GPs should use their ‘soft influence’ to lobby commissioners for better infertility treatment as the current provision is in a ‘terrible state’, according to the RCGP president.
Professor Dame Clare Gerada has also said that as a GP even she is ‘confused’ by the guidelines around in vitro fertilisation (IVF) accessibility and guidelines.
Speaking last week at an online event which discussed the funding and provision of fertility treatment in England, the South London GP called more widely for society to put a bigger focus on infertility.
She questioned why society spends so much time discussing the menopause – which is ‘not an illness’ but a ‘process you go through’ – but ‘no time discussing fertility’.
The event was called ‘NHS Fertility Treatment: Wouldn’t It Be NICE to Have a Workable Guideline?’ and was hosted by the Progressive Educational Trust (PET), a charity working to improve fertility treatment choices.
However a report from PET, published last month, claimed that GPs, who are for many the ‘gatekeeper to referral for IVF treatment in England’, have a ‘poor understanding’ of the NICE guideline.
The report found that 50% of the 194 GPs interviewed were able to correctly identify that the guideline recommends three cycles of NHS-funded IVF.
Professor Gerada said: ‘I suspect that very few people know women are entitled to three cycles, because nobody gets three cycles, it’s barely lucky if you get one cycle.
‘Over the years that I’ve been a GP the rules have changed so much that even I’m confused.’
She added: ‘The problem for GPs isn’t that I don’t think we’re sympathetic to this, it’s because society is not sympathetic and we bring up the prevailing mood of society – that if no one talks about it, if no one is lobbying on behalf of couples or women who are trying to have a child, it becomes very difficult and it then gets put into the margins.’
As a senior GP leader, Professor Gerada said she attends multiple meetings a week about the state of the NHS, but fertility is never mentioned.
Calling for ‘better information’ for GPs, she said: ‘I have been a GP in the same area and even I struggle to know where to send my patients, and sadly most of my patients, I have to advise them to go privately because of waiting times on the NHS.
‘But even I struggle to know who’s best, who’s honest, who has reasonable and honest outcomes and who doesn’t try and sell the patient treatments that they can ill-afford because they can ill-afford it anyway.’
When asked by attendees what GPs can do to help improve access to NHS-funded treatment, Professor Gerada said the profession does have influence because many now sit on integrated care boards (ICBs) who have budgets.
She added: ‘But we do have soft influence. We can start to write to commissioners and to say: “Why are we not getting infertility treatment managed so effectively. Why are many women and men – but predominantly women – in this country spending £400m per year on private IVF when they should be getting this through the NHS?”‘
However, she also said the royal colleges have a part to play, saying she will ‘take that on board’ and look at what the RCGP has done to promote access to infertility treatment.
Last year, Professor Gerada and Dame Lesley Regan co-chaired a Public Policy Projects report on women’s health which called for an end to the ‘postcode lottery’ around funding for infertility treatment and for ‘add-ons’ to be regulated with clear information provided to patients.
At the time, less than 20 per cent of CCGs were offering the recommended three cycles of IVF and some areas were offering no fertility treatment at all.
As well as issues around the patchy provision of fertility treatment around the country, Professor Gerada also cited concerns about societal attitudes towards fertility.
She said: ‘There is something I think in society about believing that child is something that’s not a health issue. It’s treated as a social factor, and as a personal choice, but not a health issue.’
The RCGP president added: ‘I would also ask the question: why do we spend more time discussing the menopause – which on the whole is not an illness, it’s just a process you go through like menarche – more time discussing the menopause, more time destigmatising the menopause, which I never considered to be a stigmatising process by the way, and no time discussing infertility?’
And earlier this year, the Department of Health and Social Care (DHSC) allocated £25m over the next two years to speed up the development of women’s health hubs to provider better access to care for menstrual problems, contraception, pelvic pain and menopause care.
Improving fertility services, including the ‘transparency on provision and availability’, was part of the Government’s first-ever Women’s Health strategy, published last summer.
The strategy also stipulated that all new doctors complete mandatory women’s health training from 2024.