Dear Dr Jenner

Re. eligibility of patients with ED for NHS drug treatment

I am writing to you regarding your practice-based commissioning take home messages, which were included in my article on the BSSM guideline on erectile dysfunction (August issue of Guidelines in Practice). I feel that the following PBC message, which you wrote, is untenable: ‘Few patients with ED but without diabetes are eligible for NHS drug treatment’.

I would like to highlight the following recommendation from the Department of Health guideline1,2 (which is also supported by the BSSM guideline3): the GP is encouraged to refer if he thinks the ED causes severe distress (defined as a significant disruption of interpersonal relationship). I would also like to point out that the prescription event-monitoring group has twice published data in the BMJ for GP erectile dysfunction prescriptions and only 25% of these were for patients with diabetes.

I look forward to hearing from you regarding this matter.

Yours sincerely,

Dr Geoff Hackett
Chair of the British Society for Sexual Medicine

1. Department of Health. Treatment for impotence. HSC 1999/148. London: DH, 1999.
2. Department of Health. Treatment for impotence: patients with severe distress. HSC 1999/177. London: Department of Health, 1999.
3. BSSM. British Society for Sexual Medicine guidelines for erectile dysfunction 2007.


Dear Dr Hackett,

I am sorry that one of my practice-based commissioning (PBC) take home messages in the August issue of Guidelines in Practice appears to give the wrong impression.

I am grateful to you for clarification here and do not dispute your argument, particularly as I am not an expert in the field of erectile dysfunction.

Clearly the interpretation of ‘severe distress’, as highlighted in the guidance from the Department of Health, is not an easy one to measure.

My task of trying to condense whole articles into simple bullet points is not an easy one and I hope you will understand this.

Perhaps the real point is to get rid of this rather illogical and restrictive legislation, which I would support you in and which I was actually trying to expose in my bullet point. I was trying to point out that many patients seem illogically excluded from NHS treatment as you highlight in your article, thereby reinforcing your case; however, I seem to have scored an own goal!

Apologies for any misunderstanding that may have resulted from this particular PBC message, and thank you for raising this issue.

Yours sincerely,

Dr David Jenner
NHS Alliance PBC Lead