Page URL:

Fertility services in the new NHS

28 May 2012
By Mark Johnson
Independent policy advisor to the National Infertility Awareness Campaign
Appeared in BioNews 658
The decision has been made. Fertility services will be commissioned at a local level from April 2013 onwards (1).

From next year, local GP-led Clinical Commissioning Groups (CCGs) will take on the commissioning responsibilities of Primary Care Trusts (PCTs), with the latter due to be abolished in April 2013. This now includes responsibility for commissioning fertility services such as IVF treatment.

The recent decision by Government ministers marks an end to months of uncertainty and speculation. Until last month, there was a possibility that fertility would fall under the remit of the new NHS Commissioning Board (NHSCB) - a national body which is due to become fully operational next year. The Board will commission services for a number of specialised conditions and oversee the activity of the CCGs.

The news has disappointed groups such as the National Infertility Awareness Campaign (NIAC), which would have preferred to have seen IVF commissioned on a national level. Their concern stems from the fact that devolved decision-making could potentially create an even more fragmented system than before. As of 2011, over 70 percent of PCTs were failing to provide the three full cycles of IVF to eligible couples as recommended by the National Institute for Health and Clinical Excellence (NICE).

Currently there are 151 PCTs in England and there will be 212 CCGs. The fear is that the greater number of CCGs will lead to an asymmetrical commissioning system in which conditions such as infertility are subject to an even wider postcode lottery.

That is the fear, but there is also cause for optimism.

In March, the National Quality Board at the Department of Health referred a number of new topics to NICE, including fertility. These topics will be processed into NICE quality standards by 2015. Quality standards set markers of best practice for health professionals and are expected to inform the content of the Commissioning Outcomes Framework (COF) - the mechanism by which the NHSCB will hold CCGs to account. The COF will in turn, inform payment mechanisms and incentive schemes like the Quality and Outcomes Framework for GPs.

So in theory, the measures that are being taken could be quite effective. At the recent 2012 NICE annual conference, Health Secretary Andrew Lansley said that 'quality standards should become the backbone of the commissioning system' (2). The incentives certainly look to be there, but what happens if CCGs just decide to do things their own way? Isn't local autonomy the whole idea behind local commissioning anyway?

Right now it is unclear what powers the NHSCB will have to intervene in instances where a CCG is not following NICE guidance. At the 2012 NICE annual conference Professor Malcolm Grant, chair of the NHSCB stressed the importance of ensuring that NICE's quality standards and advice do not go unheeded (3).

NIAC has learned that the Board will also be producing its own guidance for collaborative commissioning of infertility services, to sit alongside the NICE guideline and quality standards on fertility. One would expect this third piece of 'guidance' to differentiate itself from its NICE counterparts, but it is perhaps expecting too much to think it will include a punitive clause.

If you are a real optimist then you might argue that there is no need for a punitive system to be in place. NHS North Staffordshire's recent decision to fund IVF for the first time (4) was, after all, sanctioned by the new local shadow CCG. Indeed, GPs may well be more naturally inclined to commission such services for their local population.

The jury is out on that one.

One thing is certain. This latest decision by ministers marks a fork in the road and it will not be apparent for some time whether they have chosen the right path. What is clear however is the relatively short time available before CCGs take on their new commissioning responsibilities. The key challenge now for the Health Secretary is to ensure that fertility services do not suffer in the short term as a result of the transition to local commissioning.

1) Final list of CCGs published in 'landmark moment' for GP commissioning
Pulse |  24 May 2012
2) Health Act makes NICE stronger than ever before
NICE |  17 May 2012
3) NHS Commissioning Board to embrace NICE
NICE |  15 May 2012
4) NHS North Staffordshire sets aside IVF funding
This Is Staffordshire |  17 May 2012
9 June 2014 - by Purvi Shah 
The Vale of York Clinical Commissioning Group has agreed in principle to fund IVF treatment for couples in the area, although a formal decision on the matter will be made at a later date....
25 February 2013 - by Mark Johnson 
On 20 February 2013, the National Institute for Health and Clinical Excellence published its new guideline on the assessment and treatment of couples with fertility problems...
3 December 2012 - by Cait McDonagh 
The Progress Educational Trust's annual conference 'Fertility Treatment: A Life-Changing Event?' was an opportunity for experts in the fertility sector to debunk myths surrounding the impact of life-style factors on fertility and fertility practice...
3 September 2012 - by Clare Lewis-Jones MBE 
Last summer the National Infertility Awareness Campaign (NIAC) launched its most comprehensive patient survey to date. The aim of the survey was to identify problems faced by people seeking NHS-funded fertility treatment...
3 September 2012 - by Cathy Holding 
Around one in three women who are entitled to receive IVF are being denied this right, according to a survey carried out by the National Infertility Awareness Campaign (NIAC)...
26 March 2012 - by Ayesha Ahmad 
Couples in Northern Ireland claim they are being discriminated against as they are only offered one cycle of IVF treatment on the NHS. This is in comparison to the two or three available in the rest of the UK...
12 March 2012 - by Dr Rosie Morley 
Nine NHS primary care trusts (PCTs) have introduced restrictions to IVF treatment for patients who smoke or are overweight...
16 January 2012 - by Professor Allan Pacey 
Crystal ball gazing has never been my strong suit but I found myself rising to the challenge now that I have taken over the mantle of Chairman of the British Fertility Society. What is clear is that 2012 should turn out to be an interesting year...
28 November 2011 - by Nicola Drury 
An increasing number of NHS clinics that provide assisted reproduction technologies (ART) are denying treatment to women who smoke or have a partner who smokes. But is it appropriate for any lifestyle factors to be used to deny state-funded treatment? And where should the line be drawn between medical 'advice' and 'restrictions'?...
31 October 2011 - by Rosemary Paxman 
An investigation by the Daily Telegraph has found that a fifth of PCTs are offering single women IVF on the NHS...
to add a Comment.

By posting a comment you agree to abide by the BioNews terms and conditions

Syndicate this story - click here to enquire about using this story.