Individual Funding Requests (IFR) and Priorities Policies
NHS Milton Keynes CCG has the legal obligation to promote the health of the local population but also not to exceed its annual financial allocation. It has adopted a range of policies to assist with its management of lower priority treatments, surgical and clinical procedures, and high cost drugs. These policies describe the interventions and indicate under which circumstances such interventions are funded and whether prior approval from the Individual Funding Review Panel or the MK Priorities Panel is required. The CCG is required to have a process for considering funding for individuals who seek NHS commissioned services outside established commissioning policies.
Individual Funding Requests
There are in general two types of requests that come before an Individual Funding Request (IFR) Panel, namely:
Requests for funding treatments for medical conditions where the CCG has no established commissioning policy (as shown by CCG policy or the treatments which are approved for routine funding in service agreements).
Requests for funding treatments for medical conditions where the CCG does have an established commissioning policy for that condition but where the requested individual treatment is not in the CCG policy or does not meet the criteria set out in the policy.
This policy requires requests in the first category to be considered against the tests of clinical effectiveness, cost effectiveness and affordability provided the requesting clinician is able to demonstrate that the patient represents an Individual Patient (as defined in this policy who does not have exceptional clinical circumstances).
For patients in the second category the policy requires, as a threshold condition, the requesting clinician to demonstrate that the patient has exceptional clinical circumstances. If the clinician demonstrates that the patient has exceptional clinical circumstances (as defined in this policy) the request will be considered against the tests of clinical effectiveness, cost effectiveness and affordability.
NHS Milton Keynes CCG inherited a range of policies developed by a regional group of PCTs comprising Milton Keynes, Oxfordshire, Berkshire East, Berkshire West and Buckinghamshire (MOBBB) and previously Milton Keynes and Buckinghamshire PCTs (BMKPC). These policies were formally adopted by the CCG at its Board meeting on 24 April 2013.
As of December 2013 Milton Keynes CCG has updated its priority policies. The following cohorts of patients should not normally be referred for treatments designated as requiring funding approval:
Patients with a BMI of 35 or greater.
Patients who smoke who have not COMPLETED a smoking cessation course prior to referral
GPs of patients falling into these groups will discuss individual circumstances with patients and support them on a case by case basis.
A number of interventions which were responsibility of PCTs have been transferred to NHS England as part of their Specialised Commissioning service. These policies are listed here.