Individual Funding Requests for NHS Treatment

Individual Funding Requests (IFR) - Introduction

The NHS Norfolk & Waveney Clinical Commissioning Groups (CCG’s) have a duty to spend the money they receive from the Government in a fair and efficient way, taking in to account the health needs of their local community.

As there is only a set amount of money available to spend, sometimes difficult decisions have to be made about which treatments are routinely provided.

In some circumstances, your clinician (usually a GP or Consultant) may believe you have exceptional clinical circumstances and may benefit from a treatment which is not routinely provided.

Requests for such treatments must be made through an Individual Funding Request (IFR). The same IFR policy is used across Norfolk & Waveney to ensure patients are treated consistently and fairly.

What does "exceptional" mean?

In deciding whether your clinical circumstances are “exceptional” the IFR Panel who sit on behalf of the CCG’s will consider the following;

  • Is the patient significantly different to the general population of patients with the same diagnosis/condition in question?

           and

  • Is the patient more likely to benefit from the treatment/intervention than might be expected for the average patient with the same diagnosis/condition?

It is important to note social or psychological factors are not usually considered as part of the IFR process.

Who can make an Individual Funding Request?

If your GP or Consultant agrees a certain treatment would be of benefit to you and there are no alternative treatments or services available for your condition, they can make a request to the IFR Panel on your behalf but only if they consider your individual circumstances are exceptional.

As part of the IFR application, your GP or Consultant is asked to describe your personal clinical circumstances, how they believe the treatment will specifically benefit you, the evidence which is both safe and effective, the cost of the treatment and how commonly your condition occurs in the community.

All requests are treated in strict confidence and all personal details are removed from the paperwork before being submitted to the IFR Panel.

How is a decision made?

The IFR Panel is made up of health professionals and CCG managers who meet once a month to consider requests against an agreed set of criteria to ensure the decision making is fair, consistent and transparent. You will not be asked to attend the Panel meeting.

A letter will be sent to your GP or Consultant informing them of the Panel’s decision within 10 working days of the panel meeting explaining the reasons for the decision. Your GP or Consultant will contact you to discuss the decision so it can be fully explained. Your GP or Consultant can then discuss with you what it means for your care and the next steps which may need to be taken.

What can I do if the request is declined?

In the first instance you should speak to your GP or Consultant. If you, your GP or Consultant are unhappy with the IFR Panel decision:  

  • In any case where further relevant information becomes available which has not been considered by the IFR Panel, your Doctor may ask the IFR Panel to reconsider the case specifically in light of this further information; and

  • Where all the relevant information was available to the IFR Panel when the decision was made,  but the referring clinician remains dissatisfied with the decision, they may request it to be reviewed by the IFR Appeals Panel on one of the following grounds only:

    • Due process was not followed; or

    • The IFR Panel failed to give a clear rationale for its decision.

In the case of failure to follow due process or an inadequate rationale for the IFR Panel decision, your Doctor may request an IFR Appeals Panel review by making a formal request in writing to the Chair of the IFR Panel and copied to the IFR Administrator within 30 working days of the date of the IFR Panel’s decision. 

The role of the IFR Appeals Panel is to determine whether the IFR Panel has followed its own procedures, has properly considered the evidence presented to it and has come to a reasonable decision upon the evidence. The IFR Appeals Panel shall not have power to authorise funding for the requested treatment but shall have the right to make recommendations to the IFR Panel.

Should you, your GP or Consultant remain dissatisfied with the IFR Appeals Panel decision, the matter may be pursued through the NHS Complaints Procedure. Information on how to do this is available from the relevant NHS Norfolk and Waveney CCG Complaints Manager.

Your information

All Individual Funding Requests may be reviewed by the CCG as the statutory body responsible for funding decisions. The application form and any other supporting information supplied may therefore be shared with the CCG or other trusted organisations legitimately acting on behalf of the CCG. Personal information may be retained only for the purposes of this Individual Funding Request and, in some cases, may be used for invoicing and payment reconciliation and your medical records may be used for the purposes of clinical audit which will be completed by a clinician. Anonymised information may also be shared as part of CCG reporting processes.

Your Doctor will explain the funding process to you and will inform you of any funding decision made, including your right of appeal, if appropriate.