Sexual health is another commissioning crisis

We were concerned to read the investigation on NHS contracting and the threats to complex service provision and training reported in ophthalmology and dermatology.1 2 A crucial service to the public to detect, treat, and prevent HIV and other sexually transmitted infections (STIs) is also in peril.

In April 2013, English local authorities became responsible for commissioning services for sexual health, HIV prevention, and HIV testing. HIV treatment services are commissioned separately by NHS England.

We have received reports from clinicians across England describing dysfunctional commissioning processes in areas undergoing competitive tendering, with compromised patient pathways and fragmentation of sexual health services.

Cost efficiency seems to be over-riding quality; patient pathways, including those for complex sexual infections and specific groups, such as men who have sex with men, are at risk; and postgraduate training is compromised because service specifications failed to take these requirements into account. Some local HIV services have been destabilised, with access to testing and treatment for STIs for people with HIV being jeopardised.

STI care is a key clinical public health service. More than one million HIV tests were performed in sexual services last year and almost 450 000 new STI diagnoses recorded.3 Co-location of HIV testing and outpatient treatment gave the UK world class rates for retention of HIV positive patients into care and treatment, and successful viral suppression.4

The clinical nature of local authority contracts for sexual health needs to be recognised with sustained ring fencing of resources. Sexual health does not feature in the NHS plan for sustained and protected funding, and without this services will be highly vulnerable.

We call for a strong national steer for co-commissioning of HIV and sexual health services, with an urgent review and revision of the contracting process because a serious risk to public health is developing.