title: An evaluation of commissioning arrangements for intrauterine and subdermal contraception services from general practitioners in London, UK.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: General 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.
authors: Richard
authors: http://orcid.org/0000-0001-6877-2785
authors: R
authors: Ma
authors: Options UK Technical Specialist, Research and Policy, Options Consultancy Services Limited, London, UK.
authors: Eleanor
authors: E
authors: Brown
mesh_terms: D003267:Contraception / Q000191:economics*; D003284:Contract Services / Q000379:methods*; D005193:Family Planning Services / Q000458:organization & administration; D005260:Female; D058006:General Practice / Q000379:methods*; D058005:General Practitioners; D006801:Humans; D007434:Intrauterine Devices; D008131:London; D011247:Pregnancy; D013222:State Medicine
keywords: family planning service provision; general practice; long-acting reversible contraception; service delivery