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Professor Helen Stokes-Lampard on the obstacles preventing GPs from providing and delivering high-quality SRH care that they aspire to
Date: 26 Jul 2017
Author: Prof Helen Stokes-Lampard
Professor Helen Stokes-Lampard is a GP partner in Lichfield, formerly an academic lead and Head of GP Teaching at Birmingham Medical School. She was also the Programme Director for the MSc in Clinical Primary and Community Care at the University for two years and was lead for the Community Gynaecology module for four. She became the Chair of the Royal College of General Practitioners in November 2016 and since then has been fully seconded from the University of Birmingham.
In this month’s eFeature, Professor Stokes-Lampard outlines some of the obstacles preventing GPs from providing and delivering the high quality sexual and reproductive health (SRH) services they aspire to and highlights complexities in the current system that are negatively impacting on patients and patient-centred SRH care.
In 2014, the College published its first position paper on sexual and reproductive health. It highlighted the risks to the system in England caused by the Health and Social Care Act 2012. Two of the main findings were i) reduced availability of Long Acting Reversible Contraception (LARC) in primary care and ii) the difficulty of retaining training qualifications.
In Oct 2016, we polled RCGP members to get a better feel for how SRH services were functioning on the ground. It quickly became clear that that the concerns we highlighted in 2014 were being realised, with the situation in England so serious that SRH provision as a whole is at risk of imminent collapse in some areas. It’s likely that by the time this downturn is more fully reflected in official figures these problems will have become entrenched and more difficult to reverse.
“SRH provision as a whole is at risk of collapse”
This week we have released a new report – Time to Act – outlining our findings and making a series of recommendations on what action is needed at local and national level to protect the progress made in the sexual and reproductive health field. The report is fully endorsed by the FSRH, and I am pleased to be able to share some of the key findings with you in this feature.
The RCGP exists to promote quality in general practice, GPs are expert medical generalists, and we believe that quality SRH should enable patients to have a choice of methods, delivered by a well trained professional and accessed without fear of harassment or stigma. We think that services should be fully integrated with clear referral pathways, creating a seamless experience including contraception, reproductive healthcare and STI care.
Unfortunately, our members are telling us that current circumstances are preventing GPs from delivering the fully patient-centred service that they aspire to.
Obstacles to SRH service success
GP access to training – GPs say they are finding it harder to access the training they need to be able to give patients the most effective forms of contraception. Only 18% of UK GPs who took our survey agree that LARC training is easy to access, this may reflect a combination of other service pressures (unable to take time out to train) and lack of training opportunities. There is uncertainty in England around the future of the service and the lack of meaningful communication with public health commissioners are reducing incentives for GPs to continue to keep up their training qualifications resulting in reduced services.
“Training is not easy to access as there is quite a waiting list and it is not sufficiently funded”
Payments in England no longer cover the cost of administering LARC services – Some GPs tell us that they are providing this service for love and not money, which is completely unsustainable in the long term.
“We run this service in our GP practice at a significant financial loss”
Fewer specialist SRH services - The cuts to public funding and the inevitable redistribution of money to other services has had a knock-on effect on the availability of specialist SRH services meaning that patients are not always able to access the best care for their needs. Contraceptive care has increased in medical complexity over time, resulting in even the most experienced GPs often needing to refer patients to specialist care. Specialist SRH services are better equipped to deal with more complex cases. It’s therefore worrying that our survey showed that only 74% of GPs in England are able to access specialist support when they need it.
Patient access to services – Our survey showed that in England only 62% of GPs patients, whose best option was LARC, are able to access it. 86% of GPs in England provide LARC for their practice but 39% of these said that they have experienced cuts to the funding for this service. 29% of English GPs taking part in our survey believe that their LARC service will get worse in the next year.
“Dedicated clinics are far away from many clients living in rural areas. This is especially a problem for the younger population - particularly if they don’t want their parents involved.”
Fragmented commissioning pathways - The Health and Social Care Act 2012 led to the fragmentation of the commissioning responsibilities for SRH provision in England. From a GP perspective, reimbursement for contraception and sexual health provision from primary care is extremely complicated! A coordinated approach to the commissioning of SRH, pooling policy based around shared aims, would not only improve patient pathways but would also make the entire system more robust to budget cuts.
A move away from patient-centred care
GPs and indeed all professionals delivering SRH services are doing a great job considering the complexities of the current system however there are still negative impacts for our patients.
Health inequalities – Patients trying to navigate this complex system are experiencing language, cultural, financial and geographical barriers. None of these things should prevent a patient receiving the best quality care possible.
Little oversight of the whole system – Due to split commissioning responsibilities there is little oversight of the whole SRH system. This goes against patient-centred care aimed at improving the health of individuals and the population as a whole. Services appear to be shaped by the source, availability and amount of funding rather than by patient need.
Knock-on effect on other services – If services aren’t utilised effectively and efficiently, there could be a huge impact on the workload pressures on other parts of the system e.g. General practice, maternity services and abortion services. 41% of GPs in England agree that appointments for contraceptive advice have increased over the past year.
Inability to plan for the future – Due to the short timescales for which services are now commissioned it has become more difficult for providers to commission for the future. Professionals need to be able to plan for appropriate training and ensure there is money in the budget for it.
Summary of recommendations
We have put together 10 recommendations to improve SRH services, some of which are for England only and others which should apply across the UK. Our recommendations can be summarised as:
- Review of public health indicators around SRH and HIV and more power to act on them
- Sharing best practice in SRH and HIV commissioning among local commissioners
- Training in the delivery of LARC to become easier to access for general practice
Our next steps
We’re looking to share GPs’ experiences around the commissioning and provision of SRH services and we’d like for you to share our (or your!) stories @rcgp using #SRHTimeToAct. You can also join our campaign mailing list for updates here.
We’ve started talking to commissioners, PHE and Government Ministers about the issues raised in our report and we’ll soon be looking to discuss access to training with training bodies. We hope that by working with other like-minded organisations such as the FSRH, we’re able to identify best practice for the provision of SRH services for our patients across the UK.