Sex: the new postcode lottery

Abstract

Background: A list of all the Primary Care Trusts (PCTs) in England, Scotland and Wales was obtained from the websites of National Health Service (NHS) choices', NHS Scotland and NHS Wales. Methods: Each PCT's website was visited to find the email address for their Freedom of Information (FOI) department. FOI requests were made to each PCT asking questions regarding their criteria for funding and the number of requests made and implants funded in the previous 12 months. Results: A total of 129 PCTs were emailed with a 95% response rate. Thirty-one per cent of the PCTs that replied funded penile prostheses and 22% did not. A further 45% of PCTs would fund under exceptional circumstances, but only 20% of these had any clinical criteria on which to base their decision making. Twenty-three per cent of clinical criteria used were based on guidelines. Non-funding PCTs were spread in patches throughout the country, but the West Midlands stood out as a particularly black spot. On reviewing PCTs that had received requests for funding in the preceding 12 months, 46% did not fund any of the requests, 17% funded 50% or less and 37% funded all the requests received. Of the PCTs funding under exceptional circumstances, only 37% actually funded any of the requests received. Conclusion: Despite guidelines on the management of erectile dysfunction, there remains variability in access to penile prosthesis surgery. The West Midlands and the Southeast (excluding London) are the worst places to live with regards to access to prostheses; Scotland and Wales appear to be the best. Guidelines are rarely used in decision making. Funding remains an important factor in determining who receives potentially life-changing treatment for erectile dysfunction refractory to all other management options. A patient's address and personal wealth appear to have a larger impact than guidelines.