Welcome to the Clinical Policy Implementation (CPI) Service
The NHS has a duty to spend the money it receives from the Government fairly, taking into account the health needs of the whole community.
The Clinical Commissioning Groups’ (CCGs’) job is to get the best value for this money by spending it wisely on your behalf. Demand for healthcare is growing, but there is only a set amount of money available to spend so difficult decisions must be made.
The CCGs have a legal duty to provide health services for patients registered with NHS GPs within their geographical area with the fixed amount of money they have received from the Government. They also have a legal duty not to spend more than this. This means that some hard choices must be made and not all treatments can be provided by the NHS. Treatments that are limited by CCGs are shown in their Clinical Commissioning Policies.
However, the CCGs know that there will always be times when a patient would benefit from a particular treatment not usually given by the NHS. To apply for this treatment, an Individual Funding Request (IFR) must be made.
The priority is paying for those medicines and treatments that are proven to work well, can demonstrate they improve peoples’ health, and offer good value for money.
We aim to make a difference to patients, helping to ensure the best value for money and optimal clinical outcomes. We support the work of the NHS commissioners and providers to develop health and social care services for their local populations, based on evidence of best practice and research within the principles of safe, effective and cost-effective care by implementing the clinical commissioning policies, managing applications for treatments that are not routinely available on the NHS or which are subject to restrictions. Information for patients – Will the NHS pay for my treatment?
Clinical Commissioning Policies
This website lists the Clinical Commissioning Policies that have been agreed by each of the CCG Boards that this service represents. NHS organisations caring for patients must refer to these statements when considering treatment or referral to other specialists.
A Prior Approval (PA) is a funding request for an application to fund healthcare which is usually given on the NHS but has a list of criteria that must be met.
Individual Funding Requests
An IFR is an application to fund healthcare that is not usually funded by the NHS. These requests are considered by an IFR Panel which considers evidence of clinical and cost-effectiveness, as well as equity for the whole population.
The CCGs are happy to consider an IFR if the clinician believes there is a strong case for a specific patient on grounds of an exceptional health need. You can read about exceptional health needs in this guide: Exceptional Health Need – guide for patients and clinicians.
The process is managed on behalf of the local CCGs by the CPI Service within NHS South, Central and West.
Applications for PA and IFR funding must be made by a patient’s NHS clinician. The policies and forms can be found on the relevant CCG page listed below:
Please note that several specialised services and treatments are commissioned by NHS England, and these have a separate PA and IFR route.
Personal Health Information
The Data Protection Act 2018 is now in effect and the General Data Protection Regulations 2016 (GDPR) came into force on the 25th May 2018. Due to this, we are in the process of updating all of our documents to reflect these changes. Whilst we do this please accept any reference to the Data Protection Act 1998 in any of our documents to mean the new Data Protection Legislation referenced above.
For more information on how personal health information is used, please click on this link: How is my own personal health information used?