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The Health and Social Care Act 2012 introduced major changes to the National Health Service (NHS) in England, including responsibility for public health services moving to local authorities, from April 2013. The local authorities then became responsible for commissioning services for sexual health, HIV prevention and testing and health promotion.
HIV treatment and care services are commissioned separately by NHS England, while clinical commissioning groups (CCGs) commission abortion, vasectomy, sterilisation and community gynaecology services.
Introduction of tendering
Since 2013 many local authorities have tendered for sexual health services and others have indicated that they plan to do so.
The British Association for Sexual Health and HIV (BASHH) has produced a ‘Six Steps’ guidance document, slide presentation and podcast to assist members prepare for tendering. These are available on the BASHH website1 and are summarised and updated below.
Step one-build relationships
It is essential to build relationships internally with your sexual health team and provider as well as externally with your local director of public health and public health team, local authority and CCG sexual health leads and other relevant groups.
Make sure your service profile is raised with your provider, the local media and on social media.
Step two-reduce the risk of your sexual health service being put out to tender and position your service in case this happens
Demonstrate that your service is effective, emphasise that investment in sexual health will save on future healthcare costs2 and highlight crucial sexual health pathways such as:
HIV and sexually transmitted infections (STIs)
men who have sex with men
serious infections and laboratory links
education and training.
Be aware of issues that are important to your local authority, such as child sexual exploitation and safeguarding and demonstrate that your service is ‘safe’.
Step three-how to influence local service specifications
Use the BASHH standards for the management of STIs and key commissioning documents, to promote inclusion of critical components in the local service specifications.5–8
Highlight with the commissioners that the service specifications need to include open access, all elements of level 1–3 sexual health provision, partner notification, safeguarding, research, education and training.
Participate in stakeholder events and inform your commissioners that BASHH and the Faculty of Sexual and Reproductive Healthcare have designated individuals that can provide independent advice.
Ensure that education partners are engaged in local authority discussions and raise the possibility of co-commissioning HIV treatment and care with the sexual health service to avoid fragmentation.
Step four-how to approach a tender
Confirm that your provider will submit a bid and set up a project team to develop this. In the project team:
include sexual health team leaders/managers, contracting, finance and human resource members;
involve communications and medical illustration teams;
task members with different parts of the bid submission;
give final editorial control to one person and ensure it makes sense to non-specialist readers.
If there is an interview the panel will be mostly lay members, avoid jargon and develop a professional slide deck. In the interview team include individuals who can discuss:
the proposed service and outcomes
whole system governance
the financial model
mobilisation and implementation plans.
Step five-what to do if you are awarded the tender
Obtain written confirmation, inform your team and enact the mobilisation plan.
Meet with the commissioners to discuss the contract details, performance and reporting arrangements.
Step six-what to do if you are not awarded the tender
Maintain staff morale and see if there are grounds for appeal.
Check what arrangements the new provider has made for each aspect of your service, including premises, information technology, data protection and staffing.
If service fragmentation will occur then seek alternative options. This is most critical for HIV care and urgent discussions will be needed to determine the way forward.
Tendering is likely to affect most sexual health services. The guidance from BASHH aims to increase understanding of the process, help with preparations and maximise the chances of a successful outcome.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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