Morthen Road Group Practice
Private Referral Information
Introduction
With nearly 7.6 million people on NHS waiting lists in December 2023 patients are increasingly resorting to seeking private health care. A private provider is any consultant, hospital or other organisation that charges for healthcare. We understand that some patients will opt to have some or all, of their treatment privately and support your right to do so. However, to prevent any misunderstanding please read the information below which explains how the NHS and General Practice work alongside private providers.
Private Providers – Patient Information
If the GP was going to refer 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.
Did you know you do not need a GP referral letter for a private referral? Any patient can self-refer to any private provider without any input from a GP. You do not need a GP referral letter. Simply ring up the provider and ask to be seen. If you need, we can supply a summary printout of your record free of charge to take with you to your appointment.
If you decide to be seen by a private provider and that provider requests an insurance form completing before they can see you, we can fill out a form for you, but there will be a charge as this constitutes as Non-NHS work. For more information see our Non-NHS Services page
We are unable to a recommend or direct you to a private provider as this could be seen as competitive behaviour.
Where a GP has made a referral to a private provider, whether at your own request or at the GP’s instigation, this does not obligate the GP to carry out any tests, monitoring or prescribing of any medications requested by the private provider. Please see sections below for more information.
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 an inclusive package with your private provider. If your private provider tells you not to worry, your GP will do the monitoring and/or prescribe your medication, they are providing you with false assurance.
A private provider themselves can request tests or supply medication to the patient for the appropriate fee.
Morthen Road Group Practice respect the right of any patient to choose and pay for a private provider, but it is not the responsibility of an NHS GP to request tests or prescribe medications on behalf of that provider to reduce the cost burden of private care for the patient or for the purposes of reducing waiting times. Due consideration must always be given towards proper clinical oversight and patient safety.
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, 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 www.bma.org.uk.
Tests and Medication Requests
NHS GPs are not commissioned and have no obligation to perform any investigations or prescribe medications following attendance at a private provider. The following section describes each type of request in more detail.
Investigations
Morthen Road Group Practice GPs are not commissioned nor obliged to perform or request any tests that are required because 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.
Medications
The private healthcare provider 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.
In some cases, your GP may not be able to continue to prescribe these medications on an NHS prescription, if the request does not follow the national and local clinical guidelines. To help the practice to review a prescription request for a treatment initiated by the private clinician a full clinic letter from the provider 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. Even with this information, we will not guarantee that we will offer an NHS prescription in all cases.
There are several reasons why your GP may not be able to transfer your private prescription onto an NHS prescription. These include:
- The medicine being recommended on your private prescription is not allowed (blacklisted) on an NHS prescription and so it cannot be prescribed by anyone on the NHS.
- The medicine being recommended is not included in the local medicine formulary and therefore is not provided by your local NHS. A medicine formulary contains a list of preferred local medicine choices. You may be offered a preferred alternative on NHS prescription instead of the medicine on your private prescription.
- The medicine being recommended is only suitable for specialist or specialised prescribing. Normally, NHS specialists and not GPs, would prescribe the medicine. So, GPs may be unfamiliar with the medicine and how it should be prescribed, monitored, and reviewed. GPs would not normally prescribe these medicines on NHS prescription.
- Your GP may not agree with the choice of medicine recommended by your private clinician. You may be offered an alternative on NHS prescription.
- The medicine is not what would normally be prescribed for you first. In your local area other treatments are recommended to be tried and considered first. You may be offered one of these medicines on NHS prescription first.
Shared Care Agreements
Shared care is when the responsibility for a patient’s medication and monitoring is shared between the GP and consultant. In these situations, the consultant will decide a patient’s suitability for the medication, perform any necessary baseline investigations, counsel the patient fully regarding the medication and then prescribe the medication, adjusting the dose until the patient is stable.
Once the patient is on a stable dose, the consultant then writes to the GP to ask them to consider a shared care agreement. If the request is appropriate and the GP accepts the shared care agreement, they then take over the prescribing and monitoring of the patient, notifying the consultant should any problems arise. It is important to note that the GP signing the prescription is responsible for the decision to prescribe and not the consultant. However, 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 process of shared care is in the patient’s best interest, to facilitate appropriate clinical oversight and to maintain patient safety.
