Somerset Clinical Commissioning Group
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Interventions Not Normally Funded (INNF)

Where a Commissioner does not wish to place a restriction on a procedure listed in this schedule, the Commissioner will need to confirm funding with the Provider for each case of treatment.

Individual Funding Request (IFR) Panel – Referral for the following interventions can only be made following authorisation from the PCTs Individual Funding Request Panel. Applications should only be made to the Individual Funding Request Panel if the patient has evidence of exceptionality i.e. there is something about the patient’s condition or circumstances that differentiate them on the basis of need from other patients with a similar diagnosis or condition and would justify funding being provided in an individual case when it is not routinely funded for others.

Criteria Based Access (CBA) – If the patient meets the specific criteria for treatment the patient can be referred directly via Choose and Book if appropriate with a standard referral letter. If the patient does not meet the criteria for treatment then a referral can be made to the Individual Funding Request Panel only if the patient has evidence of exceptionality, i.e. there is something about the patient’s condition or circumstances that differentiate them on the basis of need from other patients with a similar diagnosis or condition and would justify funding being provided in an individual case when it is not routinely funded for others

Prior Approval (PA) – Is a process that requires the referrer to obtain prior authorisation for patients who meet the criteria. This is in order to control procedures of limited clinical benefit being undertaken. If the patient meets the criteria then the application must be forwarded to the Commissioners for approval and confirmation of funding received before a referral is made. If the patient does not meet the criteria for funded treatment then a referral can be made to the Individual Funding Request Panel only if the patient has evidence of exceptionality i.e. there is something about the patient’s condition or circumstances that differentiate them on the basis of need from other patients with a similar diagnosis or condition and would justify funding being provided in an individual case when it is not routinely funded for others.

CONTACT US

Contact Somerset CCG by phone or email:

01935 384000

somccg.enquiries@nhs.net 

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