NHS fertility treatment hit by cash row

This is like a doctor saying: 'OK, you have cancer, we can cure you - but not unless you buy the drugs'

Many couples eligible for NHS fertility treatment are missing out because of a dispute between health authorities and GPs over who pays for the fertility drugs they need.

A growing number of health authorities will pay for one or two cycles of in vitro fertilisation (IVF) treatment but not for the drugs necessary to stimulate a woman's ovaries beforehand.

Instead, couples are being referred back to their GPs, many of whom decline to write the prescription on the grounds that the drugs are part of a hospital treatment and not their responsibility.

The couple must pay for the drugs themselves - between pounds 600 and pounds 800 - or forgo the chance of a child, according to Issue, the National Fertility Association. In some cases, the health authority will, under pressure, pick up the bill for the drugs but is forced to ration treatment even further, treating fewer couples overall.

This reduces still further the already miserly provision of NHS fertility treatment. As rationing of healthcare becomes more explicit in the NHS, some health authorities already ban IVF treatment. A 1993 survey found that about half of health authorities did not provide even the most basic treatment.

The situation has worsened since April when genetically engineered forms of a fertility drug known as Follicle Stimulating Hormone (FSH), became available. This is a purer form of FSH which is between 25-50 per cent more expensive than older drugs which were derived from the urine of pre- menopausal women.

One couple from south-west London whose GP would not write a prescription for fertility drugs, were told in a letter from the Ealing, Hammersmith and Hounslow Health Authority that the cost of the FSH for their first cycle of IVF treatment at the Hammersmith Hospital would be refunded if they paid up front. This offer was then withdrawn and the couple have since been told there is no money left for the second cycle of IVF, to which they are entitled, before next April.

"All we got out of the NHS was one treatment cycle and no drugs," said Mrs D, 37, who has asked not to be identified. "This is happening when you are going through all the trauma and upset of treatment." Her husband said the couple would seek private treatment but added: "What happens to the couples who cannot afford this?" Mr and Mrs D have spent pounds 1,000 so far on drug treatment.

Tim Hedgley, a spokesman for Issue said it was an "absolutely crazy" situation which the group is very concerned about as it hears of more reports from around the country. "It is like a doctor saying to you 'OK, you have cancer, we can cure it but not unless you buy the drugs yourself.' Infertility is a medical condition and should be treated as one," Mr Hedgley said.

Dr Grant Blair of the Lillie Road Surgery in Fulham who treated Mr and Mrs D, said the issue of prescribing fertility drugs was one of growing concern for the profession.

"I have huge sympathy for these couples. But there are two issues at stake. The Department of Health advises us not to prescribe drugs unless we are going to be clinically responsible for them. But these treatments are part of an intensive hospital treatment. It is 'community dumping' [shifting the cost from the hospital budget to the community]."

The British Medical Association last week advised GPs that sub-fertility treatment should not be considered a "core service" - a treatment they are obliged to provide. Instead, where GPs were willing to become involved in this speciality, they should seek specific contracts with, and extra payment from health authorities

In a letter to Mr and Mrs D, Julie Dent, executive director of the Ealing, Hammersmith & Hounslow Health Authority confirmed that it had contracted with Hammersmith Hospital for IVF treatment in 1995/96 excluding the drugs "on the assumption that GPs would prescribe them..."

However, Ms Dent wrote: "As the year has progressed it has become increasingly clear that many GPs are not willing to prescribe the drugs for clinical reasons... In addition, the actual cost of the drugs charged by the drug companies has almost doubled since April causing further problems."

Professor Stephen Killick, director of the Hull IVF unit, which has just negotiated with the East Riding Health Authority for it to fund fertility treatment on the NHS, including IVF, said the drug issue was a problem. "We have included the drugs in the treatment contract in our case but it does mean we can't treat as many patients," he said. "I am sympathetic to GPs, it's a complicated medico-legal problem." Professor Killick said that one option was to take money from the primary care budget and give it to infertility clinics.