Prescribing ED treatments on the NHS

Restricted Access to Treatment

Since the introduction of the first oral treatment in the UK, the prescription of treatments for ED has been an area of controversy.

Following its UK launch in 1998, the Government, along with health service managers and doctors, feared that the NHS would be swamped by requests for the drug from otherwise healthy people wanting to improve their sex lives ⁴¹.

In May 1999, the High Court ruled against the Government. In response, the Department of Health moved all treatments for ED onto Schedule 11 (now known as Schedule 2 following the 2003 Health Bill passing through Parliament) thereby restricting access to ED treatments on the NHS to men with specific conditions, such as diabetes and Parkinson's disease.

Restricted Frequency of Prescribing

The NHS Executive advised doctors [HSC 1999/148] that treatments for ED prescribed under Schedule 2 should be restricted to allow patients one treatment per week based on:

• Data suggesting men aged 40-60 have sex once a week
• Concern over the street value of 'some treatments for impotence' leading to unlicensed use of these treatments

Importantly, the advice recognises the value of clinical judgement and states that: 'If the GP in exercising his clinical judgement considers that more than one treatment a week is appropriate, he should prescribe that amount on the NHS' ²⁰.

This is vitally important when considering the needs of each patient individually and particularly when initiating patients on treatments such as PDE5 inhibitors, as up to 8 treatments may need to be used before maximum efficacy is reached ²⁹ and doctors may wish to prescribe these in one consultation.

Referral to Secondary Care

Many GPs respond to these complex rules by referring patients to secondary care specialists, under further guidance issued by the NHS Executive [HSC 1999/177], for confirmation of patients with 'severe distress’ ²¹.

Under these regulations, treatment under the NHS may be available for those men with ED who are not eligible under Schedule 2 on the grounds that the patient is suffering:

• Significant disruption to normal social and occupational activity
• Marked effect on mood, behaviour, social and environmental awareness
• Marked effect on interpersonal relationships

It would seem reasonable to suppose that under these criteria most men with ED could qualify for treatment and that the process of referral is more expensive to administer and increases waiting lists for important urological conditions.

If this diagnosis, never previously defined in medical literature, is confirmed, the patient is eligible for indefinite prescriptions from the hospital pharmacy at its expense.