It is possible to make an IFR in the following situations:

• When the ICB does not have a policy stating who can have the treatment that is being requested
• When the ICB has a policy, but the patient’s clinical circumstances do not meet the criteria for treatment
• When the ICB has a policy stating that it will not routinely fund the treatment
• When the patient has a rare medical condition that is not covered by an ICB policy.

The referring clinician is responsible for keeping the patient updated throughout the process and clearly explaining the outcome of the IFR.

What does exceptional mean?

The patient’s clinical circumstances may be considered to be ‘exceptional’ if:

• The patient has clinical features that makes the patient significantly different from other patients who have the same clinical condition.

Exceptional does not mean

The fact that a treatment is likely to be successful in producing the desired or intended result is not by itself an exceptional circumstance.  The Panel has to consider if there is likely to be a group of patients:

• With the same or similar clinical circumstances, OR
• Whose clinical condition means that they could make the same request, OR
• Who could be expected to benefit from the requested treatment to the same or similar degree.

Individual personal and social circumstances will not be part of the decision, the decision is purely a clinical decision.

If the request is not covered by an existing policy, or the patient falls outside the criteria of a policy, the request will be triaged by the IFR Team and if necessary, referred onto the HNY IFR Panel. They generally meet once a month. The IFR Panel includes at least two clinicians.

IFR applications are taken through a formal, clinically-led triage and, where this is appropriate, referred on to a monthly clinically-led IFR panel for a funding decision.

Decision making is based on the ICB’s Individual Funding Request Policy.  We aim to make these difficult choices in a robust way which is fair, clear and consistent. If the Panel considers the request to be exceptional, it reviews the following criteria:

• Clinical effectiveness (If the treatment is likely to be beneficial and safe.) 
• Cost effectiveness (How much it costs to achieve the health benefit predicted. The proposed treatment should be the most cost-effective option that meets the clinical need.)
• Affordability (Resources used to support an individual patient will reduce the availability of resources for other treatments or services.)
• Exceptionality (Clinical exceptionality of the patient within the group/cohort of patients.)

Information submitted to the Panel is anonymised. Only the patient’s medical condition will be considered as part of the IFR process. Social and personal circumstances cannot be taken into account.  These factors cannot set the patients case apart from that of another patient without implying that one patient is more deserving than another because of who the patient is or what the patient does.

If there are likely to be other similar patients who would also benefit from the requested treatment, the Panel cannot agree funding under the IFR process. In this instance the ICB may need to consider developing a case for change for a new service the evidence for which will be considered by ICBs prioritisation and commissioning investment/disinvestment process and may ask for the referring clinician to submit a Business Plan.

Decisions are communicated through the IFR system within 10 working days of the IFR Panel meeting. Once a decision has been uploaded the referring clinician will receive a notification via email.

If a funding request is declined by the IFR panel, the referring clinician can ask for it to be reconsidered but only if new, clinically significant information or evidence is provided.  Patients are unable to ask for a reconsideration directly.

If your individual funding request (IFR) has been declined, your referring clinician may submit an appeal—if there are valid grounds to do so.

Appeals are reviewed by a separate panel from the original IFR panel to ensure fairness and avoid any conflicts of interest. An appeal must be submitted by your referring clinician within three months of the original decision. An appeal can only be considered if there is evidence that the IFR process wasn’t properly followed. For example:

• Relevant evidence or important information was not taken into account
• The panel applied the decision-making criteria incorrectly

The following will be links to the actual documents

• IFR Policy
• IFR Panel ToR
• Link to Commissioning Policies
• Contact details of team
• IFR Leaflet from Julie

The ICB can only consider requests for funding for patients who are registered with a GP within the Humber and North Yorkshire Integrated Care Board (HNY ICB) area. IFR applications for patients who reside outside of Humber and North Yorkshire, please follow the relevant ICB IFR process. The HNY ICB Places are as follows: East Riding, Hull, North Lincolnshire, North East Lincolnshire, North Yorkshire, York

Referrers are asked to note that when considering a provider, NHS funding remains subject to an appropriate qualifying NHS Standard Contract being established between the Provider and an ICB which explicitly states the location and services/specialties covered by the contract. The ICB will validate activity invoices following the provision of the qualifying contract and against activity data submitted to SUS (where applicable). Providers are responsible for ensuring they are fully compliant with the nationally directed requirements prior to accepting referrals. Where a qualifying contract has not been established, providers are advised to request further pre-payment approval from the contracting team in your local ICB to avoid the risk of non-payment.