Dual provision or duplication? A survey of family planning provision.

Background: Family planning has been delivered through dual provision by general practice and community based clinics since its inception. This may be perceived as duplication of services and can be regarded as an area of possible disinvestment in a climate of rising health care costs.

Objective: A survey of family planning service provision across a health district was carried out to establish the potential to rationalise current service provision by studying the pattern of service provision in the district and the links between family planning clinics and general practices.

Methods: A postal questionnaire and covering letter were sent to all practices and clinics in May 1997. Following analysis, results were,fed back to clinic staff and general practitioners through accredited meetings.

Results: Basic family planning was universally available to the population at all practices and clinics. Clinics offered a wider range of services, especially specialist services for psychosexual counselling and hormonal implants. Very few separate services for young people were identified. Within the primary care sector there was little 'out-of-hours' provision of contraceptive services. Half of the practices responding had used or would use family planning services as referral centres; implants and psychosexual services attracted most referrals.

Conclusions: An understanding of the complementary nature of the services in primary care and community FP clinics was achieved and agreement was reached that disinvestment in clinics locally was not appropriate. The need to raise public awareness of availability of all contraceptive services was identified. Services in general practice and community clinics are complementary and need to develop a joint strategy to ensure an effective, comprehensive service. Quality of care needs to be examined in future work.