The Department of Health has announced the imminent publication of revised guidance on top-up payments in the wake of the consultation on last November’s Draft guidance on NHS patients who wish to pay for additional private care.
One aspect of the draft guidance, which can be accessed here, that has unexpectedly caused problems for PCTs is paragraph 4.4, which states that “Clinicians should exhaust all reasonable avenues for securing NHS funding before suggesting a patient’s only option is to pay for care privately. In these situations, which are likely to be exceptional, clinicians should consider [amongst other things] whether exceptional funding can be secured for the patient via the PCT’s exceptions procedure …”
It has been reported that Mark Wright, Head of Contracts at the Royal Marsden Foundation Trust, has written to commissioners stating that the Trust must now send exceptional case requests even when the patient does not fulfil exceptionality criteria. The Department of Health has responded by saying that “There is no intention to require clinicians to use exceptional funding procedures where this would be clearly inappropriate”.
It is more imperative than ever that PCTs hold a firm line and are not tempted by this increased pressure to authorise requests for funding where the applicant clearly does not satisfy the criteria for establishing exceptionality.