Individual funding requests

The NHS belongs to us all. To make sure that we can provide the best care for the maximum number of people, it’s vital that we make every penny count.

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Carrying out treatments or procedures which are not of great health benefit uses up resources that could be spent on really making a difference elsewhere. However, it is important to remember that, while the NHS does not want to carry out treatments or procedures which have little health benefit in general, there may be overwhelming health benefits for an individual patient.

In these cases, a doctor or other clinician, on your behalf, may ask NHS Fylde and Wyre Clinical Commissioning Group (CCG) to consider funding the treatment.

If your referring clinician thinks that one of the two reasons below applies, your case will be put forward to a commissioning request panel:

  1. The treatment for your medical condition is not covered by a CCG policy.
  2. The NHS has a policy not to routinely fund the treatment requested, but your doctor or clinician feels there are ‘exceptional clinical circumstances’.

What is a commissioning request panel, and why is the request to fund my treatment being referred to it?

The panel is made up of doctors and other clinicians who will look at your individual case and decide whether the NHS will change its normal rules to fund your treatment.

What does exceptional mean?

Your circumstances may be considered exceptional if they are significantly different to other patients who have the same condition as you.

It is important to note that the panel cannot consider psychological or social circumstances as grounds for exceptionality.

How long does it take to make a decision?

While we need to properly consider whether to approve or decline a request, we will try to make a decision as quickly as possible. The time taken to make a decision will depend on:

  • What the request is for
  • Whether additional clinical information is required
  • If the request falls under the CCG’s commissioning policies
  • If the request is routine or clinically urgent

Can I tell the panel why I think my circumstances are exceptional?

You can provide a statement of your particular circumstances if you wish. Your referring clinician will be able to send this to the panel on your behalf. However, your referring clinician will need to supply the clinical rationale for exceptionality.

How will I find out about the panel’s decision?

Your referring clinician will be informed of  the panel’s decision in writing. You will also receive a copy of this letter.

If the panel decides your treatment can go ahead, you will be able to discuss the practical arrangements with your referring clinician.

If, based on the clinical evidence, the panel decides your circumstances are not exceptional enough for the treatment to go ahead, you will receive a full explanation about why this decision has been taken. You may want to talk this through with your referring clinician, and they will be happy to do so.

Can I appeal against the decision?

There are two ways in which you can appeal if you or your referring clinician are unhappy about the decision.

Firstly, you can provide extra clinical evidence and ask the panel to reconsider your request. You may wish to consider seeking assistance with this via your referring clinician.

Secondly, you can challenge the process by which the decision was reached. This process is in place to make sure that the NHS has followed all the correct procedures and that the decision was a reasonable one. Again, you may wish to seek assistance from your referring clinician when submitting a request for appeal. Alternatively, you may wish to contact our customer care team on freephone 0800 0322424 or 01772 777952. You can also email: MLCSU.customercarelancashire@nhs.net and ask them to provide you with a list of advocacy agencies within your area.

If your request is refused, the decision letter will provide details of the appeals process.

For more information

If you would like to discuss this further, your referring clinician will be pleased to do so. Alternatively, if you need any further information regarding the IFR process, the IFR team can assist you and they can be contacted on 01772 214 030 or via email on funding.requests@nhs.net

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