Health authorities must be allowed sufficient time to implement new guidance on fertility treatment from the National Institute for Clinical Excellence to ensure they can meet the financial and resource implications, according to NHS managers.

The announcement by health secretary Alan Milburn that the Department of Health is to request NICE to consider and update existing clinical guidelines on fertility treatments came at last week's NICE annual conference. It followed the publication of a DoH survey showing massive variations in access to treatment around the country.

The NHS Confederation said it was important that the timing of any decision fitted within the NHS's service planning timescales.

It said HAs and primary care trusts had already begun planning for the financial year 2001-02, taking into account existing government service priorities, including cancer and coronary heart disease, and would therefore not be in a position to consider implementing 'any costly NICE guidance on infertility' until 2002-03.

Confederation chief executive Stephen Thornton said although the review was the right thing to do, there could be major financial implications. 'Some HAs have denied access to treatment because they could not afford to pay for it, not because they considered it ineffective. Those HAs and their PCTs will now have to plan to spend more in this area.

Across the country this could add up to tens of millions of pounds.'

North Yorkshire HA director of finance John Grimes said the biggest problems for the authority were the volume of guidance from NICE, affordability and the time it would take to acquire the new staff and facilities needed. He said: 'We are very happy to have more resources, but it is coming into a tight environment.'

The DoH said it was likely to take a few months before it formally notified NICE of its request for a review, which will then produce a timetable for the guidance.

Mr Milburn also announced last week monitoring of HAs and trusts to ensure they are taking full account of each NICE appraisal. Monitoring will take place shortly after publication of an appraisal and then six months later to track progress. The Commission for Health Improvement will then incorporate successive NICE appraisals into its routine clinical governance monitoring.