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Patients ‘get around’ rationing rules by registering with out-of-area practices

Patients have been changing GP practice in order to ‘get around’ rationing of services by CCGs, a health minister has said.

Minister Jackie Doyle-Price said last week that patients had been switching surgeries in order to access IVF services.

Some CCGs offer different numbers of funded courses of IVF. Ms Doyle-Price said her CCG had recently cut the number of courses from three to two, following ‘lack of provision’ in neighbouring CCGs.

She implied her CCG had seen increased demand from patients who registered with a practice within her constituency’s CCG in order ‘get around’ the disparity of provision. 

Ms Doyle-Price was responding to a question in parliament from MP Rachel Maclean, who said: ‘Provision of IVF in Redditch has been reduced from two cycles to one. I warmly welcome the work that the minister has done to increase equity across the country, but what more can she do to address the postcode lottery in this and other areas, such as hip and knee surgery?’

Responding, Ms Doyle-Price said: ‘The postcode lottery is not acceptable, and patients manage to get around it. My local CCG, having funded three courses of IVF, has had to reduce that to two because demand has doubled owing to the lack of provision in neighbouring CCGs.’

The Department of Health later confirmed that the minister meant patients ‘get around it’ by switching to a CCG that offers more rounds of IVF than their former GP practice under a different CCG.

Patients can switch GP practice to one that is not in their area under the out-of-area patient choice scheme, which is used by digital provider Babylon to enable patients from across London and Birmingham to register.

Dr Richard Vautrey, BMA GP Committee chair, said: ‘The BMA has always been clear that patients should have access to all NHS services wherever they live. After all, we have a national health service.

‘If, as a result of CCG financial pressure and cuts to services, patients feel they have to switch to another CCG to access treatments that are not available in their own area, it not only underlines the unfairness in these commissioning “postcode lotteries”, but also risks destabilising the way local services run.’

He added: ‘This is particularly true when we consider the out-of-area regulations, which allow patients to register with a GP practice far away from their homes.

‘While we appreciate commissioners are under pressure to meet rising demand despite increasingly stretched resources, national access to services should be equitable, clear and non-discriminatory.’

Ms Doyle-Price added: ‘I have made it very clear that it is unacceptable for any CCG to offer no IVF cycles at all, I have given them that guidance.’

NHS Thurrock CCG, Ms Doyle-Price’s constituency CCG, said it was currently reviewing its specialist fertility policy but that it was ‘correct’ that there is variation in IVF treatment offered by CCGs. 

NHS Redditch and Bromsgrove CCG said it made the decision to cut the IVF cycles two years ago due to a ‘financial challenge’.

It follows reports in 2018 that seven CCGs had stopped offering IVF entirely, and 12 offer just one for women over 34.

Last month, the NHS released part of a consultation on out-of-area patient registration, in which it announced plans to make it easier for digital-first providers to set up practices in deprived areas in a bid to reduce the numbers of patients registering out of area.