NHS Funded Treatment

Paying for assisted conception is a concern for many people, although after some thought and consideration of the reality of the costs, most patients find a way to fund their fertility treatment.  To estimate how much treatment may cost, use the MFS Cost Estimator^© and also explore the possibility of receiving funding from the NHS.  This section offers guidance on how to do this effectively.

Researching and applying for NHS funding is complicated because every area has different availability and criteria for funding fertility treatment.

What is a Primary Care Trust (PCT)?

Each area in England has a PCT, the organisation responsible for allocating funding for all healthcare, including fertility treatment, on behalf of the GP practices in that area.  In Wales, the Health Commission Wales has this responsibility.

How to access funding

For information on the availability and criteria for funding for fertility treatment, and on how to make an application, a potential patient should:

• email Linda Tanner, MFS’s NHS contracts manager 10.00am-3.30pm, Wednesday to Friday or phone her on 01922 45591
• or ask her GP for the name of the commissioning manager at their Primary Care Trust (PCT)

Be prepared to ask:

• if the PCT has a contract with MFS
• if the PCT doesn’t have a contract with MFS if it will fund treatment at MFS on an extra-contractual basis
• what is the length of any waiting list
• what are the criteria for eligibility
• what is the route for referral
• how many cycles are offered to each patient
• what is the duration between each funded cycle
• what types of treatment can be funded

Criteria for funding

All PCTs manage the list of patients who require fertility treatment in varying ways and each has different criteria for selecting patients for treatment, including:

• age of female patient
• age of male patient
• length of relationship
• any previous sterilisation/vasectomy
• duration of infertility
• any existing children
• any previous fertility treatment
• the woman’s BMI
• whether wither partner smokes

MFS or the PCT commissioning department can advise of the specific criteria for the PCT.

How long is the wait for funding?

The length of time varies for each PCT list.  Some PCTs will allow treatment immediately, but others have waiting lists.

How do patients get funded treatment at MFS?

• Linda Tanner or the potential patient’s PCT will advise her to contact either her GP or consultant to get a referral to MFS
• their GP/consultant will assess their situation and:
• either advise her that she is not eligible for funding by the PCT
• or add her to the waiting list that PCT controls
• or refer her directly to MFS to be assessed for eligibility and management

How long before MFS makes contact?

Once MFS has received details of a potential patient from a GP or consultant, the clinic will write to her to confirm her first appointment - or initial consultation.  She will usually have to wait about four weeks for this appointment.

After the initial consultation, baseline tests and subsequent follow-up appointment, MFS will be able to recommend the best treatment for her.

If the PCT funds the treatment, the patient’s name will be added to the waiting list at this point.  If so, her next appointment will be made, depending on:

• the PCT funding the treatment
• how the waiting list is managed
• the length of that list

Managing the PCT treatments

MFS manages the treatment for each PCT according to each PCT’s requirements.  Generally, there are three different ways:

• MFS receives a patient referral, funding is available for treatment and there is no waiting list
• or MFS receives a patient referral, checks that the patient meets the criteria for her PCT, applies to the PCT for the funding on her behalf, waits for funding, then notifies the patient when the funding becomes available
• or MFS receives a patient referral and issues an appointment for an initial consultation. After the patient’s baseline tests and follow-up appointment MFS adds her name to the relevant PCT waiting list. As funding becomes available, MFS will contact the patient for a next treatment appointment, depending on the length of time she has been on the list and, sometimes, age.

When PCT funding becomes available

MFS will contact the patient to:

• advise her that the funding is available
• check that she still meets the criteria
• confirm her BMI (height/weight ratio) is between 19 and 30
• confirm the type of treatment being funded
• confirm the number of available treatment cycles
• confirm a date for her next appointment

Once advised that funding is available, patients are asked not to defer treatment for non-emergency reasons such as holidays, changing jobs or promotions at work.

Self-funding while on a PCT waiting list

If a patient is considering self-funding fertility treatment while waiting for PCT funding to become available, she should contact Linda Tanner at MFS to discuss, as it could affect her eligibility for funding.  If any self-funded treatment results in a live birth, PCT funding will no longer be available to that couple.

What if funding is not available?

If a couple is not eligible for funded treatment and feels they should be, some PCTs will allow an appeal in writing.  Contact Linda Tanner for details of the PCTs which have an appeal process.

Stay in touch

Patients are encouraged to stay in touch with Linda Tanner and advise her of any information which could affect their eligibility for funding.  MFS should be told of any changes to a patient’s circumstances, including:

• change of address
• change of telephone number
• change of GP
• change of partner or to their living arrangements
• if either partner has a baby