England: national commissioning of HIV testing and treatment, local government to fund sexual health clinics

The Department of Health proposed today that HIV testing, treatment and care services should be funded and co-ordinated on a national level, by the future NHS Commissioning Board. At the same time, a wide range of sexual health services - including clinical services - will become the responsibility of local authorities, as part of their new public health role.

Their proposals are open for consultation until 31 March 2011.

The Conservative / Liberal Democrat government announced radical reforms for the English National Health Service (NHS) soon after taking office in May. A central plank of their proposals is the abolition of  NHS organisations known as primary care trusts (PCTs). Most of their responsibilities for co-ordinating and funding services (“commissioning”) are to be handed over to local consortia of general practitioners. On the other hand, public health services that PCTs have commissioned will become the responsibility of local authorities.

Many health professionals have expressed reservations about the proposals. And especially in parts of the country where there are relatively few HIV-positive people, there has been some concern that the new GP consortia may lack the skills, experience or interest to commission high-quality HIV services.

However, the government released further details of their commissioning plans today. They stated that HIV testing, treatment and care will, in fact, be commissioned nationally by the NHS Commissioning Board.

The government document states that these arrangements will allow efficiencies to be made in the procurement of drugs and services.

“We’re pleased that HIV treatment is not going directly to inexperienced GP consortia,” commented Lisa Power, head of policy and public affairs at the Terrence Higgins Trust.

Another key part of the government’s reforms is that responsibility for public health programmes will shift from NHS primary care trusts to local authorities. They will be allocated a ring-fenced budget that must be spent on public health activities.

Notably, this will affect local HIV prevention and health promotion projects.

However the government also revealed today that a very wide range of open-access sexual health services which contribute to public health will be commissioned by local authorities.

This includes services for the testing and treatment of sexually transmitted infections (GUM clinics), as well as partner notification, STI services in primary care, termination of pregnancy and contraceptive services that are not provided by GPs. Local authorities are likely to be legally required to provide open-access sexual health services, but with some flexibility about how they do so.

Lisa Power of Terrence Higgins Trust suggested that the financial implications of the proposals have not been fully worked out. She estimated that providing open-access sexual health services would swallow around 20% of the budget provided for public health activities in relation to all health conditions.

Drug services, including prevention and treatment, will also be co-ordinated and funded by local authorities.

The government's proposals include confirmation that the epidemiological surveillance functions of the Health Protection Agency will transfer to Public Health England, a division within the Department of Health.

The document makes no specific mention of the national HIV-prevention programmes CHAPS and NAHIP (for gay men and African people respectively). However it does state that some national campaigns may be commissioned by Public Health England.

Yesterday, the Department of Health also released details of its proposed Public Health Outcomes Framework - a set of indicators which will be used to help judge how well the public health system is performing. This list includes the proportion of new HIV patients who are diagnosed late, the rate of Chlamydia diagnoses in young people and treatment completion rates for TB.

Both documents are open for consultation. Andrew Lansley, health secretary, commented: “I want to hear views from the people that this new [public health] service will benefit and from those who provide the services we seek to improve; this is your chance to comment on our proposals and to let us know how you think key elements of the service should be designed.”