Exclusive: GP public health services cut by local authorities, poll reveals

One in three GP partners say public health services at their practice have been reduced since local authorities took over commissioning them in 2013, a GPonline poll reveals.

Smoking: GP public health services cut back
Smoking: GP public health services cut back

GPs across England have seen services such as weight management, smoking advice, sexual health and contraception cut back.

Out of 303 GP partners who responded to a GPonline poll on public health and sexual health provision, a third (33%) revealed that public health services commissioned from their practice had decreased since local authorities took control in April 2013.

Just 13% said it had increased, while those remaining – over half – indicated they did not know.

And respondents warned that services may be further ‘under threat’, as funding and payments cuts put greater strain on the practices attempting to continue delivering services.

LARC services reduced

One in eight (13%) partners whose practice provided LARC services in 2013 said they had since had to stop following the changes to commissioning, and 8% of those still providing the service fear they may have to close it within the next year.

Dr Andrew Green, chairman of the GPC’s clinical and prescribing committee, warned that the shift to local authorities commissioning services had 'damaged' sexual health provision and would gradually force more and more practices to give up on providing contraceptive schemes.

Partners revealed they had been forced to consider axing the services as high costs meant they were losing money despite investing vast amounts of staff time to keep them running. Others said the services had been tendered out to other providers.

Others are struggling to continue providing services to patients. ‘Still doing STI screening, unsure if still being paid,’ said one GP. ‘We just absorb all to try and help patients,’ revealed another.

Public health cuts

One in eleven (9%) reported that their practice had had to stop other sexual health services, such as STI screening and fitting IUDs.

One GP felt that decisions to cut back on services were made with ‘less understanding of health priorities and more based on money’.

Dr Green said the poll results showed that ‘damage had already begun’ from local authorities scaling back services.

‘The changes to LARC provision were completely unnecessary and it is so sad to see the damage they will cause to women’s health in the future,’ he warned.

‘In many areas the local authorities have not only reduced the level of funding provided, but also increased the complexity and financial risk of the schemes to the point where, if practices were to do the sums properly, they would realise they are being provided at a loss.

'Damaging' care

‘No business can continue to provide loss-making services without harming other areas of care, and it is inevitable that as time goes by fewer and fewer practices will do this work and access to services for women will be reduced.

'The real danger then is that the skills required to do this work are lost and will not be regained, even if the short-sightedness of the policy is realised.'

The government announced last week that it would cut £161m from the public health budget over the next two years, on top of £200m in cuts made last year, threatening to further squeeze commissioning of services.

A Local Government Association (LGA) spokesman said: ‘Local authorities have increased spending on sexual health services since they took control of public health to the tune of approximately £600m a year, and as these figures show, the vast majority of GP practices continue to provide sexual health services.

‘However, the significant cuts by government to public health grants announced [last week] will have a major impact on the many prevention and early intervention services carried out by councils, including sexual health.

‘Given that much of councils' public health budget goes to pay for NHS services like sexual health, public health nursing, drug and alcohol treatment and health checks, these are cuts to the NHS in all but name. And it will put further pressure on other NHS services.’

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