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 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 sexual health services (including free STI testing and treatment, notification of sexual partners of infected persons and free provision of contraception).
The commissioning responsibilities of local government, CCG’s and NHS England are set out in the Health and Social Care Act 2012.
Additionally, local government responsibilities for commissioning sexual health services and interventions are further detailed in The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013. These mandate local authorities to commission confidential, open access services for STIs and contraception as well as reasonable access to all methods of contraception.
Since 1 April 2013, North Yorkshire County Council (NYCC) have been required by regulation to commission:
- Contraception (including the costs of Long-Acting Reversible Contraceptive (LARC) devices and prescription or supply of other methods including condoms) and advice on preventing unintended pregnancy, in specialist services and those commissioned from primary care (GP and community pharmacy) under local public health contracts.
- Sexually transmitted infection (STI) testing and treatment in specialist services and those commissioned from primary care under local public health contracts, chlamydia screening as part of the National Chlamydia Screening Programme (NCSP), HIV testing including population screening in primary care and general medical settings, partner notification for STIs and HIV.
- Sexual health aspects of psychosexual counselling.
- Any sexual health specialist services, including young people’s sexual health services, outreach, HIV prevention and sexual health promotion, service publicity, services in schools, colleges and pharmacies.
To meet this regulation the Public Health team commissions a fully Integrated Sexual Health Service, currently provided by York Teaching Hospital NHS Foundation Trust; branded as YorSexualHealth.
Re-procurement
A re-procurement process for this service is currently underway. Visit our Integrated Sexual Health Service procurement page for more information.
A Strategic Framework for Sexual Health
Sexual health is an important part of physical and mental health. It is a key part of our identity as human beings together with the fundamental human rights to privacy, a family life and living free from discrimination. Sexual health goes well beyond the medical model of the treatment of disease. The World Health Organisation defines sexual health as:
‘… a state of physical, emotional, mental and social wellbeing, related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.’
(World Health Organisation 2006).
Sexual Health is not the responsibility of any one organisation or service. The local system is set out in the diagram below; action is needed by all partners in the local sexual health system in order to achieve the vision.
Sexual Health in Primary Care
Primary Care provide an element of the wider sexual health service commissioned by NYCC Public Health which contributes to the overall delivery of the local sexual health system. These contracts are delivered by participating GP practices and Pharmacies in North Yorkshire, signed up to the Public Health Approved Provider List.
Providers deliver these services alongside building relationships with other GPs, pharmacies and the local Integrated Sexual Health Service.
General Practice
Targeted Primary Care for GPs are services are provided in addition to contraceptive services which are already delivered as part of their General Medical Services (or PMS) contract managed by NHS England.
Providers opting to deliver services as part of the NYCC Approved Provider List must deliver all services within the ‘Sexual Health Basket’. These include:
- LARC (Long–acting reversible contraception) service to women of all ages – subdermal implant (SDI) or intra-uterine system / intrauterine device (IUS/IUD)
- Chlamydia screening service to under 25 year olds (as part of the National Chlamydia Screening Programme)
- Free condoms to under 25 year olds
- Provision of sexual health information to service users
This provision aims to increase availability of LARC, contribute to improved uptake of LARC and ensure the fitting of post-coital IUD for emergency contraception is more widely available. In addition the GP provision aims to improve access to ‘self-administered’ chlamydia screening kits to under 25 year olds, increase the number of test samples returned for analysis, encourage partner notification, screening and treatment, promote the use of condoms and encourage safer sex practice.
Community Pharmacy
The Targeted Primary Care Sexual Health Service for Community Pharmacies are provided by participating pharmacies in North Yorkshire under the Approved Provider List. The providers opting in to deliver this service must deliver all services within the ‘Sexual Health Basket’. These include:
- The provision of free emergency hormonal contraception (EHC) to service users aged 13 years to 24 years.
- Provision of Chlamydia screening kits to under 25 year olds (as part of the NCSP – national chlamydia screening programme)
- Free condoms to under 25 year olds
- Provision of sexual health information to service users
This provision aims to increase the awareness and access, especially among young people, of the availability of free EHC for 13 to 24 year olds. The targeted work also aims to improve access to ‘self-administered’ Chlamydia screening kits and increase the numbers of test samples returned for analysis in addition to other service objectives.
