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RESOLVED:
 
1. 
Agree to award the Commercial Sex Workers Service
contract to the Homerton Healthcare NHS
Foundation Trust for an initial period of 5 years with 1+1+1 years
as an extension option. Commencing on 1st April 2025, the total
cost of the contract will be a maximum of £2,710,128.
2. 
Agree to award the NHS Health Checks and Sexual Health
Enhanced Service contract to the City and Hackney Integrated
Primary Care Community Interest Company (formally known as City and
Hackney GP Confederation) for an initial period of 5 years with
1+1+1 years as an extension option. Commencing on 1st April 2025
the total cost of the contract will be a maximum of
£4,160,000.
3. 
Agree to award contracts for the “Public Health
Pharmacy Services - Sexual and Reproductive Health Services”
to 47 community pharmacists operating in City and Hackney (list of
pharmacies to be awarded can be found in Appendix 5). Commencing on
1st April 2025 the total cost of the proposed contracts will be
£1,280,000 (additional pharmacies may meet the requirement to
be issued a contract, in which case they will be within the
authority of the Director of Public Health to approve).
4. 
Agree that any further pharmacies that meet the
requirements to be issued a contract are awarded under the
delegated authority of the Director of Public Health.
 
Reasons For Decision
 
1. 
In accordance with the Council's governance process, a contract
award report articulating the recommendations for contract award is
a requirement.
 
2. 
Commissioning of the Primary Care Based Services and Commercial Sex
Workers Service supports the local authorities ability to deliver
against the five main sexual health Public Health Outcomes  Framework
measures:
 
· 
under 18 conceptions
· 
chlamydia detection rate 
· 
new STIs diagnosis (excluding chlamydia in the under 25s)
· 
prescribing of long-acting reversible contraception (LARC)
excluding injections (females aged 15 to 44)
· 
people presenting with HIV at a late stage of infection
 
3. 
The commissioning of health checks plays a crucial role in meeting
the council's mandate to improve public health and well-being
within its community. Health checks are a vital aspect of
preventive healthcare, aiming to identify health risks early,
encourage healthy lifestyles, and prevent the onset of chronic
diseases that can burden both individuals and the healthcare
system. NHS Health checks will support the delivery of the
following Public Health Outcomes  Framework measures:
· 
healthy life expectancy, inequality in life expectancy and
disability free life expectancy
· 
diabetes diagnosis rate
· 
% of the eligible population who receive a Health Check
· 
mortality rate from cardio vascular disease
 
4. 
Primary care based enhanced services (Community Pharmacies, GP
enhanced sexual health and NHS Health Checks)
 
Community Pharmacies
 
5. 
The provision of Public Health services which include an enhanced
service for sexual health. The services provided by pharmacies will
contribute to an improvement in the sexual and reproductive health
and wellbeing of people in the City of London and Hackney with a
particular emphasis on young people.
 
6. 
The principal aims of this Service are:
 
· 
To increase the access to and use of condoms by sexually active
young people (aged under 25 years).To
achieve high screening rates for Chlamydia and Gonorrhoea in
sexually active young people.
· 
To improve access to treatment of Chlamydia and other Sexually
Transmitted Infections (STIs) for sexually active young people.
· 
To increase access to Emergency Hormonal Contraception (EHC) for
all women, non-binary persons and transgender men who have had
unprotected sex.
· 
To reduce the number of unplanned pregnancies in the client
group.
· 
To refer clients, especially those from inclusion communities groups, into mainstream contraceptive
services.
· 
To increase the knowledge of risks associated with STIs.
· 
To refer clients who may have been at risk of STIs to an
appropriate service.
· 
To reduce inequalities in sexual health outcomes, in line with the
aims of the City & Hackney sexual and reproductive health
strategy and action plan.
 
Enhanced Sexual Health Services -  GP
 
7. 
GP practice led sexual and reproductive health services.
Specifically, GP practices will be required to:
 
· 
Ensure sexual and reproductive services are accessible to City and
Hackney GP patients, in particular to those who are at a higher
risk of unwanted pregnancies and poorer sexual health outcomes.
· 
Provide a LARC service that is widely promoted and easily
accessible, providing convenient and timely appointments to
encourage take-up, including through self-referral.
· 
Provide services for the prevention, detection and management of
STIs.
· 
Provide Chlamydia screening in line with the National Chlamydia
Screening Programme (NCSP).
· 
Provide data which can be used to determine and address health
inequalities amongst the population.
· 
Contribute to the implementation of the City & Hackney Sexual
and Reproductive Health Strategy and Action plan, 2024-2029.
· 
Contribute to place and neighbourhood based partnership working in
sexual and reproductive health.
 
