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Expanding IVF services 'not a priority' say CCG leaders

Exclusive CCG leaders are unlikely to implement NICE’s new guidance on expanding access to IVF treatment, due to cost constraints, Pulse has found.

NICE recommended last week that women aged over 40 years should be offered IVF on the NHS, but CCG leaders on the ground report that this area is ‘not a priority’ and that they do not have the funding to implement the guideline.

The new guideline extends access to IVF in women aged 40 to 42 years, if they have not been able to conceive after two years of regular unprotected intercourse and provided they meet certain conditions. Previously NICE did not recommend IVF for women older than 39 years.

It also recommends couples should be advised to try and conceive through unprotected vaginal intercourse - or 12 cycles of artificial insemination - for two years before being referred for IVF, rather than three years as was formerly recommended.

The GPC said at the time that the guidance would only be implemented if extra funding was made available, due to the funding constraints imposed on them by the ‘Nicholson challenge’ programme of efficiency savings.

Pulse has learnt that after looking at the implications of the guideline, many CCGs say they are unlikely to be able to fund its recommendations in full.

But the Government’s commissioning tsar has called CCGs ‘callous’ for putting cost before patients’ needs.

Dr Tony Kostick, chair of East and North Hertfordshire CCG said that at a time when CCGs are required to make cost-savings, fertility ‘isn’t a priority’.

He said: ‘I strongly suspect that we would take a similar view to other CCGs, namely that this isn’t a priority area for us at a time of extreme financial pressures.

‘Just because you can do something, doesn’t mean you should. I think we will be especially keen to discuss this particular issue with our patient groups and seek their views.’

Dr Andrew Pryce, chair of  Knowsley shadow CCG said his own view was that the guidelines would not be implemented, but added he would discuss the issue with the CCG board.

He said: ‘We already have criteria in place regarding fertility treatment and we have no plans to revisit them in the immediate future.’

Dr David Chilvers, clinical chair of Fareham and Gosport CCG, also said the CCG was currently not implementing even the older NICE guidance, for a mixture of reasons, including ‘value for money’

He told Pulse: ‘It’s unlikely we’ll be able to expand services. We believe NICE guidance is flawed, it doesn’t take the population into account and how much resource the CCG has.’

Dr Chaand Nagpaul, a GPC negotiator, said the IVF guidance has raised important questions about the status of NICE guidelines.

He said: ‘The Government have said NICE guidelines let the public know what they’re entitled to; however, there needs to be political honesty about the resource constraints.

‘The cost of implementing the guidance should be included in its evaluation. NICE guidance such as this is often divorced from the harsh reality of cuts.’

Dr Michael Dixon, interim president of NHS Clinical Commissioners, said it was inevitable that CCGs would implement this guidance variably, depending on factors such as resources.

‘NICE guidance is made by NICE, but they aren’t paying for it,’ he said.

But Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside said he was ‘saddened’ by the news that CCGs would not implement the guidance.

He said: ‘CCGs must not just be seen to be rationing. The law we’ve just enacted says NICE is the standard setter for the NHS and CCGs are ignoring it. This feels very uncomfortable.

‘What is the primary urge of all humans? Reproduction. It shows a callous outlook on health. Clearly there are finite resources and I understand where these people are coming from, but NICE wouldn’t have made this guidance lightly.’

The controversy comes after a CCG faced legal action over its age restrictions of IVF therapy, which went further than the previous set of NICE guidelines.

A spokesperson for NICE said: ‘We are aware that the NHS is currently under considerable financial constraint. However, our recommendations are based on the best available evidence and cost-effective practice.’

Readers' comments (5)

  • This is just the start.

    CCGs will be set up by Government to be the bad boys ( and girls) who deny patients their right to free access to all treatments. They will be constantly challenged legally by Patient Groups with axes to grind.

    GPs are crazy to take this on. Even when they make considered decisions they are often challenged and overturned by the Government who set them up in the first place to make such decisions!

    Thank goodness I retire in 5 weeks.

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  • Dr Nagpaul is spot-on - NICE IVF advice may well be evidence-based and as cost-effective as it can be but that doesn't mean it is affordable or a priority. Affordability and prioritsation are sadly not part of NICE's remit - they have the freedom to advise away to their heart's content without any accountabilty and little regard to real world budgetary pressures or competing claims for limited resources.

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  • The only "fair way for the NICE guidance to be followed to the letter is if the DoH were to suppliment CCG for NICE Guidance related clinical activities.

    e.g. If a locality is to offer IVF treatment as per the guidance, the DoH will foot the bill incurred in IVF, rather than the CCG.

    In this way, CCG will be able to implement all of the NICE guidance to the letter and not face unrealistic budgetary constraint. But no, DoH will not do such thing - it's too expensive!

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  • I totally agree that expanding IVF services should not be a priority.In the current economic climate we'll be lucky if we can protect the current services let alone expand them.But be prepared to take on the media hailstorm accusing us "lazy","incompetent","overpaid" GPs of protecting our own interests.

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  • GPs getting the blame for such things was always bound to happen. The GP professional bodies, etc went into all this with their eyes open. PCTs always used to get the blame, but they had no option but to be where they were. GPs had a say in their position now, but chose to be compliant with government goals.

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