Individual patient treatments

Requests for individual funding

Like any other organisation, the NHS has limited resources and we have a duty to manage them carefully. This means we have to:

• look at evidence for the safety and effectiveness of any treatment;

• ensure that the services we pay for will give patients the greatest health gains from the finite resources we have.

This means that we have to make decisions about what treatments can be routinely funded and be available to you through the local hospitals and what treatments can only be provided under special circumstances or with prior approval from your Primary Care Trust (PCT).

A joint policy exists between NHS Bournmeouth and Poole and NHS Dorset that sets out the principles behind our decisions on individual treatment funding. It also explains the system we have for processing requests for treatment. This policy is called Joint Policy for Commissioning Treatments for Individual Patients.

There are a number of treatments that are not routinely funded by your PCT. These may include cosmetic surgery, apronectomy, complementary or alternative therapies, removal of ganglia and benign lumps. Such treatments are often referred to as “low priority procedures”.

How we make our decisions

The PCT has clear processes for approving new medicines and treatments. New treatments are considered by Clinical Commissioning Groups and the Elective Care Forum.

These forums review new and emerging technologies deciding whether to fund new technologies by assessing the clinical effectiveness of treatments (do they work and what are the benefits when compared with existing treatments?) and their cost effectiveness for the local area.

Where there are big cost consequences for the PCT, but proven health benefits, the final decision rests with the Board of the PCT who will prioritise the new treatment in relation to other services.

New medicines are considered by the Prescribing Forum who look at the effectiveness and efficacy of new medicines and decide what new medicines will be approved for funding. Funding of new drugs is generally decided before the beginning of each financial year. It also reviews medicines that have just been licensed.

Individual funding requests are considered by the Individual Patient Treatments (IPT) panel. This panel receives requests from health professionals to fund treatments that are not normally commissioned by the PCT. If the request could apply to a number of patients, the decision is referred to Clinical Commssioning Groups. Otherwise, the decision the panel needs to make is whether the patient is clinically exceptional to our policy (for example likely to benefit more from the treatment than other patients with the same condition who have been denied treatment).

If the request is for a drug or treatment that is so new that it does not yet have a policy, then the relevant panel has to develop a policy before any consideration can be given to individual requests.

Requests for Individual Patient Treatments

The IPT team ensures that policies are followed and will consider whether your case meets our policy criteria and will make a decision. If it is clear that your case does/does not meet a policy a letter or email will normally be sent to the referrer in a few days. In some cases we may feel that we do not have sufficient information to make a decision and we may have to make further enquiries into your case. Please be reassured that information we receive about you will be treated in the strictest confidence and used only according to the data-protection laws.

Cases where we have had to make further enquires or where an outcome decision is not easily reached are taken to our monthly IPT panel meeting. The panel consists of the IPT team, senior Commissioning Managers from the PCT, a consultant from the Public Health department and up to two GP’s.

Stages of our decision-making process

We receive a letter from your doctor or clinician requesting treatment for you.

• A decision will be made if it is clear whether the case does/does not meet a policy.
• If an outcome decision is not easily reached, or it is felt that more information is needed, we gather more information. 
• The IPT panel meets monthly to consider ongoing requests.
• We let you, and your doctor or clinician know what we have decided.

If the decision is that your treatment request has been declined you should discuss this with your doctor or clinician. There is a right of appeal against the process in reaching a decision, however appeals cannot be submitted against decisions alone and cannot include new information. Please note that appeals cannot be accepted directly from patients. Cases can, however, be re-reviewed if new evidence (not available at the time of decision making) becomes available.

For further information or advice on using the NHS, please contact the Patient Advice and Liaison Service using the links on the right hand side of the page.