18 Jan Why NHS GPs are failing IVF patients
Is GP care for IVF patients declining? We think it is. The NHS postcode lottery, tighter criteria for treatment (a third of GPs don’t want to fund IVF at all) and an increasingly obstructive attitude are creating a difficult environment. While most of our fertility patients are well looked after by their GPs, a growing number report sub-standard care.
It all went wrong when GP commissioning groups replaced PCTs. Putting doctors in charge of the purse strings should have made things better for IVF patients. Doctors understand infertility and are more compassionate and proactive, right? Wrong. 20 per cent of the 212 GP consortia still completely ignore NICE guidelines recommending three cycles of IVF treatment to qualifying women under 40. Many consortia place arbitrary and unfair obstacles in the way. Smoker? No treatment. Existing child? Can’t help. Partner has a kid? Terribly sorry. Overweight? There’s the door.
What’s going on? Fertility patients cost the NHS billions of pounds less than obesity, diabetes and alcohol-related illness. GPs should be helping would-be mums in their hour of need, not turning them away. Even when women do manage to get a round of IVF on the NHS, clinic standards in the UK vary enormously. See the wide regional variation in success rates on the HFEA website.
Surely GPs aren’t allowing a culture of hostility towards IVF patients to affect them? That erodes quality of care, not just funding. Several of our patients have been refused pregnancy blood tests and post-treatment scans. Home pregnancy tests will do, they were told. Wrong – that’s medical negligence. Consecutive blood tests and an early scan at 6.5 weeks look for ectopic and multiple pregnancies, more common after fertility treatment. Multiple pregnancies are risky. Ectopic pregnancies can kill.
We’ve had feedback on other GP shortcomings. One doctor had never heard of thrombophilia screening. Another wanted to charge for karyotype (genetic) testing. A third didn’t know what reproductive immunology was. As for our donor-egg patients, while many nurses in GP surgeries will happily administer their depot injection at the start of treatment, some won’t. When challenged, their GP colleagues down the corridor say they’ve never heard of the injection. All they had to do was look it up.
Lack of understanding about fertility treatment is common among GPs. Take pre-treatment blood tests. If GPs agree to pay for them, and manage to schedule them at the right time in your cycle (don’t count on it), they frequently request too few tests. FSH and LH aren’t enough, but are often the norm. (A proper hormone profile should also include TSH and Prolactin.) And most GPs have never even heard of AMH – the best ovarian-reserve test of all. Mid-cycle transvaginal scan? You’d be lucky. If NHS GPs don’t know the key fertility tests, what’s the point of funding a later IVF cycle?
Here’s another fertility procedure GPs won’t fund: the Harmony Test, or non-invasive pre-natal (NIPN) test. Fertility patients are often older. The chance of their baby having a chromosomal abnormality, like Down’s syndrome, is higher. The Harmony Test is 99% accurate at detecting such problems. It removes the need for invasive procedures like CVS and amniocentesis, both miscarriage risks. Those tests are probably more expensive to the NHS than the NIPN test. So it makes financial sense for GPs to refer older IVF patients for this test. Stop press: this might happen soon.
Some NHS GPs hate patients going abroad for IVF treatment. Thankfully, they’re rare. This kind of ignorant discrimination is unacceptable. It makes no sense for the following reasons. First, patients only go abroad because the NHS won’t fund them and UK private clinics are too expensive. Second, self-funded private treatment saves the NHS money – so GPs should be happy. Third, the same strict fertility laws apply across the EU – so patients are just as safe at registered fertility clinics in other member states. Fourth, success rates and care standards are higher at many clinics abroad.
NHS GPs are failing IVF patients. It’s time for them to grow up. Far from being a burden on the state, fertility patients don’t cost the NHS that much. Infertility is a disease (fact). Patients need respect, cooperation and access to the best treatment and care. If GPs won’t provide it, we may need legislation to force them to.