Speaking at a health and social care committee meeting last week, RCGP clinical champion for women’s health and Bradford GP Dr Anne Connolly told MPs that sexual health had become a ‘postcode lottery’ after responsibility for services was taken away from NHS England and handed to local councils in 2013.
Separating sexual health from other areas of primary healthcare has led to a ‘fragmentation’ in the management and delivery of services, Dr Connolly argued, leaving practices ‘unable to provide holistic care’ to women.
She said: ‘An example of our problems is with cervical screening… It is an insult that a woman has to be examined so many times - that they have a coil fitted and cannot have the smear done at the same time, because it is not funded. I think that is an assault, actually.'
Sexual health services
She added: ‘Even though the woman is in the position, and trained clinicians could do that, they are being told not to. The woman is told that she can have a coil fitted and have her swabs done, but she has to go somewhere else to have another examination. Those of us who have had smears know that it is quite intimate and quite an assault.’
A £600m reduction to councils’ public health grants between 2015/16 and 2019/20 has left local authorities and GP practices struggling to meet increased demand for sexual health services. Last year, a GPonline poll revealed that more than three quarters (77%) of GP partners had seen funding withdrawn or reduced for the provision of public health services at their practice, with sexual health being one of the most affected services - second only to smoking cessation.
Dr Connolly said: ‘I work in the centre of Bradford, where the cuts hit the most deprived most severely, because they cannot always navigate the social, cultural or financial factors; they cannot navigate the hurdles put in their way when access is changed. We know that increased inequalities are occurring across the system, with reduced access. From the point of view of the RCGP specifically, it is about payment for services. Payment has been reduced or stopped, or it is inadequate, or there is no promise of future funding, so nobody can plan…
She concluded: ‘It is very much a postcode lottery; in some areas [the funding] is there, and in some areas it is not, or not that much… The RCGP position is that it should come back under health, so that we can offer holistic care across the system, recognising that women spend a lot of their time either trying to be pregnant or trying not to be pregnant. Fragmentation, whereby funding is cut on one side and the expectations of managing the consequences are on the other side, is not working.’
Public health cuts
Committee chair and GP Dr Sarah Wollaston described Dr Connolly’s reports of fragmentation as ‘really concerning’, while committee member Rosie Cooper MP said the provision of sexual health services had become ‘so complicated that it is ridiculous’.
This comes less than a year after RCGP chair Professor Helen Stokes-Lampard warned MPs that funding cuts and inconsistent commissioning had left sexual health services across England in ‘crisis’ - resulting in ‘disrupted, disconnected and ultimately disappointing experiences for patients’.
Also speaking at the committee meeting was councillor Ian Hudspeth, chairman of the community wellbeing board at the Local Government Association (LGA). He said that the provision of sexual health services alongside a reduction in funding had posed ‘major challenges’ for local government and resulted in ‘some really difficult decisions’.
Cllr Hudspeth told the committee: ‘There have been opportunities to look at local government, which has been stepping up to the mark in places, perhaps making sure that things are more accessible in different units, bringing them in with other council services to make it more part of the holistic approach…
‘Ultimately, it comes down to the funding we have, and the increase in appointments as well, from 2.9m to 3.3m. With that upward curve and the reduction in funding, we are rising to the challenge, but it is difficult, and we would appreciate the cuts being reversed.’
Last year, the Health Foundation called for an additional £3.2bn of funding a year to reverse the effects of cuts to public health. However, spending will continue to drop this year with local council funding set to fall from £3.2bn in 2018/19 to £3.1bn in 2019/20.
A DHSC spokesperson said: ‘Prevention is at the heart of our bold plans to secure the future of the NHS, as outlined in the NHS long-term plan, and comes alongside the £3bn we are giving to councils to fund public health services this year including sexual health services.'