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Exceptional Cases

With the inception of the new Cambridgeshire PCT in October 2006, (now NHS Cambridgeshire) the Board approved the Exceptional Requests Policy in May 2007.

The Exceptional Cases Panel is authorised by the Board to process requests for exceptional treatments (procedures, drugs or health care services) that are:

Undertaken outside the criteria agreed locally for surgical thresholds
Classified as low priority treatments
Tertiary referrals ie. to a Consultant or a service not covered by contracts with local providers or not covered by the ‘Choice’ policy
Drugs not funded for routine prescribing e.g. primary care red List or drugs outside secondary care contracts which practices may be asked to prescribe or support for your patients

Surgical Thresholds

The Cambridgeshire and Peterborough Public Health Network has produced surgical thresholds with the help of local primary and secondary care clinicians; and approved by PEC or PCT Board. The thresholds provide criteria to be used by GPs for referral and by providers before performing that surgical procedure. These surgical thresholds are available on the Public Health Network website

Low Priority Treatments

The low priority treatments are usually of unproven clinical effectiveness, poor cost effectiveness or of low overall priority, eg. cosmetic procedures or treatment for benign skin lesions. Policies for low priority treatments have also been developed by the Cambridgeshire and Peterborough Public Health Network. The low priority policies are available by clicking here

Drugs not funded for routine prescribing

If a GP identifies a patient whom they judge may benefit from a treatment that we do not routinely fund which practices may be asked to prescribe or support for your patients e.g. primary care Red List or drugs outside secondary care contracts, then advice should usually be sought by contacting the locality medicines management team. They can advise on circumstances where red List and other restricted drugs may be funded.

For drugs to be prescribed by GPs:

the rationale for choosing a restricted drug over other alternatives will be considered by the pharmacist team manager, taking into account the treatments already tried and the clinical urgency of the request.
it is not normally necessary for drugs to be prescribed by GPs to go to the exceptional cases panel if the costs are under £3000 for 12 months and an appropriate case has been made and approved by the pharmacist team manager. They will notify the chief pharmacist so that an appropriate adjustment can be made to the practice budget.

If GPs are asked by hospital doctors to prescribe restricted drugs these should be changed to a suitable alternative and the medicines management team advised of the request. Where the GP decides that there is no suitable alternative eg. a case for this has been made by a consultant, then the medicines management team, should normally be consulted.

The Exceptional Cases Panel

The Panel considers funding requests for exceptional treatments (defined above). Where the clinician feels that the patient should be considered for treatment as an exception, a request for funding can be made to the Exceptional Cases Panel, which meets monthly.

The Panel considers requests for funding of treatments on the basis of the information provided by the clinician. It is essential for the clinician to complete the application form giving as much details as possible, particularly the criteria for exceptionality and quantification of the benefits of the proposed treatment.

Request Form for the Exceptional Cases Panel

In November 2007, the Professional Executive Committee and the Board approved the use of the updated request form to consider cases by the Exceptional Cases Panel.

The form also gives detailed guidance on what information should be provided to the Panel, definition of exceptionality, what discussion takes place at Panel meetings and what is minuted and the appeals process.