A Guide to Individual Funding Requests 

The PCT is committed to improving the health of the residents of South Gloucestershire, and ensuring that patients are treated at the right time, in the right place, by the right people to the right standard and for the best value. The PCT is responsible for making the best use of its resources to look after the needs of our local population. Our aim is to provide comprehensive, effective and accessible health services.

However, as the demand for health services is greater than the money available, we must carefully prioritise the use of funds. To help us do this, some unusual or uncommon treatments or treatments which provide only limited benefit will not be routinely funded. The highest priority for funding will be given to those treatments of proven benefit in meeting the health needs of the population.

Why are some treatments not normally funded by the NHS?

The NHS does not normally pay for treatments or operations if they are:

• Clinically not effective or their effectiveness has yet to be determined;
• Restricted in number due to capacity and resource constraints;
• Only certain people will benefit from treatments or operation;
• Have a low clinical priority and offer little health gain.

For those treatments not routinely funded, the Individual Funding Request Panel will look at each case individually and consider the following factors:

• Evidence of clinical effectiveness;
• Evidence of cost effectiveness;
• Evidence of health care need;
• Equity of health care;
• Exceptional need.

Applying to the PCT for Funding Approval

Please note that applications must be received from a GP or other healthcare professional such as a Hospital consultant on the appropriate funding application form.

If you are a patient who wishes to access a specific treatment which is not routinely funded, then ask your doctor write to the PCT.  You can also write to the PCT to tell the PCT how your condition affects you and how the treatment will benefit you.
 

In order to guide the Panel in their decision making, the PCT has developed a number of policies which set out the criteria which allow the patient to access the treatment they wish to have. These policies are available:

List of Treatments Not Normally Funded

It may also be necessary to gather additional information from any doctors or healthcare professionals involved in your care.

What Happens Next?

The Individual Funding Request Panel meets regularly and includes doctors, at least one will be a GP (not your own) and a lay representative. If there is evidence that your case is ‘exceptional’, we will pay for your treatment or operation. You and your doctor will be sent a letter to tell you what the panel’s decision is within five working days of the panel meeting.

Further information about the Individual Funding Request process can be found here:

Individual Funding Request Leaflet

Individual Funding Request Appeals Leaflet

The Commissioning Advisory Forum

The “CAF” is a joint Commissioners, Primary Care and Secondary Care committee which aims to support the decision-making process, identify local priorities, and develop local commissioning policies for the commissioning of drugs and health care interventions that are not routinely funded.

The committee is comprised of membership of GP representatives from all three Commissioning areas, Medicine Management, Public Health Consultants and Commissioning Managers from each PCT. In addition, each BNSSG based Acute Trust has provision to send their Medical Director or deputy, a Commissioning/Management representative and their Pharmacy Directors.

WAHTand AWMHP can also send representatives to the CAF.

The Commissioning Advisory Forum Leaflet

The Commissioning Advisory Forum Application Template

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