Non-NHS Services

What happens when you see a private consultant/provider?

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 we would like to take this opportunity to explain how the NHS and General Practice work alongside Private providers of care.

What do I need to do?

For patients making use of health insurance e.g. Bupa, your GP will write a referral letter if they feel this is appropriate and it will be available to collect from reception, this will include any relevant medical details about you. These letters go through our normal administration/secretarial system and take time to produce.

You will need to wait until you have this letter before making an appointment, as the details within it will help the doctor you see. 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 health insurance and wish to book directly with a private clinic, you do not require a letter and can arrange the appointment as you wish. You should contact the Consultant’s team or your Private Health Care Provider or Insurer to organise an appointment. Should you have any questions regarding your appointment you should contact them directly. 

Seeing the Consultant

What happens if I need a test or procedure?

If the Consultant thinks that you need any tests - including blood tests - or a surgical procedure, then the Consultant 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. Please note: the cost of these are your responsibility to fund yourself. If the consultant is located further away you will need to consider how you will arrange to have these blood tests/investigations when you arrange your appointment.
• 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 Consultant’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.

What happens if I’ve had tests through a private screening clinic that show an abnormality?

Health screening is becoming very popular and well marketed in the Private sector.  Lots of these tests are not evidence based and not supported by the NHS Screening Committee or NICE (National Institute for Health and Care Excellence).

 Examples would be:

• Testosterone levels
• Vitamin D levels
• Screening ECG (electrocardiograms)

If an abnormality is found on such screening tests, it is the responsibility of the private provider to action them appropriately.  NHS GP Practices are not responsible for repeating these tests or following them up unless they are part of a recognised NHS Screening programme.

Why am I being given a private prescription?

If you have seen a doctor or other healthcare professional privately and they need you to start a treatment, you may be issued with a private prescription. Private doctors are not allowed to issue NHS prescriptions. This is because private consultations are not part of the NHS treatment pathway.

What is the difference between a private prescription and an NHS prescription?

With a private prescription you will need to pay for the full cost of the medicine plus a dispensing fee. The pharmacy will calculate the total cost, and this is paid by you or your medical insurance company. The total cost can vary at different pharmacies, so it is worth asking more than one pharmacy how much they will charge you to dispense the prescription. Sometimes private prescriptions cost less than the NHS prescription charge.

With an NHS prescription you pay an NHS prescription charge per item (a fixed tax) unless you are entitled to free NHS prescriptions. The current cost of the prescription charge is available at: https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/how-much-nhs-prescription-charge/

You can get more information about whether you are entitled to free NHS prescriptions at: https://www.nhs.uk/using-the-nhs/help-with-health-costs/get-help-with-prescription-costs/

How do I get my medicines if they are on a private prescription?

If you have been given a private prescription by your healthcare professional, you can have this dispensed at a pharmacy of your choice. A private prescription is normally written on letterheaded paper and has all the information about the medicine and how you need to take it. The pharmacy will inform you how much they will charge you to dispense the prescription. The pharmacy has to keep the private prescription for their records once your medicine has been dispensed.

Can I ask my GP for an NHS prescription if I have seen the clinician privately?

If you enter the NHS for further treatment after your initial prescription was dispensed privately, then your GP may be able to issue a prescription on the NHS.  In some cases, your GP 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 GPs. 

However, there are a number of reasons that 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 on an NHS prescription

If a medicine is not allowed on an NHS prescription (blacklisted) then it cannot be prescribed by anyone on the NHS.

• The medicine being recommended is not included in your local NHS treatment pathway

In your local area the medicine may not be included in the normal NHS treatment pathway, therefore would not normally be recommended on an NHS prescription.

• The medicine being recommended is not included in your local medicine formulary

A medicine formulary contains a list of preferred local 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

In the normal NHS treatment pathway, NHS specialists and not GPs, would prescribe the medicine. So, GPs may be unfamiliar with the medicine and how it should be prescribed and reviewed. GPs would not normally prescribe these medicines on NHS prescription.

• Your GP may not agree with the choice of medicine being recommended
  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 included further down the NHS treatment pathway
  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.

If I have any question or difficulty obtaining the medicines, what shall I do?

You should speak to the clinician that issued the private prescription to discuss what to do next. This includes asking about side effects or issues related to your medication.

I cannot afford to pay for the treatment privately, what can I do?

It is important to consider all potential costs when accessing a private consultant and this includes medicine costs. If your GP is unable to prescribe the medicine on an NHS prescription for one of the reasons documented, you should speak to the clinician that issued you with the private prescription to discuss what to do next. This may include them recommending an alternative less costly medicine or one which may be prescribed by your GP on an NHS prescription.

My private provider has suggested a private ‘shared care agreement’ What is this?

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. As a rule, we do not accept shared care agreements with private providers.

If we are unable to issue an NHS prescription you can still obtain the medication recommended via a private prescription from the private provider you have seen but we would recommend that you investigate the cost of this and associated monitoring before proceeding.

What is NHS right to choose?

NHS waiting lists to receive an assessment for autism or ADHD, respectively, are often very long. Understandably, many people on these waiting lists want to explore other options. Some people consider a private assessment, while others use their right to choose. This means you can be referred to private providers and they will provide appointments for diagnostic review. Under the ‘right to choose’ NHS funding they will not start medication and you will need to be referred to the NHS for any treatment.

The waiting list for these services may be shorter than NHS clinics but as they become more popular these waiting lists are increasing. Whilst we all share the frustration with the under-funding of the mental health services under the NHS we have no power to alter waiting lists or start prescribing whilst you are waiting for this.

What happens if I need to transfer my care back to the NHS?

If after seeing the Consultant privately you want to be back under NHS care, and national regulations allow for you to transfer back. This transfer ideally needs to be done by the private Consultant who is overseeing your care but if this is not possible please request that your consultant writes directly to the practice to request this. Due to NHS waiting times, you may have to continue paying under the private care whiles waiting for you to be accepted under NHS care. We will not take over prescribing during the transition period between private and NHS care.

My GP has offered me a private prescription even though I am being seen on the NHS. Why is this?

There are a few rare circumstances where NHS healthcare professionals may issue private prescriptions to their NHS patients. These are:

• Malaria prophylaxis for protection when travelling abroad or medicines only needed in case there is an illness or injury when travelling abroad

Treatments that may be needed whilst travelling are not considered suitable for prescribing on the NHS. The traveller should pay the cost of these treatments.

• Travel vaccines that are not allowed on the NHS, such as yellow fever or rabies vaccine

Some vaccines for travel are not allowed on the NHS and therefore travellers needing these vaccines will need to pay for them privately.

• Items which are blacklisted or not available for specific conditions on the NHS

In very rare circumstances, your healthcare professional may think that an item not available for prescribing on the NHS is suitable for you and with your agreement may need to issue a private prescription for this item.

Your healthcare professional may charge you a fee for writing a private prescription.

This position is supported by the Royal College of General Practitioners and the British Medical Association.