Individual funding requests - accessing treatment not normally provided by the local NHS
All patients have access to a wide variety of treatments that are funded by the NHS. However, there are some that we do not routinely fund. These include:
- cosmetic procedures,
- various fertility treatments,
- treatments not approved by the National Institute for Health and Care Excellence (NICE).
Your GP or consultant can approach the CCG on your behalf to request funding for treatment that is not routinely available. These individual funding requests (IFR) can be made, because;
- you have a rare medical condition not covered by general policies for treatment,
- there are exceptional clinical circumstances why treatment should be funded.
Making an individual funding request
To make an individual funding request, you will need to discuss this with your GP or consultant. They will complete an application form on your behalf and send it to us, alongside any supporting information. This supporting information must demonstrate your exceptional clinical circumstances and how your condition affects daily life.
Each request is individually assessed and discussed at the individual funding request (IFR) panel. Urgent requests may be considered at a special panel. The IFR panel is made up of qualified and trained people who only have sight of your medical information. Any contact or additional information that may need to be supplied to the panel should be done via your doctor or consultant.
The panel carefully consider a number of factors before reaching a decision, including:
- clinical evidence that the treatment will help manage your condition
- whether the treatment will be value for money for the NHS
- safety concerns and side effects
On occasion, the panel may go back to your GP or consultant for additional information to support your request.
Once the panel has made a decision, we will let your GP or consultant know the result 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 or consultant 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 to them,
- 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 or consultant 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 or consultant.
If you remain unhappy after making an appeal, you can raise your concern with our patient support line.
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:
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