Forms and applications

Individual funding requests

Contents

Defining exceptionality

Stages of the IFR decision-making process

How IFR decisions are made

How to make a request for funding

Completed funding request forms

An Individual Funding Request (IFR) is a request to fund healthcare for an individual who falls outside the range of services and treatments that Pan Mersey Clinical Commissioning Group (CCG) have agreed to commission.

An IFR is only regarded as such when a case can be set out by a patient’s clinicians that they have exceptional clinical circumstances. Here you will find the definition of exceptionality as detailed in the Individual Exceptional Funding Requests for Clinical Interventions Policy.

The patient is significantly different to the general population of patients with the condition in question and the patient is likely to gain significantly more benefit from intervention than might normally be expected for patients with that condition.

Dr Henrietta Ewart

Defining Exceptionality

The following information explains how CCGs across the Pan Mersey health economy makes decisions about providing treatments that are not normally available through the National Health Service (NHS).

Like any other organisation, the NHS has limited resources and CCGs have a duty to manage them to a robust process.

This means they have to:

• look at evidence for the safety and effectiveness of any treatment and
• ensure that the services they pay for will give patients the greatest health gains from the finite resources have available.

There are a set of recognised principles which are used in the NHS to guide commissioning decisions on individual treatments. There are some treatments that are not routinely funded and as such CCGs have policies on particular drugs or treatments. These clinical commissioning policies are agreed with other CCGs in Cheshire and Merseyside, are reviewed regularly and are available on the Pan Mersey website Internal hyperlink.

The IFR Team will validate requests in line with the respective CCGs’ commissioning policies.

All personal Information received is treated in the strictest confidence and used according to the data-protection laws.

The IFR Team will consider whether a case meets the respective CCG policy criteria and will make a decision. On occasions a case may need to be discussed by the Individual Funding Panel who meet regularly. The panel consists of representatives from the IFR Team who will present your case as well as clinicians and senior managers.

There are times when an IFR may be refused and this is always a difficult situation. A detailed response on the reason for the decision will be provided including the criteria considered by the IFR panel.

Stages of the IFR decision-making process

1. The IFR clinical triage team will screen it against the respective CCG’s local policies and a decision will be made.
2. If the triage team cannot make a decision, further information may be requested.
3. On receipt of further information requested the triage team will then review this request again and make a decision if possible.
4. If the triage team cannot make a decision, your request will be considered by the Individual Funding Panel.
5. If the person concerned or their referring clinician thinks the IFR team have not followed the correct process to reach their decision, or you feel they did not consider everything relevant when they made the decision, your referring clinician can appeal by writing to say why.

How IFR decisions are made

The IFR team makes its decision on whether to fund new technologies and medicines by assessing the clinical effectiveness of treatments (do they work and what are the benefits when compared with existing treatments?) and their cost effectiveness. Where there are significant financial implications for a CCG but proven health benefits, the final decision rests with the Governing Body of the respective CCG.

The IFR team also receives requests from health professionals to fund a treatment that is not normally commissioned by the CCG. If the request could apply to a number of patients, the decision is referred to the CCG to consider the development of a relevant policy. Otherwise, the decision the panel needs to make is whether the patient is clinically exceptional to our policy (as defined above) and whether it is fair and equitable to offer this treatment to one individual when it is not routinely available to others.

How to make a request for funding

IFR’s are dealt with by Midlands and Lancashire Commissioning Support Unit who provide the service on behalf of all CCGs across Cheshire and Merseyside.

Patients are unable to submit IFR’s. However, if the patient’s treating clinician believes that their case is clinically exceptional then they can submit a request (and all relevant clinical information to support the application) using the relevant IFR form which can be accessed on the links below.

 Individual Exceptional Circumstances Submission Form

For non-contract activity treatment funding requests ONLY where local or national guidance exists and routinely funded by CCGs within the provider’s local health economy:

 Non-contract Activity Submission Form

For Cheshire and Merseyside patients, completed funding request forms should be returned to:

Email

ifr.manager@nhs.net

Post

In the event that you are unable to forward the application from a secure email address, the application can be posted to:
CONFIDENTIAL
1829 Building – Mail Account 
Facilities Services 
Individual Funding Request Team 
Countess of Chester Hospital NHS Foundation Trust 
Liverpool Road 
CHESTER
Cheshire 
CH2 1UL 

Process

 Appeal process

The decision to issue a Pan Mersey policy statement recommendation is made by the Pan Mersey Area Prescribing Committee. It does this after consideration of the recommendations of its sub-committees, and in consultation with its stakeholders.

In line with good practice recommendations that a clinician is best placed to submit a formal appeal on behalf of their patient population, the appeals process is open to clinicians (GPs, Consultants, Senior Nurses, Senior Pharmacists or non-medical independent prescribers) with relevant expertise and who work within the Pan Mersey Health Economy. It exists to give those clinicians who feel that that the Pan Mersey policy statement recommendation may result in a compromise in care to patients, an opportunity to make their case for the recommendation to be amended.

Application form

 Appeal form

Use this form to make an appeal against a policy statement recommendation issued by the Pan Mersey APC.

You can use this form if you are a clinician (GP, Consultant, Senior Nurse, Senior Pharmacist or non-medical independent prescriber) with relevant expertise and who work within the Pan Mersey Health Economy, and for the following reasons:

• You are appealing against a decision by the Pan Mersey APC to accept, reject or position an application for a specific medicine because vital evidence was not considered or incorrect information was considered in the original application.
• You are appealing against a decision made by the Pan Mersey APC because its procedures and policies were not followed.

You cannot use this form if you are appealing against a decision because new evidence has come to light since the original decision was made. In this case, a new business case, highlighting the new evidence, should be made.