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Commisisoning dilemma: removal of a service

The commissioning group has decided that it will no longer fund vasectomies – in your view, a very short sighted approach. Do you decide to accept the decision, argue your case with the commissioning group or consider training up to provide a personal and private service to your patients? Dr Helena McKeown advises

I consider arguing my case for longer term benefits to our local health and social care budget, citing evidence of the failure rates of the various commonly used contraceptives, the failure rate of vasectomy being similar to the LARCs, and the costs of procedures. Vasectomy performs very favourably for cost in the long-term at about £220, including counselling and two semen analyses. Once this is considered alongside the £300 for an early non-surgical termination or £500-700 for later termination, without even considering the psychological costs, I think I have a strong financial argument.

However I also consider the opportunities. Firstly, could I provide the service myself to local patients, including my own? GPs contemplating making any charge to their NHS patients must ensure they comply with the strict requirements of the regulations and that they act in accordance with the ethical duty not to use, or appear to use, their position of trust to influence patients to follow a particular course of action which may offer the doctor some advantage, financial or otherwise. Furthermore, charging patients is still significantly restricted under all primary medical services contracts so careful advice must be sought and I would check the GPC guidance, including the latest premises regulations for potential rate abatements, for example. Secondly, have I had enough post-graduate surgical experience (SHO), are my partners in agreement, what would be the demand and could I beat off the competition from other private providers? Assuming I would like to do this I would need to research the training, accreditation and revalidation issues and look at the funding for satisfactory facilities, infrastructure, training and time. For example, the training includes fifteen hours (?) of supervised clinical experience. I’d have the costs of on-going training as well as increased medical defence insurance premiums . It’s risky as there would be no guarantee of recovering capital or the relative reassurance of at least one continuing contract. If I wasn’t doing at least one operation per month and 40 operations a year I wouldn’t comply with the Faculty of Family Planning’s requirements to demonstrate a continued sustained level of activity. I‘d need to take part in audit, peer review and be appraised.

On balance I’ll go for arguing on patient choice.

Dr Helena McKeown is a member of the GPC Commissioing and Service Development Sub-committee, and GPC member for Wilts and Dorset

Dr Helena McKeown