Integrated Care Boards (ICB) have a legal duty to provide health services for patients registered with NHS GPs within their geographical area. The amount of money received from the Government is fixed and cannot be exceeded. It is the ICBs’ job is to get the best value for this money by spending it wisely on your behalf.

NHS organisations nationally and across the country have developed Clinical Commissioning Policies for many common healthcare interventions with the following key principles:

• Improve the quality of care for everyone
• Reduce the risk of harm to patients
• Minimise unwarranted variation in service provision
• Optimise the use of finite resources and ensure any money saved is spent on effective treatments.

This means that only treatments with good evidence-base will be funded by the NHS and only when the clinical needs of the patient require so as described in the Clinical Commissioning Policies.

Frimley ICB’s Clinical Commissioning Policies are listed below and all providers providing NHS funded care must follow these.

The ICB also checks providers undertaking these interventions also follow these policies. These checks can take many forms and the main options are:

• Clinical audits;
• Prior Approvals; or
• Individual Funding Requests (IFR).

These compliance processes are determined by the ICB and may change over time to ensure that the administrative processes are as minimalist as possible, while ensuring full compliance with the policy. This is a brief overview of what these compliance processes mean in practice.

As the name suggests this is an audit done retrospectively to check compliance to the clinical policy criteria for an intervention. This audit only considers if a patient met the minimum clinical indications to have an intervention. Adherence to the clinical policy, will ensure that patients do not have unnecessary treatments, which may harm them more than the possible benefits of the intervention.

This is often used for well-established interventions, like a Colonoscopy in the management of hereditary colorectal cancer. It is not disputed that the intervention is effective and safe, but it should only be used for patients who will benefit more from this than the risks associated with the intervention.

Prior Approvals are to be obtained by the treating clinician (usually a surgeon) before undertaking an intervention. This is usually a simple tickbox form, based on the relevant clinical policy, confirming that the given patients meet the agreed clinical criteria. Adherence in this more rigorous process is deemed necessary due to several factors, such as level of possible harm to patients, compliance-level with the policy by the provider.

Interventions under Prior Approval include established interventions such as hip replacement. Once again it is not disputed that the intervention is effective and safe, but it should only be used for patients who will benefit more from this than the risks associated with the intervention. Prior Approval requests are determined within days and should not delay patient care.

Interventions that fall under IFRs are not routinely funded by the NHS and before a clinician can perform this approval must be obtained by the treating clinician (usually a surgeon). These are interventions that are not considered to benefit the population at large either on clinical, safety or cost grounds. However, ICBs will consider specific clinical circumstance for individual patients via the IFR process to determine if an intervention should be available to them, while others do not have such access.

Several interventions that are considered purely cosmetic fall into this category and given that there are no direct clinical reasons for this to be prioritised for NHS funding. Please note that IFR applications may take several months to conclude, due to the rigorous process required to determine the application.

The Prior Approval and IFR process are managed on behalf of the ICB by the CPI Service within NHS South, Central and West Commissioning Support Unit (CSU). For further information please visit:

Prior Approvals – Clinical Policy Implementation Service

Individual Funding Requests – Clinical Policy Implementation Service