REQUEST FOR URGENT CONSIDERATION

OF AN INDIVIDUAL FUNDING REQUEST (IFR)

Please ensure the form is typed

IFRs will not be handled as urgent on grounds that waiting until the next IFR panel is inconvenient or problematic for the patient or requesting clinician. Pre-booked appointment is also not an acceptable reason for clinical urgency. Before considering an IFR as urgent careful consideration will be given as to whether sufficient information is available for the IFR Panel to make a decision without compromising any of the principles upon which decisions should be made.

If your IFR request is considered to be at a level of such clinical urgency that it cannot wait until the next scheduled panel date, this form must be completed and submitted together with the NHS NWL CCGs IFR form-2014-2015.This can be found here:

Alternatively the standard IFR form can be downloaded from our website,

An Urgent (virtual) Panel will be convened and a decision will be made within 3 working days from the date the case is received by NHS NWL CCGs IFR team via our dedicated inbox, , on condition that all the information to enable the panel to make a decision has been provided.

Please note that cases canonly be accepted as urgent if the criteria for Q1 and Q3 are met:

1. / Are there immediate life threatening consequences to this treatment not being commenced?* / Yes (Go to Q2)
If you wish to add anyfurther information to that already supplied in the standard IFR form, please do so here:
No(Then it is not urgent – please fill in a standard IFR form, the case will go to the first scheduled panel)
2. / Has this request been agreed by the Trusts’ Multi-Disciplinary Team as the most appropriate therapy (If appropriate)? / Yes (Go to Q3)
If minutes from the MDT meeting are available please include them to your application.
No(Go to Q3)
3. / Does treatment need to be started within a fortnight? / Yes
Please explain why, if you have not already done so in the standard IFR form:
No(Then it is not urgent – please fill in a standard IFR form, the case will go to the first scheduled panel)

*Please do not withhold treatment if treatment is clinically necessary pending funding approval. However, treating without finding approval will be at the Trust’s own financial risk.

Please note that Service Developments will not be considered. A Service Development is defined as a request pertaining to a cohort of patients and not reflective of an individual’s clinical circumstances. Please note that the IFR Panel is not the appropriate route for service developments. These requests should go through the appropriate procedures within the requesting Trust in the first instance.

Please attach additional sheets if required CONFIDENTIAL

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