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The NHS must demonstrate that it is making the most effective use it can of public money to deliver quality healthcare. The aim of this policy is to set out an overview of those interventions or procedures considered to be of low clinical priority, such as surgery for cosmetic reasons. There is evidence that many of these interventions or procedures are clinically effective and may bring benefit at an individual level. However, the role of the commissioners is to ensure that public funding is directed to best meet the identified health needs of the population and therefore must take a view on population level prioritisation of relevant interventions and treatments. As part of this process commissioners must therefore make a judgement on those procedures that are not considered a priority.
Implementation of the policy in Primary Care is a pre-requisite to avoid inappropriate referrals with its unintended consequences such as:
This policy includes:
It is recognised that every patient is an individual and that there may be particular circumstances which give grounds for funding treatment in an individual case contrary to the decision not to fund in general.
In making a case for special consideration it needs to be demonstrated that:
A referral to secondary care services should not be made prior to approval for the procedure being given by the Restricted Treatments Funding Panel, unless the relevant criteria are met.
All applications should be made in writing by the relevant clinician, in most cases this will be the patients GP as they are able to demonstrate more clearly the impact of the patient's condition on their day to day life. In certain circumstances it may be relevant for another clinician to submit an application for funding approval; however, these cases are considered to be rare. The panel is unable to accept requests for funding directly from the patient.
Following the meeting of the panel, the decision will be conveyed to the requesting clinician. It is the responsibility of the requesting clinician to convey the decision of the panel to the patient in a timely manner. The patient should not be directed to the panel as it is not able to pass this information to the patient.
Should a negative decision be reached, details of the Appeals and Complaints process will also be provided.
Applications for consideration for funding approval should be sent to: