Discussion
Depends on what you are asking to be funded. Would need a little more info but you may not wish to share that on a public forum. I know more about secondary care processes than primary care.
Some drugs are NICE approved and funded, but require discussion at a multi-disciplinary meeting before they can be authorised for use. We have an MDT meeting weekly and so it is usually a relatively quick process.
Some drugs or procedures may have benefit but are not NICE funded. This may be because they are very new or do not make the threshold for cost effectiveness. In that event an individual funding request is made to the local funding body (CCGs or whatever they call themselves that week). They will meet much less often (maybe once a month) to consider the evidence. Much lower success rate - needs to be a very good reason to deviate from the usual route. Need a really good application from your doc as it makes a difference, not something banged off in 5 minutes.
Good luck
Some drugs are NICE approved and funded, but require discussion at a multi-disciplinary meeting before they can be authorised for use. We have an MDT meeting weekly and so it is usually a relatively quick process.
Some drugs or procedures may have benefit but are not NICE funded. This may be because they are very new or do not make the threshold for cost effectiveness. In that event an individual funding request is made to the local funding body (CCGs or whatever they call themselves that week). They will meet much less often (maybe once a month) to consider the evidence. Much lower success rate - needs to be a very good reason to deviate from the usual route. Need a really good application from your doc as it makes a difference, not something banged off in 5 minutes.
Good luck
The process is a bit too complex to go into detail but broadly speaking there are 3 levels of IFR (Individual Funding Request) but it varies across the country :-
1) Some procedures can only be carried out if they meet specific criteria. The GP doesn't need to apply for funding as such but does need to meet a set of per-determined criteria in order for things to proceed.
2) Anything outside 1) can be applied for via the local CCG. These are usually rarer procedures / drugs but they will have to meet some kind of local value for money criteria.
3) The next level up is for extremely rare procedures / drugs. These will be discussed at a regional level before a decision is made.
My personal experience is that 2) and 3) are hardly ever funded as it is extremely difficult to prove they are value for money when CCGs have limited funds available.
Difficult to comment on your personal circumstances.
1) Some procedures can only be carried out if they meet specific criteria. The GP doesn't need to apply for funding as such but does need to meet a set of per-determined criteria in order for things to proceed.
2) Anything outside 1) can be applied for via the local CCG. These are usually rarer procedures / drugs but they will have to meet some kind of local value for money criteria.
3) The next level up is for extremely rare procedures / drugs. These will be discussed at a regional level before a decision is made.
My personal experience is that 2) and 3) are hardly ever funded as it is extremely difficult to prove they are value for money when CCGs have limited funds available.
Difficult to comment on your personal circumstances.
The CCGs are understandably worried about creating precedent. If they give it to you, then others then be able to cite your case and also be eligible. My approach to applications is to 1) show why a certain patient situation is unique backed by a relevant patient factors from their history 2) that it will save money elsewhere (eg reduce admissions to hospital/ other more expensive interventions) backed by evidence based/ published health economic data 3) I set clear targets and timelines eg we will assess success/ failure of drug using metric x at x months of treatment and if not met we will discontinue. Needs to be a recognised objective clinical scoring system. They like an exit strategy.
The above is why it will take me Several hours to do an application properly for a patient
The above is why it will take me Several hours to do an application properly for a patient
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