Clinical commissioning groups (CCGs) commission local NHS health services and NHS England commissions highly specialised health services. Both organisations use national and local policies to prioritise treatments based on available resources and competing demands. This web page relates solely to services commissioned by Northern, Eastern and Western Clinical Commissioning Group. If you require further information about access to specialist services, please contact NHS England.
What are the options for patients and clinicians if a treatment is not commissioned?
NHS NEW Devon CCG commissioning policies can be found here
We recognise that there will always need to be a process for considering making additional NHS funding available for the atypical or uncommon patient. The Northern, Eastern and Western Devon Clinical Commissioning Group have an Individual Funding Request Panel to perform this function.
Where a commissioning policy exists, the Individual Funding Request Panel considers whether there are sufficient grounds to agree funding for a treatment contrary to our commissioning decision not to fund the treatment for the population in general. The process for consideration in these circumstances is whether ‘exceptionality’ has been demonstrated by the evidence presented.
Where no commissioning policy exists, the Individual Funding Request Panel will consider whether ‘individual funding’
can be supported.
The following bullet points set out some of the key guiding principles for our Individual Funding Request Panel:
Clinical need – your GP, hospital consultant or healthcare professional must provide evidence of this when submitting your application using their clinical judgement
Evidence of clinical and cost effectiveness – evidence is required to demonstrate the clinical and cost effectiveness of the treatment, drug, operation, referral or second opinion. The proposed treatment must be the most cost effective option that meets your clinical need
Impact of refusal – what would happen if treatment was denied? What alternatives might be available?
Exceptionality – there must be an exceptional reason as to why you need to be treated over and above other patients with similar conditions, for whom treatment is not available.
What is the role of the Individual Funding Request Panel?
The role of Individual Funding Request Panel is to consider applications for funding for treatments, on a case-by-case basis that fall outside existing contracts, or for which prior approval is required within existing contracts.
Who can apply for funding?
The Individual Funding Request process applies to individuals who require treatments, drugs or therapies that NHS commissioning organisations do not generally fund.
How can I access the service and have an application considered?
To access the Individual Funding Request process, you should approach your GP or specialist clinician and ask them to submit an application on your behalf.
Applications should be submitted by clinicians to the Individual Funding Request Panel via our generic email address: firstname.lastname@example.org
Can I challenge a decision made by the CCG’s funding panel?
The decision of the Individual Funding Request Panel cannot simply be challenged because you or your clinician disagrees with the outcome. If you are unhappy with the decision, you have the right to make a complaint to the responsible commissioner and you should follow your Clinical Commissioning Group’s complaints procedure to do this.
If you do not feel that the Individual Funding Request Panel followed due process however, you can ask the Clinical Commissioning Group to review its decision.
The decision making process can be reviewed on request by the Clinical Commissioning Group’s Treatment Decision Review Panel. This panel is chaired by a member of the senior leadership team and will also include a non-executive director and a senior doctor.
The review panel checks:
That the funding panel considered all the evidence provided by your clinician correctly
Whether new evidence has emerged that was not available at the time your request, which might alter the funding decision
That the funding panel acted in accordance with the applicable CCG policies
Please note that a number of these policies are currently under review.
For patients thinking about having investigations or medical treatment in another European country, it is important to understand how the process works and the risks involved.
If patients do not follow the correct procedures, there is a risk that individuals will end up being responsible for the full cost of treatment.
provides further information about accessing NHS Funded Healthcare in other EEA countries.
The cost of investigations and treatments that NHS NEW Devon CCG does not routinely fund in the UK will not usually be met (e.g. policies relating to restrictions on which service or treatments will be funded by the NHS in the UK will also apply when accessing treatment abroad).
Patients may need to apply for funding prior to treatment. If individuals are not sure whether prior authorisation is required they must contact NHS NEW Devon CCG, prior to arranging any treatment. This will enable NHS NEW Devon CCC to confirm their eligibility and the funding or reimbursement process.
All Individual Funding Requests should be sent to: email@example.com
If you need to provide photographs to support a request, these should be sent to:
Please note: a maximum of four photographs can be provided to support any single application.