Individual Funding Requests (Exceptional Treatments)

Individual Funding Requests

Clinical Commissioning Groups need to make decisions on the range of health services/treatments that we commission (buy).  This includes ensuring that the services and treatments we commission meet the needs of our resident population and  offer value for money.  The majority of services/treatments we commission are available for the whole population, however, some are only clinically effective in very specific clinical situations or for a very narrow group of patients.  In these instances there is often considerable variation in the evidence of clinical effectiveness for these treatments, while costs also vary. In these cases we commission the service/treatment on a named individual (patient) basis having first assessed that there is evidence that the proposed treatment is clinically effective in the address the individual patient’s need and that the patient should see a demonstrable benefit from receiving the treatment.

Our Process

Our individual funding request (IFR) process relates to referrals that can generally be grouped as follows:

  • Where a treatment is specifically restricted under our Individual Funding Request Policy (Please click here) but where there may be exceptional circumstances that could justify relaxation of the policy.
     
  • Where specific approval is needed for a treatment to take place:  This may be because such treatment is new or costly and a hospital trust needs to gain specific authorisation or because the request is for treatment in the private sector or with an organisation with which we do not have commissioning arrangements.

We have a number of commissioning statements which set out our position on a number of more common clinical conditions/treatments.

Making a Request

Requests are only accepted from Consultants, Principals in General Practice, General Dental Practitioners or Autonomous Nurse Practitioners.  Requests are not accepted directly from patients.  Each request should be accompanied by a completed Individual Funding Requests application form. The following information should be provided:

  • Identity of the patient: cases are dealt with anonymously by the panels, but there must be confirmation that the patient is the responsibility of the CCG and there must be a unique identifier for discussion with all agencies concerned.
     
  • Information about the treatment being requested.
     
  • Justification for the referral for treatment from the referring clinician or rationale for the identified treatment from the treating clinician in terms of clinical effectiveness and, where possible, cost effectiveness.
     
  • Information about alternative treatments that may be available and about what contact has taken place with local clinicians and services.
     
  • Explanation of the exceptional circumstances that may justify referral.

Requests for consideration should be sent to:

Individual Funding Request Panel
NHS East Riding of Yorkshire Clinical Commissioning Group
Health House, Grange Park Lane, Willerby, HU10 6DT

Making a decision

This patient information leaflet explains how we make decisions about providing treatments which are not normally available through the NHS in this area.

Requests will be acknowledged and this acknowledgement will include the date of the panel meeting.  The panel meets monthly and results of the panel’s decisions will be sent out in the week following the meeting.  Where it is clear that the patient is aware of the request to the panel (for example, where the patient has been copied into correspondence), the patient will be copied into Individual Funding Requests Panel letters.

If a case is of such urgency that an immediate decision is necessary, a request can be dealt with outside of the normal panel arrangements. In these cases the clinician requesting individual funding should contact the IFR Administration Team to agree the best method of submitting the IFR request.

Where the request for approval is declined, the referring clinician can ask for reconsideration by the panel, supported by additional information.  If the referring clinician feels that the process had not been handled appropriately, they may appeal against the decision by writing to the CCG’s Chair asking for the case to be considered at the Individual Funding Requests Appeal panel.  This panel has a different membership from the Individual Funding Request Panel.

This patient information leaflet explains the process if your Individual Funding Request has been declined and you want to know what you can do next.

Related documents and links: