An internal discussion document on existing services in King's College and Dulwich hospitals, south London, and in the local community, recommends the closure of five clinics and questions whether high-grade nursing staff need to undertake so much training. It also recommends a review of the grading of doctors who attend the clinics and of administrative staff with a view to cuts. The report recommends that one clinic should be changed to provide an experimental Saturday morning clinic; that another should switch to provide a special service for young people and that family doctor contraceptive services be reviewed. A month ago Virginia Bottomley, the Secretary of State for Health, set targets in The Health of the Nation, the Government's White Paper, including a reduction in unwanted pregnancies. It sought to halve the number of pregnancies in young teenagers by 2000.
In Camberwell, the district served by King's Healthcare, which provides the hospital and community services, 38 per cent of conceptions end in abortions - 39.5 per cent among young women aged 16 to 19.
In England and Wales, the rate is 25.9. In Camberwell, there were 2,407 abortions in 1990 according to government figures, compared with 1,135 in nearby Greenwich or 343 in Hastings, the lowest number in South East Thames Regional Health Authority's area.
Ruth Grigg, spokeswoman for the Family Planning Association, said: 'We are shocked that cuts are being proposed before there has been an assessment of consumer views or of local GP provision, especially because Camberwell has such a high level of unwanted pregnancies and abortions.
'Camberwell has the second highest number of abortions in South East Thames and the fifth highest in the country. We are amazed that this is happening when the Government has just announced targets for a reduction in the number of abortions. There is such a huge problem here. Closing clinics is not the way. They should be finding out why there are low clinic attendances,' she said.
Most of the proposed clinic closures are in sessions where attendance is low. For example one clinic sees on average 6.36 women per session. It is one of the report's main criticisms that clinics with the lowest attendances have been marked for closure, without a parallel assessment of need in the community.
Malcolm Alexander, secretary of Camberwell Community Health Council, the local NHS watchdog organisation, said that King's Healthcare failed to advertise its family planning services.
'We should be seeing advertisements in schools and colleges. There is a very severe problem in this area.'
Mary Wells, acting general manager for the Community and Family Services Division of King's Healthcare, said: 'This is a discussion paper which was only released last week. We want to see if money can be better spent. From time to time in an organisation we need to look at how we deliver the service.' The question of how services were advertised may be revamped.