Individual funding requests
The Integrated Care Board (ICB) is responsible for using NHS funds fairly and efficiently, considering the health needs of the entire local population. In general, funding is allocated for treatments outlined in the ICB’s commissioning plans.
However, in certain cases, a clinician—often a GP or hospital doctor—may believe that a patient’s condition is significantly different from others with the same diagnosis. If this clinical difference justifies a treatment that isn’t routinely funded, it is considered a case of clinical exceptionality.
In such situations, the clinician can submit an Individual Funding Request (IFR) to apply for NHS funding for the treatment. Patients cannot make these requests themselves; it is the responsibility of the clinician overseeing their care to prepare the IFR and provide supporting medical evidence.
What is an IFR
An IFR is a formal request for NHS funding for a treatment not usually offered. It is only considered under specific circumstances and applies to any clinical intervention not already included in ICB commissioning agreements.
Because NHS resources are limited, funding decisions through IFRs are based on:
- The clinical evidence of the treatment’s safety and effectiveness.
- The degree to which the patient’s condition is clinically exceptional.
- Whether the treatment will deliver the greatest possible health benefit from the available resources.
When can a request be made – heading with drop down
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.
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.
- 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.
What happens to the application – heading with drop down
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.
Appeals process
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 ICBs Clinical Effectiveness Unit 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
More Information
- IFR Policy
- IFR Panel ToR
- Link to Commissioning Policies
- Contact details of team
- IFR Leaflet from Julie
Additional Information for Referrers
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.