Estimating the balance of general practice versus family planning clinic coverage of contraception services in London

Objective. To compare levels of provision of contraception from general pra ctice and family planning clinics for the populations of the 32 London Boro ughs. Method. Retrospective analysis of routine activity data, including the esti mated numbers of first attendance, for 295 family planning clinics (managed by 28 NHS Trusts) ann more than 1800 GP partnerships in Greater London, su pplemented by data from cc survey of family planning clinics. The results w ere expressed as the estimated percentage of women aged 16-49 obtaining adv ice on contraception from GPs and family planning clinics. These results Lt ere compared to those expected based oil results in the General Household Survey Results. Across London in 1995/96, 12% of women aged 16-49 obtained contrac eption services from family planning clinics, and 24% obtained contraceptio n services from a GP. At a borough level there was Variation from 11% to 25 % in coverage by family planning clinics, and from 11% to 41% in coverage b y GPs, Estimates of the proportion of women in this age group not using NHS -provided medical or surgical contraception ranged from 0 to 30%. Across al l boroughs, there wins no consistent relationship between levels of GP acti vity and family planning clinic activity Conclusion. The results indicate substantial variations Between boroughs in the proportion of women using NHS-provided medical or surgical methods of contraception. The absence of any clear inverse relationship between activi ty in family planning clinics and activity in general practice suggests tha t changes to one will not De compensated by changes in the other More speci fically, health authorities that opt to purchase lower levels of family pla nning clinic activity cannot assume that women may opt to use GPs as an alt ernative. Such a strategy may increase the likelihood that women who would have used family planning clinic services will either not rise contraceptio n at all, or will use less effective 'over the counter' methods.