Enhanced GP Services - NHS Health Checks
 
8. 
The Local Authority is mandated to make provision for the NHS
Health Checks programme provided for eligible residents.
9. 
The NHS Health Check programme aims to improve the health and
wellbeing of adults (aged 40-74 years) through the promotion of
early awareness, assessment, and management of the major risk
factors for CVD – risk factors that are associated with
premature death, disability and health inequalities in England.
10.The programme objectives
include:
· 
To promote and improve the early identification and management of
the individual behavioural and physiological risk factors for
vascular disease and the other conditions associated with those
risk factors.
· 
To support individuals to effectively manage and reduce behavioural
risks (smoking, alcohol, diet and physical activity) and associated
conditions through information, and evidence based behavioural and
clinical interventions.
· 
To help reduce inequalities in the distribution and burden of
behavioural risks, related conditions and multiple morbidities.
 
11.Commercial Sex Worker Service (Open Doors)
 
12.Sex workers have specific sexual
health needs with those street sex working often having additional
complexities and vulnerabilities from dependent alcohol and drug
use, increased rates of domestic abuse, mental health needs,
homelessness and violence.
13.Supporting clients through
outreach and drop in to access drug and sexual health treatment
services, harm minimisation, overdose prevention and exit street
based sex working are all key outcomes from the service provided
across City and Hackney.
14.A specialist service has enabled
a trusted relationship to be established with this vulnerable group
and both sexual health and substance use needs to be effectively
addressed.
 
 
.
15.Specifically, the service aims
to:
 
· 
improve the sexual wellbeing of on-street and off street Commercial
Sex Workers (CSW) through the provision of targeted and tailored
sexual health outreach services,
· 
ensure CSWs have access to clinical harm reduction advice,
information and interventions around substance use via smooth
referral pathways, joint working and integrated service provision,
and multi-agency coordination of care,
· 
increase uptake of specialist and mainstream clinical sexual health
and mental health services by on-street CSWs,
· 
reduce the risk of sexual ill-health of those who use on-street
commercial sex services and onward transmission of HIV and STIs to
the general population,
· 
encourage behaviour change to exit CSW to reduce the associated
social and health burden borne by this population and the general
population,
· 
increase access and uptake of mainstream services for CSW by
removing service barriers.
 
Alternative Options
Considered and Rejected
 
Option
1-  End the services at the currently
scheduled contract end dates and do not commission all or any of
the services
 
This option was considered and rejected
because whilst not commissioning the full range of services
outlined may provide a saving in year one, costs in future years
would significantly rise as residents
access services out of area who will then recharge for the cost of
provision.
 
In addition to this, both sexual health
services and NHS Health Checks are included as legally mandated
services for local authorities to commission. Not providing these
services would open up the authorities to legal challenge and
breach the conditions of the ring-fenced public health grant.
 
Option 2 -
Re-procure the current services via a competitive procurement
process.
 
This option was considered and rejected
because opting for a procurement route other than via direct
contract award would be contrary to the local and national
strategic direction of increasing partnership working with the
local NHS.
 
There are also no other providers who can
deliver this service due to the nature of the commissioning
arrangements of these NHS services.
 
Option 3:
Insourcing
 
This option was considered and rejected
because the GP Enhanced Sexual Health and the NHS Health Checks are
delivered within the GP practices, and both services require access
to registered patient data. Insourcing will require significant
system changes to be able to access patients' records/data which
may not be possible, or are likely to take many years and
significant discussion to achieve. The Council does not have the
infrastructure in place or data sharing agreement to access the
information necessary to provide an insourced service.
 
Open doors is a
highly specialised service which requires formal clinical expertise
and clinical supervision.  Neither LBH
nor the City of London Corporation has the required professional
staff nor structures to undertake this.
 
Insourcing would increase costs, delays,
impact negatively on local partnership working and may not be
achievable in terms of data sharing.
 
Consequently, the proposed services to be
commissioned cannot be insourced in the future.
 
The full options appraisal can be found in
Appendix B.
 
Hackney Council’s Sustainable
Procurement and Insourcing Strategy (SPIS) approved by the Cabinet
in November 2024 confirms that all services should be reviewed for
insourcing inline with the
insourcing-outsourcing hierarchy described in the
Strategy.  The hierarchy recognises the
importance of NHS and VCS partners and it should be noted that all
the services described in this report are delivered by local NHS
organisations (acute trust, GP practice or local pharmacy) based in
Hackney and the City of London.