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Open GP access to infertility imaging test would slash IVF waits

Giving GPs open access to an imaging test for infertility could save the NHS millions by immediately identifying women who need IVF and avoiding referring them through infertility clinics, a new primary care study has shown.

Hysterosalpingography (HSG) has been recommended by NICE as a first-line investigation in women experiencing difficulty conceiving. This study suggests giving GPs open access to HSG could cut demands on secondary care by identifying and treating patients more than two months sooner than other patients given standard care.

The two-year randomised controlled trial offered GPs at 33 practices in the north east direct access to HSG. GPs referred 9% of couples for HSG, but these couples were diagnosed an average of 10 weeks earlier, at 22 weeks, compared with couples in control practices who were diagnosed after 32.5 weeks.

41226542Overall, women in the intervention group received a diagnosis of their failure to conceive on average after 30.3 weeks, compared with 32.5 weeks in the control group.

The study is published in the May issue of the British Journal of General Practice. Lead researcher Dr Scott Wilkes, a GP in Amble, Northumberland and clinical research fellow at the university of Sunderland, told Pulse he is working with the support group Infertility Network UK and the Royal College of Obstetrics and Gynaecology to widen direct GP access to HSG.

‘Direct GP access allows couples to access diagnostic tests for infertility 10 weeks sooner. Access to the tests was criteria driven so the service was not abused or swamped with inappropriate referrals.

‘Open access to HSG allows GPs to make a diagnosis of total tubal blockage. If GPs are able to make that diagnosis there's only one option – IVF at a tertiary centre. It's a waste of money and NHS resources to refer them to secondary care. But at the moment there's no way for a GP to know so couples are being referred to hospital inappropriately.'

In an accompanying editorial, Professor Bonnie Sibbald, deputy director of the National Primary Care Research and Development Centre, said: ‘GPs like having the option of direct access even if they elect not to use it. The principle risk is that GPs will make inappropriate use of the service and push up demand on hospital diagnostic services.

‘This study found that the completeness of information on referral was higher when GPs had used direct access HSG, aided by the use of clear guidelines, suggesting that those GPs who use a direct access diagnostic test do so appropriately.'

What is hysterosalpingography?

• HSG is an X-ray imaging test to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes.
• A radio-opaque material is injected into the cervical canal.
• A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material.
• It needs to be carried out in the preovulatory phase of the cycle.

Key findings

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