The ICB has a fixed budget to plan and pay for NHS services and must make sure that NHS resources are allocated fairly and help as many people as possible.
As the NHS cannot fund every possible operation, procedure, or medication, the ICB makes decisions about which treatments to fund based on national guidance, clinical evidence, and population need.
The ICB has agreed clinical treatment policies to make sure funding decisions are impartial, consistent, and fair.
Evidence-based treatments and prior approvals process
Some treatments and procedures – where clinical evidence shows there is limited general clinical benefit – are not routinely funded for all patients. However, clinical evidence shows that treatments may be appropriate and beneficial for some patients in certain circumstances.
In these cases, the ICB can approve funding on an individual case-by-case basis if it is satisfied the patient meets the treatment criteria.
The treatments and procedures that require prior funding approval are covered by clinical policies that set out the eligibility criteria for patients.
We keep clinical policies under continual review. We make changes where needed to reflect changes such as new clinical evidence.
Find the Central East ICB Clinical PoliciesPrior approvals process for evidence-based treatments
If a doctor or specialist considers that a patient meets the criteria to have NHS funded treatment, they can apply to the funding team at the ICB. The funding team will consider each application and give approval on a case-by-case basis.
If you do not meet the stated policy criteria for a particular procedure, the doctor or consultant looking after you should explore alternative options.
If you do not meet the criteria for a particular treatment, but your health circumstances subsequently change so that you do meet the criteria, you can talk to your doctor or specialist about reapplying for a treatment.
Exceptional or individual funding requests (IFRs)
An exceptional or individual funding request (IFR) is a formal request made by a doctor, consultant or other specialist on behalf of a patient. It asks Central East ICB to fund treatment that the NHS does not normally provide.
Patients cannot make their own IFR. However, your doctor or specialist will explain your options and discuss whether a request may be appropriate.
The ICB reviews each request using the criteria of its Exceptional and Individual Funding Request policy. This helps ensure decisions are fair, consistent, and based on evidence. This policy can be found at the bottom of this page.
Can an individual funding request consider personal or social factors too?
The NHS wants every person to have equal right to NHS treatment no matter what their social, family or other circumstances are. To ensure fairness and avoid discrimination, the IFR process only considers medical factors.
Personal circumstances such how a treatment might support a patient’s ability to work or study, care for dependants, or meet financial commitments cannot be considered as part of the IFR process.
How decisions are made
The ICB’s funding team first looks at whether the treatment is already available through an existing service.
If not, and the request is for an individual case rather than something other people would also need, it may be reviewed by the Individual Funding Request Panel.
This is an independent panel of professionals who have not been involved in a patient’s treatment. The panel is made up of doctors, nurses, public health consultants, pharmacists, ICB representatives and lay (non-clinical) people and is led by a lay chair. To ensure impartiality, they do not see the patient’s personal details. They consider clinical benefit, safety, value for money, affordability, and fairness.
The IFR process cannot be used when the request would effectively introduce a new treatment for a wider group of people.
In this way, decisions remain fair and consistent.
How long does it take to reach a decision?
If all the required information is submitted, it usually takes 30 working days from receiving an application to a decision. If the panel needs to ask the clinician for additional information, this may cause a delay.
Urgent cases can be processed more quickly, if clinically necessary.
What happens after a decision
The panel will inform your doctor or specialist of their decision (based on clinical evidence and NHS policy).
Your doctor or specialist will then inform you of the outcome and explain the next steps.
If funding is agreed
If the panel agrees funding, your doctor or specialist can then make the treatment available to you.
If funding is refused
If the IFR panel decides not to fund your treatment, or if it has approved a treatment subject to conditions you do not agree with, you should speak to your doctor or specialist.
- Your doctor or specialist will talk you through the reasons for the decision and what other treatment options may be available.
- Your doctor or specialist can also request a review if you think the decision-making process was not followed correctly. Your doctor or specialist must request this review within 30 days of the date of the letter or email detailing the decision.
- If your medical situation changes or more clinical evidence becomes available about the effectiveness of the treatment being sought, your doctor or specialist can subsequently submit additional information for further consideration.
Exceptional or Individual Funding Request Policy and Forms
Central East ICB IFR policy v1.0 (840kB docx)
Harmonised IFR forms will be available soon.