Individual funding requests.

The NHS cannot always fund drugs, operations or other care that is not routinely funded by the NHS. Normally this is because they:

• Are clinically not effective or effectiveness has yet to be determined
• Are not cost-effective in comparison to all the competing demands on NHS funding
• Have a low clinical priority and offer little health gain
• Are largely cosmetic in nature.

Sometimes we will consider paying for a treatment or operation that is not normally funded. This happens when:

• You have a set of circumstances that are very different from anyone else with the same, or a similar, condition.  Your health professional will need to explain how you will derive greater benefits from the intervention than others who are in a similar position
• And there is good evidence to suggest that you would be healthier after the treatment or operation

Individual funding request panel

In Devon, the individual funding request panel considers applications for funding for treatments, based on the following:

• Clinical need – your GP, hospital consultant or healthcare professional must provide evidence of this when submitting your application using their clinical judgement
• Evidence of clinical and cost-effectiveness – evidence is required to demonstrate the clinical and cost-effectiveness of the treatment, drug, operation, referral or second opinion. The proposed treatment must be the most cost-effective option that meets your clinical need
• Impact of refusal – what would happen if treatment was denied? What alternatives might be available?
• Exceptionality – there must be an exceptional reason as to why you need to be treated over and above other patients with similar conditions, for whom treatment is not available.

Making an application

Only your doctor or another health professional, such as consultants or specialists, can make an individual funding request to NHS Devon.

Applications should be submitted by clinicians via email.

Guidance on completion of IFR applications

Please note that NHS Cornwall and Isles of Scilly and NHS Devon ICBs have established joint cluster working arrangements ahead of a formal merger. As a result of integrated working between Devon and Cornwall IFR teams in the interim, data may be shared and accessed by a limited number of IFR staff across both ICBs to support the effective functioning of IFR processes. All information will be handled securely and confidentially in line with data protection requirements.

Challenging a decision

The decision of the individual funding request panel cannot simply be challenged because you or your clinician disagrees with the outcome. If you are unhappy with the decision, you have the right to make a complaint.

If you feel the panel did not follow due process, you can ask NHS Devon to review its decision via the treatment decision review panel. The panel is chaired by a member of the senior leadership team and will also include a non-executive director and a senior doctor.

The review panel checks:

• That the funding panel considered all the evidence provided by your clinician correctly.
• Whether new evidence has emerged that was not available at the time your request, which might alter the funding decision.
• That the funding panel acted in accordance with the applicable NHS Devon policies.

Documents and further information

For more information, please email the individual funding request team.

All policies, documents and application forms related to individual funding requests are available to download.