Introduction Coalition government health policy has necessitated NHS restructuring. Sexual health provision was opened to competitive tendering with responsibility transferring to local authorities. BASHH/BHIVA published standards and it was expected local sexual health strategy agreements would continue.

Methods DGH genitourinary care was provided by university hospital consultants since 2006 facilitated by the local sexual health network, HIV care wasn’t due to funding restrictions. To improve care/retention, hub-and-spoke outreach was established in 2011 for 45 HIV+ individuals – ⅓ DGH diagnosed, ⅓ transferring from the larger centre, ⅓ from other clinics. Nine (20%) had previously disengaged. When tendering opened the local authority made no provision to maintain this service.

Results After awarding the tender to a community trust it became apparent that qualified staff would not be available to continue care of the cohort therefore it was maintained by the previous trust. Due to service fragmentation no new local referrals were made. Despite excellent feedback we reluctantly closed as continuing the spoke service became economically unviable. Patients were offered remaining with the same team at the teaching hospital (51%), transfer to another clinic locally (20%) or nationally (15.5%) with some moving overseas (4.5%). Of concern 4 (9%) are presumed to have disengaged. Several complaints were raised at local authority level.

Discussion Despite upheavals patients must remain at the centre of NHS care. We found BASHH support helpful and suggest dissemination of our experience to others. Highly regarded and well-functioning services are not immune to change and an uncertain future may be expected.