Restricting access to vasectomy, sterilisation and IVF
In November 2017, we proposed restricting access to three services in B&NES: vasectomies, female sterilisations and fertility treatment. We consulted widely on these proposals from November 2017 until the end of January 2018.
A summary of the public’s feedback was included in this report, with recommendations, which were presented to the CCG Board in March 2018.
The final decision, on the basis of public feedback and the likelihood of incurring greater costs associated with unplanned pregnancies than the costs incurred by vasectomy, was to continue to fund vasectomies. Similarly, women will still be able to access NHS-funded sterilisations if they have first explored alternative, less-invasive forms of contraception.
With regard to fertility services, the Board balanced public feedback with clinical evidence on IVF success rates and the CCG’s financial position. You can read more about the rationale for our decision in our news story.
The Board decided to change the CCG’s policy on fertility services so that:
- The female partner receiving treatment must be aged between 23 and 37 years
- The male partner of the woman receiving treatment must be aged 55 years or under
- The female partner receiving treatment must have a body mass index (BMI) in the healthy range for women wanting to conceive, of 19–30
- The male partner of the woman receiving treatment must have a healthy BMI of under 30
- Heterosexual couples must have been trying to conceive for at least 2 years where the female partner is aged 35 years or younger, and 1 year where the female partner is aged 36 -37 years.
This policy came into force on 2 June 2018.
Curbing the prescription of over-the-counter medicines
In January 2018, we formally adopted NHS England guidance that aims to curb routine prescriptions for over-the-counter medicines for minor, short-term conditions. Many of the conditions targeted by this guidance will cure themselves or cause no long-term negative effects on health.
It is estimated that this new guidance, the result of a joint public consultation carried out by the NHS Clinical Commissioners (NHSCC) and NHS England, could release around £136m a year for CCGs to reinvest in other services.
The new guidance will curb the routine prescribing of products that are for:
- A self-limiting condition, that does not require any medical advice or treatment as it will clear up on its own, such as sore throats, coughs and colds.
- A condition that is suitable for self-care, which can be treated with items purchased over-the-counter at a pharmacy, such as remedies for indigestion, mouth ulcers, warts and verrucas.
The guidance does not affect the prescribing of over-the-counter medicines for longer term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious.
The consultation received more than 2,500 responses nationwide with the majority from patients, members of the public and clinicians, including responses from 140 CCGs. Over 70 per cent of the responses supported the proposals.
Stopping gluten-free products on prescription
Following a public consultation in early 2017, we advised local GPs to prescribe gluten-free products to only the most vulnerable people living with coeliac disease. Before we took this decision, the CCG was spending £112,000 each year on gluten-free products.
Historically, gluten-free foods were not widely available to buy, and receiving them via prescription was often the only way that many patients could access them. However, today there is much more awareness of coeliac disease, gluten sensitivity and other similar conditions, and gluten-free foods are much easier to get hold of, with an increasingly varied range of products available from supermarkets and online retailers.
The price paid by the NHS for gluten-free foods on prescription is much higher than the price of similar products found in supermarkets, representing poor value for money for the NHS.
As a result of our public feedback, we have provided GPs with guidance to help identify and support vulnerable people, such as those on low incomes, children, people with learning difficulties and those with complex medical needs, and GPs will continue prescribing gluten-free products to these individuals.