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 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.

You can view a flowchart of the IFR process here and see our document for more information about the process here.

Making a Request

Requests are only accepted from Consultants, Principals in General Practice, General Dental Practitioners or Autonomous Nurse Practitioners and are not accepted directly from patients.  Requests will only be accepted when submitted via the IFR Electronic System website at https://ifryh.necsu.nhs.uk/.

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.
  • Reason for the request – please provide as much detail as possible
  • Detail all approved alternative treatments that have been tried and failed
  • Patient’s clinical history relevant to the requested treatment
  • Detail any exceptional circumstances – clearly demonstrate that:
  1. The patient is significantly different to the general population of patients with the condition in question and 
  2. The patient is likely to gain significantly more benefit than might normally be expected for patients with that condition

Making a decision

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.

Related documents and links: