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This page specifically covers private providers. If you have a query about NHS hospital care in general, including appointments, tests, results and medications, please visit our hospital care page. For information on expediting your hospital appointment, please see our expediting appointment page

Dear Patient

A private provider is any consultant, hospital or other organisation that charges for healthcare. References to private provider on this page will refer to the person or body who is providing you with private healthcare.

 

PRIVATE REFERRALS

If you are already under the care of a GP here at the surgery and you wish to discuss a private referral, please do so at the time of your consultation. The following describes some situations regarding private referrals.

SELECTING A PRIVATE PROVIDER Please note that you must yourself select which private provider you wish to attend as any recommendation directing you towards a particular private provider may be seen as being anti-competitive. We can however supply information as to which providers may be available, but you still need to make the choice yourself.

YOU CAN SELF-REFER TO A PRIVATE PROVIDER Contrary to popular belief about needing a GP referral letter, any patient can self-refer to any private provider without any input from a GP. You do not actually need a GP referral letter. You simply contact the provider and ask to be seen. To facilitate your self-referral, if you need it, we can supply a summary printout of your record free of charge to take with you to your appointment.

REFERRAL LETTERS IF ALREADY UNDER THE GP If you are under a GP, and they have agreed with you that you need a referral, they will supply a referral letter for you to take to the private provider and you can then book your own appointment. This is free of charge.

REFERRAL LETTERS IF SELF-REFERRING As indicated in section . above, if you are self-referring, you can simply book with a private provider without any input from a GP. However, if you do still require a referral letter before the private provider will see you, we can supply a referral letter for you, but this will be chargeable, in line with our current fees policy.

REFERRED TO NHS BUT NOW WANT TO GO PRIVATE If your GP was going to refer you or has already referred you to an NHS hospital, but you wish to go private instead, we can supply the referral letter that we would have sent to the NHS hospital. This is free of charge. Simply discuss with your GP at the time, or, if you have already been referred, please contact our admin team to facilitiate this.

INSURANCE FORMS REQUIRING COMPLETION BEFORE BEING SEEN If your insurer or private provider requires an insurance form completing before they can see you, we can fill out the form for you, but this will be chargeable, in line with our current fees policy.

letter

REFERRAL PROFORMAS REQUIRING COMPLETION BEFORE BEING SEEN Referral proformas are different from referral letters. Referral letters are traditional letters dictated by the GP and typed up by their secretary to help facilitate a referral, and which have been used ever since the inception of the NHS and well recognised as the standard of communication between health professionals.

Referral proformas are different. These are custom document templates supplied by a provider for the GP to complete a series of questions about your condition. In recent years there has been an explosion of such forms, almost all of which GPs have not had a hand in developing, and furthermore, which have not formally approved for use before roll-out. It is impossible as well as completely inappropriate for any GP surgery to accommodate custom document templates for every single provider available, of which there are hundreds.

Often referral proformas are excessively long, very specific in their line of questioning, take an inordinate amount of precious GP time to complete, require information that the GP is not actually in possession of, used by providers to make rejection of referrals easier (see section below), or are intended to inappropriately use the GP to perform a full triage and assessment service for the provider - such a service is actually the responsibility of the provider themselves to be carried out in discussion with the patient, either in their actual appointment or in some form of pre-appointment assessment.

GPs are under no professional or contractual obligation whatsoever to complete any hospital, organisation or other provider's referral proforma, whether NHS or private. For the avoidance of doubt, we will not complete any referral proformas for any private referral. Please also see section below regarding rejected referrals related to referral proformas.

If you meet the criteria for a referral and the referral has been agreed with you, then the GP can write a referral letter with the salient information, as we would ordinarily do with most referrals. This is more than sufficient and the GP will have fulfilled their GMC and GP contractual obligations by referring you in this manner. In the case of self-referral, you may refer yourself to a private provider without a GP referral letter, as described in section above.

REJECTED REFERRALS Please be aware that some private providers may reject your referral if a referral proforma has not been completed, even though they may have already received an entirely appropriate referral letter. We must emphasise that where a private provider requires further information, whether that be in the form of a referral proforma or some other data, the private provider themselves has the ability to contact the patient directly to obtain the relevant information. For the avoidance of doubt, we will not complete any referral proformas even if your referral has been rejected. The reasons for this are outlined in section above. Our obligations as your GP will already have been fulfilled by provision of a referral letter.

If your chosen private provider rejects your referral, you are at liberty to lobby that existing provider yourself to accept your referral, or you can choose an alternative private provider who will accept it.

TESTS AND/OR MEDICATIONS AFTER ATTENDANCE Please note that where GPs have made a referral to a private provider, whether this is at your own or at the GP's instigation, this does not obligate the GP to carry out any tests or prescribe any medications should these be requested by the private provider. Please see the section immediately below on investigations, medications and shared care.

DISCLAIMER STATEMENT Any patient requiring a referral from the GP to a private provider is required to sign a statement indicating that they understand that any tests and/or medication requests from the private provider may not be honoured by us. The reasons for this are detailed below.

 

TEST REQUESTS AND MEDICATION

chemistry test

Contrary to popular belief, NHS GPs actually have no obligation to perform any investigations or prescribe any medications following attendance at a private provider. The following section describes each type of request in more detail.

 

INVESTIGATIONS NHS GPs are not obliged to perform or request any tests that are required as a result of a patient attending a private provider. This is especially so, if such a test falls outside ordinary care usually provided by the GP and where the interpretation of the result of such test would fall outside the GPs knowledge, skills and competence. Such tests can be requested and actioned by the private provider themselves.

