The Authorisation Process

There are two clear processes in place for considering the funding of procedures of limited clinical value and non commissioned procedures; your GP and/or NHS Consultant will be able to advise you on both and which route your funding request will follow.

Process for funding approval for Procedures of Limited Clinical Value

Procedures of limited clinical value generally have clear clinical criteria in place and if you meet that criteria then a Prior Authorisation form needs to be completed by your GP/Consultant and sent to the IW CCG's Prior Authorisation team (South Central West Commissioning Support Unit (SCW CSU)). On receipt the team will ensure that all appropriate information has been received and will validate the funding request, providing a response to your GP/Consultant within 10 working days of receipt of the request.

In the instances where funding has been approved, an authorisation number will be issued to your GP/Consultant who will then proceed to arrange an appropriate appointment for your procedure.

In those circumstances where funding has not been approved, the SCW CSU will provide reasons to your GP/Consultant for the refusal which may because you do not meet the clinical criteria.  Your GP/Consultant will discuss with you your options which may be to undergo a different course of treatment or activity or your GP/Consultant may consider putting in an application for funding through the Individual Funding Request Panel. For the latter your GP/Consultant will need to demonstrate that you have 'exceptionally' of needs compared to other people with similar circumstance.

Non-Commissioned Procedures

Funding requests for non-commissioned procedures, e.g. elective cosmetic surgery, will always required approval by the IW CCG's Individual Funding Request Panel. An IFR form along with all appropriate information will need to be submitted by your GP/Consultant to the IW CCG's IFR team (SCW CSU) who will then review and prepare the papers for the IFR Panel.

The IFR Panel convenes on a regular basis to consider funding requests; The Panel's deliberations will take into account previous requests of a similar nature and will consider whether 'exceptionally' has been sufficiently demonstrated by your GP/Consultant.

In the circumstances where funding is approved, an authorisation number is issued, your GP/Consultant will be notified and they will then arrange an appropriate appointment for your procedure.

In those circumstances where the Panel declines funding the IFR Panel will provide full reasons to your GP/Consultant. Your GP/Consultant will then discuss with your your options, which as above may be a different course of treatment. In the event that your GP/Consultant is not satisfied with the IFR Panel's decision they may consider lodging an Appeal.

Full details of the two processes for funding and the Appeal process can be found within the Clinical Funding Authorisation Policy