Policy for appealing a funding decision made by the IFR Panel regarding an intervention not normally funded.
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How do I make an appeal?
Requests to appeal a decision made by the Individual Funding Request (IFR) Panel can be made by you or the healthcare professional in charge of your care (normally your GP or hospital consultant).
If you feel that your case meets the criteria for appeal you or your referrer must send an initial letter to the chief officer of the organisation who dealt with your request within 28 days of the date of the decision letter, saying that you wish to appeal and clearly outlining your grounds for appeal. This information will be considered by the chief officer or nominated deputy not previously involved in your case.
The outcome of their decision will be communicated to you in writing within 28 days of receipt of your appeal letter.
How can I challenge a decision made by the Individual Funding Request Panel?
A patient, GP, hospital consultant or healthcare professional can write to the Clinical Commissioning Group (CCG) and appeal a funding decision made by the IFR Panel.
Grounds for appeal
There are three grounds for appealing a decision. At least one of these must be satisfied or the appeal will be rejected.
The grounds for appeal are:
- The panel failed in a material way to consider the evidence presented.
- The panel came to a decision that no reasonable IFR panel could have reached based on the evidence.
- The organisation failed in a material way to follow its own procedure when dealing with your application.
If material new information is presented your case will be considered by an appeal panel OR reconsidered by the IFR Panel.
Further discussion and advice can be obtained by contacting the Individual Funding Request Team or the Patient Advice and Liaison Services (PALS) who will answer any further queries on your eligibility to appeal and can provide you with any further information you require.
You can contact the Bristol CCG individual funding team on 0117 900 2214 or email firstname.lastname@example.org
Individual Funding Requests (IFR) appeals policy
This policy sets out the process by which appeals against exceptional funding decisions made by the Commissioner are considered.
If an appeal is granted, what happens during an appeal panel?
The appeal panel will meet and look over your case notes. They will check to see that the decision was made fairly and that all relevant information was taken into account.
You are welcome to attend the first part of the appeal; you may bring someone with you for support. This excludes legal representatives acting in their professional capacity.
You are welcome to make an oral or written representation to support your case, or have someone to do this for you. The panel will make their decision in private; if you attend, you will be asked to leave at this point.
Who sits on the appeal panel?
The chief officer (or nominated deputy), a lay member of the CCG Board and a local GP form the appeal panel. Where necessary they will seek expert opinion to inform their decision. They will not be any of the same people who made the first decision.
What happens next?
We will write to you and your doctor within five working days of the panel meeting to let you know the decision. The reasons for the decision will be outlined in the letter.
The decision of the appeal panel is final.
What else can I do?
You can use the NHS Complaints procedure and the Ombudsman. PALS will give you any relevant information and contact details.