Individual Funding Requests (IFR)
The NHS belongs to us all. It exists to:
- Improve our health and well-being
- Support us to keep mentally and physically well
- Help us get better when we are ill
- Stay as well as we can throughout our lifetime especially when we cannot fully recover
To make sure that the NHS can provide the best care for the maximum number of people it is vital that every penny is spent wisely. This means only funding treatments that have been demonstrated to work and where there is also a high likelihood of benefit for as many people as possible and a low likelihood of harm. We always have to bear in mind that carrying out treatment that is not of great health benefit uses up resources that could be spent on really making a difference elsewhere.
We may decide that a treatment or procedure should not be routinely funded because:
- There is only limited or no evidence of its effectiveness (whether it works or not)
- It is considered a low priority for funding, (for example, cosmetic surgery) compared to other treatments (for example, dementia or stroke care).
When is it appropriate to submit an IFR application?
Where there is a new or rare treatment or a policy specifies a treatment is ‘not routinely commissioned’ meaning a decision has been taken not to commission (fund) that specific treatment, an IFR (clinically exceptional case) Approval will be required. This means treatment will only be funded if the application proves exceptional clinical need compared to other people with the same or similar condition. Funding approval must be obtained via the IFR process prior to any treatment commencing or a patient being placed on a waiting list.
An IFR application can also be submitted when the patient does not meet the specified clinical criteria within a specific treatment policy and where a clinician considers their patient has exceptional clinical need.
Funding applications can be made in either Primary or Secondary Care. Applications for funding should ideally be made by the clinician who has the most knowledge of the condition and intervention the request relates to.
What is clinical exceptionality?
A clinician may think that their patient’s clinical situation is so different to other patients with the same condition, that it is appropriate that they should have a specific treatment. Believing that their patient will gain greater benefit than other patients within the same cohort or similar clinical circumstances. In such circumstances, clinicians, on behalf of their patient, may submit an IFR. This route should only be used in exceptional clinical circumstances and not as a route to gain consideration of funding a new treatment or to start a service development.
There can be no exhaustive description of the situations which are likely to come within the definition of exceptional clinical circumstances. The onus is on the clinician making the request to set out the grounds for clinical exceptionality clearly for the IFR Panel to consider.
The Integrated Care Board (ICB) defines exceptionality solely in clinical terms. Personal or social circumstances will not be taken into consideration. In essence it is a question of equity. To consider personal, social or other non-clinical factors could introduce inequity.
The IFR process
All applications should be submitted by a clinician on behalf of their patient. Please refer to the IFR Decision Making Policy, IFR Management Policy and IFR Standard Operating Procedure for further guidance and information regarding the process.
For patients living in the Cheshire and Mersey area including Cheshire East, Cheshire West, Halton, Knowsley, Liverpool, Sefton, St Helens, Warrington and Wirral, please complete the IFR application form below.
Reconsidering an application which was not approved for funding
If an IFR application has been refused funding the patient or their representative clinician are entitled to ask that the decision be reconsidered.
If a requesting clinician believes they have significant new clinical evidence that they did not previously provide which they think may have made a difference to the decision, then they can submit this new evidence or explain the basis of their disagreement and request reconsideration of their decision.
All reconsiderations must be submitted to the IFR Team, using the designated Reconsideration form. The application and the new information will then be reconsidered in line with the IFR process.
For patients living in the Cheshire and Mersey area including Cheshire East, Cheshire West, Halton, Knowsley, Liverpool, Sefton, St Helens, Warrington and Wirral, please complete the reconsideration form below
IFR process reviews
There is no statutory requirement for the ICB to hold process reviews. However, in line with best practice, the ICB does allow an appeal to be made against the process that was followed to arrive at the decision.
All process reviews must be made in writing using the designated form and submitted to the IFR Team within 12 weeks of the decision. Requests for process reviews must be supported by the clinician who submitted the original application and set out the grounds on which the IFR decision is being challenged.
For patients living in the Cheshire and Mersey area including Cheshire East, Cheshire West, Halton, Knowsley, Liverpool, Sefton, St Helens, Warrington and Wirral, please complete the designated form below:
Individual Funding Request Team
Contact details - Clinicians only
Tel: 01244 650315
If you are a patient and have an enquiry about an IFR application or the process please speak with your clinician in the first instance.