For treatments with restricted access, patients need to meet certain criteria to be offered a particular treatment on the NHS.
Some evidence-based treatments or interventions have to go through a prior approvals process. If a clinician considers that a patient meets the criteria to have NHS funded treatment, they will need to seek prior approval by making an application treatment from the funding team at the ICB. The funding team will consider each case and give approval on a patient-by-patient basis.
The treatments and procedures that need prior funding approval are covered by policies that set out the eligibility criteria for patients.
We keep policies under continual review and make changes where needed to reflect changes in factors, including the most up to date clinical evidence.
If you do not meet the criteria for a particular procedure, the doctor or consultant looking after you can make an Individual Funding Request for you to have your procedure on the NHS if they believe that you have ‘exceptional’ clinical circumstances.
If you are assessed and do not meet the criteria for a particular treatment at that time, but your health circumstance subsequently change so that you do meet the criteria, you can talk to your doctor about being reconsidered for a treatment.