Clinical Commissioning Policies
Reducing differences in access to healthcare across Buckinghamshire, Oxfordshire and Berkshire West (BOB)
In July 2022, the responsibility for commissioning local healthcare treatments for the population of Buckinghamshire, Oxfordshire and Berkshire West (BOB) moved from clinical commissioning groups (CCGs) to the newly formed integrated board, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board. NHS England commissions highly specialised health services.
Previously local areas made decisions around their clinical commissioning policies which has resulted in some differences across Buckinghamshire, Oxfordshire and Berkshire West. To address these differences, commissioning policies for a range of treatments are being reviewed to look at how they can be made the same for all three places.
Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board is now responsible for reviewing clinical policies on a regular basis to ensure they are informed by the latest population needs, clinical evidence and national guidance. Reviewing clinical policies also includes consideration of any new legislation or legal decisions. All clinical policies have a review date, which is usually within two or three years of their adoption.
Clinical policy reviews are to ensure the clinical effectiveness, quality and safety of patient care.
The review of clinical policies is being carried out in stages. Some clinical policies were found to be the same across all the local areas of Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board. these are referred to as harmonised policies.
Some of the clinical policies vary from area to area. Harmonising these clinical policies will mean changes for some areas. Where this is the case, we will ensure that appropriate consultation contributes to the process as we work through the different stages of review.
Individual Funding Requests
The NHS belongs to us all. It exists to:
- Improve our health and well-being
- Support us to keep mentally and physically well
- Help us get better when we are ill
- Stay as well as we can throughout our lifetime especially when we cannot fully recover
To make sure that the NHS can provide the best care for the maximum number of people it is vital that every penny is spent wisely. This means only funding treatments that have been demonstrated to work and where there is also a high likelihood of benefit for as many people as possible and a low likelihood of harm. We always must bear in mind that carrying out treatment that is not of great health benefit uses up resources that could be spent on really making a difference elsewhere.
We may decide that a treatment or procedure should not be routinely funded because:
- There is only limited or no evidence of its effectiveness (whether it works or not)
- It is considered a low priority for funding, (for example, cosmetic surgery) compared to other treatments
(Please note that there are a number of specialised services and treatments that are commissioned separately by NHS England which has its own IFR route.)
Where there is a new or rare treatment or a policy specifies a treatment is ‘not routinely commissioned’ meaning a decision has been taken not to commission (fund) that specific treatment, an IFR (clinically exceptional case) Approval will be required. This means treatment will only be funded if the application proves exceptional clinical need and exceptional capacity to benefit compared to other people with the same or similar condition. Funding approval must be obtained via the IFR process prior to any treatment commencing or a patient being placed on a waiting list.
An IFR application can also be submitted when the patient does not meet the specified clinical criteria within a specific treatment policy and where a clinician considers their patient has exceptional clinical need.
Funding applications can be made in either Primary or Secondary Care. Applications for funding should ideally be made by the clinician who has the most knowledge of the condition and intervention the request relates to.
A clinician may think that their patient’s clinical situation is so different to other patients with the same condition, that it is appropriate that they should have a specific treatment. Believing that their patient will gain greater benefit than other patients within the same cohort or similar clinical circumstances. In such circumstances, clinicians, on behalf of their patient, may submit an IFR. This route should only be used in exceptional clinical circumstances and not as a route to gain consideration of funding a new treatment or to start a service development.
There can be no exhaustive description of the situations which are likely to come within the definition of exceptional clinical circumstances. The onus is on the clinician making the request to set out the grounds for clinical exceptionality clearly for the IFR Panel to consider.
The Integrated Care Board (ICB) defines exceptionality solely in clinical terms. Personal or social circumstances will not be taken into consideration. In essence it is a question of equity. To consider personal, social or other non-clinical factors could introduce inequity.
All applications should be submitted by a clinician, if they support an application, on behalf of their patient. An IFR application cannot be made by a patient.
