• Letter circulated in Yorkshire and the Humber says NHS England will no longer pay for HIV drugs provided by local authority commissioned services
  • Association of Directors of Public Health says move is not in interests of those at risk of HIV
  • Local government has accused NHS England of “shunting” responsibility for some drugs to councils to contain costs

NHS England has said it will no longer pay for HIV drugs provided by local authority commissioned services.

A letter circulated in Yorkshire and the Humber said NHS England would only pay for antiretroviral (ARV) drugs for post exposure prophylaxis (PEP) – medication which can prevent infection after exposure to the virus – for providers in a limited set of circumstances.

Hand with pills

Hand with pills

NHS England said there had been ‘no change in the way ARVdrugs are funded’

The decision has been criticised by the Association of Directors of Public Health, which said it was not in the best interests of those at risk of HIV.

The letter was sent by Matthew Groom, NHS England’s assistant director of specialised commissioning in Yorkshire and the Humber, on 21 March.

Mr Groom writes that the letter is in response to “a number of queries around the payment of ARV medicines for PEP within sexual health and [genital urinary medicine] services which are commissioned through the local authority and delivered by independent sector providers”.

He goes on to list circumstances in which NHS England will commission such drugs, including through specialist HIV treatment centres, through sexual assault referral services, and where a provider holds an NHS standard contract.

However, he states that “if a provider is not part of an A&E or a trust providing HIV then we would not expect them to be involved in the dispensing of ARVs and therefore would not be reimbursing them.

“Therefore, if they are a standalone provider of GU service and they can separately account for PEP then this should be invoiced to local authorities.”

The ADPH said it was “concerned that NHS England is restricting access to PEP” by not reimbursing other providers, such as those commissioned by local authorities to provide integrated sexual health services.

Andrew Furber, president of the ADPH, told HSJ the restrictions were a break with current practice in the region.

Dr Furber, who is Wakefield Council’s director of public health, said that in his own area the contract to provide integrated GUM and family planning services had transferred from Mid Yorkshire Trust to a community interest company.

This meant the council would now “have to pick up the cost” of the drugs, or those wanting to receive PEP would have to go to A&E or a specialist HIV service.

Dr Furber said NHS England’s decision would affect roughly half of the areas across Yorkshire and the Humber which now had providers which did not hold an NHS standard contract.

He said the move would “disrupt the patient journey” at a time when health and care organisations were “supposed to be moving towards integrated services”.

“Somebody that feels they need PEP clearly needs screening for other STIs as well, which isn’t going to happen in A&E. So they [will] need to go to A&E for their PEP, and then come to our service anyway for the rest of their treatment and the wider education and support and prevention measures around HIV and good sexual health.”

Dr Furber said those councils which wanted to fund PEP would “have to take the money out of somewhere else”, but that many would decide they were unable to offer them, creating a “postcode lottery”.

Local government leaders have recently accused NHS England of “shunting” responsibility for some HIV drugs to councils as a way of reducing the “spiralling costs” faced by its specialised commissioning budget.

NHS England has claimed it is not responsible for funding HIV “prevention”, although commissioning guidance published by Public Health England and the Local Government Association in 2013 states it is responsible for funding PEP.

Alison Rylands, NHS England’s clinical director for specialised commissioning in the North, said there had been “no change in the way antiretroviral drugs are funded”.