Download Treatment for Erectile Dysfunction for Patients with

NHS Blackpool Clinical Commissioning
Group
November 2016
Policy for the Commissioning of Services for People with Erectile
Dysfunction.
1
Introduction
1.1
This is the policy of the Blackpool CCG to enable it to commission
services for people with erectile dysfunction. It forms part of a suite of
Policies for the Commissioning of Appropriate, Effective, Cost-effective,
Affordable and Ethical Health Care. It is based on the considerations
outlined in the S ta t em e nt of P rin cip le s and in accordance with
the other policies and procedures within the suite.
1.2
This policy is written in recognition of service agreements that exist for
the provision of this service (explicitly or implicitly).
The policy
describes eligibility criteria for treatment within those service
agreements. Patients may satisfy those criteria, or may be confirmed as
exceptions in writing by the CCG on an individual patient basis.
Funding for the treatment of these patients should be taken from that
contained within the service agreement, and their cases can be
counted towards the healthcare activity required by those service
agreements. The criteria will also apply to requests for treatment
outside of the service agreements, when the provisions of the CCG's
Policy for the Choice of Service Provider for Health Care will also apply.
2
Definition
2.1
Erectile dysfunction is the persistent inability to attain and maintain an
erection sufficient to permit satisfactory sexual performance (National
Institute for Health and Care Excellence, 2014). Erectile dysfunction
may occur for no clear reason. It may occur as a result of a range of
diseases or injuries or as a side effect of medications. Erectile function
may also decline with age.
2.2
Possible disorders that may cause erectile dysfunction are:
 Vasculogenic — such as cardiovascular disease, hypertension,
hyperlipidaemia, diabetes mellitus, smoking.
 Neurogenic — such as multiple sclerosis, Parkinson’s disease,
tumours, stroke.
 Anatomical — such as Peyronie’s disease, hypospadias.
 Hormonal — such as hypogonadism, hyperthyroidism,
Page 1 of 6


hypothyroidism, Cushing’s disease.
Drugs — such as diuretics, antihypertensives, antidepressants,
cytotoxics, alcohol.
Psychosocial — relationship problems, mental health problems.
(NICE, 2014).
2.3
The CCG is aware of the competing demands for its limited financial
resources and the need to expend those resources on the most
appropriate and effective treatments to improve the health of its
population. The CCG's view is that (subject to careful consideration of
the circumstances of the individual case to see whether there is an
exceptional reason for adopting a more favourable view) the treatments
addressed by this policy should not receive as high a priority in the
allocation of resources as services of proven effectiveness for illnesses
which are life threatening or cause more severe pain, discomfort or
disability.
2.4
This policy applies to health care (including out of area treatments) for
which this CCG is the ultimate source of funds. It also applies to health
care commissioned by this CCG for people who reside elsewhere, but
who are referred to NHS Trusts for whom this CCG is the lead
commissioner, for out of area treatments.
3
The Policy
3.1
Blackpool CCG will support general practitioners who prescribe
medications for their patients for erectile dysfunction in accordance with
national guidance.
3.2
The CCG may also commission the prescribing of medications by
specialist services for patients whose erectile dysfunction causes
severe distress, in accordance with the procedure outlined in Appendix
1, which is to be read subject to any NHS national guidance on such
prescribing.
3.3
The CCG may also commission implants or surgical interventions for
patients who would be eligible for medical treatments, if those
treatments would be considered clinically preferable on an individual
patient basis. Such treatments may be commissioned only on the prior
authorisation of the IFR Panel who will consider issues of
appropriateness, effectiveness, cost-effectiveness, affordability and
ethics, and may consider clinical advice about the patient, in reaching
the judgement.
3.4
Any patient with erectile dysfunction may make use of whatever NHS
psychological and psychosexual counselling services are available at
that time within the portfolio of service agreements.
3.5
This protocol does not need to be applied if the general practitioner has
reason to suspect that the erectile dysfunction may be the presenting
Page 2 of 6
symptom of other serious physical or mental illness for which urgent
assessment or treatment may be required. Such a patient may be
referred through the usual arrangements applying to any urgent
referral. However such a patient may subsequently need to be
considered in accordance with this guidance if the prescribing of
specific medications for erectile dysfunction is subsequently requested.
3.6
If the patient is not satisfied with the clinical judgement of the health
professionals, then this should be considered in accordance with
the procedures within the NHS Trust in question. If the patient is
otherwise unhappy with this policy or its application, then he can ask for
the case to be considered in accordance with the CCG’s policy for
Considering Applications to make Exceptions or to Waive
Commissioning Policies.
