PCTs in England had commissioning arrangements with GPs to provide LARC. The researchers studied the commissioning arrangements in some London PCTs to evaluate these contracts’ cost and clinical governance.
We requested commissioning contract specifications and activities for IUC and SDI from responsible officers in each PCT in London relating to activities in three financial years. We evaluated each contract using a structure, process, and outcome approach.
Half the PCTs responded and submitted twenty 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. Data from twenty contracts suggested a variation in clinical governance and quality assurance mechanisms; there was also a range in the reimbursement for IUC insertion, SDI insertion, and SDI removal.
The study concluded that 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 as poor-quality specifications can give rise to severe untoward incidents and litigation.