Issue details

Proposed Decision:

The Cabinet Member for Adult Social Care and Public Health

1. APPROVE the commissioning arrangements to continue to contract with primary care via a procurement compliant process for the delivery of Long-Acting Reversable Contraception. The contract period will be for one year (1 October 2023 to 30 September 2024) with two potential 12-month extensions (1 October 2024 to 30 September 2026)
2. DELEGATE authority to the Director of Public Health to undertake all necessary actions toimplement the decision, including, but not limited to, awarding new contracts, finalising terms, entering into contracts, initiating extensions, and establishing any required legal agreements.

Reason for the decision:

The current Long Acting Reversible Contraception (LARC) Service, provided by primary care, is due to end on 30 September 2023. To ensure continuity of service while a review of reproductive health and the public health transformation program is underway, new contracts are required within the primary care setting. Continuing to commission LARC through primary care offers advantages in terms of accessibility, convenience, comprehensive care, and cost-effectiveness.

Background

Local authorities are mandated to provide sexual health services, including prevention, testing, and treatment of sexually transmitted infections, and advice on and access to a broad range of contraceptive substances and appliances via The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013^[1].

LARC is an extremely effective method of contraception^[2] and is long lasting (typically over three years from insertion/implantation). LARC is delivered by trained practitioners in certain General Practices (GPs) who have achieved a Letter of Competence (LoC) accreditationfrom the Faculty of Sexual and Reproductive Healthcare (FSRH)^[3]. This LoC provides assurance of a minimum recognised standard of training and competency.

LARC is currently provided to the Kent population through two routes: Integrated Sexual Health Services and primary care settings within local communities. Integrated services primarily cater to complex LARC cases, while primary care providers, encompassing around 103 contracted GP Practices in Kent, offer LARC services to a wider range of individuals, performing approximately 14,000 procedures each year. This paper focused on the offer via primary care.

The Public Health Team is currently conducting a comprehensive review of reproductive health, accompanied by an upcoming Public Health Transformation Programme. These ongoing reviews will play a crucial role in shaping the future commissioning arrangements for Kent Sexual Health Services, including the provision of LARC and primary care services from April 2025.

The current contract with primary care was initially awarded in 2019 via article 32(2)(b) of the Public Contracting Regulations (2015) and comes to an end on 30 September 2023.

The recommendation is to commission LARC services though primary care via a light – touch procurement compliant process for a period of one year (1 October 2023 to 30 September 2024) with two additional 12-month extensions (1 October 2024 to 30 September 2026). This will allow sufficient time for the review and transformation program to take place while minimising disruption to residents and maintain compliance with the PCR regulations. There is a risk that GPs are not used to bidding for work in this way and may not sign up via this route. However, this will be reduced by working closely with the Local Medical Committee and putting in place support.

Options (other options considered but discarded)

Decommission the service – This option was deemed non-viable due to concerns about accessibility and convenience. Without primary care offering LARC services, there would likely be a decrease in uptake, leading to more unintended pregnancies and terminations. Integrated sexual health services may struggle to handle the increased workload, resulting in longer wait times and limited availability. Moreover, shifting LARC services away from primary care would disrupt the continuity of care and limit patient choice. 

Extending the current contract – Extending the current contract was not feasible as all viable extensions for the contract have been exhausted by Kent County Council. Therefore, an alternative approach is necessary to ensure the continuous provision of LARC services.

Direct Award to current providers -This option was deemed unfeasible due to several factors. Directly awarding the contract without conducting a legal procurement process raises questions about the adherence to procurement regulations and may be viewed as favouritism towards a specific provider or group of providers. Such an approach could undermine transparency in the decision-making process and potentially invite legal challenges or criticism.

Developing a Dynamic Purchasing System (DPS) -This option was deemed non-viable due to several factors. Firstly, there will be limited opportunities for primary care to access the DPS, as its primary focus is on LARC services. This could restrict the involvement of primary care providers in the system. Secondly, providers participating in the DPS may require guidance and support to navigate the process effectively, which could potentially strain the available resources. Lastly, there is a risk of limited provider participation, which could lead to an inequitable distribution of LARC services across different areas. These factors should be taken into account when assessing the viability of this option.

How the proposed decision supports the Council’s Strategy 2022-26:

This service contributes to ‘Priority 1: Levelling up Kent’ of the Framing Kent’s Future Our Council Strategy 2022-2026 as providing contraception to women can prevent unplanned pregnancies which is a preventative approach of improving the populations health and narrowing health inequalities.