Download narrative for gp gateway relating to

NARRATIVE FOR GP GATEWAY RELATING TO
INDIVIDUAL FUNDING REQUESTS (IFR)
An Individual Funding Request (IFR) may be made for a treatment, therapy, drug or piece of
equipment because:

The CCG’s routinely commissioned services do not cover the patient’s situation or

The CCG’s commissioning policy does not cover the patient’s situation
An IFR submission needs to demonstrate that the patient:

Has an exceptional clinical condition

Is significantly different to the general population of patients with the condition in question

Is likely to gain significantly more benefit from the intervention than might be expected for
other similar patients with similar circumstances

Is not part of a cohort of patients and, therefore, the request constitutes a service
development and should be considered in the annual round of health service prioritisation
The basis for exceptionality:

The fact that a treatment is likely to be effective for a patient is not, in itself, a basis for
exceptionality

If a patient’s clinical condition matches the “accepted indications” for a treatment that is not
funded, the patient is, by definition, not exceptional

The responsibility for demonstrating exceptionality lies with the requesting clinician, as
support for the case should be based on clinical factors and not social factors
Basis of decision making by the CCG’s Individual Funding Request panel:

Demonstration of exceptional clinical condition

Demonstration of exceptional benefit

Effectiveness

Equitable

Evidence based
What is meant by ‘exceptional clinical circumstances’
NHS Coventry and Rugby CCG has policies and commissioning arrangements, which describe how
the available resources are shared between the treatments of a range of conditions. In many cases
these policies describe the group of patients in whom the treatment will be routinely available and, by
definition, other groups of patients would not ordinarily be able to have the treatment. An exceptional
case may arise when a clinician finds a patient who would not normally be eligible for treatment under
a CCG policy or commissioning arrangements but whom the clinician believes has factors about their
case that mean that they warrant special consideration.
Such cases are given particular scrutiny because not only does a decision to fund the requested care
requires the CCG to find the necessary resources from other areas of care but if the patient were to
have their treatment funded, the CCG would have to make the treatment available to other patients
who have similar clinical circumstances. This would require the CCG to agree a new commissioning
policy (or amend an existing one) setting out that the treatment was now available for a new group
of patients and setting out how this group had been identified.
Therefore, to meet the definition of ‘exceptional clinical circumstances’ it must be demonstrated that
the patient is both:

Significantly different clinically to the group of patients with the condition in question and at
the same stage of progression of the condition for whom the treatment is not routinely
available
AND

Likely to gain significantly more clinical benefit than others in that group of patients with the
condition in question and at the same stage of progression of the condition
In other words, it must be shown that the patient is very different from others in a group of patients
with the same condition/stage of the disease and has clinical features that mean that they will derive
much more benefit from the treatment/therapy/drug/equipment being requested.
Clive Campion
Individual Funding Request Lead
NHS Arden Commissioning Support
Westgate House, Market Street,
Warwick CV34 4DE
[email protected]