3.7
Date of adoption: November 2016
3.8
Date of review:
This policy remains in force for a period of four years from the date of
its adoption, or until it is superseded by a revised policy, whichever is
sooner.
3.9
In the event of NICE guidance being superseded by new NICE
guidance, then:
•
If the new NICE guidance has mandatory status, then that NICE
guidance will supersede this policy with effect from the date on which it
becomes mandatory.
•
If the new NICE guidance does not have mandatory status, then
the CCG will aspire to review and update this policy accordingly.
However until it adopts a revised policy, this policy will remain in force
and any references in it to NICE guidance will remain valid as far as the
decisions of this CCG are concerned.
Page 3 of 6
Policies for the Commissioning of Appropriate, Effective and Priority
Health Care - Policy for the Commissioning of Services for People with
Erectile Dysfunction.
Appendix 1
Guidance for identifying those patients who should receive NHS
Assessment and Treatment.
Treatment for Erectile Dysfunction for Patients with Severe Distress.
The government has issued guidance on the treatment of impotence (HSC
1999/115 and HSC 1999/177) detailing which patients are eligible for
impotence treatments on the NHS by prescription from their general
practitioners. It details the specific conditions for which GPs can issue
prescriptions. Other patients who do not have these conditions can receive
private prescriptions from their general practitioner for this purpose. However,
the guidance also says that treatment will be available from secondary care
specialists in exceptional cases of severe distress.
This appendix describes how general practitioners will be able to access such
secondary care specialists in such cases of severe distress. It also describes
the actions to be taken by secondary care specialists in respect of patients
presenting directly to them without referral from their general practitioner.
A patient who satisfies the national guidelines, within which general
practitioners may prescribe, may occasionally present to a consultant in
secondary care. That consultant may assess that patient, possibly manage a
short trial of appropriate medications, and advise the general practitioner
about the longer term management. The secondary care provider will not
normally prescribe the medication on a longer term basis. (One exception to
this being a circumstance where a referral back to the general practitioner
would result in a breach of patient confidentiality, in which case that consultant
may continue to prescribe on a long term basis.).
A patient who does not satisfy the national guidelines within which general
practitioners may prescribe, may occasionally present to a consultant in
secondary care seeking physical treatments for erectile dysfunction. That
consultant will normally advise the patient to consult the general practitioner
(who may then commence the application of this guidance), and t h e
consultant will take no further immediate action regarding the erectile
dysfunction. (One exception to this being a circumstance where a referral
back to the general practitioner would result in a breach of patient
Page 4 of 6
confidentiality, in which case the consultant may assume the role of the
general practitioner in the application of this guidance.)
When a patient presents with erectile dysfunction to a general practitioner (in
accordance with the previous paragraphs or otherwise) the general
practitioner will be expected to conduct a full assessment of the patient’s
physical problem and mental state. Depending on the findings of this, he/she
will be expected to treat the patient as appropriate. This may entail referral of
the patient to secondary services.
If the patient’s condition falls within the specified conditions for which the
general practitioner can prescribe treatments for impotence, he/she will be
able to do this. He/she may still wish to establish whether there is an
underlying physical or psychological problem that is contributing to the
impotence, and to refer the patient accordingly.
If the patient’s condition is not included within the specified list of treatments
then the general practitioner will consider whether the level of distress may
warrant referral for specialist advice. If the general practitioner does conclude
that such a referral is warranted, then he/she will make a referral as
appropriate, confirming that assessment of the level of distress has been
carried out. The general practitioner will make the referral by means of any
form agreed for the purpose. This referral may be to a psychiatrist. (This will
be the case if the general practitioner believes that the problem is due to
mental illness or is otherwise of predominantly psychological origin.)
Alternatively, this referral may be to a urologist, genitourinary physician, or
other consultant with relevant interest and expertise. (This may be the case if
the patient’s needs are likely to be for physical treatments including
medications.).
The consultant receiving the referral will ensure that the referral
documentation demonstrates that the general practitioner has made a
reasonable assessment to confirm that the patient is suffering severe distress.
If the consultant is not satisfied, he/she may return the referral to the General
Practitioner. In cases of doubt, the Commissioning Panel may be asked to
advise about the appropriate application of this policy.
Page 5 of 6
References:
1) National Institute for Health and Care Excellence (NICE) (2014). Clinical
Knowledge Summaries Erectile Dysfunction. NICE. Available at:
https://cks.nice.org.uk/erectile-dysfunction#!topicsummary
2) Department of Health guidance, Health Service Circular:
HSC 1999/115, 7th May 1999, (Information, General Health Services)
HSC 1999/177, 6th August 1999, (Guidance on patients with Severe Distress).
Available at:
http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.u
k/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/d
h_4012101.pdf
Page 6 of 6