Dear Commissioners,

We, the undersigned General Practitioners of Enfield, write to express our grave concerns regarding the decision to decommission the Enfield Sexual Health and Contraceptive Service (Echo Clinics) from February 2025. This decision will have significant and far-reaching consequences for the health and well-being of our patients and the wider community.

The Echo Clinics provide essential services that are critical to the public health of Enfield and its surrounding areas. These include:

-Contraceptive Care: Access to Long-Acting Reversible Contraceptives (LARC), Emergency Contraception, and general contraceptive advice.

-Sexual Health Care: Comprehensive screening, diagnosis, and treatment for common sexually transmitted infections (STIs), including Chlamydia, Gonorrhoea, Syphilis, HIV, Hepatitis B, Genital Herpes and Genital Warts. The service also addresses less commonly tested conditions, such as Trichomonas vaginalis (TV) and Mycoplasma genitalium, which are not routinely available for testing in most GP practices. Crucially, the service also provides immediate treatment for infections like Gonorrhoea—where antimicrobial resistance testing is critical—and Syphilis, both of which require intramuscular antibiotics that can be difficult to arrange acutely in other healthcare settings. Additionally, the service plays a vital role in contact tracing to prevent further transmission and protect public health.

-Preventative Health: Provision of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) to prevent HIV transmission, as well as vaccination services.

-Specialist Support: Care and support for survivors of sexual and domestic violence.

-LGBTQ+ Care: Staff specialised in managing care for the LGBTQ+ community, offering tailored sexual health and contraceptive care, mental health support, and an inclusive, non-judgmental environment. This includes advice specific to the needs of this community, who often faces higher rates of discrimination, stigma, and barriers to accessing care.

The loss of these services will have devastating consequences, particularly for vulnerable groups who already face barriers to accessing care. Residents of Enfield, many of whom may lack the means to travel, will be forced to seek care in other boroughs, including Hatfield, Islington, and Tower Hamlets. This not only places an undue burden on patients but will also create additional pressures on already overstretched services in these areas.

We are also deeply concerned about the downstream impact on local health services:

-Primary Care: GPs are already overwhelmed by the increasing demand for services, with many practices operating at or beyond capacity. Decommissioning the Echo Clinics will further exacerbate this pressure, as GPs will face an influx of patients seeking sexual health and contraceptive care that we may not be adequately resourced to provide.

-Urgent and Emergency Care: Patients unable to access routine services will inevitably turn to A&E and Urgent Care Centres for non-urgent sexual health and contraceptive needs, further exacerbating the strain on these services.

-Public Health Outcomes: Reduced access to contraception and STI prevention services will lead to increased rates of unintended pregnancies and sexually transmitted infections, undoing years of progress in public health.

We understand the need for fiscal responsibility, but cutting such a vital service is a false economy. The long-term financial and social costs—rising health inequalities, poorer public health outcomes, and the strain on other health services—will far outweigh any immediate savings.

We urge Enfield Council to reconsider this decision and engage with local healthcare providers to identify alternative solutions that protect the health of our community. As GPs, we stand ready to work collaboratively to advocate for sustainable funding and effective service delivery models.

The health and well-being of Enfield’s residents must remain the highest priority.

Yours sincerely,

Enfield GPs