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Individual funding requests

 

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

Completed funding request forms should be returned to:

Email

Halton, Knowsley, Liverpool, South Sefton, Southport and Formby, St Helens CCGs: ifr.manager@nhs.net

Eastern Cheshire CCG: easterncheshireccg.ifr@nhs.net

South Cheshire CCG: southcheshireccg.ifr@nhs.net

Vale Royal CCG: valeroyalccg.ifr@nhs.net

Warrington CCG: warringtonccg.ifr@nhs.net

West Cheshire CCG: westcheshireccg.ifr@nhs.net

Wirral CCG: wirralccg.ifr@nhs.net

Post

North West Commissioning Supporting Unit
Individual Funding Request Team
1829 Building
Countess of Chester Health Park
Liverpool Road
Chester
CH2 1HJ