Individual Funding Requests

 

Making the best use of our limited resources and prioritising what we spend public money on are of crucial importance in providing the best possible NHS service across Surrey Heartlands.

 

If you have any questions about Individual Funding Requests (IFRs) you can email the IFR Team via:

  • This email address is being protected from spambots. You need JavaScript enabled to view it. 

 

To help us prioritise, we use national and local policies to ensure that the treatments and medicines we commission have a clinically proven benefit in meeting the health needs of the population.

This means that we won’t routinely fund individual treatments or medicines that do not have clinically proven benefit.  For some procedures or medicines we fund subject to national and local criteria being met.

For more information, go to the Policies and Guidance (Clinical policies section) page of this website to view:

  • Treatments not Routinely Funded
  • Procedures with Restrictions and Thresholds
  • Operating Process for Procedures with Restrictions
  • Assisted Conception Policy
  • Individual Funding Request Policy
  • Individual Funding Request Standard Operating Procedure

 

For information about medicines, go to the Policies and Guidance (Clinical policies section) page of this website to view:

  • Surrey Interface Prescribing Policy - this policy outlines the specialised medicines that may be funded and the circumstances in which they are funded.

 

To apply for an IFR, please complete the following form:

 

What are procedures with restrictions and thresholds, and specialised medicines?

Alongside providing routine healthcare, the CCG also commissions highly specialised health services which require clinicians to consider unusual treatments which may meet the needs of their patients.

The CCG has reviewed evidence of clinical effectiveness, as well as information on current national activity and cost-effectiveness, and has put in place criteria for decision-makers with regard to those procedures within the 'List of procedures with restrictions and thresholds' policy.

Specialised Medicines in our ‘List of Specialised Medicines’ will be routinely funded where a request meets national and local criteria. In this instance, medicines will be marked ‘tick box’ OR ‘invoice’ in the right-hand column. If a tick box form is required, this will be completed by your consultant. 

 

I don’t meet the criteria / the treatment I need is not listed. What can I do?

If you do not meet the criteria, you may still be eligible to receive funding for treatment if there’s evidence that your circumstances are clinically exceptional – in which case you may be eligible for 'individual funding' and your clinician would be required to make an individual funding request.

Likewise, if the procedure you require is included within the List of procedures that are not routinely funded requiring individual funding applications policy your clinician would be required to make an individual funding request.

If the medicine that you require is not on our ‘List of specialised medicines’, it may be because the drug is funded by NHS England rather than the CCG. Your consultant will be able to advise you in this instance.

 

How are IFR’s considered?

IFR’s are submitted electronically via the Blueteq database by the requesting clinician or their representative.  Patients are not eligible to submit applications.

All IFRs are reviewed via a screening process to determine whether the requesting clinician appears to have presented an arguable case for the clinical exceptionality of their patient compared with other patients with the condition.  If so, then the application will be considered by the next available IFR Panel.  The IFR Panel meets on a monthly basis and includes lay members and GP representation.

If the IFR Panel agrees there to be evidence that your case is clinically exceptional, there is sufficient evidence that the proposed treatment is likely to be clinically effective, and it is considered to be a cost effective use of NHS resources, the CCG will pay for your treatment or medicine.

The IFR Team will notify the requesting clinician of the Panel’s decision within ten working days of the meeting.

The IFR Panel may refuse a funding request, and this is always a difficult decision. In this case, the IFR Team will provide a detailed response to the requesting clinician (and the patient if requested) confirming the rationale for the decision to decline funding.

 

How can I challenge a decision made by the IFR Panel?

A clinician, the patient or a patient representative may make a request to the CCG for a process review of an IFR Panel decision. The request should be made in writing, addressed to CCG Clinical Director for Planned Care. Such requests must be lodged within 20 working days of the date of the letter from the CCG setting out the IFR Panel decision.  The request for review must be supported by the requesting clinician who will set out the grounds on which the IFR Panel decision is being challenged. 

The IFR Review Panel will only be able to consider whether the process followed by the IFR Panel was fair and consistent, based on whether the decision reached:

  • Was taken following a process which was consistent with the policies of CCG;
  • Was a decision which a reasonable IFR Panel was entitled to reach;
  • Understood, took into account and weighed, all the relevant evidence; and
  • Did not take into account any irrelevant factors

 

A process review cannot requested to review a decision made at the screening stage.

 

IFR Activity Reports

The latest reports can be viewed on the Performance Reports page of this website.

 

 

Review Date: 2020-09-24
Review Due: 2021-09-24
Model Publication Scheme Class: Class 7: Policies and Procedures