A referrers guide

Every year, NHS Kernow receives money from the Government to pay for health services. It is our responsibility to achieve best value for money and to spend it for the benefit of all our population.
Demand for healthcare continues to grow and we have to prioritise the most effective and cost effective treatments available. Decisions to fund new treatments mean less is available for other health services. Difficult choices have to be made over the healthcare we can afford and which benefits the most people. We try hard to make these choices in a way which is impartial, consistent and fair.

What is an individual funding request?

This is a request made by you, for treatment which is not routinely funded by the NHS. In making a request, you need to show evidence that there is an exceptional clinical need.

What does exceptional clinical need mean?

In making a case for consideration, you should provide evidence that the patient is significantly different to the general population of patients with the condition in question and is likely to gain significantly more benefit from the intervention than might be normally expected for patients with that condition.

How do I apply for funding?

Please complete an application form. Forms are available on our individual funding request page.

Read the individual funding request policy (PDF, 521 KB) before completing the form.

What happens next/?

Your application will be triaged and:

  • agreed, where the requested treatment meets an existing policy or pathway
  • refused, when there is a clear policy covering the situation and where there is no evidence of exceptional clinical need
  • returned, if further information is required
  • forwarded, to the relevant panel

How does the panel make decisions?

The panel operates within an ethical decision-making framework. The following is taking into account:

  • evidence of clinical and cost effectiveness
  • evidence of exceptional clinical need
  • the needs of the patient
  • the needs of the community

What happens after the panel has met?

Within 5 days you will be informed of the panel’s decision and why they made it.

What can I do if funding is not approved?

Reconsideration

If there is new or additional evidence which the panel did not see, a case can be made for reconsideration.

Appeal

If it is felt that the panel did not follow the decision making process as outlined in our individual funding request policy (PDF, 521 KB). Any appeal must be made within four weeks of the panel decision, stating the grounds for appeal.

Complain

If you are unhappy with the outcome make a complaint.

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