Individual Commissioning / Exceptional Funding
A Guide to Exceptional Funding
The PCT is committed to improving the health of the residents of North Somerset, and ensuring that patients are treated at the right time, in the right place, by the right people to the right standard and for the best value. The PCT is responsible for making the best use of its resources to look after the needs of our local population. Our aim is to provide comprehensive, effective and accessible health services.
However, as the demand for health services is greater than the money available, we must carefully prioritise the use of funds. To help us do this, some unusual or uncommon treatments, or treatments which provide only limited benefit, will not be routinely funded. The highest priority for funding will be given to those treatments of proven benefit in meeting the health needs of the population.
Why are some treatments not normally funded by the NHS?
The NHS does not normally pay for treatments or operations if they are:
·
Clinically not effective or their effectiveness
has yet to be determined
·
Restricted in number due to capacity and resource constraints.
·
Only certain people will benefit from treatments or operation
·
Have a low clinical priority and offer little health gain.
For those treatments not routinely funded, the Individual Commissioning Panel will look at each case individually and consider the following factors:
- Evidence of clinical effectiveness
- Evidence of cost effectiveness
- Evidence of health care need
- Equity of health care
- Exceptional need
Applying to the PCT for Funding Approval
Please note that applications must be received from a GP or other healthcare professional such as a Hospital consultant on the appropriate funding application form.
If you are a patient who wishes to access
a specific treatment which is not routinely funded, then ask your doctor to
write to the PCT. You can also write to the PCT to tell the PCT how your
condition affects you and how the treatment will benefit you.
In order to guide the Panel in their decision making, the PCT has developed a number of policies which set out the criteria which allow the patient to access the treatment they wish to have. These policies are available by clicking here.
It may also be necessary to gather additional information from any doctors or healthcare professionals involved in your care.
What Happens Next?
The Individual Commissioning Panel meets regularly and includes doctors, at least one of whom will be a GP (not your own). If there is evidence that your case is ‘exceptional’, we will pay for your treatment or operation. You and your doctor will be sent a letter to tell you the panel’s decision within ten working days of the panel meeting.
Additional Information
In order for the application to proceed as quickly as possible, please
include as much relevant information as possible, such as copies of letters
/ clinical information from Consultants, a photograph of the condition where
appropriate, or clarification as to how the patient's condition fits the
policy criteria.
| ICP application form | ||
| Other useful documents:
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