Individual Funding Requests
Treatments not routinely available from your local NHS
Individual Funding Requests
Individual funding requests may be received by the PCT at any time and will be considered for funding if they fall within the categories below.
- Where no existing PCT Commissioning policy exists
- For consideration as an ‘exception’ to an existing policy.
Exceptional Circumstances
No standard definition of exceptional circumstances exists. In order for funding to be agreed there must be some unusual or unique clinical factor about the patient that suggests that they are:
- Significantly different to the general population of patients with the condition in question.
- Likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition.
The fact that a treatment is likely to be efficacious (successful in producing the desired or intended result) for a patient is not, in itself, a basis for an exemption.
If a patient's clinical condition matches the 'accepted indications' for a treatment that is not funded, their circumstances are not, by definition, exceptional. It is for the requesting Clinician to make the case for exceptional status. Social value judgements are rarely relevant to the consideration of exceptional status.
Process
There are three tiers to the Individual Funding Request process;
Tier One: Nominated Commissioning managers, Public Health consultants and Medicine Management staff will review all requests as appropriate and respond to cases which are clearly covered by existing policy and where the case is not a request for consideration under exceptionality.
Tier Two: Cases where there is no existing policy and requests for consideration as an exceptional case will be considered by the individual funding request (IFR) Panel on a monthly basis. The Panel will consider each case in line with the PCT’s general Commissioning principles.
Tier Three: Where the PCT’s Individual Cases Panel has not supported funding for the referral, patients have the right to review the decision making processes that were followed in tiers 1 and 2. The decision itself however cannot be appealed against unless new information about the case is presented. The Appeals Panel will review the process that the IFR Panel has followed but not the decision that has been reached. If the Appeals Panel believe that the correct procedures have not been followed then it will instruct the IFR Panel to review the case.
Procedure for putting Cases before the Panel
Clinicians should consider the appropriateness of a referral or treatment outside of the normal PCT Commissioning portfolio or existing Area Prescribing Committee (APC)/ PCT formularies and guidelines.
If, after considering the criteria above, the referral/treatment is deemed by the Clinician to be appropriate, he/she should complete an Individual Funding Request pro-forma which can be accessed by emailing PALS@coventrypct.nhs.uk
If you wish to talk to someone at NHS Coventry about how we make decisions about special treatments, medicines or drugs; then please email nhscoventryifr@nhs.net , or contact the PALS Team on tel: 024 7624 6002 or via email: PALS@coventrypct.nhs.uk
Low Priority Policy Leaflet
In Coventry, new and established treatments are regularly reviewed by a panel of doctors, other clinicians and NHS managers who make recommendations on their use. Guidance from the National Institute for Health and Clinical Excellence (NICE) is also taken into account.
As happens in other parts of the country, we may decide that a treatment or procedure should not be routinely funded by NHS Coventry because:
• there is only limited or no evidence of its effectiveness (whether it works or not)
• it is considered a low priority for funding (e.g. some cosmetic surgery) compared to other treatments (e.g. cancer drugs or stroke care)
These are known as Low Priority Treatments or Treatments Not Normally Funded. These are set as a policy which is applied equally to the Coventry population.
Low Priority Policy Leaflet
- Clinician
Any health professional who is directly involved in the care or treatment of patients. - Commissioning
Process by which the health needs of the local population are identified. Priorities for investment are set and appropriate services are purchased and evaluated. Primary Care Trusts do not provide all of the healthcare services needed by the local population, they buy-in or commission services from other provider organisations. Typically this includes local hospitals. - PCT
Primary Care Trust. A PCT is responsible for commissioning the most appropriate services for the local community. - PALS
Patient Advice and Liason Service - PALS is a confidential and free service, providing information, advice and support to patients, service users, carers and relatives with the aim of resolving local difficulties on-the-spot.
- stroke
A stroke is caused by a disturbance of blood supply to the brain. Strokes are the leading cause of disability in the UK and the third most common cause of death after cancer and coronary heart disease.