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Joint Formulary

What we do and don’t fund
South Devon and Torbay CCG is responsible for making best use of the NHS budget allocated to us for our population’s health services. Unfortunately, the demand for these services is always greater than the money available, so we have to prioritise the use of funds carefully.

To help us do this, we use national and local policies to ensure that the treatments, operations or drugs we commission have proven benefit in meeting the health needs to the population.

This means we will not routinely fund treatments or operations that will provide limited benefit or are considered to be of low clinical priority. Nor will we routinely fund unusual or uncommon treatments. A list of these treatments is here.

What exceptions apply?
There are some circumstances when we do fund interventions from this list. You may be eligible to receive funding for treatment that is not normally funded if:

  • you meet certain clinical criteria and, therefore, are eligible for criteria-based access or prior-approval funding
  • there is evidence that your circumstances are exceptional compared with those of other patients having the same condition – in which case you would be eligible for individual funding

What is a criteria-based access or prior-approval request?
Criteria-based access – If you demonstrably meet the specific criteria for treatment outlined in the policy, your GP/clinician may refer you directly for the intervention.

Prior approval – The referrer will need to obtain prior authorisation, from commissioners, for patients who meet the criteria outlined in the policy. A referral for the intervention can only be made once confirmation of funding has been received.

What is an individual funding request?
You can ask your doctor or health specialist to make an individual funding request if a procedure is not normally funded. For example, if:

  • it is a very new treatment or drug and the CCG has no commissioning policy
  • there are exceptional reasons why the treatment or drug should be available to an individual
Leaflet: Will the NHS Fund my treatment?

How do I apply to the CCG for funding approval?
The hospital consultant, specialist or GP treating you must apply for funding on your behalf.

They can apply if they feel there are exceptional clinical circumstances relating to your case or if there is evidence that you meet the criteria outlined in published policies.

You may also provide us with information and photographs, showing how your condition affects you and how you might benefit from this particular condition.

What happens next?
Once we have received a prior-approval request from your GP or health specialist, the individual funding team will assess it. If there is evidence that your case meets the criteria in the policy, we will pay for your treatment, drug or operation.

Individual Funding Requests (IFR) will be considered by the IFR panel. The panel meets regularly and consists of clinicians (at least one of whom will be a GP, but not your own), and CCG managers.

If the panel agrees there is evidence to show that your case is ‘exceptional’, we will pay for your treatment, drug or operation. We will send your doctor a letter explaining the panel’s decision within five working days of the panel meeting.

The IFR may refuse a funding request, which is always a difficult decision because we realise the effect that this will have on the individual involved. In this case, we will write to your doctor, explaining the reason for refusal.

How can I challenge a decision made by the Individual Funding Request Panel?
A reappraisal of the case can be requested on the following grounds:

  • Significant new information has come to light that was not available at the time the case was considered
  • You have reason to believe that the panel did not follow due process, or adhere to the CCG policies

More information?
If you would like more information, guidance, support or advice, or you would like to make a complaint, please contact our Patient Experience team on 0300 123 1672 or email pals.devon@nhs.net.

Information for clinicians:
For further details on this issue, contact the CCG individual funding team on 01769 575144 or 01626 883701.

Individual Funding Request Panel Applications, which can be found here, should be sent to:
Bridge House
Collett Way
Newton Abbot
TQ12 4PH
d-ccg.ifr-newsdt@nhs.net​​