FOI Summary Issue: IVF Policy. This information relates to Bristol Clinical Commissioning Group

Transcription

1 FOI Summary Issue: IVF Policy This information relates to Bristol Clinical Commissioning Group 1. According to your current IVF treatment policy: a. How many cycles of IVF do you offer to eligible patients? b. Do you fund a full cycle of IVF, as defined by NICE, which includes replacement of all frozen embryos? If not how many frozen embryo transfers do you fund? 1 cycle. A full IVF/ICSI treatment cycle includes: Diagnostic tests, scans and pharmacological therapy Counselling for couples Stimulation of prospective mother s ovaries to produce oocytes Harvesting of the oocytes Fertilisation using IVF or ICSI (assisted hatching is not provided) One fresh embryo transfer If unsuccessful, within twelve months of cryopreservation, one frozen embryo transfer from remaining frozen embryos. [maximum of 2 embryos per cycle] A follow up consultation with fertility services post IVF treatment Where patients have completed their NHS funded full cycle of IVF treatment but have frozen embryos remaining in storage, they can elect to self-fund further treatment with the fertility services. Bristol CCG funds for one frozen cycle using frozen embryos will follow a fresh cycle if deemed clinically appropriate (maximum of 2 embryos). Page 1 of 9

2 c. What is your upper and lower age limit that female patients must meet in order to qualify for treatment? d. Do you fund one full cycle of IVF for women aged in line with the NICE guidance? e. Do you have an age criteria that male patients must meet in order to qualify for treatment? If so, please state what the criteria is. f. What must the smoking status of patients be? No lower age limit. The prospective mother must not be older than 18 weeks before her 40th birthday at referral as no female patient will be placed on the waiting list for secondary care fertility assessment within 18 weeks of their 40th birthday. Bristol CCG does not fund fertility treatment for perspective mothers older than 18 weeks before her 40th birthday at time of referral. No lower age limit Upper age limit for perspective father 55 years of age. Both partners must be non-smokers. g. What weight requirement exists (i.e. BMI)? The prospective mother s body mass index (BMI) must be between 19 and 29.9 kg/m2 for a period of six months as evidenced from her primary care record. Prospective mothers with a BMI of 30 and above should be offered a referral to weight management services in order to reduce their weight prior to assessment and treatment by fertility services. Where the prospective mother is aged between 37 and up to 18 weeks before her fortieth birthday, her BMI must be between 19 and 35 kg/m2 prior to referral for assessment. Prospective mothers with a BMI above 29.9 in this age group should be referred to weight management services at the same time as being referred to fertility services in order assist her to lose weight and aid fertility. The prospective father should aim to have a BMI of 29.9 and under. h. How long do couples need to be trying to Hetero-sexual couples: Page 2 of 9

3 conceive before becoming eligible for treatment? Hetero-sexual couples have failed to conceive after regular unprotected sexual intercourse for two years. Patients may be referred outside this timeframe if there is a known condition which is likely to affect the fertility of either partner (e.g. severe oligomenorrhoea or previous testicular surgery) or oncology treatment is likely to compromise the fertility of either the prospective mother or father. Hetero-sexual couples who have failed to conceive after regular unprotected sexual intercourse for more than one year but less than two years and where the prospective mother will be older than 18 weeks before her fortieth birthday may also be referred. Same sex female couples: Same sex female couples may be assessed if self-funded insemination on at least ten non-stimulated cycles over a period of two years has failed to lead to a pregnancy or oncology treatment is likely to compromise the fertility of the prospective mother. NHS funding is not available for access to donor insemination facilities for fertile women or surrogacy. i. Is there a minimum period that the couple need to have been in a relationship before becoming eligible for treatment? j. What eligibility criteria do you apply in relation to existing children that either one or both partners may have? No minimum period. At least one partner must have no living offspring/children to qualify for funding. This includes genetic and legally adopted children and offspring who are adults but does not include foster children or step children. If the couple adopt a child or become pregnant naturally during assessment or treatment the couple are no longer eligible for fertility assessment or treatment. Page 3 of 9

4 k. What policy is in place (if any) for the use of Single Embryo Transfer? l. Do you fund fertility treatment for same sex couples, and if so what eligibility criteria do they have to fulfill? At Clinical discretion. Same Sex (female) couples are required to meet the same general principles as heterosexual couples (section A of the fertility assessment and treatment policy) and also have to meet the criteria in section C of the policy (Section C - Investigation, Assessment and Advice on Fertility Issues for Same Sex Couples (For review and consideration by the GP at time of Referral to fertility services)) The CCG s Fertility Assessment and Treatment policy is available at: m. Do you fund fertility preservation for cancer patients and if so what budget is the funding taken from? The CCG does fund fertility preservation prior to oncology treatment but does not have a predetermined budget for this treatment. If a patient meets the criteria of the CCG s Fertility Assessment and Treatment policy for fertility preservation prior to oncology treatment is offered. Please refer to section G of the CCG s policy which is available at: 2. What is the average cost of a cycle of an IVF cycle funded by the CCG and what does that include? Average cost What providers does the CCG contract with to As part of the CCG s Contract with North Bristol NHS Trust fertility assessment and Page 4 of 9

