The Delivery of Family Planning and Health Services in Great Britain

Abstract

70% of all British women 15-44 years of age use some method of contraception compared with 54% of US women of reproductive age. The wider utilization of family planning services in Great Britain than in other developed countries is attributable to specific characteristics of the British health care system. Since 1973 family planning services have been available free of charge through the National Health System (NHS) and since 1975 general practitioners have been providing family planning services within the NHS. At present the 2 main providers of family planning services are general practitioners and family planning clinics staffed by physicians with special training. Contraceptive counseling and supplies are also available through pharmacies. In general general practitioners who offer family planning services are more accessible than clinics and serve about 25% of women of reproductive age. Patients are generally able to obtain an appointment within 1 day of their request. On the other hand general practitioners tend to offer a limited range of contraceptive options and 90% of their patients are prescribed oral contraceptives (OCs) regardless of their age. Many general practitioners find it less time consuming and more financially rewarding to prescribe only OCs and refer patients who request other methods to the clinics. Clinic patients who comprise 40% of contraceptive users in the UK are more likely than patients of general practicioners to be young single childless women interested in delaying childbirth or older women who have completed their families and are seeking a permanent method of contraception. Most UK family planning clinics offer all available contraceptive methods--OCs injectables IUD diaphragm the cap condoms spermicides natural family planning postcoital contraception and occasionally sterilization. Despite the lack of financial barriers to obtaining contraception a number of obstacles remain. Poor women immigrant women men and those in rural areas are underserved population groups. There is also a lack of widely disseminated information about family planning clinic hours and locations as well as about policy issues such as the ability to consult with a general practitioner other than ones own around family planning issues. Likely future trends are that general practitioners will provide more comprehensive contraceptive services while family planning clinics will develop even greater expertise in specialized areas such as infertility psychosexual problems sterilization and adolescent sexuality.