Every year the CCG receives money from the Government to pay for healthcare for everyone registered with a GP in the area. The NHS has limited resources, and we have a duty to manage them carefully.
Demand for healthcare is growing. New and often expensive treatments are becoming available all the time. Our priority is to pay for those medicines and treatments that have good scientific evidence for their safety and effectiveness and offer good value for money.
As a result there are some treatments we do not normally pay for. This is when a GP could refer your case to the Individual Funding Request (IFR) process.
What happens if a treatment is not normally available?
Your clinician can make an IFR for either of two reasons:
(a) for treatment which is not routinely funded
(b) or for a treatment which is funded in line with specific criteria, which you do not meet.
For either of the above, funding can only be approved if a case of “exceptional clinical need” has been
What is “exceptional clinical need”?
A patient may be considered to be clinically exceptional to the general policy if both of the following apply:
- the patient is significantly different from the general population of patients with the condition in question and
- the patient is likely to gain significantly more benefit from the intervention than might normally be expected for patients with that condition.
The IFR Panel
On behalf of our CCG, the Individual Funding Request (IFR) Team manages around 200 cases a year; each request is considered on an individual basis and a decision is made based on the CCG's commissioning policy for the treatment or procedure.
A joint North Yorkshire CCG IFR Panel meets fortnightly to consider requests; the Panel consists of two GP decision-makers taken from a pool of eight GPs from across all four North Yorkshire CCGs. In addition, a number of IFR staff attend the Panel to present the cases and provide administrative support and advice.
A patient may be considered clinically exceptional if BOTH of the following have been demonstrated:
- The patient is significantly different from the general population of patients with the condition in question
- The patient is likely to gain significantly more benefit from the intervention than might normally be expected for patients with that condition.
It is important to note that only evidence of clinical need will be considered. Factors such as gender, ethnicity, age, lifestyle or other social factors such as employment or parenthood cannot lawfully be taken into account.
- Leaflet: Will the NHS fund my treatment? (PDF 408KB)
- Leaflet: My Individual Funding Request has been declined, what can I do now? (PDF 379KB)
- Policy - IFR (please note that a referral form is located in the Referral Form area of the website and is for clinical access only)
Please contact CCG Patient Relations with IFR queries