General practice responsibility in responding to private healthcare

We understand that some people will chose to access health care privately, which is a choice you are entitled to make. However there are a few things that you need to be aware of before making this decision.

NHS guidance states:

Patients can pay for additional private healthcare while continuing to receive care from the NHS.

 However, in order to ensure that there is no risk of the NHS subsidising private care:

• It should always be clear whether an individual procedure or treatment is privately funded or NHS funded.
• Private and NHS care should be kept as clearly separate as possible.
• The patient should bear the full costs of any private services. NHS resources should never be used to subsidise the use of private care.
• The arrangements put in place to deliver additional private care should be designed to ensure as clear a separation as possible of funding, legal status, liability and accountability between NHS care and any private care that a patient receives

 Organising tests requested by private providers

Sometimes we receive requests from private providers to arrange tests or investigations, for patients that they have seen privately. We appreciate that this may be to save you the cost of these investigations, however complying with this request is outside the scope of NHS general practice work and NHS guidance above.

Our contract states that a GP should only carry out investigations and prescribe medication for a patient where the GP is the responsible doctor and it is necessary for the care of the patient. This means that the GP has had the full consultation with the patient themselves and has agreed, with the patient, the investigations that are needed.

 The reason for this is not only because we are not contracted (and therefore not paid) to do this work, we also may not have the knowledge, resource or capacity to be able to perform these tests on behalf of private providers. When we get these requests will advise you and the private provider that these services do not fall within NHS primary medical services and suggest they make alternative arrangements to get the investigations done.

 At Ashley Centre Surgery, we regret that we don’t have the resources or capacity to be able to arrange investigations for patients who have been seen in a private clinic. We advise it is your responsibility to also arrange these privately as part of your package of private care.

Prescribing medication requested by a private provider

GMC Good Medical Practice states that doctors in the NHS and private sector should “prescribe drugs or treatment, including repeat prescriptions, only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.”

If a private consultant requests that a GP starts or continues to prescribe medications, and if the GP agrees with this advice, then this could be appropriate.

However, at Ashley Centre Surgery, if the GP does not feel competent to prescribe the requested medication, or they do not know if the medication best serves the patient’s need, the GP should inform the private provider that the prescriptions should be provided by a specialist. This is also true for off licence recommendations for medications, which is where medications are being suggested to be used outside of their product licence.

Referring to an NHS service following a private consultation

Sometimes, after a private consultation, the private specialist may suggest that you are referred to an NHS service.

Please note that private providers can make referrals to NHS services, without referral back to the GP, provided the patient would be eligible for NHS referral. Any patients referred should be treated based on clinical need. Read NHS England guidance around consultant-to-consultant referrals within the NHS.

At Ashley Centre Surgery, if we receive private requests for referral to an NHS service, we will kindly ask the private provider to make the referral themselves.

“Shared Care” with private providers

Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care agreement’ setting out the position of each, to which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by clinicians with the necessary competence under the shared care arrangement.

 Shared Care with private providers is not recommended due to the general NHS constitution principle of keeping as clear a separation as possible between private and NHS care. Shared Care is currently set up as an NHS service, and entering into a shared care arrangement may have implications around governance and quality assurance as well as promoting health inequalities. A private patient seeking access to shared care should therefore have their care completely transferred to the NHS.

 All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.

 At Ashley Centre Surgery, if you are being cared for by a private provider and they wish to have a “shared care agreement” with us for a medication you are being prescribed, it is with regret that we will will not agree to prescribe under a shared care agreement.  You will need to have your prescriptions issued by your private provider and they will remain responsible for regular reviews.   You can ask them to refer you to an NHS service so we can consider agreeing to “shared care”.

 

For more information see the BMA guidance on General Practice responsibility in responding to private healthcare.