This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

GPs are the convenient scapegoat for postcode lotteries

Editor’s blog

jaimie kaffash 2 duo 3x2

The reports that IVF is being rationed by various CCGs is of no surprise to anyone – it has been happening for years now. I stand to be corrected, but in my mind, IVF is the most blatant form of rationing by CCGs.

An otherwise healthy 30-year-old patient might be entitled to it – their equally healthy 30-year-old near-neighbour down the road will not be. There is no dressing this situation as ‘clinically inappropriate’ (as they might do for imposing thresholds on hip replacements, for example) – the only justification for rationing is on cost.

I understand there will be people who argue that IVF isn’t core, and the NHS cannot afford to provide ‘nice-to-have’ services (although there are equally strong arguments about the detrimental effects it has on the mental health of those affected).

But this is an issue of fairness, and there is no justification for postcode lotteries. Patients are offered treatment depending on their CCG, which is unconnected to local tax rates – and they don’t have the option of voting a CCG board out.

The 2012 reforms shifted the blame for unpopular decisions onto GPs

Postcode lotteries have been around for ages. But what the 2012 reforms did was shifted the blame for unpopular decisions. And NHS England’s statement in response to the reports yesterday made clear this is still the attitude: ‘Ultimately these are decisions for local GPs, who rightly decide how best to balance the various competing demands on the NHS.’

Thank you, Andrew Lansley.

Jaimie Kaffash is editor of Pulse.You can follow him on Twittter @jkaffash or email him at

Related images

  • jaimie kaffash 2 duo 3x2
coronavirus john lewis vouchers 180x250px v2

Rate this article  (5 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (2)

  • ‘Ultimately these are decisions for local GPs..." This would have been hilarious if it was not so tragic. Since when GPs have been allowed to decide? The orders come from Leeds down to regional NHSE and on to the CCG's Finance Officer. He or she then puts it on the agenda of a compliant Governing Body and to an equally accommodating LMC (whose members often change hat and sit on their CCG's Governing Body). It's a mystery that the Daily Mail hasn't sniffed yet this process and the often associated conflict of interest (Pulse in the past offered several examples)

    Unsuitable or offensive? Report this comment

  • David Banner

    It was blindingly obvious to even the dimmest doctor that Lansley’s cynical reform was dumping the blame for spending cuts on the doorstep of CCGs and the GPs daft enough to staff them, so no crocodile tears, please.
    Those GPs that fancied dabbling in CCG power politics (whilst leaving the real work to their suffering partners) can’t cry foul now it’s gone all horribly and inevitably wrong.
    IVF rationing is merely the tip of a huge spending cuts iceberg, whilst the government can shrug and direct you to your hapless culpable local CCG. Political genius!

    Unsuitable or offensive? Report this comment

Have your say