| Abstract: | A review of the experience of adolescent reproductive health clinics in Liverpool and Bristol highlights the potentially disruptive impact of new National Health Service (NHS) policies and competing professional interests on the attempt to provide integrated, high-quality services. In particular, responsiveness to client needs often collides with NHS demands for efficiency. UK health authorities accept, in principle, the need for separate, informal family planning centers for young people. The 34 Brook Advisory Centers, which deliver confidential contraceptive and counseling services to adolescents, face pressure to become population rather than client-based and to reduce time spent on individual sessions. Moreover, new NHS contracting arrangements have greatly increased the role of general practitioners (GPs) in contraceptive provision, with serious implications for family planning clinics. At present, about 70% of UK women obtain contraceptive and sexual health services from a GP. This encroachment has further increased the marginalization of family planning practitioners, the majority of whom are female, within the medical profession. Concerns have been expressed, however, that GPs are not able to offer the comprehensive services available in clinics and lack sufficient female staff. |
