Procedures for managing individual funding requests

Background

The CCGs in Kirklees fund a range of services, drugs or treatments because it is a national requirement or because we have identified a local need. However, there may be times when a particular procedure or medicine is not routinely available.

Our Individual Funding Request Policy is used when a drug or treatment is not routinely available in Kirklees.   In such cases a GP, hospital consultant or other clinician can make a request for funding using the policy.

The majority of cases considered through this policy are cosmetic, which means that they are requested for reasons of appearance rather than because there is a clinical need.  This could include for example, breast reduction or augmentation, “tummy tucks”, laser hair removal, removal of tattoos.  Occasionally we receive requests to fund treatment or procedures where there is risk to life e.g. for a high-cost drug.

Last year, the CCGs in Kirklees received around 800 requests and just under half of these were supported.

What the CCGs are proposing   

We are proposing to change the criteria (reasons) for approving individual funding requests for a period of 18 months, during which time we will only approve funding in cases where:

  • the condition is immediately life‐threatening
  • undue delay would result in a real and imminent risk of harm i.e. death, infirmity or disability
  • the procedure needs to be performed within a strict time‐frame as otherwise delay would result in it becoming ineffective.

As a result of these proposals it is likely that fewer individual funding requests will be received and/or approved through this process.

During this 18 month period we intend to undertake a more detailed review of our policy and the procedures which are currently included in it, with a view to proposing further changes. 

Who might be affected by the proposal?

Individuals who request treatments and procedures which are not routinely funded by the CCGs.  You can view the policy and list of treatments on the CCG websites.

Who would remain unaffected by the proposal?

People who require treatment that is routinely available in our area.

People who make a request through the Individual Funding Request Policy which meets the new criteria.

Proposed saving

In the region of £750,000.