last updated 21 June 2016
What is an IEFR?
An Individual Exceptional Funding Request (IEFR) is a request to fund healthcare (including high cost drugs) for an individual who falls outside the range of services and treatments that are routinely commissioned. An IEFR is prepared by a patient’s clinician to demonstrate that there are exceptional clinical circumstances which are different to other patients with the same condition and at the same stage of their disease and how the treatment requested will be beneficial. An IEFR may also be a request for a treatment that is regarded as new or experimental, that is not yet routinely commissioned, and where there are no other similar patients who would benefit from this treatment.
Which services are commissioned by NHS England and which are commissioned by the CCG?
NHS England is responsible for managing applications for funding for specific individual patients where the specialised service treatment falls outside of nationally-agreed service specifications and policies. Guidance relating to this can be accessed here.
Clinicians are required to make a decision as to whether the treatment/service their patient requires is commissioned by their local CCG or nationally through NHS England
To support this decision a manual describing which elements of specialised services are directly commissioned by the NHS England and which by CCGs has been produced and can be accessed here.
The current Clinical Commissioning Policy, agreed for all CCGs in Cheshire and Merseyside can be accessed here. Changes to this policy will be made public as soon as these are approved.
Who can make an application for an IEFR?
A clinician, or other health care professional directly involved in the care of a patient, can make an IEFR request. It is the referring clinician’s responsibility to ensure the treatment request form is completed as accurately and comprehensively as possible to avoid possible delays in considering the request. Requests submitted by a Secondary Care Consultant fall within the 18 week RTT rules and the clock cannot be stopped whilst awaiting a decision re funding.
How do I make an application to NHS England?
An application must be made by a clinician on behalf of the patient. The NHS England IEFR application form can be found here.
How do I make an application to the CCG?
An application must be made by a clinician on behalf of the patient. To make an IEFR, the clinician (applicant) should complete a pro-forma supported by relevant clinical assessments. (There are two standard pro-formas – one for high cost drugs and one for all other treatments). Consent to share information about the patient must be sought from the patient before completing the proforma and this should be indicated on the form. This information will be treated in accordance with the Data Protection Act.
The proforma should then be sent to the following address:
Countess of Chester Health Park,
Tel: 01244 650597
Fax: 01244 650377
What happens when the application is received?
The application will first be screened for completeness of the application, and then reviewed against local commissioning policies and where possible a decision will be made.
If a decision cannot be made on this basis, the request will be reviewed by the IEFR’s clinical panel
If the clinicians cannot make a decision, further information may be requested. We will review this new information and make a decision.
If it is still not possible to arrive at a decision, the request will be considered by a multi-disciplinary panel of Public Health, Pharmacists and GPs. At each stage we will let the applicant know what has been decided.
How long will it take to reach a decision?
A decision will usually be communicated within 56 working days of receipt of application. Occasionally, when the case is particularly complex it may take longer than this to reach a decision, however the applicant will be kept informed of any delays which may occur.
How often are IEFR panels held?
Three IEFR panels are held every month. Each panel will review cases from all areas covered by the Commissioning Support Unit.
Who is on the Panel, are they all experts?
Each panel consist of a number of core members including:
Medicines Management representation
Representative from Public Health
Any other members who may be invited at the discretion of the Chair of the Panel (who is a CSU representative), to provide expert advice
What about urgent applications?
An urgent request is one which requires consideration and a decision because the patient faces a substantial risk or significant harm if a decision is not made quickly.
Urgency cannot arise as the result of failure by the clinical team to expeditiously seek funding through the appropriate route and/ or where commitments have been given by a health care organisation to provide a specific treatment to the patient. In such urgent circumstances the CCG will expect the NHS trusts to proceed with treatment. IEFRs may not be made in retrospectively once treatments have begun.
When/How will I be notified of the decision?
Applicants will be informed of the decision within 10 working days of the decision being made. There are times when an IEFR may be refused and this is always a difficult situation. A detailed response on the outcome for the decision will be provided within the decision correspondence.
Decisions are normally sent out via letter, however, it is possible for a copy of the letter Where there is additional new information, complex clinical factors, or where further clinical advice/other specialist information can be provided, this should be submitted to facilitate further review.
What if I disagree with the process followed to reach the decision of my application?
An Appeals Panel is convened to consider appeals against the decision of the IEFR Panel, and specifically whether:
The original IEFR Panel acted fairly and followed the CCG procedures and policies.
The IEFR Panel considered all relevant factors and did not take into account irrelevant factors.
The IEFR Panel made a ‘reasonable’ decision in the circumstances i.e. not irrational or perverse.
There was any important relevant clinical information that IEFR was not aware of when it made its decision.
An appeal must include details as to why the decision is being appealed
Can you inform patients directly of the decision?
Unfortunately the IEFR Team cannot inform patients directly on the outcome of the application at this time. The outcome should be discussed with the patient by the clinician who made the application to ensure that any further decisions relating to the outcome can be discussed and then acted upon.
What about retrospective applications?
Unfortunately, we do not accept applications for retrospective funding.
Who do I need to contact if I have any questions?
Applicants (the clinician applying on behalf of a patient) can contact the IEFR Team on:
Midlands and Lancs Commissioning Support Unit,
Countess of Chester Health Park,
Chester, CH2 1HJ
Tel: 01244 650305
Fax: 01244 650327
If you are a patient with a query, please contact the clinician applying on your behalf.
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