The NHS cannot always fund drugs, operations or other care that is not routinely funded by the NHS. Normally this is because they:
- are clinically not effective or effectiveness has yet to be determined
- are not cost effective in comparison to all the competing demands on NHS funding
- have a low clinical priority and offer little health gain
- are largely cosmetic in nature.
Who decides what is not routinely funded?
A group including local doctors agree the list. It is based on expert assessments of clinical evidence and is checked regularly in order to keep it up to date.
Who can make an individual funding request?
Only your doctor or another health professional, such as consultants or specialists, can make an individual funding request to the CCG.
For example if:
- it is a very new treatment or drug and Bristol Clinical Commissioning Group (CCG) has no commissioning policy available
- there are exceptional reasons why the treatment or drug should be available to an individual patient.
Restricting the availability of some interventions ensures that the money the NHS spends on treatments is put to the best use - where patients will gain the most benefit.
All treatments that are not routinely funded are listed within the Individual Funding Requests Directory.
What is ‘an exception’ to this list?
Sometimes we will consider paying for a treatment or operation that is not normally funded.
This happens when:
- You have a set of circumstances that are very different from anyone else with the same, or a similar, condition. Your health professional will need to explain how you will derive greater benefits from the intervention than others who are in a similar position.
- There is good evidence to suggest that you would be healthier after the treatment or operation.
If you meet these conditions, your treatment will be considered for funding by the Individual Funding Request Panel.