making it Work – a guide to whole system commissioning for sexual health, reproductive health and HIV Public Health England (PHE) 2015

HIV, sexual and reproductive health: current issues bulletin 3 – commissioning HIV services PHE 2014

Sexual health, reproductive health and HIV: commissioning review PHE 2017

Needs assessments

Sexual health needs assessment: a how to guide

Prescribed places of detention: health needs assessment toolkit PHE 2014

Data and evidence

National Survey of Sexual Attitudes and Lifestyles (Natsal)

Sexual and reproductive health profiles

Sexual and reproductive health: spend of outcome tool (SPOT) PHE 2018

Health economics evidence resource PHE 2017

Chlamydia screening to focus on reducing harm from untreated infections PHE 2021

Addressing late HIV diagnosis through screening and testing: evidence summary and briefing PHE 2014

Promoting the health and wellbeing of gay, bisexual and other men who have sex with men PHE 2014

Local health and care planning: menu of preventative interventions PHE 2016

Designing services

Sexual health: clinical governance DHSC 2013

Teenage pregnancy prevention framework PHE 2018

Teenage mothers and young fathers: support framework PHE 2016

National chlamydia screening programme PHE 2017

C-card condom distribution schemes Brook and Public Health England 2014

Sexual health commissioning in local government Local Government Association 2015

HIV, sexual and reproductive health: current issues bulletin 2 – commissioning from primary care PHE 2013

HIV, sexual and reproductive health: current issues bulletin 4 – tendering sexual health services PHE 2014

Service specifications

Integrated sexual health services: national service specification DHSC 2013

Public health commissioning (NHS cervical screening programme service specification) NHS England

Public health commissioning (sexual assault referral centres) NHS England

Framework of principles on cross charging arrangements for sexual health services DHSC 2013

HIV, sexual and reproductive health: current issues bulletin 1 – payment for patients living outside your authority PHE 2013


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

Postal self-sampling kits guidelines and report BASHH 2021

Standards for online and remote providers of sexual and reproductive health services FSRH and BASHH 2019

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

You’re welcome: quality criteria for young people friendly health services DHSC 2011

National Institute for Health and Care Excellence (NICE) guidelines and resources

Long acting reversible contraception guideline NICE 2019

Reducing sexually transmitted infections guideline NICE 2022

Contraceptive services for under-25s guideline NICE 2014

HIV testing: increasing uptake among people who may have undiagnosed HIV NICE 2016

Sexually transmitted infections: condom distribution schemes NICE 2017

Contraception quality standard NICE 2016

HIV testing: encouraging uptake – quality standard NICE 2017

Keeping up-to-date

Knowledge Hub

Sexual health and HIV policy ebulletin FSRH

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:

Published 22 November 2013
Last updated 27 February 2023 + show all updates
  1. Updated list of resources.

  2. Updated sources of information.

  3. Link to guidance 'Sexual and reproductive health in England: a guide to local and national data' added.

  4. Replaced consultation link to the published commissioning guidance.

  5. A link to 'PHE Guide to National and Local Sexual and Reproductive Health Data' is added to the 'Data to help commissioners identify local needs' section.

  6. Edited to update the guide with HIV and reproductive health resources

  7. First published.