Commissioning local HIV sexual and reproductive health services
Source: gov.uk (2025-01-06)

Tools and resources for commissioners of HIV, sexual and reproductive health services to help plan and commission regional and local services.

Sexual and reproductive health is not just about preventing disease or infection. It also means promoting good sexual health in a wider context, including relationships, sexuality and sexual rights.

Commissioning responsibilities

Sexual health services (SHSs) are commissioned at a local level to meet the needs of the local population, including provision of information, advice and support on a range of issues, such as sexually transmitted infections (STIs), contraception, relationships and unplanned pregnancy.

Local authorities commission comprehensive open access SHSs (including free STI testing and treatment, notification of sexual partners of infected persons and free provision of contraception). Some specialised services are directly commissioned by integrated care boards (ICBs), and at the national level by NHS England.

Local authorities commission:
- comprehensive SHSs including most contraceptive services and all prescribing costs, but excluding GP additionally-provided contraception
- STI testing and treatment, chlamydia screening and HIV testing
- specialist services, including young people’s sexual health, teenage pregnancy services, outreach, HIV prevention, sexual health promotion, services in schools, college and pharmacies
- delivery of HIV pre-exposure prophylaxis (PrEP)
ICBs commission:
- most abortion services
- sterilisation
- vasectomy
- non-sexual-health elements of psychosexual health services
- gynaecology including any use of contraception for non-contraceptive purposes
- adult specialist services for people living with HIV (from April 2025)
NHS England commissions:
- contraception provided as an additional service under the GP contract
- promotion of opportunistic testing and treatment for STIs and patient-requested testing by GPs
- sexual health elements of prison health services
- sexual assault referral centres
- cervical screening
- specialist fetal medicine services
Across England there is considerable regional variation in how SHSs are provided and commissioned. They vary from distinctly separate general practice and community-based contraceptive provision with hospital-based abortion and genito-urinary medicine services, to fully integrated SHSs in the community. The variations occur because of differences in commissioning and contractual models used in local areas.

Resources

This section brings together existing resources that commissioners can use to support the commissioning process. It is primarily aimed at people working in local authorities who are either new to sexual health or new to commissioning, or to both. It should also be useful to those who have been working in the field for some time, as a reminder of a familiar issue, a prompt about something new or a useful reference point for key important documents.

The document should be used as a reference that can be dipped into at all stages of the commissioning cycle.

Policy context

The Provider Selection Regime (PSR) (https://www.england.nhs.uk/commissioning/how-commissioning-is-changing/nhs-provider-selection-regime/), NHS England

Sexual and reproductive health statistics for England (https://commonslibrary.parliament.uk/research-briefings/cbp-10049/), House of Commons Library 2024

Integrated care systems explained (https://www.kingsfund.org.uk/insight-and-analysis/long-reads/integrated-care-systems-explained), Kings Fund 2022

NHS Long Term Plan (https://www.england.nhs.uk/long-term-plan/), NHS England 2019

A framework for sexual health improvement in England (https://www.gov.uk/government/publications/a-framework-for-sexual-health-improvement-in-england), Department of Health and Social Care (DHSC) 2013

Commissioning responsibilities

Sexual health, reproductive health and HIV: commissioning review (https://www.gov.uk/government/publications/sexual-health-reproductive-health-and-hiv-commissioning-review), Public Health England (PHE) 2017

Making it work: a guide to whole system commissioning for sexual health, reproductive health and HIV (https://www.gov.uk/government/publications/commissioning-sexual-health-reproductive-health-and-hiv-services), PHE 2015

Needs assessments

STI Prioritisation Framework (https://www.gov.uk/government/publications/sti-prioritisation-framework), UK Health Security Agency (UKHSA) 2024

Variation in outcomes in sexual and reproductive health in England (https://www.gov.uk/government/publications/sexual-health-variation-in-outcomes-and-inequalities), PHE 2021

Prescribed places of detention: health needs assessment toolkit (https://www.gov.uk/government/publications/prescribed-places-of-detention-health-needs-assessment-toolkit), PHE 2014

Sexual health needs assessment: a how to guide (http://webarchive.nationalarchives.gov.uk/20170106083739/http:/www.apho.org.uk/resource/item.aspx?RID=74982), Department of Health 2007

Data and evidence

National Survey of Sexual Attitudes and Lifestyles (Natsal) (https://www.natsal.ac.uk/)

Sexual and Reproductive Health Profiles (http://fingertips.phe.org.uk/profile/sexualhealth)

Spend and Outcomes Tool (https://analytics.phe.gov.uk/apps/spend-and-outcomes-tool/#!/), Office for Health Improvements and Disparities (OHID)

Towards Zero: the HIV Action Plan for England: 2022 to 2025 (https://www.gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-england-2022-to-2025), DHSC 2021

Health economics evidence resource (https://www.gov.uk/government/publications/health-economics-evidence-resource), PHE 2017

Local health and care planning: menu of preventative interventions (https://www.gov.uk/government/publications/local-health-and-care-planning-menu-of-preventative-interventions), PHE 2016

Designing services

National Chlamydia Screening Programme (NCSP) (https://www.gov.uk/government/collections/national-chlamydia-screening-programme-ncsp), UKHSA 2023

Teenage pregnancy prevention framework (https://www.gov.uk/government/publications/teenage-pregnancy-prevention-framework), PHE 2018

