An individual or exceptional funding request is a request for a drug or treatment of a lower priority or where a drug or treatment is not normally commissioned by the NHS.
The Exceptional Cases Panel is authorised by the Governing Body to process requests for exceptional treatments (procedures, drugs or health care services) that are:
- Undertaken outside the criteria agreed locally for surgical thresholds.
- Classified as low priority treatments.
- Tertiary referrals, ie to a Consultant or a service not covered by contracts with local providers or not covered by the ‘Choice’ policy.
- Drugs not funded for routine prescribing eg primary care Red List or drugs outside secondary care contracts that practices may be asked to prescribe or support for your patients.
Surgical thresholds are produced with the help of local primary and secondary care clinicians; and approved by Joint Clinical Professional Executive Group (JCPEG) and/or Governing Body. The thresholds provide criteria to be used by GPs for referral and by providers before performing that surgical procedure.
Low priority treatments
Low priority treatments are usually of unproven clinical effectiveness, poor cost effectiveness or of low overall priority, eg cosmetic procedures or treatment for benign skin lesions. Policies for low priority treatments have also been developed by the Clinical Policies Forum.
The Exceptional Cases Panel
The Panel considers funding requests for exceptional treatments (defined above). Where the clinician feels that the patient should be considered for treatment as an exception, a request for funding can be made to the Exceptional Cases Panel, which meets every other week (bi-weekly).
The Panel considers requests for funding of treatments on the basis of the information provided by the clinician. It is essential for the clinician to complete the application form giving as much details as possible, particularly the criteria for exceptionality and quantification of the benefits of the proposed treatment.
Request form and the policy for exceptional/individual funding requests
The funding request form gives detailed guidance on what information should be provided to the Panel, definition of exceptionality, etc. A Patient Consent Leaflet is also available. The Exceptional and Individual Funding Requests Policy provides information on the funding request processes.
For further information contact:
Exceptional Cases Team
Cambridgeshire and Peterborough CCG
Cambridgeshire Business Park
Cambridgeshire CB7 4EA
Tel: 03 300 571 027