NHS IVF/ICSI Funding

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Many people have queries about NHS IVF Funding so I thought I would set up this information post for information.


Identifying your CCG - England

All NHS funding, for everything from cataracts to clomid, is decided by your Clinical Commisioning Group: or CCG for short. You may still hear people refer to them as the PCT (Primary Care Trust), but these were dissolved and restructured a few years ago.

Your CCG depends on the postcode of your home address, not where your GP is based or which hospital you attend. Due to this people under different CCGs can attend the same Hospitals, or even GPs, which means that the people treating you may not be fully aware of the policy for which your treatment is being carried out under as they maybe treating people from 5 or 10 different funding policies.

It's important to know which CCG you live within so that you can find out what you are entitled to. Unfortunately it's not always that easy to identify which CCG you come under, but there are a few ways of finding out:

1. Click on the following link and put in your post code. It will give you a link to your nearest CCGs. You can often presume that the one closest to your address is yours, but this is not always the sae so you may need to contact them directly to check. An easy way to tell is by which Borough/District council you come under as a lot of them are the same areas:
http://www.nhs.uk/Service-Search/Clinical%20Commissioning%20Group/LocationSearch/1

2. Click on the NHS England Map. It's not the best map, but it may give you a rough idea:
http://www.england.nhs.uk/wp-content/uploads/2014/02/ccg-map-Feb2014.pdf

3. Call your GP and speak to the receptionist. If you live on the border of an area you may need to clarify which area you come under.


Scotland, Wales, Northern Ireland etc

Funding is slightly different as people in these areas are not separated by CCGs in the same way as they are in England. As such your Clinic and GP should have the accurate details as to what funding is available, and what the exact details of the cover is.


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What funding is available?

The government use an organisation called NICE (the National Institute of Care Excellence) to identify how NHS funding is best allocated. They make recommendations on treatment process and drug provisions for all health conditions.

The policy on Assisted Fertility was originally devised in 2004, and then underwent an overhaul in 2013. If you click the following link you will see the very detailed policy. This policy is due to be reviewed again in March 2015:

http://www.nice.org.uk/guidance/cg156/chapter/1-recommendations

Sadly, these recommendations do not have to be adhered to, and many CCGs will tailor their provisions based on their own areas. Some areas may have above average funding needs in some health that require funding to be increased, and therefore they have to reduce funding to other areas: it can be a very complicated balancing act.

To further complicate things, some CCGs work with other local CCGs and form Consortiums so that several local CCGs agree to adhere to the same policies. Given the number of different health problems, the extensive budgets that have to be managed, this again means that things may be extremely complex and difficult to understand.

The best place to start is by having a look on the website of your CCG. They will often have their policy published, and although it might make for heavy reading, it's usually there somewhere! If you are struggeling to find the policy then you can call, write, or email, a request for the information. Most CCGS will have a policy that they will respond to your request within a set amount of time; usually 10 to 14 days. Please note: you do not need to make a Freedom Of Information request, this is something different and could lead to a delay in you receiving the information.

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites
 

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What does it mean?

As with everything related to infertility, it's all in the details.

When reading your CCGs policy it is useful to note down some basic notes, and any questions you may have. Some of the important ones include:
 
1. What is a cycle?  NICE might say a cycle is the transfer of an embryo, but it's important to check your own CCGs policy as they may say that a cycle is up to egg collection (or donor egg, if applicable), or even that a cycle is completed when all embryos created from one egg collection are transferred.

2. What about frozen embryos? If you are lucky enough to get frozen embryos it's important to check what is covered; although it's probably preferably to check this before you start your cycle so you don't get a shock on the day! Some areas may pay for the freezing for a few years, others will want you to pay, some will cover the cost of freezing and transfers, and others will only cover a limited number.

3. How do I qualify for funding? Everywhere has different rules regarding things like children from previous relationships, BMI, and smoking. Don't rely on what other people tell you happened to them, and don't necessarily trust what you read on the web or in the news. Check this information directly with your CCG as they do change their policies, but it's not always accurately update on other websites.

4. What is included in my funding? Can I pay for extra things to help it work? In some areas your treatment covers all your drugs, the IVF/ICSI process, and freezing. In other areas you may have to pay some NHS prescription charges for some of your drugs, or towards the freezing of embryos. With regards to "extras" (like embryo glue, the scratch, and drugs like intralipids or steroids) it can get quite complicated. Some things may be available under your funding, or may be available by being part of a "research trial", or you may be allowed to pay privately for them (either at your own clinic, or elsewhere), or they may not be allowed at all. Additionally, you may be allowed to be treated empirically (e.g. Without having the tests to prove you could benefit from the treatment), or be treated if you have privately paid for tests that prove you would benefit. However, even if you have proof that something could help (like steroids or aspirin), you may not be allowed to use them as part of a NHS funded cycle if it has been done privately.

It's very important that if you have any questions or queries (e.g. your questions are not clearly/easily answered by the policy document) that you contact your CCG directly, preferably in writing. Don't just go on what friends/GPs/Nurses/clinics have said, make sure you hear it straight from the horse's mouth!

I would also recommend that you find this information out before your first appointment for fertility treatment so that you understand the treatment/service you are entitled to, and that you don't miss out on anything that can help you in this difficult journey.