THE NHS-PRIVATE INTERFACE

Local Guidance for NHS General Practice & Private Providers

The purpose of this guidance is to explain key principles of care over the NHS & Private interface and apply them to frequent scenarios that occur in NHS General Practice. It is written for NHS GPs and private providers serving patients in Cambridgeshire & Peterborough.

If a patient requests a private referral, a GP should honour this if they think it meets the clinical needs of their patient, and without charge, as they would do for any patient. GPs have a right to decline to refer (including privately) if they do not think it is clinically appropriate. A private GP can refer into NHS services; they don’t need to ask the patients NHS GP to do so on their behalf.  

Any pre-referral work-up should be offered by the NHS GP as they normally would do for any of their NHS patients. However, GPs should not be asked to do any investigations requested by the private specialist. The patient should expect to pay for all aspects of the private care including consultations, investigations, privately issued interventions, and any unplanned or planned follow-up related to that private care in order to clearly separate out private and NHS activities. However, the NHS should never decline emergency care, even if it is the result of private interventions, or decline any care simply because the responsibility is unclear. GPs should liaise with private specialists to co-ordinate care as they would do for their patients in NHS secondary care. A patient cannot retrospectively ask the NHS to reimburse them for private care costs.

A private specialist may ask a GP to prescribe for them, but a GP should only prescribe what they would normally do for any other NHS patient with the same condition and in accordance with their CCG formulary (http://www.cambridgeshireandpeterboroughformulary.nhs.uk). If the medicine request falls outside of the local formulary arrangement, the specialist will either have to offer this privately to the patient (including all subsequent monitoring) or transfer the patient into NHS care if the patient requests it. 

A private patient has a right to transfer into NHS care at any time. If they do transfer, they are entitled to that which is available locally to any other NHS patient with the same condition – no more, no less – and they should join the relevant NHS service at the same point as if their last episode of private care was delivered in the NHS, facing the same wait times as other NHS patients with the same clinical predicament at that point in the care pathway. In these circumstances, the private specialist should complete a consultant-to- consultant referral into the equivalent NHS clinic (which may be their own NHS clinic) – they should not ask the GP to do the referral for them.

This guidance draws upon the following, which lay out the principles for managing the interface between the NHS and private care:

THE NHS/PRIVATE INTERFACE

FULL PDF DOCUMENT

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