Woodlands Family Practice Responsibility in Responding to Private Healthcare
Background
This policy aims to set out practice responsibilities in responding to requests from private providers of healthcare services and from patients who may have chosen to seek care within the private sector.
To make sure that the NHS remains free at the point of delivery and access to NHS services is based on clinical need, but not an individual's ability to pay, guidance (Guidance on NHS patients who wish to pay for additional private care (publishing.service.gov.uk)) states that the NHS should never subsidise private care with public money.
So called “co-funding”, which is when both private and NHS funding is used for a single episode of care, is not permitted under NHS rules. Any additional private care must be delivered separately from NHS care. In line with NHS guidance, NHS Kent and Medway only supports shared care to be undertaken with an NHS commissioned provider providing an NHS service.
Investigations
Investigations suggested or requested by a private Clinician should usually be requested by the private Clinician at the patient’s cost. As a general principle in clinical practice and medicolegally, requesting clinicians remain responsible for the rationale behind requesting tests, their results and any actions that are required from them.
This ensures that NHS/practice capacity is prioritized for those with the greatest clinical need and NHS GPs are not expected to request tests or review results which may fall outside the scope of a primary care physician.
On an exceptional basis, if a GP within the practice considers the proposed investigations to be clinically appropriate, they are competent to both interpret them and manage the care of the patient accordingly, then the GP may proceed with arranging the tests or investigations.
Prescriptions
If any medications are requested following assessment of a patient in the private sector, these may be offered on an NHS prescription provided the medication
· is one which would ordinarily be prescribed in primary care
· and practice clinicians are familiar with their use
· and they are listed as suitable for prescribing in primary care on the Medway and Swale Formulary.
Prescriptions for medications requiring a shared care agreement according to NICE / BNF or which are not routinely offered in primary care will not be provided.
Referrals
If a patient chooses to seek private treatment, they can self-refer.
Some consultants will only see patients that have a referral from a GP and in these situations a private referral letter will be provided as a courtesy to the patient and private consultant, and this would be classed as a transfer of care.
If a private insurer requires a GP claim form to action referral, this is not an NHS commissioned service and so would incur a private service fee dependent on the complexity of the claim form and the time required for completion. A guideline for private fees is available on the practice website and from the reception team.
Patients have the right to transfer their care from the private provider to the NHS. The practice will only refer onwards where such a referral would be considered clinically necessary, with comprehensive information provided by the private provider about the further care or assessment deemed required and where this isn’t an example of “co-funding” for a single episode of care as described above.
Shared care may be undertaken with a private provider where they have been commissioned by an ICB to undertake NHS work where the practice is satisfied that they follow the same protocols as an NHS organisation would for the same condition and the shared care provided will be of the same standard.