A medical practice in the Stoke on Trent area

3. Mrs R complains the Practice gave her and her wife inaccurate information about how to apply for NHS funding for IVF on two occasions when they asked them for advice in April 2017 and June 2019. Mrs R also complains the Practice did not give guidance about how the local Clinical Commissioning Group’s (CCG) criteria for IVF worked.

4. Mrs R says she and her wife were wrongly led to believe that they had to receive private treatment to get NHS funding. She says they were later told in January 2021 that as they had received IVF privately, they were no longer eligible for NHS support with this.

5. Mrs R wants the Practice to apologise and pay financial compensation of £7,520 for the costs of the egg collection and transfer that she received privately.

6. Mrs R told us that she and her wife began trying for a baby in 2017. She says she spoke to a GP at the Practice on 28 April 2017 about how to access NHS funding for fertility treatment for same-sex couples. She says the GP told her that same-sex couples have to show infertility in the same way a heterosexual couple would.

7. Mrs R told us that she understood from this that she had to get private treatment before she would be eligible for NHS funding. She says she received three cycles of intra uterine insemination (IUI, a form of artificial insemination where sperm is directly inserted into a woman’s womb) from a private clinic on 3 June, 21 July and 21 August 2018. After this Mrs R says she first had IVF from the private clinic on 9 March 2019.

8. Mrs R attended the Practice again on 26 June 2019 to ask for more information about how to access NHS funding for fertility treatment. The Practice recorded in this consultation that Mrs R told them she had received three privately funded cycles of IUI and two of IVF but these were unsuccessful. The GP she saw told her they were not aware of the eligibility criteria so would get some further information and pass this on to her.

9. Mrs R says the Practice provided a copy of the CCG’s ‘Infertility and Assisted Reproduction Commissioning Policy and Eligibility Criteria’, but she and her wife did not understand this. She told us she asked the receptionist at the Practice if a GP could explain this to her but the receptionist was unhelpful. Mrs R says she rang the Practice to ask if a GP could give her more information but she did not get a response.

10. On 6 January 2021 Mrs R told us she had a phone call from the Practice advising her that as she had received two cycles of IVF privately, she was not eligible for NHS-funded IVF from the local CCG. Mrs R is unhappy that she was not given this information before and considers the Practice gave her wrong advice.

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so, we cannot link the events complained about with the negative impact Mrs R has claimed.

14. The Practice provided a copy of the CCG’s ‘Infertility and Assisted Reproduction Commissioning Policy and Eligibility Criteria’ in its response to Mrs R’s complaint. However, this was a version created in 2020 after the events complained about. As such, we requested the original version of the policy (created in July 2012) which was in place between 2017 and 2019.

15. The CCG’s 2012 policy said:

• the CCG will fund one cycle of IVF or a maximum of three cycles of IUI based on the patient’s choice • previous treatment, however funded, prevents patients from being eligible for NHS-funded cycles • same-sex couples must show infertility in line with the policy for heterosexual couples to become eligible for NHS funding for assisted reproduction.

16. Mrs R told us that she received private IVF in March 2019. By the time of the second consultation on 26 June 2019 she was already ineligible for NHS funded fertility treatment, in line with the CCG’s policy. Any advice from the Practice on 26 June 2019 would not have affected this. As such we do not consider we could connect any failing by the Practice at this consultation to Mrs R'’s claimed injustice. Therefore, we have decided not to consider this part of her complaint further.

17. The Practice’s records of the first consultation on 28 April 2017 note Mrs R attended for abdominal pain but also asked about fertility treatment for same-sex couples. The Practice’s records support Mrs R’s account that she was told that a same-sex couple would have to show infertility as a heterosexual couple would, to get NHS-funded treatment, which was an accurate reflection of the CCG’s policy.

18. We asked Mrs R why she decided to seek private treatment after the consultation in April 2017. Mrs R told us that she and her wife did not get any guidance from the Practice about how they would become eligible, so she believed they needed to seek treatment privately. She said she decided to get private IVF as the private clinic explained how IUI and IVF worked, and she understood that IVF was more likely to result in pregnancy. Mrs R did not provide us with any signs that she asked for any further advice from the Practice between 28 April 2017 and getting private IVF in March 2019.

19. As outlined above, to be eligible for NHS funding in line with the CCG’s policy the patient would have to show infertility. The later version of the CCG’s policy defined infertility as ‘the failure of a woman of reproductive age to conceive after 1 year of unprotected vaginal sexual intercourse’. However, for circumstances where this could not be applied (such as same-sex couples) the policy stated that infertility may also be demonstrated by ‘the failure to conceive after 6 cycles of self-funded donor insemination/IUI in the previous 12 months’.

20. The version of the CCG’s policy that was in place during April 2017 to May 2019 did not provide a specific definition of how a same-sex couple would show infertility. The policy says it follows the definition of infertility set out by NICE and that the policy should be read in conjunction with NICE guidance CG11, ‘Fertility: assessment and treatment for people with fertility problems’.

21. NICE guidance CG11 was updated and replaced by NICE guidance CG156: ‘Fertility problems: assessment and treatment’ in February 2013. This guidance gives two scenarios where further clinical assessment and investigation should be offered:

• ‘A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility’ • ‘A woman of reproductive age who is using artificial insemination to conceive (with either partner or donor sperm) … if she has not conceived after 6 cycles of treatment, in the absence of any known cause of infertility’.

22. Though the original version of the CCG’s policy did not define how a same-sex couple would show infertility, it seems that in line with NICE guidance CG156, which the policy should be read in line with, the CCG would also have needed evidence of six unsuccessful cycles of artificial insemination (such as IUI) before it would have considered a same-sex couple to be infertile.

23. Our view is that Mrs R would have needed to get self-funded IUI to show she was infertile, and therefore eligible for NHS funding for fertility treatment in line with the CCG’s policy. Therefore, we have seen no signs that the costs of Mrs R getting three cycles of IUI privately would have been avoidable, regardless of the advice given by the Practice in April 2017.

24. With Mrs R’s decision to have private IVF treatment, we recognise that although what the Practice recorded telling Mrs R on 28 April 2017 was correct, it could have highlighted any factors that would make a patient ineligible for funding. That said, we do not think we could connect the Practice’s actions on 28 April 2017 to Mrs R’s decision to pay for private IVF. Nearly two years had passed between Mrs R’s consultation with the Practice and her getting private IVF. Considering the amount of time that passed we do not consider that Mrs R could have reasonably believed, based on what the Practice told her in April 2017, that she needed private IVF to access NHS-funded fertility treatment.

25. Since there is no evidence that Mrs R asked for any further advice from the Practice in the 23 months between the consultation in April 2017, we do not consider that her decision to get private IVF was due to the advice she got from the Practice. We think it would have been reasonable for Mrs R to get further advice in these 23 months, from the Practice or other sources such as the local CCG, if she was unclear on the process or eligibility requirements for NHS-funded fertility treatment.

26. In summary, we have decided not to consider Mrs R’s complaint further because we could not link her claimed injustice to the claimed failings. We are grateful for Mrs R for taking the time to tell us about her and her wife’s difficult experience.

1. We have carefully considered Mrs R’s complaint about a GP practice in the Stoke-on-Trent area (the Practice). We have decided we cannot link the events complained about to her becoming ineligible for NHS-funded in vitro fertilisation (IVF).

2. We were sorry to hear about Mrs R’s difficulty in starting a family with her wife. We recognise that her concerns around accessing information about NHS-funded fertility treatment have added to her frustration.