I am aware that there is some uncertainty and lack of clarity over what services practices are obliged to provide to their patients under the contraception additional service (assuming of course that the practice has not chosen to opt out of this additional service, and I am not aware that any Birmingham practices have opted out). The issue has generated some confusion recently because of the change of responsibility for commissioning sexual health enhanced services from the NHS to the public health department of the local authority but please be aware that the GP contractual regulations in respect of providing the contraception additional service commissioned by the NHS England local Area Team remain unaltered.
The contraceptive additional services which must be provided are explicitly set out in the regulations and are as follows:-
(1) A contractor whose contract includes the provision of contraceptive services shall make available to
all its patients who request such services the services described in sub-paragraph (2).
(2) The services referred to in sub-paragraph (1) are--
(a) the giving of advice about the full range of contraceptive methods;
(b) where appropriate, the medical examination of patients seeking such advice;
(c) the treatment of such patients for contraceptive purposes and the prescribing of contraceptive substances and appliances (excluding the fitting and implanting of intrauterine devices and implants);
(d) the giving of advice about emergency contraception and where appropriate, the supplying or prescribing of emergency hormonal contraception or, where the contractor has a conscientious objection to emergency contraception, prompt referral to another provider of primary medical services who does not have such conscientious objections;
(e) the provision of advice and referral in cases of unplanned or unwanted pregnancy, including advice about the availability of free pregnancy testing in the practice area and, where appropriate, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections;
(f) the giving of initial advice about sexually transmitted infections; and
(g) the referral as necessary for specialist sexual health services, including tests for sexually transmitted infections.
There is no obligation under the additional service to provide any care or service not listedabove, for example screening, testing and treatment for sexually transmitted infections (the obligations are limited to giving initial advice and referral as necessary); nor is there any obligation to provide routine pregnancy testing (although you may consider it appropriate as part of your management under essential services to test for pregnancy in cases of suspected ectopic pregnancy). In respect of HIV testing then the same principles apply as for other sexually transmitted infections; screening of asymptomatic or high risk individuals is not covered by the additional service, although of course an HIV test might be an appropriate investigation to be carried out under essential services on any patient in whom you suspect immunodeficiency, as indeed might be clinical examination and HVS testing on a patient with genital symptoms which you believe may have a cause other than a STI.
I trust all this is self-explanatory.
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