What happens when you see a doctor/specialist privately?
We understand that some patients will opt to have some or all of their treatment privately and we support your right to do so. However, to prevent any misunderstanding we would like to take this opportunity to explain how the NHS and General Practice work alongside private providers of care. Please note that patients should bear the full costs of any private services. NHS resources should never be used to subsidise the use of private care.
What do I need to do?
For patients making use of private health insurance eg BUPA, AXA etc:
You will need to contact your private health insurer to gain authorisation before making your appointment. The practice will write a referral letter if they feel this is appropriate, this will include any relevant medical details about you..
Please note that if an insurance company wishes for a specific form to be completed you may be charged for this additional work.
For patients who do not have a health insurance policy:
If you do not have private health insurance and wish to book directly with a private clinic, you can arrange the appointment as you wish. The practice will write a referral letter if they feel this is appropriate, this will include any relevant medical details about you.
Should you have any questions regarding your appointment you should contact the doctor/specialist’s team or your private healthcare provider directly.
Seeing the doctor/specialist
What happens if I need a test or procedure?
If they think that you need any tests, including blood tests or a surgical procedure, then the private specialist is responsible for:
- Arranging tests and any medications that might be needed prior to the test, as well as explaining how and when you will receive a date for the test, and what to do if the date is not suitable for you
- Giving you your results and explaining what they mean. This may be via letter or a further face to face appointment.
Please do not contact the practice to discuss the results of tests organised by other doctors. It is the specialist’s responsibility to discuss this with you, and the practice may not have access to the results or be in a position to interpret them.
We are not obliged to undertake any tests requested by a private provider and reserve the right to refuse to undertake any tests requested if we feel it is not clinically appropriate to take place following a review with a clinician.
What happens if I need new medicines?
The specialist might suggest prescribing new medicines for you or might want to make changes to the medicines that you are already taking. They will be responsible for giving you the first prescription of any new medicine that you need to start taking straight away. Please note if you take a private prescription to any NHS Pharmacy you will have to pay the actual cost of the medication rather than the current NHS standard prescription charge, which may be more or less dependent on the medication prescribed.
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.
Please do not bring a private prescription to the practice to request a substitute NHS prescription as we will not be able to provide this.
In some cases, the practice may be able to continue to prescribe these medications on an NHS prescription. This will need to be considered by the practice and is at the discretion of the prescriber at the practice. Prior to this, a full clinic letter from the consultant is required, outlining the reasons for treatment, explaining the precise details of the prescription; what it is being used to treat; how long the treatment is intended for; and what monitoring or follow up is required before the practice can decide whether we can continue to prescribe.
Please allow at least seven days to allow this letter to arrive before contacting the practice.
If a prescription is needed sooner than this, you should contact the doctor/specialist’s team (usually via their secretary) for them to prescribe.
Private doctors/specialists may suggest medications to patients which wouldn’t normally be prescribed by NHS GPs. If this is the case, you will need to continue to receive them from the specialist. Please contact them directly to organise this.
Please note NHS guidance states that where a patient has an immediate clinical need for medication as a result of attending an outpatient clinic, the secondary care provider must supply medication sufficient to last at least until the point at which the outpatient clinic’s letter can reasonably be expected to have reached the patient’s GP, and when the GP can therefore accept responsibility for subsequent prescribing. Consideration should be given to providing a minimum of 7 days’ supply to allow patients sufficient time to contact staff at their general practice. This applies equally to private and NHS providers.
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.
Most shared care arrangements are commissioned by NHS commissioners and may not be funded for patients seeking private treatment. If this is not funded by local commissioners, the prescriptions and investigations remain the responsibility of the private provider.
GVMP Prescribing Policy
We believe that providing the best quality care to our patients is our top priority. When a prescription is necessary our main considerations are effectiveness and safety.
In order to prioritise patient safety and the best value to the NHS, we are bound to prescribing from an approved list of medications called the Derbyshire Formulary. This is a list of medicines colour coded according to whether they can be safely prescribed by practices (Green), whether they have to be started and monitored by a hospital doctor (Amber), or whether they are not recommended as effective treatments or safe to be prescribed (Red)
The Practice may not be able to issue you with an NHS prescription following a private consultation for the following reasons:
- If the Practice considers that there is not a clear clinical indication for the prescription, and that in the same circumstances an NHS patient would not be offered this treatment
- If the private doctor/specialist recommends a new or experimental treatment, or recommends prescribing a medication outside of its licensed indication or outside of our formulary recommendations
- This includes all prescriptions outside recommended licensed doses or uses as per the British National Formulary
- If the medication is not generally provided within the NHS
- If the medication is of a very specialised nature requiring ongoing monitoring we may be unable to accept responsibility for the prescription. This includes medication that we can prescribe on the NHS but requires what is known as a Shared Care Agreement.
- Without such a Shared Care Agreement in place with an NHS provider of care, we are unable to safely prescribe and monitor certain medication. This would include, but is not limited to, what are known as Disease Modifying Drugs, IVF associated medications and those to treat ADHD
Therefore to maintain prescribing safety and quality, we are unable to accept Shared Care Agreements with private clinics of any sort, nor provide drug monitoring (blood tests, blood pressures, ECGs etc.) for private providers. All such prescriptions will have to be provided and monitored by the clinic themselves, and we expect any legitimate private provider whose service necessitates blood testing and physiological measurement to have their own access to these facilities.
If we are unable to issue a NHS prescription you can still obtain the medication recommended via a private prescription from the specialist you have seen but we would recommend that you investigate the cost of this and associated monitoring before proceeding.
Further information is available from GMC Safe Prescribing Guidance.
What happens if I need to transfer my care back to the NHS?
If after seeing the doctor/specialist privately you want to be back under NHS care, national regulations allow for you to transfer back. This transfer ideally needs to be done by the private specialist who is overseeing your care. If this is not possible please request that your specialist writes directly to the practice to request this.