Principles and support private medical care

GP REFERRAL

There simple answer is you do not normally need a GP referral for private treatment though some insurance companies will insist on a referral letter being completed by your GP. So, it is worth you checking with the insurance company if relevant. This is all explained in more detail by the NHS.
Do I need a GP referral for private treatment? – NHS

OBTAINING YOUR MEDICAL HISTORY

The private clinician seeing you has a responsibility to go through any relevant medical history and any medication you are taking. With online access to your medical notes, you can now print off information on your medical history and present medication to assist you in this process and bring that to your consultation. You can find out how to do this, see under

• Online Access To Your Record
• Your NHS Account

Or 

On linked practice websites see page “online access to your records” under the heading “Getting help” on the main menu.

BOOKING AN APPOINTEMNT WITH A PRIVATE PROVIDER

GP practices have no involvement in the process of booking a private appointment so you can normally book the appointment when you want and with whoever you want (unless you are using an insurance company and they dictate who you can see).

If a patient is required by their insurance company to see their GP for a referral letter, then the letter may take a number of days to be ready. The timescale will be dependent on the other demands on secretarial time and their availability. The practice may have a stipulated time scale for private referral letters which can be up to a week. However, this should not stop you booking a private appointment.

CHOOSING A PRIVATE MEDICAL SERVICE

From the Patient Association
Private healthcare – an overview (includes section on “what to consider”) Private healthcare – an overview | The Patients Association 

From Patient info
The article “NHS and Other Care Options”  NHS and Other Care Options | Health | Patient contains a section “Private medical treatment options in the UK” which covers some common issues.

The process of choosing a private service

If you do see your GP for a referral many GPs will not necessarily recommend a particular consultant. GPs only have access to information which is already in the public domain (such as private hospital websites and qualifications of private consultants). Their experience of a particular clinician doing a specific procedure for example will often be very limited and as such most GPs will not make a judgement on any private clinician on such limited data. It is always worth you checking the qualifications of any consultant you chose.  When you chose a consultant before you book the appointment, it is worth checking if you are using private insurance that they allow that particular consultant as some insurances companies limit who you can see.  Any private referral letter is collected at an agreed time from the surgery after your consultation with your GP and you take the letter to your private appointment you have booked.

local private hospitals and services

Contact details for local private hospitals and services can be found under

• Local Contact Details And Service Finder

This is not a recommendation of any particular private hospital or service and you can choose to go anywhere you like. In addition, there are many other private medical services such as private GPs and small private clinics which due to capacity are not listed here.

if you pay for private care how is NHS care affected

From the NHS
If I pay for private treatment, how will my NHS care be affected? – NHS

SWAPPING CARE

The article form Patient info “NHS and Other Care Options”  NHS and Other Care Options | Health | Patient contains a section “Private medical treatment options in the UK” which covers this question:

Can I swap between the NHS and private treatment? (e.g., transfer care from an NHS consultant to a private consultant and vice versa)

The simple answer is YES. It is a common question asked of GPs and is well explained by patient info, including from NHS to private, and Private to NHS.

A complete summary of your private care is important if you swap care

Please note: If you swap from Private to NHS it is very helpful if you can ask your private consultant to send a letter with a complete summary of what he/she has done and any test results (so these do not need to be repeated on the NHS), particularly if you are going to end up seeing a different consultant on the NHS. This letter is then just used to support your referral to the NHS. Sometimes you will chose/ be able to see the same consultant on the NHS in which case a shorter summary letter from the consultant which can be forwarded to their NHS hospital will suffice.  Normally now private consultants will always send a copy of their letter to both you and your GP practice, so you will know when this letter has been completed by your consultant. Insufficient information from your private consultant can delay your referral and treatment on the NHS and can also result in unnecessary tests been repeated on the NHS.

BLOOD TESTS, SHORT TERM MEDICATION, FIT NOTES AND SURGICAL FOLLOW UP

An overview on this is provided by the NHS
If I pay for private treatment, how will my NHS care be affected? – NHS

The key point which comes directly from the Department of Health document “Guidance on NHS patients who wish to pay for additional private care”  Guidance on NHS patients who wish to pay for additional private care  is :

P 6 -7

2.3 “As overriding rules, it is essential that:

• the NHS should never subsidise private care with public money, which would breach core NHS principles; and
• patients should never be charged for their NHS care, or be allowed to pay towards an NHS service (except where specific legislation is in place to allow this) as this would contravene the founding principles and legislation of the NHS.

2.4 To avoid these risks, there should be as clear a separation as possible between private and NHS care.”

after referral a private consultant should provide the whole episode of treatment

What does this mean in reality for blood tests, medication, fit notes and surgical follow up associated with private care?

