As Audit Committee Chairs across Integrated Care Boards (ICBs) and NHS Trusts navigate increasingly complex governance and commissioning landscapes, understanding the role and challenges of specialist providers is essential. This interview with Dr. Lucy Moore, Chair of the British Pregnancy Advisory Service (BPAS), offers valuable insights into how third-sector organisations like BPAS operate within the NHS ecosystem, and how audit committees can play a more strategic role in supporting service quality, financial sustainability, and equitable access.

Dr. Moore draws on her dual experience as a former NHS Chief Executive and current charity leader to highlight the commissioning risks, digital transformation opportunities, and governance reforms that shape BPAS’s work. Her reflections underscore the importance of proactive oversight, thoughtful procurement planning, and deeper partnership engagement—especially as ICBs move toward more integrated, community-based care.

By engaging with these perspectives, Chairs can strengthen their oversight role and contribute to more resilient, patient-centred commissioning across the NHS.

Veran Patel, Director of Health & Social Care
veran.patel@tiaa.co.uk

Interview Summary: Dr. Lucy Moore, Chair of BPAS

Q: Can you tell us about your background before joining BPAS?
A: Dr. Moore served as Executive Chair of BPAS from Nov 2023 to Nov 2024 and is now Chair. She trained in public health medicine and held senior NHS roles, including leading Whipps Cross Hospital for nearly a decade. She’s also served as a trustee for BPAS since 2017 and for the Brandon Centre, a mental health charity.

Q: What is BPAS and how does it fit into the wider healthcare ecosystem?
A: Founded in 1968 alongside the Abortion Act, BPAS now provides about half of all NHS-funded terminations in England, with a turnover of £50 million and around 100,000 procedures annually. It also offers contraceptive services and vasectomies. Other providers include MSI Reproductive Choices, the NHS (handling later gestation cases), and Nupas.

Q: How is BPAS funded?
A: BPAS is primarily funded through contracts with Integrated Care Boards (ICBs). Only a small portion comes from individual donors. One exception is a direct contract with the Isle of Wight Trust.

Q: What impact do ICB mergers and structural changes have on BPAS?
A: Dr. Moore described a historically chaotic commissioning landscape. Consolidation of commissioners increased risk—losing a single contract could mean losing over 10% of BPAS’s business. BPAS is transitioning toward an “Any Qualified Provider” model to improve stability and collaboration. She also noted that both BPAS and MSI faced financial and quality challenges due to underpriced contracts, but recent tariff-based payments have improved sustainability.

Q: Are there opportunities for more innovative commissioning to support specialist providers like BPAS?
A: Yes. NHS England has recognized BPAS and MSI as essential providers and issued guidance to improve commissioning. This includes promoting the Any Qualified Provider model and standardizing assessment criteria. However, inconsistencies remain, such as postcode lotteries in service availability. Most patients now use “pills by post” following remote consultations, with surgical services centralized.

Q: Does the NHS 10-Year Plan for community-based care help BPAS?
A: It’s too early to tell. BPAS is reviewing its care model, which currently includes remote consultations and pills by post, local clinics, and regional centres for specialist care. The goal is to streamline and digitalize pathways, improve efficiency, and ensure state-of-the-art facilities for those needing in-person care. This may reduce the number of local clinics but align better with commissioners’ neighbourhood care aspirations.

Q: What are BPAS’s strategic priorities going forward?
A: Dr. Moore identified three key areas:
Digital transformation: BPAS aims to lead in digitalizing care pathways and plans to incorporate large language models to support patients with simpler needs—pending regulatory approval.
Partnerships: BPAS seeks closer collaboration with providers like MSI to reduce postcode disparities. For example, patients in the Southwest needing surgery currently travel to London, bypassing closer MSI facilities.
Commissioning reform: Continued work with NHS England and commissioners to improve patient experience and service coordination under the Any Qualified Provider framework.

Q: How can audit committees better support BPAS and other specialist providers?
A: Internally, BPAS’s audit committee has matured significantly, focusing on risk management, governance, and commissioner relationships. Externally, Dr. Moore urged ICB audit committees to understand the impact of their commissioning decisions—such as sole provider tenders or last-minute procurements—and plan to avoid disruption. She also highlighted the lack of a national abortion care strategy, which leaves commissioners without clear guidance.

Q: What advice would you give to NHS audit committee chairs seeking more effective partnerships?
A: Dr. Moore emphasized the importance of understanding the nature and financial realities of partner organisations. BPAS, while a charity, operates similarly to an NHS Trust and relies entirely on NHS funding. She encouraged audit chairs to consider unintended consequences of broad decisions that may disproportionately affect smaller or specialist providers.

Listen to the full Podcast here –