Individual funding requests
There are some health care interventions which are not routinely funded by the CCG. These include some cosmetic procedures, various fertility treatments and treatments not approved by the National Institute for Health and Care Excellence (NICE) (opens in new window).
Your GP, consultant or dentist can approach our CCG on your behalf to request funding for treatment that is not routinely available. This is called an individual funding request (IFR).
Making an individual funding request
If you wish to make an individual funding request, you will need to discuss this with your GP or consultant or dentist. They will complete a standard IFR application form on your behalf and send it to us, alongside any supporting information supporting the request.
As part of the individual funding request your GP, consultant or dentist must demonstrate exceptionality based against the following criteria:
- the individual is significantly different clinically to the group of patients with the condition in question and at the same stage of progression of the condition.
- there are good grounds to believe the patient is likely to gain significantly more clinical benefit than others in the group of patients with the condition in question and at the same stage of progression of the condition
Each request is individually reviewed and discussed at the IFR panel. The IFR panel is made up of clinical and non-clinical representatives who only have sight of your medical information, not personal information which could identify you. Any additional information that may be required by the panel will be managed via your GP, consultant or dentist.
Whilst the IFR panel carefully considers requests against the above criteria, the panel will also consider factors including safety concerns and side effects of treatments and fairness and equity.
Once the panel has made a decision, they will let your GP or consultant or dentist know the outcome of the decision. In some cases, where approval has been given, there may be conditions or restrictions on your treatment.
Appealing a decision
Your GP, consultant or dentist can appeal the outcome of an individual funding request if they think that the IFR panel:
- did not follow the proper process
- did not consider all the relevant information available
- acted outside its authority or a decision was made in contrary to law
An appeal cannot be made on the grounds that you disagree with the original decision. If your GP, consultant or dentist wishes to make an appeal, they will need to specify which part of the decision making process is being appealed against.
If an appeal is accepted, it will be returned to the IFR panel to be re-considered. If an appeal is unsuccessful, a clear explanation will be provided to you and your GP, consultant or dentist.
If you remain unhappy after making an appeal, you can raise your concern with our patient support line [insert hyperlink to the patient support line page].
If you remain unhappy after speaking to our patient support line, you have the right to refer your request to the Parliamentary and Health Service Ombudsman (opens in new window).
Email: firstname.lastname@example.org (opens in new window)
Telephone: 0345 015 4033, Monday to Friday, 8.30 am – 5.30 pm
Write to: The Parliamentary and Health Service Ombudsman, Millbank Tower, Millbank, London, SW1P 4QP
Evidence based interventions
Clinical evidence shows some interventions are only appropriate when they are performed in specific circumstances. These are known as evidence based interventions.
The Evidence-Based Interventions (EBI) programme (opens in a new window) is a partnership between NHS Clinical Commissioners, NHS England and Improvement, the Academy of Medical Royal Colleges and NICE. It aims to reduce referrals for interventions that evidence shows should not be commissioned or only commissioned if certain clinical criteria are met.
There are 17 interventions included in the EBI programme: four that should not be routinely offered to patients unless there are exceptional circumstances and 13 interventions that should only be offered to patients when certain clinical criteria are met.
NHS England have created some resources to help health professionals, patients and the public understand the Evidence-Based Interventions Programme, you can find these on the NHS England website (opens in new window).