The aim of the Norfolk and Waveney Integrated Care Board Clinical Policy Development Group (CPDG) is to support effective commissioning by developing clinical threshold policies based on the best available evidence, in an open and transparent process.

Clinical Threshold policies are produced and developed with the assistance of local primary and secondary care clinicians, who are supported by Commissioners and Public Health Consultant, who will provide evidence reviews of policies where relevant. Clinical Threshold policies provide criteria to be used by GP’s at point of referral and also for clinical specialists within secondary care and provider services.

Policies are reviewed annually or sooner dependent on any new clinical information which may affect current policy.

The policy review process considers any new clinical evidence, national guidance such as NICE, Evidence Based Interventions, or any empirical evidence. Reviews of clinical policies, also involve consultation with Consultant clinicians within provider Trusts, other GPs and Public Health clinicians.

Low priority reatments Low priority treatments are usually of unproven clinical effectiveness, poor cost effectiveness or of low overall priority for example cosmetic procedures or treatment for benign skin lesions. Norfolk & Waveney ICB CPDG have also developed clinical threshold policies for these types of low priority treatments

Like any other organisation, the NHS has limited resources, and N&W ICB have a duty to manage its them to a robust process.

Clinicians, on behalf of their patients, are entitled to make an individual Funding Request (IFR) application to the IFR Panel for treatment to be funded by the N&W ICB that is not normally commissioned under defined conditions, namely; The request does not constitute a service development AND The patient is suffering from a medical condition for which the N&W ICB have a policy but where the patient’s particular clinical circumstances fall outside the criteria set out in the existing commissioning policy – this is a request for exceptional funding OR The patient is suffering from a medical condition, or requesting a treatment, for which the N&W ICB have no policy – this is a request for individual funding

Exceptional in IFR terms means a person to whom the general rule should not apply. This implies that there is likely to be something about their clinical situation which was not considered when formulating the general rule. Very few patients have clinical circumstances which are genuinely exceptional.

The IFR process considers clinical information only. Non-clinical and social factors have to be disregarded for this purpose in order for the IFR Panel, to be confident of dealing in a fair manner in comparable cases. If these factors were to be included in the decision making process, N&W ICB could not be assured that it was being fair and equitable to other patients who cannot access such treatment and whose non-clinical and social factors would be the same or similar.