NEL Fertility Policy – North East London

The north east London fertility policy replaces the previous five different policies that were created when there were separate clinical commissioning groups in the area. The single policy means that all eligible people registered with a GP in north east London will be able to have the same fertility treatment, such as in vitro fertilisation (IVF) – this was not previously the case.

The policy was developed using the latest national clinical guidelines from the National Institute for Health and Care Excellence (NICE), research and best practice. Clinicians, including GPs and fertility experts also helped to shape it and it was subject to a public engagement period.

The policy was approved by the NHS North East London Integrated Care Board in November 2022 and came into effect on 3 April 2023.

You can find more information about the development of the policy and engagement on NHS North East London’s dedicated fertility services page.

If you have any questions or queries about the policy, please check the Q&A document. If you still have questions, please email nelondonicb.fertility@nhs.net

Main changes

The main treatment areas where NHS North East London has made changes in its policy are:

Increased access to IVF and the number of cycles available:
- All eligible people aged under 40 are now entitled to up to three full IVF cycles. Previously people in Barking and Dagenham, Havering and Redbridge (BHR) were entitled to one embryo transfer only.
- The upper age limit to access IVF treatment has been increased by one year. All eligible people aged 40, 41 and 42 are now entitled to one full IVF cycle. Previously this was not funded for people aged 40 and over in BHR nor for people aged 42 in other areas of north east London.
Increased funding for intrauterine insemination (IUI) for eligible people:
- Trying to get pregnant using donor insemination who have fertility problems. IUI was not previously funded for these people.
- With some conditions and social, cultural or religious objections to IVF. IUI was not previously funded for these people.
- With a physical disability or psychosexual problem.
- With a condition that means they need IUI as part of their fertility treatment.
Increased the length of time the local NHS will fund the storage of eggs, sperm and embryos in cases of fertility preservation to:
- Up to their 43rd birthday for people aged under 32.
- Up to 10 years for people aged 32 and over.
- Previously storage was funded for the first 10 years in Tower Hamlets and for the first five years in other areas of north east London.

Eligibility criteria

The policy is for both individuals and couples with a fertility problem, regardless of their sexual orientation, gender identity or relationship status, and applies to people who are registered with a GP in Barking and Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets or Waltham Forest.

Patients can only be referred for assisted conception treatments if they meet the eligibility criteria outlined in the policy and when all appropriate tests and investigations have been successfully completed in primary and secondary care in line with NICE guidance.

If you have patients who have previously received treatment, have been discharged and are now eligible for more, please advise them that the new policy applies to them and re-refer them for further treatment, if appropriate. Please refer to the Q&A document for information in relation to patients in BHR and the 2017 Spending NHS Money Wisely review.

Patients who are already undergoing or have already been referred for NHS-funded fertility treatment will not be disadvantaged by the new policy.

Please note that providers will prioritise patients for treatment who are a clinical priority.

Clinical exceptionality

If you believe a patient has a clinical exceptionality not outlined in the eligibility criteria, you should follow the standard Individual Request for Funding process. Exceptional cases must have exceptional clinical circumstances supported by robust clinical evidence. We have defined exceptionality as an unusual clinical factor (or factor affecting the clinical condition) about the patient that suggests that they are:

Significantly different to the general population of patients with the condition in question;

AND

Likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition.

For more information, contact nelondonicb.ifr@nhs.net

Providers

Patients are able to choose any NHS-commissioned provider to receive fertility treatment that is published on e-RS to NEL ICB.

If patients would like advice as to which provider to be referred to, the Human Fertilisation and Embryology Authority (HFEA) website may be helpful.

How to refer

EMIS form

Referral method: e-Referrals

GPs in Barking and Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest should complete the standard referral form on EMIS and send it via e-Referrals – the form applies to all boroughs and all providers.

Referrals will only be accepted by providers if they are made using this form. If you are unsure of the referral pathway, please refer to the updated Fertility Assessment and Treatment Pathway.

Note that the form applies to NHS referrals only. Providers sometimes have different eligibility criteria for self-funders.

Mental health and wellbeing support

Fertility and fertility problems are a highly personal and emotive topic, and every person has different needs and expectations of what support the NHS should provide. With this in mind, we acknowledge that our new policy doesn’t address all of the concerns of some local people. However, we believe it does address inequalities across north east London, while prioritising treatment for people with proven fertility issues.

Though the new policy makes more people eligible for NHS-funded fertility treatment, it doesn’t guarantee that they will be successful. These treatments don’t always work, which can be hugely disappointing and upsetting for people. For example, for people aged under 43 the national success rates of IVF range from 11-32% depending on their age.

We believe counselling is an essential part of fertility treatment and the providers will encourage patients to see a counsellor and offer them an appointment with one. Across north east London there are free and confidential adult mental health services that provide support from an expert team who will work with patients to help them feel better. For more information about the mental health and wellbeing support available in north east London, please visit NHS North East London’s website.

Watch back a Q&A about the policy

Hosted by Dr Anju Gupta, GP and Clinical Lead at NHS North East London and Garima Srivastava, Consultant Gynaecologist, Clinical Lead for fertility and Person Responsible (HFEA) at Homerton University Hospital.