Circulation List: NEL PCN CDs, NEL PCN Managers, NEL Place Based Primary Care Leads & NEL Primary Care Central Team
Sent on behalf of NHS England
Dear colleagues,
We are writing to update you following the suspension on 8 March 2024 of Homerton Healthcare Fertility Unit’s license to practice until May 2024.
The suspension is a result of concerns about three incidents in the unit, which have resulted in the tragic loss of a number of embryos – either not surviving or being undetectable. Each of the incidents occurred in 2023 and were immediately reported to the HFEA. We were made aware of the incidents as soon as they were reported and have been working with Homerton to understand the issues and what improvements need to be made as a result.
Homerton is continuing to work alongside the HFEA and also is investigating the incidents. During this time, the fertility unit has been put under “Special Direction”. The direction allows for all current patients who are undergoing treatment to complete it, and for all embryos, eggs and sperm to continue to be stored in the clinic. However, the clinic is unable to accept new referrals – please see below for guidance on what this means for current patients, existing referrals and new referrals.
We are working with the HFEA and NHS England to support the Homerton and to ensure that we implement any recommendations that come out of external investigations.
Please note that we are developing a list of Q&A’s and will upload them to the GP intranet as soon as possible.
What does this mean for current patients?
Each of the patients affected by the incidents has been contacted by the unit’s clinical team and, where appropriate, they are discussing future treatment options with these patients.
In addition, Homerton has sent a letter to all their fertility patients apologising for the concern they may have caused, even if their embryos, eggs or sperm are unaffected.
If your patients have any queries or concerns or you have queries relating to the current treatment of any of your patients, please email huh-tr.fertility.unit@nhs.net.
What does this mean for existing referrals?
If you have already referred a patient to the Homerton Healthcare Fertility Unit, but they have not yet started treatment Homerton will be supporting the patients to find alternative providers for the treatment. If a patient has not yet been contacted by Homerton, please email huh-tr.fertility.unit@nhs.net.
What does this mean for new referrals?
Until further notice, please do not refer any new patients to the Homerton Healthcare Fertility Unit. Please discuss alternative treatment options with your patients. We are working with other providers to manage capacity across north east London and will endeavour to ensure all eligible patients receive treatment in a timely manner.
Below is the list of other Trusts that patients across north east London have traditionally used:
Referrals can also be made to the following London providers, with whom NHS North East London hold contracts:
If patients would like advice about which provider to be referred to, the 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 normally only be accepted by providers if they are made using this form. If you are unsure of the referral pathway, please refer to the Fertility Assessment and Treatment Pathway.
Please refer to the north east London fertility policy for eligibility criteria.
Note that the form applies to NHS referrals only. Providers sometimes have different eligibility criteria for self-funders.
Next steps for the Homerton Healthcare Fertility Unit
Homerton has appointed external experts, with the support of the HFEA, to investigate the incidents. The Trust has made the following changes in the unit to prevent recurrence of such incidents:
- All staff now work in pairs to ensure all clinical activities are checked by two healthcare professionals.
- All competencies of staff within the unit have been re-checked.
- There has been enhanced security in the unit.
The investigation into the third incident, which occurred at the end of 2023, is ongoing, and Homerton is exploring every possible cause for the problems that have occurred. As well as alerting the regulator, the three incidents have also been reported to the police. On the 8 March officers from the Metropolitan Police attended Homerton Fertility Clinic after concerns were raised by the Trust. There is no police investigation at this time.
Who to contact for more information
For queries relating to the current treatment of any of your patients, please email huh-tr.fertility.unit@nhs.net
For queries relating to referrals, please email nelondonicb.fertility@nhs.net
Main changes
The main treatment areas where we have made changes to the policy are:
• Increased access to IVF and the number of cycles available:
o 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.
o 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) so that up to six cycles will now be funded for eligible people:
o Trying to get pregnant using donor insemination who have fertility problems. IUI was not previously funded for these people.
o With some conditions and social, cultural or religious objections to IVF. IUI was not previously funded for these people.
o With a physical disability or psychosexual problem.
o 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 to:
o Up to their 43rd birthday for people aged under 32.
o Up to 10 years for people aged 32 and over.
o 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.
Note that this is a change in policy that makes more people eligible for NHS fertility treatment and so we expect you might experience an increase in activity.
Eligibility criteria and referrals
The new 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 Barking and Dagenham, Havering and Redbridge 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.
You can start referring eligible patients immediately, but please note that providers will prioritise patients for treatment who are a clinical priority. Referrals will only be accepted by providers if they are made on the referral form on EMIS. If you are unsure of the referral pathway, please refer to the updated Fertility Assessment and Treatment Pathway.
We are working closely with providers to help them manage the expected increase in referrals for treatment. They are increasing capacity to respond to the change in policy, so please manage the expectations of your patients as waiting times may temporarily increase.
More information
The full policy and other information, including about treatment providers, how to refer, clinical exceptionality, a Q&A and information about mental health and wellbeing support can be found on the north east London GP intranet.
Homerton - https://www.homerton.nhs.uk/fertility/
Guys and St Thomas's https://www.guysandstthomas.nhs.uk/our-services/acu/overview.aspx
Barts Health - Royal London Hospital https://www.bartshealth.nhs.uk/fertility
Guy's and St Thomas's provide a specifically commissioned culturally sensitive pathway for patients with religious needs. This was co-developed with members of the local orthodox Jewish community.
The are more details including refferal forms for the local Homerton Health service available here
