5. Miss O complains the Practice did not provide sufficient information in the individual funding request (IFR) application, since January 2024, to the local Integrated Care Board (ICB) to enable her to access NHS funding for in vitro fertilisation (IVF).
6. Miss O says due to this delay the IFR is still not approved. Miss O is concerned because now she is 39 years old and this impacts her prosects of becoming a mother.
7. Miss O would like to receive a financial remedy.
8. Miss O had left salpingectomy (surgical procedure that involves the removal of fallopian tubes) in 2010 and a right salpingectomy in 2016. This means Miss O cannot conceive naturally. Fallopian tubes are part of the female reproductive system. Egg cells are transported from an ovary to a fallopian tube where it is fertilized.
9. In 2018 Miss O contacted her GP and asked for a referral to fertility services.
10. The Practice made a referral and Miss O started the process of assessing if IVF treatment could be suitable.
11. Miss O says the IVF clinic advised her to return to her GP to make an IFR for IVF.
12. On 12 December 2023, Miss O advised the Practice about the IVF clinic’s recommendations.
13. On 5 January 2024, the Practice submitted the IFR application online.
14. After this date, the local ICB made a request for further information. The Practice provided this and the ICB decided to decline Miss O’s request on 13 May 2024.
15. On 13 May 2024, the ICB explained it felt the case for clinical exceptionality had not been made.
16. The Practice requested a review of the decision.
17. On 13 August 2024, the ICB detailed the IFR application did not satisfy the following criteria: ‘The stability of the relationship is very important with regards to the welfare of children; as such couples must have been in a stable relationship for a minimum of 2 years and currently co-habiting to be entitled to treatment.’
21. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
22. Miss O says the Practice did not provide sufficient information in January 2024 to the local ICB. As such, the local ICB requested more information and this in turn delayed the whole application.
23. Miss O is also of the view that the ICB declined her IFR application because the Practice did not supply sufficient information.
24. Finally, Miss O is of the view that the Practice delayed even further the IFR application when it suggested that the fertility clinic specialist may be better placed to make the application.
25. The purpose of the ICB’s IFR policy is to inform health professionals about how to request restricted treatments or appeal against individual decisions to decline a request for a restricted treatment.
26. The ICB’s individual funding request policy states:
‘It is the referring clinician’s / healthcare professional’s responsibility to ensure that all relevant clinical information has been included in the funding request. This could include, but is not limited to, copies of letters from secondary care consultants, details of the anticipated costs and length of treatment or copies of reports (e.g., physiotherapy assessments).’
27. It also states, ‘an Individual Funding Request (IFR) is a request received from a clinician or health care professional providing care to a patient where a specific treatment, intervention or procedure is requested.’
28. Access to Infertility Treatment –Commissioning Policy Document Yorkshire and Humber states:
‘The stability of the relationship is very important with regards to the welfare of children; as such couples must have been in a stable relationship for a minimum of 2 years and currently co-habiting to be entitled to treatment.’
29. Based on the ICB’s IFR policy and the IFR from the Practice submitted, we can see clinicians must provide specific details about a patient.
30. We reviewed the medical records and we can see the Practice included all relevant medical information and medical history from Miss O’s medical records in the application dated 5 January 2024.
31. Our adviser reviewed Miss O’s medical records and they informed us the IFR application dated 5 January 2024 contains all the medical information pertinent to the IVF treatment. They also advised us this was done in line with established good medical practice.
32. Based on our review of the medical records and the IFR application it is our view the Practice provided on 5 January 2024 all the information the ICB indicated it needed to make a decision and this was done in line with the ICB’s IFR policy.
33. We recognise Miss O feels aggrieved by the IFR process and we recognise she feels the Practice delayed the process.
34. Based on the advice and the evidence we reviewed, there is no other information in Miss O’s medical records pertinent to the IFR application that the Practice could have included on 5 January 2024 or after.
35. Based on the ICB’s IFR policy we can see the IVF application should be made by a clinician and it does not mandate that it should be done by a GP. As such, the fertility consultant would have been a suitable clinician to make the IFR application.
36. Furthermore, our adviser informed us it would not have been disproportional to ask the specialist fertility consultant to make the IFR application if the Practice believed the consultant could have offered more details to the IFR panel.
37. We are mindful on 31 May 2024, the fertility clinic wrote to Miss O and to her GP advising there is not IFR funding for single persons in the region.
38. Miss O confirmed to us during our phone conversations she is not in a cohabiting relationship.
39. The ICB declined Miss O’s application, on 13 May and 13 August 2024, because she was not cohabiting and in a stable relationship of minimum two years.
40. We recognise Miss O had a long IVF journey and we can see from her records she is has been trying to become a mother for a number of years. We are sorry Miss O’s IFR application was not successful.
41. We are grateful Miss O chose to refer her complaint to us and we are thankful for her patience during our investigation.
1. We have carefully considered Miss O’s complaint about the Practice.
2. We are sorry to hear above the events that led to her complaint. We can see these had an impact on her wellbeing.
3. We have seen no indication that anything went seriously wrong. As such, we are not upholding this complaint.
4. We have seen the Practice followed the Integrated Care Board individual funding request policy when it provided evidence to support Miss O’s individual funding request application.