IVF is increasingly seen as a bit of a soft touch on the funding front.

We’ve reported previously that some PCTs were restricting access as one way of saving cash, and this week we report that the number of cycles funded on the NHS has fallen by a pretty startling 14% over the course of this financial year.

Our story also contains the starkest defence I’ve seen of restrictions to funding, with GP Dr Andrew Davies, chair of the Warrington Health Consortium, putting it thus: ‘While we fully understand infertility is a condition that causes great distress to couples, it does not affect general physical health or life expectancy.’

That’s a valid viewpoint, but one I think needs to be tested in the crucible of public opinion – if GPs and NHS managers are serious about engaging the public in their commissioning decisions, then IVF looks as good a place to start as any.

But it’s pretty clear, as GPC deputy chair Dr Richard Vautrey makes clear in our story, that restrictions in IVF are here to stay, as demand outstrips the potential for supply.

And in places like Warrington, where IVF is only funded in ‘exceptional circumstances’ and only seven requests have been granted this financial year, some patients who feel they need the treatment will not be able to get it on the NHS.

Of course they could go private – as 60% of those accessing IVF currently do – but that’s only an option for couples who have the cash.

An essentially non-NHS approach to IVF like this looks to me inappropriate and inequitable, but equally, the NHS simply doesn’t have the cash to provide fertility treatment to everyone who wants it.

Is it time therefore to take a new approach – one that might not even be legal under the current NHS framework, but could become so as the health service responds to the financial restrictions it is under.

Could it be, I wonder, time to accept means-testing for fertility treatment?

It will feel like the upper reaches of a very slippery slope to many defenders of the NHS, and it’s certainly no-one’s ideal solution, but it’s arguably better than allowing an ad hoc system to develop that simply denies IVF to anyone who doesn’t have money.

There are a host of complexities to consider of course – what means-testing would be based upon, how it would be administered, and whether other treatments commonly being rationed on the NHS – such as cosmetic surgery – might also be included.

But we need to start having these debates, because as our IVF figures show, Andrew Lansley’s claims that funding restrictions will not harm front-line NHS care are being exposed for what they always seemed to be – a fantasy.

RCGP chair Dr Clare Gerada is right to warn of the dangers of bureaucracy, but she must back her words with action by streamlining the college’s own practice accreditation scheme, says Pulse editor Richard Hoey

Since taking over as RCGP chair last November, Dr Clare Gerada has displayed a knack for capturing the mood of general practice.

She has struck a sceptical note on the NHS reforms, has hardly bubbled over with enthusiasm for revalidation and has talked of the bureaucracy of CQC registration as at best a necessary evil.

So her criticism last week of the potential of red tape to detract from frontline care was entirely consistent with her own personal line.

What it did not do, however, was to acknowledge the potential role of the college’s own practice accreditation scheme in providing a streamlined alternative to the CQC – and its failure so far to step up to that plate.

Way back in the distant days of Professor Mayur Lakhani’s stint as RCGP chair, the college was attempting to lead on a joint accreditation scheme with the Government, which would have had GPs setting the official standards for general practice.

That scheme collapsed when it emerged that the college was effectively providing a fig leaf for full-blown Government star ratings for practices, but there were still hopes that the RCGP’s practice accreditation could provide a more straightforward alternative to jumping through the CQC’s intricately complicated hoops.

Those hopes received a pounding last month, though, in the form of the BMA’s response to the Government’s consultation on the CQC.

The BMA warned it would ‘strenuously oppose’ any attempt to align CQC registration with the RCGP’s practice accreditation scheme, which it described as ‘extremely expensive and burdensome’.

So then, question one must surely be – how did the RCGP manage to produce an accreditation scheme designed as the GP-led alternative to CQC registration which the BMA now seems to suggest is even more bureaucratic?

And question two must be, what is it going to do about it?

The CQC has made clear that it is open to exploring how practice accreditation could operate as an alternative to meeting the full range of its registration requirements.

But Dr Gerada must realise that most GPs will give the college’s scheme short shrift as an alternative while the BMA is describing it as ‘extremely expensive and burdensome’.

She needs to sit down with the GPC leadership, work out what it is about practice accreditation that they don’t like, and get working on a sensible and realistic set of standards.

It would be infinitely preferable for GPs to pass through a registration scheme designed by general practice for general practice, rather than one drawn up by managers and applied generically across health and social care.

But the RCGP’s practice accreditation scheme must also pass the same test that Dr Gerada is rightly applying to revalidation and the CQC’s scheme.

It must be streamlined and sensible – viable for a busy practice to take on, without sucking up GP time and detracting from frontline patient care.

Richard Hoey is editor of Pulse.

The pictures look great, but it’s the words of protest from 1,700 GPs that the Prime Minister needs to read and reflect on, says Pulse editor Richard Hoey.

