NHS Somewhere: Individual Funding Request Policy
Application for Individual Funding Requests (IFRs)
Patient Name or initials
Date of Birth
Address
NHS No
Practice name, address
and contact number
Name, address & contact
number of referring
clinician requesting
funding
Patient diagnosis /
indication
TB
24/03/74
XX
XXX XXX XXX
GP
Details of exceptional
circumstances for this
patient
Chronic pain
Unable to work
Limited function and reduced quality of life
Consultant
Chronic, debilitating multisystem disorder for 10 years
resulting from low-level exposure to toxic chemicals
(solvents) at work
Device / non drug treatment
Hyperthermia and nutritional therapy
Treatment /device
requested
Proposed provider of
requested treatment
Anticipated cost of device
/ full treatment
Length of treatment &
review date
Evidence of clinical
effectiveness for
indication in question or a
statement stating
compliance with NICE or
other recognised
guidance
XX Hospitals
£30,000
6 months
Ross GH, Sternquist MC. Methamphetamine exposure and
chronic illness in police officers: significant improvement with
sauna-based detoxification therapy. Toxicol Ind Health. 2012
Sep;28(8):758-68. doi: 10.1177/0748233711425070.
Genuis SJ, et al. Human detoxification of perfluorinated
compounds. Public Health. 2010 Jul;124(7):367-75.
Pall ML. Do sauna therapy and exercise act by raising the
availability of tetrahydrobiopterin? Med Hypotheses. 2009
Oct;73(4):610-3. doi: 10.1016/j.mehy.2009.03.058.
Krop J. Chemical sensitivity after intoxication at work with
solvents: response to sauna therapy. J Altern Complement Med.
1998 Spring;4(1):77-86.
Kilburn KH, et al. Neurobehavioral dysfunction in firemen exposed
to polycholorinated biphenyls (PCBs): possible improvement after
detoxification. Arch Environ Health. 1989 Nov-Dec;44(6):345-50.
Drug treatment only
Intervention requested
Anticipated cost of full
course of treatment
Planned duration of
treatment & review date
Is the treatment licensed
N/A
for this indication?
Has this treatment been
approved / rejected by
NICE?
Clinical reasons for the
request and relevant
detailed medical history,
including all treatments
tried to date (include
privately funded
treatment)
Explanation of why 1st line
or alternative treatments
are not suitable if
applicable
Summary of the clinical
benefits the referrer
believes the treatment will
have for the specific
patient:
Name & address of any
other clinicians involved
in current patient
management:
Any other relevant
information:
Please provide
declaration of interests
Not considered
Chronic, debilitating multisystem disorder for 10 years
resulting from low-level exposure to toxic chemicals
(solvents) at work
Previous clinical toxicology review
Previous (private) chelation therapy
As above
Reduced Polychlorinated biphenyl and perfluorinated
compound levels
Symptomatic improvements
Improved Quality of life
GP
I declare no conflicting interests in this case
Signed:…………………………………………………(requesting Clinician)
Name:………….………………………………………..
Date:……………………………………………………..
Facilitators notes
Poor quality of studies
No evidence of benefit
PBC
Polychlorinated biphenyl also have shown toxic and mutagenic effects by interfering with
hormones in the body. PCB have been shown to both inhibit and imitate estradiol, the main
sex hormone in females. Imitation of the estrogen compound can feed estrogen-dependent
breast cancer cells, and possibly cause other cancers, such as uterine or cervical. Inhibition
of estradiol can lead to serious developmental problems for both males and females,
including sexual, skeletal, and mental development issues.
The most commonly observed health effects in people exposed to extremely high levels of
PCBs are skin conditions, such as chloracne and rashes, but these were known to be
symptoms of acute systemic poisoning dating back to 1922. Studies in workers exposed to
PCBs have shown changes in blood and urine that may indicate liver damage. In Japan in
1968, 280 kg of PCB-contaminated rice bran oil was used as chicken feed, resulting in a
mass poisoning, known as Yushō disease, in over 14,000 people. Common symptoms
included dermal and ocular lesions, irregular menstrual cycles and lowered immune
responses. Other symptoms included fatigue, headaches, coughs, and unusual skin sores.
Additionally, in children, there were reports of poor cognitive development.
There has been evidence to show crash dieters that have been exposed to PCBs have an
elevated risk of health complications. Stored PCBs in the adipose tissue becomes mobilized
into the blood when individuals begin to crash diet.
PFC
Despite the presence of some natural fluorocarbons such as tetrafluoromethane, which has
been reported in rocks, man-made fluorocarbons are potent greenhouse gases.
Certain fluorocarbons tend to bioaccumulate, since they are extremely stable and can be
stored in the bodies of both humans and animals. Examples of fluorocarbons include PFOA
(perfluorooctanoic acid) and PFOS (perfluorooctane sulfonate), frequently present in water
resistant textiles and sprays conferring water resistant properties to textiles. Data from
animal studies of PFOA indicate that it can cause several types of tumours and neonatal
death and may have toxic effects on the immune, liver, and endocrine systems. Data on the
human health effects of PFOA are however sparse.
The fluorocarbon, PFOA and PFOS have both been subject for numerous investigations by
the EU and the United States Environmental Protection Agency (EPA) regarding them being
harmful to the environment.