Individual funding request

Page contents

Overview

NHS Cornwall and Isles of Scilly must provide healthcare within the budget it has been given. That legal requirement means that some hard choices have to be made.

This means that not all treatments can be provided. Information on what treatments we do and don’t fund can be found in our treatment policies.

An individual funding request is an application to fund treatments which we don’t usually fund. These requests are considered by a panel. Information about how the panel makes these decisions can be found below and in our individual funding request policy (PDF, 231 KB).

Future panel dates

Please note that applications should be received no later than 10 working days before each panel.

The panel dates are:

• 4 June 2024
• 16 July 2024
• 10 September 2024
• 22 October 2024
• 3 December 2024
• 14 January 2025

The NHS Constitution has more information about the rights to which the public and staff are entitled to. It also contains pledges which the NHS is committed to achieve.

Individual funding request panel downloads

• Application form (DOC, 59 KB)
• Assisted conception application form (DOC, 53 KB)

Email the individual funding requests team with any questions about the forms.

Will the NHS fund my treatment?

Demand for healthcare continues to grow and we have to prioritise the most clinically and cost effective treatments available. Decisions to fund new treatments mean less is available for other health services. Difficult choices have to be made over the healthcare we can afford and those which benefits the most people. We try hard to make these choices in a way which is impartial, consistent, and fair.

Can I get treatment not normally funded by the NHS?

Your clinician can ask us to fund a treatment if they consider there to be an exceptional clinical need.

What does exceptional clinical need mean?

The clinician needs to provide evidence that a person is significantly different to the general population of people with the condition in question and is likely to gain significantly more benefit from the intervention than might be normally expected for those others.

How are decisions made?

Requests for funding are considered by the individual funding requests panel.

What can I do if funding is not approved?

Reconsideration

If there is new or additional evidence which the panel did not see, a case can be made for reconsideration.

Appeal

If you believe that the panel did not follow the decision-making process as outlined in the individual funding request policy (PDF, 231 KB). Any appeal must be made within 4 weeks of the panel decision. You should state why you feel the panel did not follow the process.

Complain

If you are unhappy with the outcome make a complaint.

Your personal confidential information

The panel need to have certain information to make a decision. We need to know your name and contact details so that we can write to you if necessary. We also need information about your health. This may include medication, test results and photographs.

Your information is shared with the individual funding requests team who arrange for it to be discussed by the panel. All staff working for the NHS have a duty to make sure that your information is kept safe and is only shared so that a funding decision can be made. Details of who is involved in seeing your personal information can be found in our individual funding request policy (PDF, 231 KB).

You have the right to access the record we hold. You also have the right to object to us making use of your information, restrict what information we use and to correct information if it is not accurate.

A referrers guide to individual funding requests

What is an individual funding request?

This is a request made by you, for treatment which is not routinely funded by the NHS. In making a request, you need to show evidence that there is an exceptional clinical need.

What does exceptional clinical need mean?

You should provide evidence that:

• the person is significantly different to the general population of people with the condition in question
• is likely to gain significantly more benefit from the intervention than might be normally expected for those others

How do I apply for funding?

Please complete an application form (forms are available above). Read our individual funding request policy (PDF, 231 KB) before completing the form.

What happens next?

Your application will be triaged and:

• agreed where the requested treatment meets an existing policy or pathway
• refused when there is a clear policy covering the situation and where there is no evidence of exceptional clinical need
• returned if further information is required
• forwarded to the relevant panel

What happens after the panel has met?

You will be informed of the decision within 5 working days.

What can I do if funding is not approved?

Reconsideration

If there is new or additional evidence which the panel did not see, a case can be made for reconsideration.

Appeal

If it is felt that the panel did not follow the decision-making process in our individual funding request policy (PDF, 231 KB). An appeal must be made within 4 weeks of the panel decision, stating the grounds for appeal.

Complain

If the individual is unhappy with the outcome, they can make a complaint.

Non-contract activity

Non-contract activity is the term used to refer to NHS-funded services delivered to a patient by a provider which does not hold a contract with NHS Cornwall and Isles of Scilly but does with another integrated care board (ICB).

NHS Cornwall and Isles of Scilly will fund non-contract activity through the processes below.

Non-contract activity policy (PDF only, 349KB)

Prior notification

NHS Cornwall and Isles of Scilly has a duty to fund treatment where a patient has requested patient choice. Such as by their GP, dentist, or optometrist referral to consultant-led elective care.

To ensure payment, providers will need to:

• complete a prior notification form (DOCX, 45 KB)
• once completed, email the prior notification form to us
• a prior notification reference will be issued

Please do not send patient identifiable information with the form.

Prior approval

NHS Cornwall and Isles of Scilly does not have a duty to fund treatment if the patient goes outside patient choice.

In these circumstances, providers will need to ask for prior approval before payment.

To ensure payment for the treatment, providers will need to:

• complete a prior approval form (DOCX, 49 KB).
• once completed, email the prior approval form to us.
• a prior approval reference will be issued

Please do not send patient identifiable information with the form.

Transport requests

NHS Cornwall and Isles of Scilly will repatriate NHS Cornwall and Isles of Scilly patients from anywhere in the UK where they meet the nationally defined medical criteria.

The patient transport service is for patients who have been assessed as requiring transport due to medical need and is mainly limited to ambulance transport.

NHS Cornwall and Isles of Scilly is not able to provide patient transport for social reasons, or privately funded appointments or treatment.

If a provider has a patient they need to repatriate and they qualify for NHS transport, they should contact the Royal Cornwall Hospital NHS Trust centralised booking service. They handle all patient transport service requests for NHS Cornwall and Isles of Scilly patients.

Call the centralised booking service on 01872 252211. Opening hours are:

• Monday to Friday, 8am to 8pm
• Weekends and bank holidays, 9.30am to 5pm