Individual Funding Requests
On an individual basis, there may be situations where a clinician believes that their patient’s clinical situation is so different to other patients with the same condition that they should have their treatment paid for when other patients would not.
In such cases, NHS clinicians can request to fund a treatment which would not usually be provided for that patient. This request is called an Individual Funding Request (IFR).
Applying for a Personal Health Budget
The standard IFR application form must be used for all requests. The request will not be progressed if not completed on an IFR form. This form can be found in Appendix One of the IFR policy. It is also available in Microsoft Word format or via the Blueteq database. The word version should be submitted (as well as a PDF copy with signatures if necessary) to the IFR team (via the email address on the form) only if access to the Bluetec system is problematic.
Individual Funding Requests in Surrey Heartlands
Making the best use of our limited resources and prioritising what we spend public money on is crucial in providing the best possible NHS service across Surrey Heartlands.
Our primary responsibility is to decide which treatments and services should be funded for our designated population. This includes applying robust criteria to how services and treatments should be funded.
To help us prioritise, we use national and local policies to ensure that the treatments and medicines we commission (pay for) have a clinically proven benefit in meeting the population's health needs.
This means that we will not routinely fund individual treatments or medicines without clinically proven benefits. For some procedures or medicines, we will fund subject to national and local criteria being met.
For information about procedures, go to the Policies and processes (Clinical policies section) page of this website to view:
- List of procedures that are not routinely funded requiring individual funding applications
- List of Procedures with Restrictions and Thresholds
- Assisted Conception Policy (including Operating procedures for managing Assisted Conception applications)
- Clinical Commissioning Policy: Individual Funding Requests
- Standard Operating Procedure: Individual Funding Requests (IFR)
For information about medicines, go to the Surrey Prescribing Advisory Database.
What are procedures and medicines with restrictions and thresholds?
Alongside providing routine healthcare, the ICB also commissions highly specialised health services requiring clinicians to consider unusual treatments that may meet their patients' needs.
The ICB has reviewed the evidence of clinical effectiveness, as well as information on current national activity and cost-effectiveness, and has put in place criteria for decision-makers concerning those procedures within the 'List of procedures with restrictions and thresholds' policy and the PAD for medicines.
I do not meet the criteria / the procedure or medicine I need is not listed. What can I do?
If you do not meet the criteria, you may still be eligible to receive funding for treatment if there's evidence that your circumstances are clinically exceptional – in which case you may be eligible for 'individual funding.' Again, your clinician would have the option of submitting an individual funding request.
Likewise, if the procedure you require is included within the list of procedures that are not routinely funded requiring individual funding applications policy, your clinician would have the option of submitting an individual funding request.
If the medicine you require is not listed on the PAD, it may be because the drug is funded by NHS England rather than the ICB. Your consultant will be able to advise you in this instance.
How are IFRs considered?
The requesting clinician or their representative submits IFRs. Please note; that patients are not eligible to submit applications.
All IFRs are reviewed via a screening process to determine whether the requesting clinician appears to have presented an arguable case for the clinical exceptionality of their patient compared with other patients with the condition. If so, then the application will be considered by the next available IFR Panel. The IFR Panel meets monthly and includes lay members and GP representation.
Suppose the IFR Panel considers that there is evidence that your case is clinically exceptional. In that case, the proposed procedure or medicine is likely to be clinically effective and is regarded as a cost-effective use of NHS resources. Therefore, the ICB will pay for your treatment.
The IFR Team will notify the requesting clinician of the Panel's decision within ten working days of the meeting.
The IFR Panel may refuse a funding request, and this is always a difficult decision. In this case, the IFR Team will provide a detailed response to the requesting clinician (and the patient if requested), confirming the rationale for the decision to decline to fund.
How can I challenge a decision made by the IFR Panel?
A clinician, the patient, or representative may request the ICB to review an IFR Panel decision process. The request should be emailed to either the ECI or Medicines Management Team. Such appeals must be lodged within 20 working days of the date of the letter from the ICB IFR Panel Chair to the requesting clinician setting out the IFR Panel decision.
The request for review must be supported by the requesting clinician, who will set out the grounds on which the IFR Panel decision is being challenged.
The IFR Review Panel will only be able to consider whether the process followed by the IFR Panel was fair and consistent, based on whether the decision reached:
- Was taken following a process that was consistent with policy;
- Was a decision that a reasonable IFR Panel was entitled to reach;
- Understood, took into account and weighed all the relevant evidence; and
- Did not take into account any irrelevant factors
A process review cannot be requested to review a decision made at the screening stage.