Primary care trusts must undertake five-yearly comprehensive sexual health needs assessments of their area, set local targets and make someone at board level accountable for their strategy, according to a progress report on the national strategy for sexual health and HIV.

The report by the Independent Advisory Group on Sexual Health and HIV and the Foundation for AIDS and Sexual Health, commissioned by the Department of Health, found where there were targets services had been transformed in areas such as teenage pregnancy, access to GUM clinics and abortion services.

But where no targets were in place, progress was less clear, the authors said.

Progress and Priorities - working together for high quality sexual health also found wide variations in performance between PCTs and highly variable levels of GP engagement.

Michael Adler, who wrote the 2001 national strategy for the DH, said: "We go from PCTs where frankly no proper needs assessment has been done, where people who are directors of public health have so much on their plate, they have been reorganised so much, that they aren't able actually to look at this, to PCTs who have done fantastic jobs."

The report proposes a set of new indicators to measure progress locally and nationally (see below).

Holistic model

It adds that commissioners must adopt a holistic and integrated commissioning model which follows the care pathway from prevention to treatment, including social care and support where necessary.

It calls on PCTs to commission services together and also demands greater joint working between PCTs and local authorities, and strategic health authorities and regional government, underpinned by appropriate commissioning tools.

These include a sexual health and well-being commissioning framework and self-assessment tool, refined GUM and abortion tariffs, and tariffs for integrated sexual health services, community contraceptive services, chlamydia screening and HIV outpatients.

It also recommends sexual health services are included in the GP quality and outcomes framework.

Prioritising sexual health

Association of Directors of Public Health vice president Frank Atherton said the move away from narrowly focused targets to a broader performance management framework was positive.

"Taking sexual health as priority and then defining local targets for improvement would be the way we certainly see progress being made," he said. But he did not think making someone accountable for sexual health at board level was particularly helpful: "Couldn't you say the chief executive already is?"

Possible indicators

  • Guaranteed access within 48 hours expanded from GUM clinics to all sexual health services

  • Rates of under-18 conceptions

  • Proportion of prescribed contraceptives that are long acting and reversible, such as Depo-Provera

  • Percentage of abortions performed at less than 10 weeks

  • Number of repeat abortions within a specified time

  • Proportion of HIV diagnoses made at a late stage