Effective Commissioning Initiative Programme (ECI)

The South West London Effective Commissioning Initiative Programme and Policy deal with treatments and procedures for which restricted access criteria have been agreed by the South West London Committees in Common on the 26th February 2019.

The programme covers procedures for patients registered with GP practices in boroughs of Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth.

View the policy here:

South West London Effective Commissioning Initiative Policy

SWL ECI policy background

The South West London Effective Commissioning Initiative Policy (SWL ECI) was established in 2006 for the then Primary Care Trust (PCTs) in South West London, now called SWL Clinical Commissioning Groups (CCG).

The policy is driven by the need to ensure that NHS funded treatments are evidenced-based, clinically effective, safe and that access to treatments throughout the SWL area is equitable for patients with similar clinical needs, hence reducing variation in care.

Although not the main driving force, the policy also ensures that the NHS provides value for money and uses its resources effectively to achieve financial balance.

Scope of the policy

The policy covers the procedures listed in this document when they are undertaken as routinely planned treatments. This is excluded when patients require the procedure due to an emergency. Procedures for the diagnosis and treatment of cancer are also excluded from the policy.

SWL CCGs may modify how authorisation is granted to treating clinicians based on continuous evaluation of the services. Patients accessing services outside of SWL may be subject to the local clinical criteria set by the host commissioner CCG.

Content of the policy

SWL CCGs have considered evidence of clinical practice, clinical effectiveness, cost-effectiveness, information on current activity, resources, costs and service provision across SWL when formulating these recommendations.

The SWL ECI policy lists 62 procedures, which can be placed into two categories:

  • ‘Prior Approval Procedures’
  • ‘Individual Funding Request’

Prior Approval Procedures (PAP)

Clinical criteria have been provided where the available evidence on clinical and cost-effectiveness indicates the patient who will benefit the most from a procedure funded by the NHS.

Prior to the procedure being undertaken, authorisation must be obtained for these procedures by the treating clinician. This should be done by using the Prior Approval Tickbox forms on the BlueTeq system (secure online communication platform). This will demonstrate to commissioners that the patient meets the agreed criteria for treatment and assures the commissioners that both the concerned individual and the local population can expect to get maximum health benefits from the procedure in question.

Individual Funding Request (IFR)

The IFR process set out in the South London IFR policy will be used to consider individual requests for funding where a service, intervention or treatment falls outside existing service agreements.

Some treatments are “not routinely funded” because either their clinical and cost-effectiveness is marginal or NHS provision may be inappropriate (e.g. the benefits are purely cosmetic and not clinical).

Prior to the procedure being undertaken, authorisation for these procedures must be obtained by the treating clinician (i.e. the practitioner who is responsible for administering the treatment requested). This should be done by using the IFR form.

This will be approved only when the SWL IFR panel agrees that the patient is clinically exceptional or the patient has a very rare clinical condition. This is detailed in the South London IFR policy.

Exceptionality is defined as:

  • Significantly different from the general population of patient with the condition in question; AND
  • Likely to gain significantly more benefit from the intervention than might normally be expected for the average patient with the condition.

Any procedures not routinely funded can be requested via the IFR route. The policy cannot exhaustively list all procedures falling into this category but takes into account current clinical practice.

This IFR process will ensure that each request for individual funding is considered in a fair and transparent way, with decisions based on the best available evidence and in accordance with the South London IFR policy.

View the Patient Information Leaflet here: 

Patient Information Leaflet

View the IFR Patient’s Guide here:

IFR Patient’s Guide


How can an application be submitted for Prior Approval or IFR:

Application for Prior Approval or IFR can only be made by the treating clinician on the approved procedure specific Prior Approval form or on the South West London IFR form.

These can be submitted online via BlueTeq (secure online communication platform): https://www.blueteq-secure.co.uk/Trust/default.aspx

Please note uses must register first before submitting their first application.


Contact details

Prior Approval Service    Email:    nelcsu.pas@nhs.net     Telephone:    020 3049 4366

IFR Service    Email:    nelcsu.ifrswlondon@nhs.net       Telephone:    020 3668 1222