Individual Patient Funding Requests (IPFR)
The Welsh Health Specialised Services Committee (WHSSC) is responsible for the joint planning of Specialised and Tertiary Services on behalf of Local Health Boards in Wales. When treatments are not routinely available, patients who might get particular benefit can still access the treatment through a process called Individual Patient Funding Requests (IPFR).
Funding requests are considered by the all Wales IPFR Panel. The purpose of the Panel is to act as a Sub Committee of WHSSC and hold delegated Joint Committee authority to consider and make decisions on requests to fund NHS healthcare for patients who fall outside the range of services and treatments that a Health Board has agreed to routinely provide.
The panel will act at all times in accordance with the all Wales IPFR Policy taking into account the appropriate funding policies agreed by WHSSC.
The Panel will normally reach its decision on the basis of all of the written evidence which is provided to it, including the request form itself and any other documentary evidence which is provided in support.
The Panel may, at its discretion, request the attendance of any clinician to provide clarification on any issue or request independent expert clinical advice for consideration by the Panel at a further date. The provision of appropriate evidence to the Panel will be entirely at the Panel Chair’s discretion.
The full terms of reference for the all Wales IPFR Panel can be found within the NHS Wales Policy Making Decisions on Individual Patient funding Requests (IPFR)
The Policy clearly sets out how these requests are dealt with and how an application can be made. Funding decisions made by IPFR Panels are determined on the information provided by the GP and/or Consultant to demonstrate the significant clinical benefit expected from the treatment for that particular patient and whether the cost of the treatment is in balance with the expected clinical benefit.
Since March 2015, the All Wales Therapeutics and Toxicology Centre (AWTTC) has worked with IPFR panels and the Welsh Health Specialised Services Committee (WHSSC) to implement recommendations from an independent review to strengthen and improve the IPFR process in Wales.
Electronic Submissions
Clinicians can now register as users on the system and submit applications directly. Providing the clinician has an NHS email address, they can register as a user on the e-submissions system, this includes clinicians in NHS England by clicking on the E-form here, you will be automatically directed to the IPFR database.
A video outlining the process of considering an IPFR can be found at the AWTTC Site which also provides answers to frequently asked questions.
Our priority is to pay for those treatments that are clinically effective, can demonstrate that they improve people’s health and offer good value for money. As a result, there are some treatments that we do not routinely provide and these fall into 2 main categories.
These are:
- treatments that are new, novel, developing or unproven and are not normally available for any patients in Wales (for example, a medicine that has not been approved for use by the NHS in Wales)
- treatments that are provided by us in very specific clinical circumstances and not all patients with the condition meet these criteria (for example, a request for varicose vein treatment).
NHS Wales follows a clear policy on how to deal with Individual Patient Funding Requests:
1 All Wales IPFR Policy - June 2017
2 Individual Patient Funding Request (IPFR) Guidance - March 2018
3 AW IPFR Patient Leaflet - November 2019
4 IPFR Application Form - September 2020
5 IPFR Request for Review - September 2017
A “prior approval” is normally defined as a request for a patient to receive routine treatment outside of local services or established contractual arrangements. Such a request will normally fall within one of the following categories;
- Second opinion
- Lack of local/commissioned service provision/expertise
- Clinical continuity of care (considered on a case by case basis)
- Transfer back to the NHS following self-funding in the private sector
- Re-referral following a previous tertiary referral
- Students
- Veterans
The Prior Approval policy sets out to deliver the national context and provide clarity for referring clinicians and patients. However, additional policy processes outlining specific commissioning, contractual and additional prior approval requirements may also be in place and will vary across each Health Board.
WHSSC has a number of commissioning policies in place relating to specific services/treatment. If you have any questions about making a patient funding request please contact the WHSSC Patient Care Team on 01443 443443 ext. 78123 or email us.