Further update on commissioning and provision of Pre Exposure Prophylaxis (PREP) for HIV prevention

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PrEP is a way of using anti-retroviral drugs – usually used for treating people with diagnosed HIV-  to stop viral transmission. Evidence of effectiveness is strongest for men who do not use condoms in sex with multiple male partners.

On 21 March 2016, a statement was placed on the NHS England website explaining that PrEP could not be considered for the specialised services annual prioritisation process. Specifically, it said that:

As set out in the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, local authorities are the responsible commissioner for HIV prevention services.

Including PrEP for consideration in competition with specialised commissioning treatments as part of the annual CPAG prioritisation process could present risk of legal challenge from proponents of other ‘candidate’ treatments and interventions that could be displaced by PrEP if NHS England were to commission it.’

In light of representations from stakeholder groups NHS England agreed to reconsider the decision. This took place on 31 May 2016 at the Specialised Services Commissioning Committee. In summary, the Committee:

  • considered and accepted NHS England’s external legal advice that it does not have the legal power to commission PrEP;
  • remains committed to working with other commissioners to explore the possible provision of prep. This includes working in partnership with Public Health England to run a number of early implementer test sites, backed with up to £2m investment over the next two years, to research how PrEP could be commissioned in the most clinically and cost effective way.

A full copy of the paper and legal advice considered by the Specialised Services Commissioning Committee can be found below.

It should further be noted that, even if this were not the legal position, there is no guarantee that the annual prioritisation round would result in a decision to invest millions of pounds in PrEP over new treatments and interventions in other service areas which are also competing for funding.

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