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 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

CCGs 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 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 2013

Commissioning sexual health services and interventions: best practice guidance for local authorities Department of Health 2013

NHS five year forward view NHS England 2014

Commissioning responsibilities

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

HIV, sexual and reproductive health: current issues bulletin 3 – commissioning HIV services Public Health England 2014

Sexual health, reproductive health and HIV: Commissioning review Public Health England 2017

Needs assessments

Health needs assessment: a practical guide NICE 2005

Sexual health needs assessment: a how to guide

Prescribed places of detention: health needs assessment toolkit Public Health England 2014

Data and evidence

The national survey of sexual attitudes and Lifestyles

Sexual and reproductive health profiles

Spend and outcome tool

Sexual and reproductive health: spend of outcome tool Public Health England 2018

Health economics evidence resource Public Health England 2017

Chlamydia screening: evidence summary and briefing Public Health England 2014

Addressing late HIV diagnosis through screening and testing: evidence summary and briefing Public Health England 2014

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

Local health and care planning: menu of preventative interventions Public Health England 2016

Designing services

Sexual health: clinical governance Department of Health 2013

Teenage pregnancy prevention framework Public Health England 2018

Teenage mothers and young fathers: support framework Public Health England 2016

National chlamydia screening programme Public Health England 2017

C-card condom distribution schemes Brook/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

HIV, sexual and reproductive health: current issues bulletin 4 - tendering sexual health services Public Health England 2014

Service specifications

Integrated sexual health services: national service specification Department of Health 2013

Service specifications specialised human immunodeficiency virus (HIV) services (adult) and specialised human immunodeficiency services (children) NHS England 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 Department of Health 2013

HIV, sexual and reproductive health: current issues bulletin 1 Payment for patients living outside your authority Public Health England 2013


Service standards for sexual and reproductive health FSRH 2016

Standards for Management of STIs BASHH 2014

STI outreach standards BASHH 2016

Standards of care for people living with HIV British HIV Association 2013

The care of women requesting induced abortion RCOG 2011

National chlamydia screening programme standards (7th Edition) Public Health England 2014

You’re welcome: quality criteria for young people friendly health Services Department of Health 2011

NICE guidelines and resources

Long acting reversible contraception guideline NICE 2005

Sexually transmitted infections and under 18 conceptions: prevention guideline NICE 2007

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

English HIV and Sexual Health Commissioners’ Group

Sexual Health & HIV Policy eBulletin

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 26 March 2018 + show all updates
  1. Updated sources of information.

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

  3. Replaced consultation link to the published commissioning guidance.

  4. 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.

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

  6. First published.