5 provide IVF services? 4. When was the current assisted conception policy developed? And who was consulted? treatment can be offered at Bristol Centre of Reproductive Medicine. However, through Patient Choice, patients who meet the criteria of the Fertility Assessment and Treatment Policy can choose to be treated at any fertility treatment centre in England that holds an NHS contract. The CCG s policy was last reviewed in December 2014 by the Bristol, North Somerset and South Gloucestershire CCGs Clinical Policy Review Group. This group s members include primary and secondary care clinicians, as well as CCG Commissioners and Public Health experts. Fertility specialist at both North Bristol Trust and University Hospital Bristol Trust were also consulted. And who was consulted? 5. When will the CCG review its assisted conception policy? Currently under review. 6. Is the assisted conception policy available on the CCG s website? If so please provide a link to the policy If so please provide a link to the policy Yes. The CCG s Fertility Assessment and Treatment policy is available at: Page 5 of 9

6 7. Please could you provide me with a copy of your assisted conception policy? See above. 8. Which MPs cover the boundaries of the CCG? Kerry McCarthy Karin Smyth Charlotte Leslie Thangam Debbonaire. 9. Has the CCG conducted any financial modelling on the cost implications of funding three full cycles of IVF? 10. If the CCG does not follow the NICE guideline, have they published the reasons why they do not follow the guideline? When the BNSSG policy was implemented in 2008 by the PCTs and updated regularly since then, including 2013 when the CCGs assumed commissioning responsibility and adopted the policy, the financial implications of various option were considered, including funding three cycles. The financial and clinical aspects and implications of the policy were last reviewed in 2013 using the NICE costing tools and are due for review again in September None published If so, what are the reasons for not complying with the NICE guideline? Page 6 of 9

7 11. In the last 12 months, or at the time of the last consultation on the IVF policy, has the CCG considered collaborating with other CCGs on the fertility policy? 12. In the last 12 months, how many patients have applied for fertility funding (both successfully and unsuccessfully) through an Individual Funding Request? Bristol CCG works together with both South Gloucestershire CCG and North Somerset CCG (abbreviated to BNSSG CCGs) to develop a consistent health community approach, enabling them to implement effective commissioning policies. The Fertility Assessment and Treatment Policy is a BNSSG policy. Bristol CCG s fertility policy is criteria based access which means if a patient meets the criteria their GP can refer them directly into secondary care and consequently the CCG does not hold these patient numbers. The information supplied by the Individual Funding Request (IFR) team within this FOI is based on applications that have been made to the team where the patient does not meet criteria. The decision on whether to fund is then made by IFR Panel. Application Received by the IFR team 1 st July st July 2016 Applications Approved by IFR Panel Applications Declined by IFR Panel Applications awaiting further information from referrer or patient or awaiting IFR Panel 40 Applications 14 Applications 21 Applications 5 Applications Page 7 of 9

8 13. In the last 12 months, how many women aged between has the CCG funded IVF treatment for? Bristol CCG s fertility policy is criteria based access which means if a patient meets the criteria their GP can refer them directly into secondary care and consequently the CCG does not hold these patient numbers. The information supplied by the Individual Funding Request (IFR) team within this FOI is based on applications that have been made to the team where the patient does not meet criteria. The decision on whether to fund is then made by IFR Panel. Application Received for women between by the IFR team 1 st July st July 2016 Applications Approved by IFR Panel Applications Declined by IFR Panel 6 Applications 2 Applications 4 Applications What does the CCG estimate this to have cost? Average cost What advice has the CCG sought concerning the most cost and clinically efficient methods of setting up their tertiary infertility services? In developing this service in 2008 and reviewing the commissioning policy regularly since then, the Commissioners have worked closely with the fertility specialists from all NHS providers in the BNSSG area to ensure the most appropriate use of the limited resources whilst implementing technological advances. This includes regular bi-annual meetings between Gynaecologists and fertility specialists and Page 8 of 9

9 Commissioners. a. Where was this advice sought from? A regular joint meeting is held between Commissioners, Senior Gynaecologists and fertility specialists from the BNSSG area. b. When was this advice sought? Twice yearly 15. I would also like to request permission to republish the data provided in a publically accessible document/web-format. This information is licensed under the Open Government Licence v1.0. To view this licence, visit or write to the Information Policy Team, The National Archives, Kew, Richmond, Surrey, TW9 4DU. Any enquiries regarding this publication should be sent to: contactus@bristolccg.nhs.uk or write to FOI Manager, Bristol CCG, South Plaza, Marlborough Street, Bristol, BS3 5AQ When you use this information under the Open Government Licence, you should include the following attribution: Bristol Clinical Commissioning Group, published 21 st July 2016 The information provided in this response is accurate as of 21 st July 2016 Page 9 of 9