Some treatments are not usually funded by the NHS. However, if an NHS clinician (such as a doctor or other health professional) believes that there are exceptional clinical reasons why you should have an NHS treatment that is not offered other patients with that condition, they can make an Individual Funding Request (IfR) on your behalf. In the application, your clinician will need to explain why your clinical circumstances are different and show all available medical evidence for why they believe you would benefit more from the treatment than other patients with the same condition. This is a purely medical judgement – your personal or social circumstances will not be part of this decision.
Individual Funding Requests are considered by an independent panel who have not been involved in the patient’s treatment. The panel is made up of doctors, nurses, public health consultants, pharmacists, ICB representatives and lay (non-clinical) people and is led by a lay chair. The panel assesses the request and decides whether the integrated care board should fund the treatment.
Individual funding requests (IFR) policy, forms and supporting documents
IFR PoliciesWhen can someone make an individual funding request?
An individual funding request can be made for a treatment that is not routinely offered by the NHS when:
- Your clinician believes that your medical circumstances are clearly different from other patients with the same condition; and
- There is a reason why you would respond differently to other patients – and therefore gain more clinical benefit from the treatment.
In the application, your clinician will need to explain why your medical circumstances are different and show all available clinical evidence for why they believe you would benefit more from the treatment than other patients with the same condition. They will also explain to you why they believe a treatment that is not routinely offered by the NHS is the best treatment option for you.
Patients understand their symptoms better than anyone and may be very well informed on their condition. If you’re aware of a treatment that you think may help you, discuss it with your clinician who can advise you if an individual funding request would be appropriate.
If there are likely to be other patients with similar clinical circumstances who might benefit from the treatment in a similar way, your clinician can request that we consider introducing it as a routine treatment.
If the funding is approved, the clinician can then make the treatment available to you.
Can an individual funding request consider other factors apart from clinical exceptionality?
Every person has the same rights to treatment under the NHS no matter what their social, family or other circumstances are. To ensure fairness and avoid discrimination, the IFR process only considers medical factors.
Personal circumstances such how a treatment might affect a patient’s ability to work or study, care for dependants, or meet financial commitments can’t be considered as part of the IFR process.
Who considers the application?
We check your application to make sure all relevant information has been submitted and that it meets the criteria for an individual funding request.
Your request is then considered the Hertfordshire and West Essex IFR panel. This is an independent panel of professionals who have not been involved in a patient’s treatment. It is made up of doctors, nurses, public health consultants, pharmacists, ICB representatives and lay (non-clinical) people and is led by a lay chair. Your personal details will be kept confidential.
The panel will consider your application in detail before making a funding decision, usually within a few weeks. All panel members regularly receive training to enable them to assess individual funding requests fairly and thoroughly.
Funding a treatment for someone that is not usually available on the NHS is has financial consequences and every application needs to be considered very carefully.
How long does it take to reach a decision?
If all the required information is submitted, it usually takes 30 working days from receiving an application to a decision. If we need to ask your clinician for additional information, this may cause a delay.
Urgent cases can be processed more quickly, if clinically necessary.
How will I find out the panel’s decision?
We will let your clinician know the outcome and you will also be sent a letter.
If your application is unsuccessful, your clinician will discuss with you the reasons for the decision and what other treatment options may be available.
If the funding is approved, the clinician can then make the treatment available to you.
What do I do if I disagree with the decision?
If the IFR panel declines your request, or if it has approved a treatment subject to conditions you don’t agree with, you should speak to your clinician.
Your clinician can request a review if you think the process wasn’t followed correctly. Reviews must be requested within 28 days of when you were informed of the decision.
If your situation changes or more clinical evidence becomes available about the effectiveness of your treatment, your clinician may also be able to submit additional information for consideration.
If you have any queries abotu funding for particular services please talk to your GP or call our Individual Funding Requests team on 01707 685353 or 01707 685354.