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Doubts Raised Over Patient Access To Quality Fertility Treatment

June 11, 2004

A survey of Primary Care Trusts (PCTs) launched today at the National Infertility, reveals widespread confusion as to what commissioning fertility services actually means and who should be taking responsibility. Feedback from over 50 PCTs in England highlights issues relating to eligibility for treatment, quality of service and barriers to implementation within the organisations.

The new clinical guideline for the diagnosis, assessment and treatment of couples with fertility problems was launched by the National Institute for Clinical Effectiveness (NICE) in February this year. Fears about lack of implementation of the guideline, which represents a first step towards a comprehensive, NHS funded fertility service, prompted Infertility Network UK to undertake the PCT survey. The contact responsible for commissioning fertility services within every PCT was identified and sent a questionnaire. Areas covered by the questionnaire included their views on the new guideline, its impact on current service provision, quality of service and timings for implementation.

The main issues highlighted by the survey include:
·        although most PCTs feel that the guideline provides specific recommendations for change and guides clinical practice, more than half believe that it fails to provide much needed guidance on the social eligibility criteria for provision of fertility treatment;
·        whilst two thirds of PCTs believe that the fertility services they provide are comprehensive in quality, one third failed to respond to this question;
·        audit of quality of service is only carried out just over half of PCTs and only 17% of these use an independent third party to carry out the audit;
·        high perceived cost is highlighted by almost three quarters of PCTs as having a significant impact on implementation.

According to Sheena Young, Head of Business Development at Infertility Network UK, "We fear that the patients themselves may have to be the drivers of quality service provision in fertility treatment. Our survey shows that poor levels of audit, a lack of central guidance on social eligibility criteria and perceptions of high cost of implementation are standing in the way of equitable access."

The survey also found that:
·        responsibility for commissioning fertility services varies widely between PCTs - from directors of pubic health or service redevelopment to heads of family planning or consultants in reproductive medicine;
·        one third of PCTs will need to seek private contracts to fulfil demand for fertility treatment and this step is under consideration by a further third;
·        just over half of the PCTs have read the cost model accompanying the NICE guideline and one quarter of these believe it to be a realistic guide;
·        only one third of PCTs say that it is their intention to fully implement the NICE guideline; just under half have not finalised their plans and 15% do not plan to fully implement.

National Infertility Day is an ideal forum to discuss the service issues raised by the PCT survey. Following a keynote presentation by Melanie Johnson MP, the Parliamentary Under Secretary of Health, throughout the day, there are satellite session and talks on a variety of infertility related subjects, one satellite sessions entitled `access to treatment' will raise the question of whether social criteria are evidence-based or just another form of rationing. Both clinical and political perspectives are included in this session.

"There is an urgent need to get the message across that fertility treatment does not mean `IVF for all'. There are many other aspects of treatment that can improve patient outcomes and if subjected to closer monitoring, could reduce the overall costs of the management of infertility" highlighted Sheena Young. " I will be presenting the results of this PCT Survey at National Infertility Day and launching a survey of patients views on access to treatment. Their views on this need to be heard"

National Infertility Day is the largest one-day conference ever organised and hosted by infertility patient associations. It attracts 500-650 delegates from all over the UK. This years principal sponsor is the global biotechnology leader, Serono Ltd, who are keen to raise the quality of UK fertility treatment and to work with all stakeholders to ensure that these guidelines fully benefit patients.

British Fertility Society