Having said the above, it must be noted that shared care is entirely voluntary for GP’s and GPs are NOT obliged or commissioned to enter into this type of agreement, for whatever reason.
Whilst we are supportive of our patients, we need to ensure we are safe and not acting outside of our clinical competencies therefore we generally do not take on a shared care agreement with a private provider 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
- There is a shared care agreement, but it does not match the equivalent NHS shared care agreement for the same cohort of patients
- The private provider is an assessment or diagnosis only service, that does not prescribe medication at all
- 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)
- 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.
- The private provider has discharged the patient back to sole GP care
- The medication being recommended is one that falls outside the GP’s knowledge, experience or competence to 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)
Requesting right to choose referral for ADHD Assessment and medication
Attention deficit hyperactivity disorder (ADHD) is a condition that affects people’s behaviour.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child’s circumstances change, such as when they start school. Most cases are diagnosed when children are under 12 years old, but sometimes it’s diagnosed later in childhood. Sometimes ADHD was not recognised when someone was a child, and they are diagnosed later as an adult. The symptoms of ADHD may improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems. People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Further information can be found on the NHS website:
https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/
There has been a significant increase in the number of referrals and both the adult assessment and child /young adult waiting time is more than 1 year and we cannot give an exact estimate of the time when you might be seen.
If you choose to arrange an ADHD assessment privately via the right to choose scheme, please bear in mind that Adult ADHD medication is a specialist only medication and South Yorkshire GPs are not currently allowed to take over prescribing of these medications. With children and young adults, it is under a shared care agreement. This may mean that you must pay for your medications or will need to be referred to the NHS ADHD service for them to issue and your referral and appointment will not be expedited if you already have a diagnosis from a private provider.
Post Op cosmetic surgery
The private healthcare provider will discuss with you whether you should attend appointments with them for ongoing follow- up or care or whether you are discharged back to the GP. They should arrange any suture removal or post operative reviews. If you have any complications post-surgery and have been discharged please contact the private health care provider rather than your GP surgery.
Post Op Bariatric Monitoring
The bariatric surgical provider is responsible for the organisation of structured, systematic, and team-based follow-up of patients for 2 years post-surgery.
After 2 years if all is well the patient can be discharged from bariatric surgery service follow-up, into the care of the GP for monitoring of nutritional status and appropriate supplementation according to need in line with recommendations made in NICE clinical guidelines.
Private patients who’ve had surgery in the UK
Private patients who have had their surgery in the UK should be receiving the same 2 year follow up from their provider as NHS patients. Morthen Road Group Practice will not take on care of any private patient within two years of surgery.
What about private patients who have had surgery abroad?
NHS bariatric services are not able to provide routine follow up to patients who had their surgery done overseas but will manage any surgical bariatric emergencies. Patients are advised to seek a private bariatric follow up programme in the UK for a two-year period, these are available, and many accept self-referrals. After this, the monitoring process is the same as for any other patient and can pass into the care of the GP.
Hormone Therapy Shared Care Agreements with Private providers
Whilst we are supportive of our patients who are trans, we need to ensure we are safe and not acting outside of our clinical competencies therefore we generally do not take on a shared care agreement with a private provider.
There is no guarantee that patient will continue to remain under the private clinic which would then leave the patient and the GP in a difficult situation. In order to support our patients, we can arrange blood monitoring at the practice (provided these are bloods that are typically done by a similar NHS clinic). The patient would be responsible for obtaining the results (which can be done electronically) and ensuring that the private provider interprets them, as again, we do not have the clinical expertise to do so.
It is important to note that Morthen Road Group Practice will be happy to take on shared care agreements when their care is under NHS care but appreciate and sympathise that there is a prolonged wait for this. Sadly, we as GP’s are not able to make up for the lack of adequate commissioning of these services as we would be working outside our competence.