IPTR Review

An Investigation into an Individual Patient Treatment Request (IPTR)

This report published by Healthcare Improvement Scotland investigates how an individual patient treatment request (IPTR) was handled by NHS Ayrshire & Arran.

The investigation was called for by Mr Alex Neil MSP (the Scottish Government’s Cabinet Secretary for Health and Wellbeing) regarding how NHS Ayrshire & Arran managed Mrs June Rankin’s clinician’s request for her to be prescribed the drug Cetuximab for advanced colorectal cancer, a medicine not currently routinely available on the NHS in Scotland.

The report identifies a number of deficiencies in the management of Mrs Rankin's IPTR.

In light of these findings, the report states that there may be a need to refresh, clarify or simplify Scottish Government guidance on the management of IPTRs, including the composition of IPTR panels and the understanding of clinical need and the criteria for approving an IPTR.

Scope of the investigation

The scope of the investigation was to examine the concerns raised on behalf of Mrs Rankin in the context of the adherence to Scottish Government guidance through NHS Ayrshire & Arran’s local process for handling IPTRs. The purpose of the investigation was to assess how NHS Ayrshire & Arran managed the specific aspects of their local process which had been the subject of complaints by Mr Graeme Pearson MSP and Mr Willie Coffey MSP. The review was not asked to consider the decision of the IPTR panel or IPTR appeal panel, or make any comparison with other IPTR decisions for this medicine across the NHS in Scotland.

What is an Individual Patient Treatment Request (IPTR)?

The Individual Patient Treatment Request (IPTR) process is designed to provide an opportunity for clinicians to pursue, on a case by case basis on behalf of individual patients, a medicine that has not been accepted for routine use by the Scottish Medicines Consortium (SMC) following their appraisal on clinical and cost effectiveness.

Published Date: 11 June 2013

Scrutiny

Key findings

  • There were deficiencies in the information provided to, support offered to, and involvement of Mrs Rankin and her husband throughout the IPTR process.
  • There was a misunderstanding regarding the ownership of the IPTR process between NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran in the initial stages.
  • There was a delay in the communication of the outcome of the IPTR panel to Mr and Mrs Rankin, and insufficient time for them to consider, understand and prepare themselves for the IPTR appeal hearing.

Recommendations

  1.  NHS Ayrshire & Arran and NHS Greater Glasgow and Clyde (and other West of Scotland NHS boards) should review and/or ensure appropriate implementation of their local policies to ensure they adequately reflect Scottish Government guidance,
  2. The West of Scotland region should work together to ensure that there is a clear and consistent regional arrangement for the management of IPTRs – this arrangement should specify the respective roles, communication channels between the NHS boards, and between NHS board and the patient (or patient’s representatives),
  3. NHS Greater Glasgow and Clyde and NHS Ayrshire & Arran should ensure that when a mandate is provided by a patient that the patient’s representative has full access to all necessary information.