Clinical Thresholds and IFR Panel Referral Process Procedures of Limited Clinical Value GP reviews patient against clinical criteria Patient does not meet clinical criteria but GP refers for exceptionality Patient meets clinical criteria for non-routinely commissioned procedure Patient does not meet clinical criteria * GP refers for advice from Secondary Care Procedure refused on NHS GP provides feedback Refer to IFR Panel * GP refers to Secondary Care with completed PLCV check-list & referral letter Consultant reviews patient against clinical criteria * IFR Panel approve procedure IFR Panel does not approve procedure and patient notified Secondary Care Agreement that Patient meets clinical criteria , procedure is carried out Patient does not meet clinical criteria and is discharged and GP notified GP refers to Secondary Care with IFR Approval Patient does not meet clinical criteria , consultant applies to IFR panel for approval on grounds of exceptionality IFR Panel approve and the procedure is carried out * IFR panel don’t approve, letter to the patient and discharge (if appropriate) * Check-point