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J Fam Plann Reprod Health Care. 2014 Jul 21. pii: jfprhc-2013-100831. doi: 10.1136/jfprhc-2013-100831. [Epub ahead of print]

An evaluation of commissioning arrangements for intrauterine and subdermal contraception services from general practitioners in London, UK.

Author information

  • 1General Practitioner (GP), The Village Practice, London; formerly GP Sexual Health Champion, London Sexual Health Programme, NHS London, London; and Doctoral Student, London School of Hygiene and Tropical Medicine, London, UK.
  • 2Options UK Technical Specialist, Research and Policy, Options Consultancy Services Limited, London, UK.



General practitioners (GPs) in the UK may be commissioned to provide long-acting reversible contraception (LARC), which may have a role in reducing rates of abortion and unintended pregnancies. Primary care trusts (PCTs) in England had commissioning arrangements with GPs to provide LARC but little is known about such contractual arrangements. We studied the commissioning arrangements in some London PCTs to evaluate the cost and clinical governance of these contracts.


We requested commissioning contract specifications and activities for intrauterine contraception (IUC) and subdermal implants (SDI) from responsible officers in each PCT in London relating to activities in three financial years, namely 2009/2010 to 2011/2012. We evaluated each contract using a structure, process and outcome approach.


Half (15/31) the PCTs responded and submitted 20 contracts used to commission their GPs to provide IUC, SDI or a combination of these with testing for sexually transmitted infections. The information regarding service activity was inadequate and inconsistent so had to be abandoned. Information from 20 contracts suggested there was a variation in clinical governance and quality assurance mechanisms; there was also a range in the reimbursement for IUC insertion (£77.50 to £105.00), SDI insertion (£25.00 to £81.31) and SDI removal (£30.00 to £100.00) at 2011 prices.


It was not clear from non-responders if these PCTs had a service in place. Of those that did commission IUC and SDI services, some specifications were lacking in detail regarding aspects of clinical governance. New commissioners should make explicit references to quality and safety criteria as poor-quality specifications can give rise to serious untoward incidents and litigation.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


family planning service provision; general practice; long-acting reversible contraception; service delivery

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