Download info leaflet

Any private provider that requires investigations to be carried out as part of the care they provide must be able to arrange, provide or commission the investigation themselves. It is not the responsibility of the GP to carry out any investigations to enable the private provider to carry out their work.

Examples of such investigations include: ECGs (heart tracings) prior to commencing ADHD medication; blood monitoring for vitamin deficiencies following gastric band surgery; blood tests as part of a pre-operative assessment.

 

MEDICATIONS Again, NHS GPs are not obliged to prescribe medications that are required as a result of a patient attending a private provider, nor are they required to convert privately issued prescriptions to a GP issued ones.

However, where such requested medications are within the scope of ordinary care from a GP and where we would normally issue such medications, we will consider such requests on an individual basis and if agreed, prescriptions will be processed in line with our usual medication process and timescale. It must be emphasised, if we choose to write an NHS script, it will be processed as non-urgent.

There are no circumstances in which we will issue urgent medications at the request of any hospital, private or otherwise . If your private provider indicates that you need your medication urgently, then in line with usual hospital processes, they must supply it directly themselves.

 
 

SHARED CARE MEDICATIONS Shared care is a process whereby responsibility for a patient's medication is shared between a GP and consultant. In such a situation, the consultant will assess a patient's suitability for the medication, perform any necessary baseline investigations and counsel the patient fully on the medication, before prescribing the medication and adjusting the dose until the patient is stable.

Once the patient is stable, the consultant then writes to the GP to ask them to consider shared care. If the GP accepts, they then take over the prescribing and monitoring of the patient, notifying the consultant should any problems arise. The patient must remain under the care of the consultant. For shared care to be valid, there must also be a written agreement on the duties and responsibilities of each party.

The whole process of shared care is to facilitate appropriate clinical oversight and to maintain patient safety, all in the patient's best interests.

Having said the above, it must be noted that shared care is entirely voluntary for GPs and GPs are NOT obliged to enter into shared care, for whatever reason.

In general, we do not participate in shared care arrangements with private providers. Specifically, we will not consider shared care arrangements if ANY of the following conditions apply (most of these describe situations that are, by definition, not shared care):

  • There is no written shared care agreement NOT SHARED CARE
  • There is a shared care agreement, but it does not match the equivalent NHS shared care agreement for the same cohort of patients NO EQUIVALENCE
  • The private provider is an assessment or diagnosis only service, that is, it does not prescribe medication at all NOT SHARED CARE
  • The private provider has not completed an appropriate assessment of patient's suitability for the medication, performed baseline investigations or provided counselling for the medication (for example, information on side effects, interactions) NOT SHARED CARE
  • The private provider has not initiated the patient on medication and/or has not adjusted dosage accordingly and/or has not stabilised the patient on the medication NOT SHARED CARE
  • The private provider has discharged the patient back to sole GP care NOT SHARED CARE
  • The medication being recommended is one that falls outside the GP's knowledge, experience or competence to prescribe CANNOT PRESCRIBE
  • The private provider is recommending use of medication that falls outside its licensed indications (for instance, it is being used for a different age group or different reason from the manufacturer's recommendations) NOT LICENSED

The reason why we do not consider prescribing medication in any of the above situations is that there is no proper specialist oversight and consequently patient safety is potentially at risk. Whilst it may seem convenient (and cheaper) to 'get a prescription from the GP', we will not enter into any arrangement that has the potential to put a patient at risk.

If NONE of the above apply, we may consider the request for shared care from a private provider on an individual basis, but please note that such consideration does not guarantee that a prescription will be provided.

As already mentioned, if you are being referred to a private provider, you will need to indicate by a signed disclaimer form that you understand the implications of how we deal with medication requests, including shared care requests, and test requests from private providers.

YOUR PRIVATE PROVIDER CAN PROVIDE YOU WITH WHAT YOU NEED

If you are concerned you might not get the investigations and medications you need as part of the care from your private provider, you are advised to purchase or negotiate a package with your private provider that includes all of this. If your private provider simply says, don't worry, your GP will just do it, they are providing you with false assurance and factually incorrect information.

Ultimately, should patients require any tests or medications as part of the care given by a private provider, the private provider themselves can request tests or supply medication to the patient for the appropriate fee.

We respect the universal right of any patient to choose (and pay for) a private provider, however, it is not an NHS GP's responsibility to request tests or prescribe medications on behalf of that provider purely for the purposes of reducing the cost burden of private care for the patient* or for the purposes of reducing waiting times to assessment and/or treatment, and due consideration must always be given towards proper clinical oversight and patient safety.

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*NHS guidance states that private and NHS care should be kept as clearly separate as possible, so that funding, legal status, liability and accountability are appropriately defined, that the patient should bear the full costs of any private services, and that NHS resources should never be used to subsidise the use of private care.

BMA guidance

We hope the above goes some way to explaining the situation regarding requests from private providers.

 

REQUEST BY PRIVATE PROVIDER TO REFER BACK TO THEIR OWN NHS CLINIC

You may be asked by your private provider to ask your GP to do a referral to the private provider's own NHS clinic, perhaps because you may not have the funds to proceed with private healthcare or if your insurance company does not cover you. The private provider may state a GP referral is needed to 'balance the books' or 'to allow the referral to be counted properly', that they are 'not able to do this' themselves, or that they 'need permission from the GP for the referral to go ahead'. All of these reasons are factually incorrect and the request represents completely unnecessary administration being inappropriately passed to the GP.

The NHS referral can be achieved by the private consultant directly without the need for a further GP letter. This is in line with BMA and NHS England advice and if you are asked by a private provider to do this, please ask them to make the required referral themselves.

BMA guidance

Yours sincerely

Ivy Grove Surgery

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