I read Michael White's column with interest. I would like to offer a view from the front line. All primary care trusts have mechanisms to consider requests for funding specific drugs or interventions on a named-patient basis in exceptional circumstances. Usually termed as individual patient requests, these are for requests or interventions that the PCT does not commission.

I read Michael White's column with interest. I would like to offer a view from the front line. All primary care trusts have mechanisms to consider requests for funding specific drugs or interventions on a named-patient basis in exceptional circumstances. Usually termed as individual patient requests, these are for requests or interventions that the PCT does not commission.

Recently the PCT Network and NHS Confederation produced a resource pack for PCTs on this issue called Priority Setting: managing individual funding requests, which is available on the confederation's website.

Mr White is right in saying that more than half the appeals against PCTs on exceptional cases are won. But it is worth pointing out that the courts usually find issues with process and not the decision itself.

Many PCTs, including my own, are working in close collaboration with clinicians and provider trusts so patients can achieve the best possible care within the available resources. More often PCTs have to take tough decisions on exceptional cases and face the media onslaught. Hence it is essential PCTs set up tried and tested processes to deal with requests on exceptional grounds in an open, consistent and transparent way.

We hope the new Public Health Commissioning Network will help PCTs in this area by sharing expertise and good practice and act as a quality assurance mechanism.

Dr Padmanabhan Badrinath, consultant in public health medicine, Suffolk PCT