Plan to improve sexual health in England lacks “teeth,” say campaigners

BMJ 2013; 346 doi: (Published 18 March 2013) Cite this as: BMJ 2013;346:f1779
  1. Caroline White
  1. 1London

The government has set out its long overdue plans on how healthcare commissioners and providers should cut numbers of unwanted pregnancies and sexually transmitted infections in England—including a greater role for family doctors in helping to curb the spread of HIV.

But sexual health charities claim that the document, which sets out a series of “ambitions” and has come almost two years later than promised, lacks any real teeth or strategic direction.

The framework for sexual health improvement in England was published on 15 March, just weeks before the commissioning of sexual health services splits three ways on 1 April.1 As part of their new public health remit, local authorities will assume responsibility for most services, including contraception and testing for sexually transmitted infections. But the NHS Commissioning Board will fund contraception provided as an additional service under the GP contract, HIV treatment and care, and cervical cancer screening. Clinical commissioning groups will take charge of most abortion services, sterilisation, vasectomy, and gynaecology.

The framework says that more must be done to tackle the stigma and discrimination often associated with sexual ill health and to create a culture that prioritises prevention and that supports behaviour change, including safer sex. It says that strong leadership and joined-up working, a focus on outcomes, and an eye to the wider determinants of sexual health will be essential.

The areas most in need of improvement, it says, are teenage pregnancy rates, unplanned pregnancies, support for women seeking an abortion, the incidence of sexually transmitted infections, and the spread of—and avoidable deaths from—HIV infection.

Early testing and diagnosis almost halves the average cost of treating HIV to £12 600 (€14 700; $19 000) a year, yet the infection was diagnosed late in half of all new cases in 2011.2 Anyone being tested for a sexually transmitted infection should automatically be offered an HIV test, the framework says.

General practices are increasingly providing a range of more specialist sexual health services, “and we want to see this trend continue,” it adds.

GPs have a key part to play in HIV testing, particularly in areas of high prevalence, it says, citing evidence from practices in Haringey, north London, showing that specific training significantly boosted rates of testing for HIV and more than doubled the number of diagnoses.

But many general practice staff lack training and fear causing offence. Constraints over time and expertise make staff reluctant to broach the issue with patients, the framework says.

The chairwoman of the British HIV Association, Jane Anderson, said that the framework didn’t go far enough. “Combating HIV involves almost every discipline and area of government policy, from science through to education, economics, and social science. This means a strategy that gets all stakeholders around the table working to a coordinated plan,” she said.

The sexual health charity the Family Planning Association welcomed the framework but warned that there was “absolutely no guarantee” that local councils would act on it,” which could end up costing the economy more than £135bn over the next few years.

Its acting chief executive, Audrey Simpson, said, “While there is much in this framework to take heart from, unfortunately the government’s rhetoric for improving the entire nation’s sexual health does not match up to the reality on the ground.” The government needed to give the guidance some teeth, she said.

Labour’s shadow public health minister, Diane Abbott, wondered what had taken the government so long. “The unacceptable delay has created chaos, bringing work to a standstill, and yet this document has no new answers,” she claimed, adding that local authorities would be forced to “find their own way, relying on trial and error.”


Cite this as: BMJ 2013;346:f1779