NHS acting as 'barrier to families' (BBC News: 23 October 2014)

The NHS in England has been told to stop being a barrier to infertile couples having children, in new rules by the funding watchdog.

The National Institute for Health and Care Excellence (NICE) says women should get three IVF cycles on the NHS.

Yet the overwhelming majority of the country fails to meet this standard and women in York are refused IVF treatment completely.

Fertility doctors said the situation was "very sad".

About one in every seven couples in the UK have difficulty conceiving, but access to treatment is extremely patchy.

The decision on how much IVF to fund is made by groups led by local GPs.


Single GP practices blocked from applying for CCG enhanced service contracts (Pulse: 17 March 2014)

GPs are being excluded from contracts for enhanced services unless they form wider groups, a Pulse investigation has revealed. Pulse has learnt that contracts - including enhanced services - in some areas were being offered only to GPs working in networks, covering services such as drug misuse and spirometry, as well as evening and weekend opening, making it even harder for single-handed practices to survive.

The GPC said that although it supported collaborative working, CCGs should not be taking a ‘top-down’ approach in making member practices federate together in order to receive funding. NHS Southwark CCG in south London said it was planning to commission a service for drug misuse and one for population health, including smoking cessation, which it said were ‘required to be delivered on a collaborative basis’.

East Surrey CCG said it was ‘undertaking a review of its primary care services’ and federation working was ‘likely to be a consideration’, but added the overriding criteria was the ‘enhancement of patient quality’.


GPs warn of rise in rationing (GP Online: 31 January 2014)

A GP survey found 71% of 315 GPs believe local rationing of treatments or services in their area has increased since April 2013. GPs reported increasing difficulty accessing community nursing care, counselling services and treatments such as cataract surgery and IVF.  GP leaders warned that cuts to local services were damaging patient care. This follows a series of reports in the past year on the extent of care rationing at a time of increasing financial pressure on the NHS. Some CCGs hope to reverse rationing policies inherited from PCTs once they achieve financial balance. But this may prove difficult, with one in eight CCGs predicted to be in deficit by April 2014. GPs responding to the survey said rationing of local care had increased ‘significantly’ in the past nine months. One GP partner in England said: ‘We have huge cost pressures and this is resulting in increased rationing and fragmentation of services to reduce costs.’


Thousands of prostate patients denied drug that can extend life by five months in watchdog U-turn (Daily Mail: 28 January 2014)

Thousands of men with advanced prostate cancer could be denied a new drug after a U-turn by the NHS rationing body. Enzalutamide extends life by at least five months in men who have run out of treatment options – with some patients surviving more than 18 months. It was initially recommended for NHS funding last October but revised draft guidance issued today imposes curbs that will deny many men the chance to use it.

Around 10,500 British men have advanced prostate cancer that is resistant to standard hormone treatments. Doctors say enzalutamide could help turn prostate cancer from a killer disease into a chronic illness. Rationing watchdog the National Institute for Health and Care Excellence (Nice) says lack of evidence about the two drugs has led to its revised decision, which is now out for consultation. Cancer specialists are outraged, saying it is a perverse U-turn based on fears about the cost.


Referral scrutiny an 'attack on professionalism', GPs warn (GP Online: 24 May 2013)

LMCs have criticised referral management schemes for 'eroding' GPs' professionalism and called for GPs to refuse to co-operate with systems without certain guarantees. LMCs rejected schemes that require third-party agreement for non-urgent consultant referrals from GP principals, salaried and locum GPs. They also backed a separate motion calling for minimum guarantees on referral systems to protect GP autonomy. GPC member Dr Helena McKeown said she was ‘not prepared to have every plan I agree with a patient scrutinised before I take it to be completed’. She also rejected the idea of linking quality premium payments to reduced referrals - "This places us and the CCG members in an impossible conflict between professional and contractual responsibilities." she said. Dr Sonali Kinra from Nottinghamshire said - "These people at the referral management scheme do not know our patients like we do...[such schemes were] not for the benefit of our patients, but purely a cost-cutting exercise."

Dr Julian Bradley from Buckinghamshire voiced his concern noting that "referral, if not GPs only function, is one of our key functions, as gatekeeper, as navigator, and most importantly, as patient champions. We introduce or co-operate with systems that depersonalise and second-guess at our profession’s peril, and peril to our patients confidence in their GP."


See also...

Cancer patients forced to wait as cancelled ops hit a four-year high (Evening Standard: 28 May 2013 

Watchdog warns NHS is rationing treatment (Financial Times: 22 March 2013)

MPs "concerned at NHS rationing of treatments" (Pharmatimes: 22 March 2013) 

GPs to be given rationing thresholds for surgery (Pulse: 16 January 2013)

Warning on patient care 'rationing' (Health Service Journal: 13 December 2012)

More than half of NHS trusts rationing treatments (The Telegraph: 13 December 2012)

GP referrals could be managed by 'third party' (GP Online: 19 April 2013)

Almost half of GPs say delays caused by referral management schemes have harmed patients (Pulse: 27 September 2012)

Radical new gateways reject one in eight GP referrals (Pulse Today: 23 February 2011)

GP referral management schemes fail to deliver (HSJ: 12 August 2010)



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