Delivering a petition to 10 Downing Street can feel a slightly synthetic event. It’s great to get the pictures outside the unfeasibly shiny black door, and to make your defiant words to the camera, but how much is anybody listening?

I wasn’t expecting the Prime Minister to step out in person to accept Pulse’s No to 65 petition, but it’s easy to feel slightly deflated when the door is opened up only fleetingly, and our 1,690 statements of support accepted by an anonymous member of the security team.

But there’s nothing made-up about the anger contained in those petition statements, and the Government is being forced to listen, even if it would rather give the impression that the pension proposals are a done deal.

Just this week we learned that none other than the health secretary Andrew Lansley had written to the Treasury several months ago to express his disquiet at the plans, and the prospect they could spark a mass exodus of GPs from the NHS Pension Scheme.

I remember how a senior GP close to Mr Lansley told me earlier this year of how the Department of Health was deeply unhappy at the plans to raise the GP retirement age and ramp up contributions, knowing just how damaging they could be to its plans for GP commissioning.

Certainly that was the message at the petition event from Dr Peter Swinyard, chair of the Family Doctor Association, who was adamant the Government would be forced to back down because ‘it knows it needs GPs onside’.

The Government now faces determined, unified opposition from the health unions – as Pulse revealed earlier this month - and there’s already evidence that its resolve is beginning to weaken.

Plans to ramp up GPs’ contributions by six percentage points remain pretty horrific, but they are mildly less bad than the numbers first revealed to the BMA earlier this year.

The crunch moment will come when the Government formally confirms its plans to move to career-average pension schemes for those like consultants who are lucky enough to be on final-salary deals.

That will trigger the BMA’s new policy to hold a ballot on potential industrial action, which will cover the whole of the medical profession, including GPs, and deal with the threat to pensions as a whole.

Indeed, any industrial action might involve not only doctors, but also members of the 16 other unions involving NHS staff.

We know Mr Lansley has been squirming over the pension plans, and that the Government has already been forced into a shuffling, partial back-track on contributions.

I’d suggest Prime Minister David Cameron now takes the time to rifle through those 1,690 expressions of anger and disgust in our petition, and to reflect a little on what it would mean for his Government to be at war with professionals across the NHS.

Downing Street petitions may feel a little phony, but this one is about the ability of doctors, dentists, nurses and midwives to remain secure in their retirement plans, to be paid what is due to them, and to avoid burning out while trapped in an endless cycle of work.

Life doesn’t get more real than that.

Dr Hamish Meldrum misjudged the mood of the BMA in his response to the Government’s health bill revisions, and since then he has been coming under growing pressure from leading doctors, says Pulse editor Richard Hoey

BMA chair Dr Hamish Meldrum had a difficult job when he addressed the Commissioning 2011 conference last month, in the immediate aftermath of the Government’s adjustments to its NHS reforms.

He had to somehow convey views of BMA members, large numbers of whom remained deeply sceptical about the value of the reforms, on front of an audience largely made up of unadulterated commissioning enthusiasts.

The expectation, as one such enthusiast involved in the event told me recently, was that Dr Meldrum would bring ‘a bit of grit’ to proceedings – but he chose instead to play to the gallery.

His claim that it was time to ‘move on’ from the row over the heath bill continues to haunt him, nearly a month later, as the BMA chair comes under growing pressure from within Council over his stance on the Government’s reforms.

In the immediate aftermath of Dr Meldrum’s comments, one angry BMA Council member phoned the Pulse office, wanting to know if he’d really said what we’d reported. Soon afterwards, five top doctors, including GP Dr David Wrigley, wrote an angry open letter to Dr Meldrum demanding he change course.

And at the BMA annual representative meeting at the end of last month, delegates took the unusual step of ignoring Dr Meldrum’s advice and voted to once again call for the Health and Social Care bill to be withdrawn.

I’ve been told elements of the BMA leadership regard that rejection as a ‘big blow’, and one that places them in an extraordinarily difficult position.

And that position just got even more difficult, with the news that Dr Paddy Glackin, the north London GP who led the rebellion against the health bill at the ARM, has been elected to the GPC, in a move that some are interpreting as a direct challenge to the authority of the BMA chair.

I’m not suggesting Dr Meldrum is likely to be forced to resign, as leading GPs believe he would have done if the special representative meeting (or, for that matter, the ARM) had voted for outright opposition to the health bill.

But he is facing what another leading figure in the BMA described to me as ‘disquiet’, with a minority of Council members straightforwardly ‘out for his blood’.

He is going to have to find a tougher edge on the Government’s reforms if he is going to quieten the discontents.

Expect Dr Meldrum to take a sharper tone over the quality premium, which remains a significant threat despite some signs of it being watered down, over the imposition of any willing provider even when commissioners don’t want to use it, and over the bureaucratic nightmare that the new version of the reforms creates.

And expect him to find an added edge too on pensions – it may not be much related to the NHS reforms, but he once again will feel tempted to play to his gallery.