Prior Approval (PA)
Is a process that requires the referrer to obtain prior authorisation for patients who meet the criteria. If the patient demonstrably meets the criteria, please forward the application to the IFR Team for approval and await confirmation that funding is in place before a referral is made. If the patient does not meet the criteria for funded treatment, then a referral can be made to the Individual Funding Request Panel, but only if there is clear evidence that the patient’s clinical circumstances or condition are exceptional, i.e. there is something about the patient’s condition or circumstances that differentiate them on the basis of need from other patients with a similar diagnosis or condition and would justify funding being provided in an individual case when it is not routinely funded for others.
Please note any deviations from this policy, e.g. funding requests for a secondary care opinion only (where malignancy is not a concern), require Part C of the below application form completing and submitting to the Individual Funding Request team.
Funding requests from GP Practices can be accepted from Senior Clinicians, salaried GPs, Locum GPs or Practice Partners. Unfortunately we are unable to accept funding applications from other health professionals unless countersigned by a senior clinician or GP.
If you would like this policy in a different language or need it in another format, such as Braille, please contact the Patient Advice and Liaison Service on 0800 073 0907 or 0117 947 4477.
NOTE: NHS England Commission all specialist spinal surgeries.
Where spinal surgery may be an appropriate option, a referral to secondary care for an assessment ahead of possible surgery is requested.
(Also known as or related to – nerve root involvement, lumbar spine, back pain, leg pain and spinal fusion).