Agenda item

Dr D Geddes is the medical director for NHS North Yorkshire and York. He has responsibility for the clinical governance of the Individual Funding Request Panel which makes funding decisions for patient care that may lie outside national or local commissioning policies. Dr Geddes will describe the work the panel does, how the panel reaches its decisions, and how the patients are supported through the process, from request to appeal.

John Yates, made representations on behalf of the Older People’s Assembly in relation to the presentation. He stated that, as the Assembly had had no sight or knowledge of the contents of the presentation that they felt unable to comment. He did express concern in relation to the make up of the Individual Funding Request Panels (IFR) which they felt were made up of individuals with administrative/financial abilities rather than with clinical expertise which provided no reassurance for the patient.

Dr D Geddes, Medical Director for NHS North Yorkshire and York gave the Committee a presentation on the IFR Panel which made funding decisions for patient care that may lie outside national or local commissioning policies together with the referral guidelines.

The presentation included details of:

• The NHS Constitution;
• 2009 ‘Directions to PCTs and NHS Trusts;
• Details of the Bodies which informed the commissioning policy which include NICE, the Drug and Therapeutics Committee and clinical networks;
• IFR was a request to a PCT to fund healthcare for an individual who fell outside the range of services and treatments that the PCT had agreed to commission;
• IFRs were not decisions related to care packages for patients with complex health needs or prior approvals, which were used to manage contacts with providers.
• IFRs generally arose either if the patient had a very rare condition, the patient had a more common condition but claimed that the usual care pathway did not work for them (exceptionality) or where the patient wished to take advantage of a novel, developing or unproven treatment.
• When a decision to refuse a request for funding had been taken then the PCT must provide a written statement of the reasons for that decision and, where necessary, offer an opportunity to speak with a clinician.
• Information on what was considered ‘exceptional’ and details of non-clinical factors, which could be considered as reasons for exceptionality.
• Details of the make up of the IFR Panel and confirmation that a pharmacy Advisor attended every Panel meeting;
• Details of the hierarchy/strength of evidence required together with the balance of needs of the individual with that of the community;
• 2008/09 – 1,1587 cases of which 52% of requests had been approved;
• 2009/10 – 1,380 cases of which 44% of requests had been approved;
• Details of the appeals process - 2009/10 – 7 appeals of which 2 had been successful;
• Spinal injections – evidence based commissioning.

Members questioned a number of points including:

• How requests were prioritised, particularly urgent requests;
• How changes in the levels of service e.g. in relation to back pain, were communicated to the Committee/public;
• Where successful treatments were subsequently withdrawn, following a change in the guidelines, this could result in additional costs in the long term and a loss of quality of life for patients;
• Concern that patients were still not being kept fully informed of changes;
• Lack of communication with General Practitioner’s (GPs) as it appeared that differing services were offered to patients in that some requests were not being put forward for IFRs;

Dr Geddes confirmed that this was still a learning curve for the PCT and that there was a need for GPs to be better informed at an earlier stage and for an improvement in communications with patients already within the system.  In answer to Members questions, in relation to back pain, he expressed concern that patients were making judgements in relation to treatments received 15 years ago and that a lot of progress had been made since then. Interpreted evidence often suggested a different pathway to injections. He explained that this was usually in the form of spinal rehabilitation, a multi disciplinary course of treatment, which drew together more than just manipulation and physiotherapy but also the psychological aspects. 

RESOLVED:             That the presentation be noted together with the PCTs confirmation of their proposals for communicating with patients/GP’s in relation to the Panel and future requests.

REASON:                  To keep the Committee updated on referral guidelines and Individual Funding Requests.