Commissioning NHS Fertility Services: Ending the postcode lottery

Around one in six couples in the UK seek specialist treatment for fertility problems, and infertility can have a profoundly distressing and devastating impact. British patients have traditionally faced considerable inequality of access to NHS treatment, resulting in many having to resort to privately-funded treatment, and there continue to be wide variations in NHS provision across England and Wales. The 2004 National Institute of Health and Clinical Excellence (NICE) clinical guideline stated that up to three full cycles of IVF should be made available on the NHS to those meeting its clinical criteria, with all PCTs making available at least one full cycle by April 2005 and then progressing towards three cycles and full compliance with NICE in the longer term (1).

A number of projects have been put in place by Ministers and the Department of Health (DH) in recent years to encourage PCTs to progress towards full implementation of the NICE guideline. These have included surveys of IVF provision, strategies to help standardise access criteria and establishing an expert group in 2008 to look at any other barriers to providing three full cycles of IVF. Now that fertility services are starting to improve, it is important that service providers are made aware of the latest developments in this rapidly changing sector to ensure that this momentum is not lost.

In 2008 the DH set up an Expert Group on Commissioning Fertility Treatment with a remit to help NHS commissioners in their decision-making on the provision of infertility treatment and to encourage all commissioners to progress towards the implementation of the NICE fertility guideline. The group is currently supporting a number of government-funded projects including to help PCTs progress to standardised access criteria and to identifying barriers to implementing NICE guidelines and to identify and disseminate good practice in commissioning IVF.

One of the key outputs of the group is a new commissioning guide to fertility services, which will outline best practice on planning, specifying and managing the provision of quality treatment services. The guide will be essential reading for all those involved in commissioning, supporting key aspects of the World Class Commissioning cycle.

In support of this work, Infertility Network UK has conducted a number of multi-year projects with PCTs to standardise access criteria for treatment. These projects, sponsored by the DH, support national survey work to provide a detailed picture of treatment provision, why it varies across England and Wales, and how the gap can be closed.

Although these developments have the potential to bring about huge improvements to NHS fertility services, the challenges of regulating and implementing technological change should not be underestimated. Issues such as elective single embryo transfer, for example, have the potential to profoundly impact commissioning policy and the provision of fertility treatment and commissioners need to be briefed on effective ways to manage this.

These issues will be among those addressed at the first national conference for commissioners of fertility services, taking place on 18 June 2009 in London. This milestone conference brings together all the major strands of work on the provision of NHS infertility services. Combined with information on the latest developments in the sector, the conference will help commissioners achieve quality and excellence across the full range of fertility services they provide, both now and in the future.

The keynote speech, delivered by Rt Honourable Dawn Primarolo MP, Minister of State for Public Health, will outline how provision of fertility treatment has improved and what remains to be done to achieve greater equity and full NICE compliance.

Other prominent figures in the field speaking at this event include Professor Lisa Jardine (HFEA Chair), Tony Rutherford (BFS Chair) and Clare Lewis-Jones (IN UK Chief Executive), who will share their thoughts on key areas of commissioning fertility services, and representatives from the Expert Group on Commissioning Fertility Treatment, who will introduce delegates to a best practice commissioning guide to aid in providing quality services and achieving NICE compliance.

If you commission fertility services, this is an event you won't want to miss. And if you work in the fertility sector as a clinician, embryologist, nurse or counsellor, please let your commissioners know this event is happening! You can go to www.tcp-events.co.uk/nationalfertilityconference to register and to find out more information.