Issue details

Proposed decision.

1. APPROVE the commissioning arrangements and continued contracting with primary care via a procurement compliant process for the delivery of Long-Acting Reversible Contraception, from 1 December 2026 up to no later than 31 March 2033.

2. DELEGATE authority to the Director of Public Health to undertake all necessary actions to implement the decision, including, but not limited to, awarding new contracts, finalising terms, entering into contracts, initiating extensions, formalising variation and establishing any required legal agreements.

Reason for the decision

Kent County Council (KCC) has a statutory duty to provide reasonable access to a broad range of contraceptive substances and appliances as per Section 6 of The Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013.

Unplanned pregnancies are significant contributors to poor health outcomes, and provision of the LARC service plays an important role in reducing the negative consequences and costs of it. Continuing to commission LARC through primary care offers advantages in terms of accessibility, convenience, patient choice, comprehensive care, and cost-effectiveness.

The current Long-Acting Reversible Contraception (LARC) Service in Primary Care contract is due to end on 30 November 2026. To ensure continuity of service, new contracts are required for the delivery within primary care.

Background

Long-Acting Reversible Contraception (LARC) is a clinically effective and cost-efficient contraception method, currently delivered via integrated sexual health services and primary care providers. All practitioners providing the commissioned service have achieved a relevant Letter of Competence issued by College of Sexual and Reproductive Health (CoSRH).

The service provides LARC fitting and removal procedures to women who opt to use these methods to prevent pregnancy. Approximately 11,000 LARC procedures are performed annually in primary care settings (currently 102 practices) across Kent.

Options (other options considered but discarded)

1.   Cease commissioning through primary care - discarded due to reduced accessibility and increased pressure on integrated specialist services.

2.   Commission via a single provider model - discarded due to lack of flexibility and geographic coverage.

3.   Continue commissioning directly from multiple primary care providers via a Direct Award B (as per Procurement Act 2023) - preferred for accessibility and continuity.

The proposal is to continue commissioning LARC directly from multiple primary care providers via a Direct Award B (as per Procurement Act 2023) process. The recommendation is to maintain and strengthen these services, ensuring the council meets its statutory obligation.

 Benefits of this approach include:

-      Good geographical coverage across the county ensuring equitable service, as the same service is available regardless of geographical area in the county.

-      Fostering accessibility and patient choice.

-      The commissioning authority remains close to the communities, able to respond to local needs.

-      Direct assurance of each provider’s competence which supports good quality and safety of the service.

-      Maintaining control and access to service data and ability to audit performance.

-      Flexibility for GP practices to contract on behalf of other practices to improve access.

-      Value for money benefits demonstrated by the public health outcomes and the resulting return on investment to the wider system.

How the proposed decision supports the Framing Kent's Future - Our Council Strategy 2022-2026

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.

This approach aligns with Securing Kent’s Future - Budget Recovery Strategy and the council’s Best Value Statutory responsibility, as this decision prioritises best value considerations. This is a preventative service with evidence of good Return on Investment and can help reduce demand into other KCC services and across the health and social care system.

Locally, the provision of the services supports the Kent and Medway Integrated Care Strategy, supporting its ‘Shared Outcome 4: Empower People to Best Manage their Health Conditions’ and delivers the recently published Kent Sexual Health Needs Assessment 2024.