Guest blog: A way forward on PrEP

March 1, 2019 in ADPH Updates, President's Blog, Uncategorized by admin

by Professor Jim McManus, ADPH Vice President

As Scotland issues its report into the first year of PrEP for HIV, there is a fair amount of debate going on about where we are in England with PrEP. NHS England announced this week they wanted to roll out more places. I don’t know anyone who doesn’t want the further roll out of PrEP in England – the Local Government Association wants it, the ADPH wants it, community groups want it, even NHS England wants it.

But let’s be clear, this roll out creates an additional and unfunded £7m burden on councils’ sexual health budgets at a time when our budgets are being cut. That’s small change for NHS England. It’s a major problem for local authorities.

Despite NHS England’s press release yesterday[1] the issue of funding remains unresolved. It’s hugely welcome that NHS England will fund new places. However, clinicians tell me regularly, there is a double burden created by the PrEP Trial.

First, not all of the time and admin costs incurred by involvement with the trial are met by NHS England; “additional resources needed to help with data entry are not met by NHS England” said one clinician.

Second, the further associated costs of HIV tests and repeat GUM visits and other tests are paid for by councils through the public health budget. It’s no use saying people eligible for PrEP should be using GUM services more already, this trial is driving people into services (which is great) but creating a major financial burden we could easily solve.

And there is an easy answer. We even proposed it to government. Before Christmas, ADPH and LGA jointly called, with many sexual health and HIV charities, for the increased roll out of PrEP. At the time, ADPH said:

“PrEP is now even more affordable on the NHS. With the NHS saving substantial sums from the drug being cheaper as well as from fewer people needing treatment, we see no reason why NHS England should not extend the roll out of the trial to more people.

“While NHS England pays for the drug, local councils have to meet the costs of extra attendances and tests at sexual health services. These additional costs fall at a time when government is cutting public health budgets.

“The savings made by NHS England switching to generic Truvada would help cover the trial-associated service costs of extending recruitment to the PrEP trial and significantly reduce the burden on local authorities to support this important study.”[2]

The double burden created by the roll out of PrEP could be easily resolved by the Department of Health and Social Care (DHSC) or NHS England spending just 1% of the money DHSC has just found to bail out NHS Acute Trust deficits[3]. The money is clearly there and, in an era when we’re supposed to be moving to prevention, it is an odd policy choice not to find that money.

Getting the double benefit of rolling out PrEP and at the same time getting our residents into more frequent GUM checks would cost just £7m for DHSC or NHS England. That’s the opportunity.

What if we don’t? Well, we create £7m additional demand for sexual health services, and we either cut other public health services further to meet it or we end up with people being displaced from GUM services.

In other words, we end up with the danger of pitting one group experiencing inequalities against one or more others, while NHS England walks through the middle reaping the financial gains of generic Truvada and creating a needless fight between councils and local populations.

That can’t be good. I don’t blame councils for pointing this out. This is a clear example where we could easily work together as a system to solve a problem.

 

[1] https://www.england.nhs.uk/2019/02/prep-impact-trial-to-be-expanded/

[2] http://www.adph.org.uk/wp-content/uploads/2018/12/ADPH-PrEP-statement-Dec-2018.pdf

[3] https://www.hsj.co.uk/finance-and-efficiency/creative-accounting-behind-600m-dhsc-bailout-says-mp/7024456.article