Summary

This circular provides guidance for the NHS on the identification and management within specialist services of those men diagnosed to be suffering from severe distress on account of their impotence.

This circular:

This guidance should be read in conjunction with HSC 1 999/11 5 and HSC 1999/148 which respectively explain the Secretary of State's decisions following the public consultation and the changes to regulations put into effect on 1 July 1999.

1. The regulations which came into effect on 1 July 1 999 limit the use of NHS prescriptions by GPs for the treatment of impotence. Treatment may be available from specialist services for those men who are not eligible for NHS prescriptions from their GP to treat their impotence. Funding for this care will be part of normal arrangements between Health Authorities, Primary Care Groups, and NHS Trusts who will have to consider the priority it is to be given in the light of local circumstances and other clinical priorities. The Department recommends that treatment should be available from specialist services when impotence is causing severe distress.

2. Within the context of treatment for impotence, specialist services are defined as those services which are commissioned by Health Authorities and Primary Care Groups, and delivered through a service agreement with an NHS Trust. Local agreement will be necessary to determine the referral pathway, which may vary depending on the organisation of services locally to provide care to those patients with impotence for whom treatment is available as set out in this guidance. Mental health services, sexual dysfunction services, urology services, or genito-urinary medicine services may be involved in the care of these patients.

3. The decision about referral of individual patients for specialist services is a matter for the clinical judgement of the GP concerned who may arrange for the referral of patients as appropriate. The Department recommends that a referral should be made where the GP is satisfied that the man is suffering from impotence and that this impotence is causing him severe distress. In determining whether a patient is suffering from severe distress it is recommended that the following criteria should be taken into account:

4. Specialist services will operate their usual arrangements for prescribing and dispensing these treatments, which may be on an in-house form (for dispensing by the NHS Trust dispensary/pharmacy) or form FP1O(HP) (for dispensing by the community pharmacy). If FP1Q(HP)s are used they should be endorsed "SLS" otherwise the community pharmacist will be unable to supply the medicine to the patient.

5. The frequency of treatment will need to be considered on a case by case basis₁ but doctors may find it helpful to bear in mind that research evidence about the frequency of sexual intercourse (Johnson A, Wadsworth J, et al, Sexual Attitudes and Lifestyle Survey, UK 1990-91, 1994) shows that the average frequency of sexual intercourse in the 40-60 age range is once a week. After initial stabilisation, the Department advises doctors that one treatment a week will be appropriate for most patients treated for erectile dysfunction. If the doctor, in exercising his or her clinical judgement considers that more than one treatment a week is appropriate! he or she should prescribe that amount on the NHS through hospital prescribing arrangements.

6. Patients who are prescribed treatment for impotence on the NHS following the guidance in this circular would need to continue to receive their treatment through the specialist services. We advise that arrangements for follow-up and the provision of further treatment, should be determined according to the needs of each patient. These may include arrangements for repeat prescriptions which may or may not include a full out-patient appointment. Arrangements should be put in place to review the continuation of NHS prescriptions for patients whose circumstances change.

7. Where the GP or specialist determines that NHS prescriptions are not appropriate for individual patients, drug treatment may be prescribed privately by the GP.

8. The operation of this guidance will be reviewed within 1 year.