For patients living in the Oxfordshire area please complete an IFR application below.
- Primary Care via Datix
- Secondary Care via IFR application form
For patients registered to a Buckinghamshire or Berkshire West GP practice please click here for more information.
Frequently Asked Questions
Your healthcare is paid for by the National Health Service (NHS). The budget for healthcare is given to various organisations to pay for your treatment. Locally, the Integrated Care Board (ICB) is responsible for funding healthcare treatments for the population for which it is responsible. ICBs are allocated sums of money and have to make decisions to use the money for the healthcare needs of the population that they provide healthcare for. Unfortunately, there is not enough money to fund every possible type of operation, procedure and medication so decisions have to be made as to what will be available for everyone and what has to be restricted.
We operate in the context of the agreed Ethical Framework, which stresses the need for decisions to be fair, consistent, and equitable. All decisions are made after taking into account all of the following:
- The patient’s clinical need
- The effectiveness of the treatment
- The cost of the treatment
These requests can be for any type of healthcare, including a service, treatment, medicine, device, or piece of equipment. Usually, they fall in one the following categories:
- A patient would like a treatment that is new, being developed, or unproven. For example, a drug that has not yet been approved for use in that particular condition.
- A patient wants access to a treatment which is available in certain clinical circumstance, but not their individual circumstances. For example, a request for treatment for varicose veins.
- A patient with a rare or specialist condition that falls within specialist services, but does not meet the clinical criteria for treatment. For example, a request for plastic surgery.
- A treatment normally used for aesthetic surgery but for which a patient has a genuine clinical need. For example, a breast reduction.
NHS clinicians (GPs, hospital doctors and certain other health professionals) can ask the ICB to consider funding a low priority treatment for one of their patients.
Funding may only be approved if:
- There is something significantly different about the patient’s condition when compared with others with the same condition (who would not receive the requested treatment): AND
- As a result of the difference, the patient is likely to gain significantly more benefit from that treatment than would generally be expected.
There must also be sufficient evidence that the treatment is cost effective and that the cost of treatment does not outweigh the benefit gained - Guidance for considering ‘exceptions’ in IFRs
No, this is not possible. All funding applications have to be submitted by either your GP or hospital consultant.
No, this is not possible. In order to be fair to all patients, as well as those that are unable to attend, we do not permit patients, carers or any representative of the patient to attend the panel.
Yes, you can. You are able to provide a written statement of how your condition or illness impacts on your daily activities and quality of life if you wish. Please let your doctor know that you would like a letter from you to be sent with the application form. This will be added to your case file and reviewed by the IFR Panel.
A letter will be sent to your clinician and usually to you within 2 weeks of the IFR Panel decision.
If the panel agree to fund your treatment, the NHS will pay for it. You will not need to pay anything.
If your funding request is approved, your GP or Consultant will make arrangements for you to have the treatment. How long you have to wait after the decision may depend on a number of factors including waiting lists, but your GP or Consultant will be able to advise you.
No, it is not possible to mix NHS and private funding. See the salient Clinical Commissioning Policy - Managing the boundaries of NHS and privately funded healthcare.
If your request for funding has been declined by NHS England, you cannot apply via your ICB’s IFR process. BOB ICB only consider funding requests for treatments that are commissioned by BOB ICB.
If there is no Clinical Commissioning Policy for your condition then EITHER it is a treatment that BOB ICB do normally commission (pay for), OR it is a new/experimental treatment, and we may not yet have a Clinical Commissioning Policy.
Integrated Care Boards (ICBs) under the NHS constitution have a duty to provide treatment which NICE has recommended in the technology appraisals. Other guidance by NICE is advisory only. See the NICE website.
Clinical Effectiveness Team - Individual Funding Request
Contact details - FOR CLINICIANS ONLY:
If you are a patient and have an enquiry about an IFR application or the process, please speak with your clinician in the first instance.