Individual funding requests

Applying for treatments or episodes of healthcare which are not routinely funded by the NHS

The NHS exists to serve the needs of all patients but also has a statutory duty not to exceed the resources allocated to it by central government (NHS Act 2006). CCGs therefore need to use their limited resources effectively to obtain the best healthcare possible for their population. This sometimes results in difficult decisions having to be made about how resources should be prioritised when services are commissioned.

There may be individual cases where a patient’s needs cannot be met through existing contracts and commissioning arrangements but their GP or consultant considers that their patient has a need for an un-commissioned treatment and wishes to request funding on their patient’s behalf. When requests occur, CCGs must have a robust and transparent system in place to assess and determine whether the request should be funded, demonstrating a rational decision making process for an individual patient. These are referred to as individual funding requests (IFRs).

Many IFRs are for cosmetic surgical procedures which are generally effective but considered to be of low priority by local commissioners and will only be funded in exceptional clinical circumstances. Some people can have this type of surgery funded by the NHS if they meet certain clinical eligibility criteria. Before submitting an IFR patients and treating clinicians or GPs should refer to the South East London Treatment Access Policy which includes eligibility criteria for various procedures and treatments. This will identify the clinical information needed for the application and indicates whether the request is made on the grounds that the patient meets the eligibility criteria or whether the request is being made because they do not meet the eligibility criteria but they have exceptional clinical circumstances to take into consideration.

Exceptionality is defined in the South London IFR Policy as:

“An unusual clinical circumstance about the patient that suggests that they are:

  • Significantly different from the general population of patients with the condition in question; and
  • Likely to gain significantly more benefit from the intervention than might be normally expected for the average patient with the condition.

The fact that a treatment is likely to be efficacious for a patient is not, in itself a basis for exceptionality.”

IFR panels also review requests for funding of medical treatments that are new, novel, developing or unproven or are not normally available for any patients in England. A consultant may wish to use a licensed medication at an unlicensed dosage or for a condition the medication is not licensed to treat. In these instances clinicians are required to seek prior approval from the patient’s CCG and provide evidence of the clinical effectiveness of their proposal and evidence of the exceptionality or rarity of their patient’s clinical circumstances.The CCG commissions independent Treatment Evidence Reviews from Medicines Information services which are presented to the IFR Panel along with the information provided by the requester.

Making an individual funding request

Your GP or hospital consultant can make an individual funding request on your behalf for a treatment or an episode of healthcare which is not routinely funded by the NHS. Requests go to the Bromley CCG IFR Panel either by post or email (details below). Although requests must be submitted by a clinician patients can provide written statements about their clinical circumstances in support of the application.

Patient Consent: Individual Funding Requests (IFR) must be submitted on a current application form with a patient’s signature. Signed explicit consent assures the CCG that the IFR process has been discussed with the patient and verifies they agree to Bromley CCG and IFR support organisations to collect and use their clinical health information in their decision making process.

Drug requests are usually submitted by hospital consultants without patient identifiable data and consent is not required on these forms (see SL IFR Application Form 2016-17).

The requests are initially reviewed by an IFR Triage Panel who can decide to approve or decline funding or refer to the full IFR Panel for consideration of requests made on the grounds of exceptionality. The membership of the IFR Panel includes a consultant in Public Health, a GP, a prescribing advisor, a commissioner, and meetings are chaired by lay persons. Depending on the quality of evidence provided and when the application received the decision making process can take up to 4-6 weeks to conclude. Clinicians and patients are informed by letter detailing the rationale for the Panel’s decision.

For more information about the Bromley CCG’s IFR process, including how to Appeal, please see our IFR Bromley CCG Patient Information Leaflet and IFR Bromley CCG Procedures and appendices.

Who to contact

Correspondence should be sent to:

Kiran Bhatoa - Contract Support Manager

Bromley Clinical Commissioning Group 1st Floor Beckenham Beacon 379 Croydon Road Beckenham Kent  BR3 3QL

Email: Bromley Individual Funding Requests BROCCG.ifr@nhs.net

 

NHS Bromley CCG, 1st Floor, Beckenham Beacon, 379 Croydon Road, Beckenham, BR3 3QL

© 2017 Bromley CCG