Individual & Exceptional Treatment Panel Decision Making Process for East of England

[AnnieT]

Please find below the decision making process used when determining if a patient should be funded for surgery. My PCT sent me this on request so I don't think there should be any problem with other people getting the same in their area.

Anyhow, I thought that it might be useful for anyone who is struggling to get funding.

The file is zipped, to open just double click the file and windows will open it for you.

If the file requests a password, please click read only.

Hope it helps! xxxx

 

[Grace]

Thanks Annie

It's quite complicated and a tad idealistic methinks?

Like my doctor never really bothered about even attempting to help me manage my weight unless I went to beg for help........and he would NEVER have sugestd surgery if I hadn't asked.

I honestly expected to be laughed out of the surgery! When I went to ask, I didn't even know if they did it n the NHS or not!

and I find now that because I have sleep apnoea, funding would probably have been even easier to get.....BUT I wasn't even tested for sleep apnoea until I saw the bariatric team! (by which time I already had my funding!)

 

[AnnieT]

Hi Charis,

The thing most people don't realise is that if their GP uses this sheet as the basis for their application for funding then more people would be successful.

It sets out the template for the application by allowing the GP to list all the diets and treatments you have tried and the conditions you have along with the outcome of the sleep apnoea and diabetes tests that are the gateway conditions that result in surgery being recommended.

All PCT's have to make their criteria clear and must provide it on request. Similarly the criteria must meet the standard/guidelines established by NICE.

Also exceptional and individual treatment panels must meet monthly so no-one should ever have to wait longer than a month for a funding decision.

It seems to me that little is done to assist patients in this process, whereas we can get all the information we want about other procedures.

 

[Grace]

Annie my doctor clearly hadn't a clue about this as he told me categorically that I would NOT get funding. I seriously doubt he knew the criteria existed!

He went STRAIGHT to the exceptions panel and had me write my own letter of support as well as his. As it happens I listed in my letter every thing I had tried and showed that I HAD fulfilled their criteria in this respect!

Now I wonder (not at it matters now!) if I actually already met the PCT criteria and didn't even need to go to the exeptions panel?

In any case it all probably speeded up my application as I got my funding within a fortnight!

so my GP's ignorance worked in my favour!

 

[AnnieT]

Hi Charis,

Your GP should have applied to the individual treatment panel at your local PCT in the first instance.

The Exceptional treatment panel is the next level where cases are not clear cut. Where this ends in a refusal it always results in a letter suggesting that they have put the matter back to the PCT and that it is at their discretion to decide if to fund.

This has always seemed a strange process to me because it only goes to the SHA because of a refusal by the PCT so why would they ever change their mind.

It's a sad fact that GP's are not well informed about this process and others. They are independant business units and rely on the skills of their business or practice manager to find their way through the minefield of applications to the PCT. xxxx