Once referred to a private consultant the whole episode of treatment should be provided by the private provider, meaning that NHS and Private care should not be mixed together, so that

For private outpatients it is completely the private providers responsibility to

• To perform all blood tests relating to the private care themselves as long as you remain under their care
• Prescribe short term medication privately for any single episode of care (e.g., antibiotics)

For private inpatients, it is completely the private providers responsibility to

• Arrange blood tests and other tests
• Provide medication privately for any short-term medication which is part of the package of care (e.g., for a hip replacement any immediate medication required as a result of the operation such as low molecular weight heparin, analgesia or antibiotics following the operation)
• Provide suture removal, dressing changes, routine wound checks following an operation
• Issue a fit note covering the entire anticipated period off work and only once you have been discharged from their care would a GP be responsible if you needed more time off.

FURTHER INFORMATION

The guidance above is national, but there is also simpler local guidance which gives exactly the same message. Produced by the local integrated care board, see “managing the boundaries of NHS and Privately-funded healthcare” under

• Conditions Which May Not Be Funded On The NHS (GP)

LONG TERM MEDICATION

What if a patient requires long -term medication can this be prescribed on the NHS?

From the NHS England guidance in the previous question, it is clear if a private consultation identifies a long-term condition or a need for long term medication which is available as a routine long-term NHS treatment this should be provided by the patient’s usual GP.

However, as explained in a leaflet from an NHS organisation there are a number of other criteria which need to be met before a GP is able to prescribe a medication.

• From North Central London ICB: Guidance on prescriptions after seeing a private doctor Private to NHS prescriptions

CRITERION 1: ADHERING TO THE local FORMULARY

Most important of these criteria locally are that private consultants need to adhere to the local formulary, avoiding prescribing any “Black listed” drugs. Many consultants are aware of this formulary but it is worth you checking with them. A consultant adhering to this policy will save you and your GP a significant amount of time and trouble, as GPs are not able to prescribe drugs outside this guidance. This particularly applies to private consultants outside local areas who are less likely to be aware of such guidelines. Your consultant should check the local formulary website below before prescribing any medication particularly when they know it is outside common NHS prescribed medications, as this will save you wasted time when the medication is declined if outside guidance.

Local formulary
There are some drugs which are tightly controlled or not allowed locally. The formulary produced by Buckinghamshire Healthcare NHS Trust (in collaboration with NHS Buckinghamshire Medicines Management Team) list, using a traffic list system, covers what medication can be prescribed in Buckinghamshire and who is allowed to prescribe the medication (Hospital only, hospital initially or GP following recommendation), see under

• Buckinghamshire Formulary
• Formulary – Key for traffic light system

CRITERION 2: GP MUST BE IN RECEIPT OF A LETTER FROM THE CONSULTANT

Another important criterion is that the GP must be in receipt of a letter following your outpatient appointment explaining the full rationale for the treatment of a long-term condition.

A verbal request or private prescription will not suffice.

Whatever is said by the specialist there is always a significant delay between the clinic appointment and the practice GP receiving your consultation letter. This delay can be at different levels. The specialist must dictate a letter, the private secretary must process the letter in their system and when the practice receives the letter it must be scanned into your notes (remembering that practices are receiving 100s of letters and other messages every day for different patients). So, the process of your GP receiving a letter can take weeks.

What is very helpful now is the vast majority of private consultants now send a copy of their clinic letter to you, so when you have received your letter, the practice should have processed their copy of this letter a few days later (as normally these letters come at a similar time). If you want to pursue long term medication for a long-term condition following a private outpatient appointment and you have not received your letter then it is worth you contacting the private consultant’s secretary and asking them to send you (and the practice) a copy of the letter.

It is not the responsibility of GP practices to chase private consultants for their letter and equally they just do not have the capacity (clinical or administratively) to do so. Clinically prescribing medication without clear guidance in the form of a letter from your consultant creates an unnecessary risk of a prescribing error.

To overcome any delay most private consultants will provide you with a private prescription for 1-2 months.  GPs will not convert these private prescriptions into an NHS prescription without a letter fully explaining the rationale for the long-term medication.

Further information

The guidance above is national, but there is also simpler local guidance which gives exactly the same message. Produced by the local integrated care board, see “managing the boundaries of NHS and Privately-funded healthcare” under

• Conditions which may not be funded on the NHS (GP)

Contact details for local private hospitals and services can be found under

• Local Contact Details And Service Finder

This is not a recommendation of any particular private hospital or service and you can choose to go anywhere you like. In addition, there are many other private medical services such as private GPs and small private clinics which due to capacity are not listed here.

COSMETIC procedures

Cosmetic surgery includes a range of procedures with the more complex only undertaken by plastic surgeons. There is information on cosmetic surgery, including some questions which are worth asking before embarking on any cosmetic procedure, see under

• Cosmetic procedures

MINOR SURGERY

Minor surgery particularly relates to the removal of simple skin lesions which would not be removed on the NHS. See under

• Minor Surgery