Sexual health is still a Cinderella service

Many PCTs are still failing adequately to promote the use of long-acting reversible contraceptives, reports Sanjay Tanday.

GPs have long campaigned for sexual health to be added to the QOF, to boost the profile of what has always been considered a Cinderella service.

Former health ministers, including Caroline Flint, toyed with the idea but opted instead to educate patients about contraceptives via expensive media campaigns.

But it appears the campaigns have done little to curb teenage pregnancy rates, with figures from the Office for National Statistics showing an increase in England and Wales in 2007.

This trend may have influenced the DoH's decision to finally add sexual health to the QOF for 2009/10.

Practices can score 10 points for a register of women who have been prescribed contraception at least once a year and have received advice about long-acting reversible contraceptives (LARCs).

NICE has pushed for better promotion of LARCs since 2005. It estimates that switching just 7 per cent of women from oral contraceptives to LARCs could prevent 73,000 unwanted pregnancies each year.

Lower failure rate
Dr Patricia Lohr, medical director at the British Pregnancy Advisory Service, says that research has shown that oral contraceptives have a typical use failure rate of 8 per cent compared with less than 1 per cent for LARC methods.

But a Freedom of Information Act investigation in this week's GP reveals that GPs face a battle to persuade PCTs to offer these more effective forms of contraception.

Just 42 per cent of the 4,623 practices covered by the investigation currently offer patients a full range of contraceptives, including LARCs.

Julie Bentley, chief executive of the fpa (Family Planning Association), says the findings are worrying given that 80 per cent of women obtain their contraception from their general practice.

'This makes it imperative that GPs are given access to training that will enable them to offer comprehensive and objective sexual health and contraceptive services,' she warns.

Dr Sarah Gray, a GPSI in women's health in Cornwall, believes the findings show how badly PCTs are neglecting sexual health services.

'There is a lack of incentives for sexual health. It is at the bottom of the list when you compare it with the number of QOF points for other areas such as cardiovascular disease.

'PCTs are looking to restrict LARC use in order to save money,' she adds. 'There is a huge cost agenda for PCTs.'

North London GP Dr Richard Ma, of the RCGP's sex, drugs and HIV working party, agrees that not all PCTs are taking sexual health seriously.

'It comes down to PCT priorities. Each PCT has to decide what services to offer patients. Some are offering enhanced services but this varies across the country.'

Dr Gray says enhanced services have worked well in some areas: 'In our patch in Cornwall, we fit 80 per cent of coils in general practice.'

Regular work is important, she adds: 'You would need to fit at least one coil a month to maintain the skills.'

But Dr Gray adds that many PCTs have not established a training programme for IUDs or implants and warns that there is a shortage of trainers.

She says this could be solved by training GPs in their own practices, which would require cooperation between the local trainer, practice colleagues and patients.

Schemes like this, along with enhanced services, could help to boost LARC uptake.

But unless PCTs are on board, the chances of the DoH achieving its goal of halving the number of teenage pregnancies by 2010 appear slim.

sanjay.tanday@haymarket.com

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