In England, the cost of the drugs used as PrEP would be borne by NHS England, whose specialised services team is responsible for all commissioning of antiretroviral drugs. Staff and facility costs would need to come from local authorities, who commission sexual health services. Joint commissioning will therefore be needed.

Within NHS England, its Clinical Reference Group for HIV includes HIV clinicians, commissioners and patient representatives. They are currently preparing a draft policy on whether PrEP should be provided and to whom. This will then be evaluated by other groups within NHS England, in terms of its clinical efficacy, safety, cost effectiveness and affordability. This comes at a time when there is pressure on NHS England to reduce its overall spending on specialised services, which includes cancer and hepatitis C treatment.

In Scotland, Wales and Northern Ireland, NHS services are commissioned and organised differently. It is unclear who will make decisions about providing PrEP or when they will do so.

Clinical guidelines prepared by groups such as the British HIV Association (BHIVA) or the British Association for Sexual Health and HIV (BASHH) can make recommendations to doctors on the most appropriate use of PrEP. They can influence clinical practice, but would not oblige commissioners to pay for PrEP.