Teenage mothers and young fathers: support framework (https://www.gov.uk/government/publications/teenage-mothers-and-young-fathers-support-framework), PHE 2016

Sexual health commissioning in local government (https://www.local.gov.uk/sexual-health-commissioning-local-government), Local Government Association 2015

Sexual health: clinical governance (https://www.gov.uk/government/publications/public-health-services-non-mandatory-contracts-and-guidance-published), DHSC 2013

Service specifications

Public health commissioning (NHS cervical screening programme service specification) (https://www.england.nhs.uk/commissioning/pub-hlth-res/), NHS England

Public health commissioning (sexual assault referral centres) (https://www.england.nhs.uk/commissioning/health-just/sexual-assault-and-abuse/), NHS England

Integrated sexual health service specification 2023 (https://www.gov.uk/government/publications/public-health-services-non-mandatory-contracts-and-guidance-published), OHID and UKHSA 2023

HIV pre-exposure prophylaxis (PrEP): monitoring and evaluation (https://www.gov.uk/government/publications/hiv-pre-exposure-prophylaxis-prep-monitoring-and-evaluation), UKHSA 2022

Sexual health services: key principles for cross-charging (https://www.gov.uk/government/publications/public-health-services-non-mandatory-contracts-and-guidance-published), DHSC 2018

Standards

Clinical Standards (https://www.fsrh.org/Public/Public/Standards-and-Guidance/clinical-standards.aspx), Faculty of Sexual and Reproductive Healthcare (FSRH)

Establishing youth-friendly health and care services (https://www.gov.uk/government/publications/establishing-youth-friendly-health-and-care-services), OHID 2023

Standards for the management of sexual health in UK prisons (https://www.bashh.org/resources/85/prison_standards/), BASHH 2023

National chlamydia screening programme standards (8th edition) (https://www.gov.uk/government/publications/ncsp-standards), UKHSA 2022

Postal self-sampling kits guidelines and report (https://www.bashh.org/resources/44/selfsampling_recommendations), BASHH 2021

The care of women requesting induced abortion (https://www.rcog.org.uk/en/guidelines-research-services/guidelines/the-care-of-women-requesting-induced-abortion/), Royal College of Obstetricians and Gynaecologists 2011

Standards for online and remote providers of sexual and reproductive health services (https://www.fsrh.org/standards-and-guidance/documents/fsrhbashh-standards-for-online-and-remote-providers-of-sexual/), FSRH and BASHH 2019

Standards for management of STIs (https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/), British Association for Sexual Health and HIV (BASHH) 2019

Standards of care for people living with HIV (https://www.bhiva.org/standards-of-care-2018), British HIV Association (BHIVA) 2018

STI outreach standards (https://www.bashh.org/about-bashh/publications/sti-outreach-standards/), BASHH 2016

National Institute for Health and Care Excellence (NICE) guidelines and resources

Reducing sexually transmitted infections guideline (https://www.nice.org.uk/guidance/ng221), NICE 2022

Long acting reversible contraception guideline (https://www.nice.org.uk/guidance/cg30), NICE 2019

Sexually transmitted infections: condom distribution schemes (https://www.nice.org.uk/guidance/ng68), NICE 2017

HIV testing: encouraging uptake: quality standard (https://www.nice.org.uk/guidance/qs157), NICE 2017

Contraception quality standard (https://www.nice.org.uk/guidance/qs129), NICE 2016

STI outreach standards (https://www.bashh.org/about-bashh/publications/sti-outreach-standards/), BASHH 2016

HIV testing: increasing uptake among people who may have undiagnosed HIV (https://www.nice.org.uk/guidance/ng60), NICE 2016

Contraceptive services for under-25s guideline (https://www.nice.org.uk/guidance/ph51), NICE 2014

Keeping up-to-date

Knowledge hub (https://khub.net/web/guest)

Sexual health, reproductive health and HIV policy eBulletin (https://www.fsrh.org/Public/Public/News-and-Advocacy/sexual-health-reproductive-health-and-hiv-policy-ebulletin.aspx?hkey=238e4d92-029b-4a90-87b9-c72db04e48b7), FSRH

Further resources for commissioners

Various organisations provide additional information and guidance to inform the commissioning of SHSs. These include statutory organisations, educational bodies and the voluntary sector:
- NICE (http://www.nice.org.uk/) provides evidence-based practice, pathways and guidelines for sexual health
- BASHH (http://www.bashh.org/) champions good sexual health and provides training and workshops and information on governance and guidelines
- BHIVA (http://www.bhiva.org/) is a national advisory body to professions and other organisations on all aspects of HIV care, providing clinical guidelines and standards as well as educational events
- FSRH (https://www.fsrh.org/home/) produces guidance and advice on all aspects of contraception, including service standards and clinical governance for reproductive services
- Family Planning Association (http://www.fpa.org.uk/) has details of training courses for health professionals
- Brook (http://www.brook.org.uk/) has information for professionals about sexual health advice for young people
- National AIDS Trust (http://www.nat.org.uk/) has information, advice, a range of publications and useful leaflets, and also runs the English HIV and sexual health commissioners network
- Terence Higgins Trust (http://www.tht.org.uk/) has resources and information on sexual health and HIV for several audiences, including for teachers and healthcare staff