Background

The National Health Service (NHS) has become unaffordable through no fault of its own. Advances in medical technology, increased availability of better treatments, and disease epidemiology have all contributed to this challenging situation. People are living longer and putting a strain upon the NHS with an increasing burden of chronic illness. Will the new White Paper, Equity and Excellence: Liberating the NHS,1 prove to be the salvation of the NHS?

Where have we come from?

We have grown accustomed to NHS restructuring every 3 years or so, but the current proposals suggest the biggest change in strategic direction since the inception of the NHS. Many of us have lived through general practitioner (GP) fundholding, followed by primary care groups (PCGs), only for these to be scrapped and replaced with primary care trusts (PCTs).

Historically, the provision of reproductive and sexual health has been poorly funded, and viewed as a ‘Cinderella service’. Despite this we understand only too well that the relatively small amounts of money spent in primary care to provide contraception and genitourinary medicine services have a significant impact upon the sexual health of those who receive the service and that this is regarded as an efficient use of scarce NHS resources.

How are we performing?

Community contraceptive services play a pivotal role in preventing unwanted pregnancies, the need for terminations or antenatal care and, in many instances, significant social support. Chlamydia screening and treatment reduces the number of women developing complications such as pelvic infection and ectopic pregnancy. The cervical screening programme with its army of primary care nurses has contributed to a significant reduction from 1433 to 960 cervical cancer deaths annually over the last 30 years.2 We have, however, struggled with equity of access to NHS-funded assisted reproductive technologies (ART), with PCTs using clinical and/or social criteria (e.g. child in a previous …