www.medlaw.eu is a self help tool for patients to make applications and appeals for NHS funding for treatment. Information and guidance is provided on the processes to follow, the forms to complete, the evidence required and on the law. Many treatments are not routinely funded by the NHS and these include newer treatments for rare cancers, rare disease, and surgery. Consultants and GP on behalf of patients now have to make applications and appeals for funding under what is known as the Individual Funding Request (“IFR”) process. Since April 2013, you or your doctor may have to apply for approval for funding to either:- (a) your Clinical Commissioning Group (“CCG”) or (b) NHS England - for some rarer medical conditions. The first issue is to find out whether your treatment is to be funded by your CCG or NHS England. NHS England rarer medical conditions – these are listed by NHS England. Check out the current list of NHS England rarer conditions for funding in this link to the NHS England manual: http://www.england.nhs.uk/wp-content/uploads/2014/01/pss-manual.pdf
For cancer patients, the Cancer Drugs Fund (“CDF”) acts as a “back stop” so you can apply to them for funding for cancer drugs once you have exhausted the IFR application and appeal process.
1. If you apply to your CCG, download the guidance booklets from the “Useful Resource” Menubar. For patients it is “Treatment We Need” and for Consultants “Your Patient’s Right to Treatment”. In the booklets there are pro forma letters for information, applications and appeals. The “Applications” item updates information contained in the booklets. Primary Care Trusts (“PCT”) were replaced by CCG in April 2013 so for the time being, when reading the guidance in the booklets and in this website, read CCG for PCT.
2. If you apply to your CCG, find your IFR process from the “Useful Resource” Menubar. The main elements to look out for in your IFR process are:- who can apply, what evidence is allowed, whether you are limited to clinical matters, whether it is you or your condition that has to fit the exceptional criteria, whether you can attend or be represented in any panel meeting. Many CCG do not publish their IFR online so you may have to telephone, write or email them for a copy. Check the Press Release and the .pdf file on CCG to find out if your CCG provide online IFR information.
3. Using your CCG IFR process, discuss with your consultant and decide your basis of application or appeal. Help the consultant get it right.
4. If you have to apply to NHS England, you may find you need more detailed guidance and personal advice. NHS England has additional barriers to funding which are not easily understood or explained. We can help with this at www.medlaw.eu
If you have done all you can and find you need further help or support, please contact us at www.medlaw.eu by clicking HERE