Private Healthcare Guidelines

Bewdley Medical Centre Policy For Patients Who Want To Make Use Of Private Medical Services

(This document describes the policy of the practice in respect of private and NHS healthcare and the use of resources in these sectors)

The NHS has limited resources. We have a responsibility to ensure, as far as is possible, that those resources are fairly and sensibly distributed for the benefit of all our patients.

Bewdley Medical Centre has no private patients of its own so all patients are cared for under the auspices of the NHS. We clearly recognise however that a significant number of patients have private medical insurance or wish to purchase private health care. We do not differentiate between patients who need care from either the private or NHS sector.

We do however believe that patients need to receive health care for a specific problem from either the private sector or from the NHS - not both. Patients who have opted for care under one or other system can decide to change midway through a particular problem, but need to change all their care for that problem. This does not mean a change of GP but does mean that any related investigations, hospital appointments and treatments will be the responsibility of the new health care provider. Additionally we will not support requests from private health care providers to augment the patient's care by use of scarce NHS resources. Formal guidance for this is covered by West Midlands Strategic Commissioning Group - Defining the boundaries between NHS and Private Healthcare WM/13 April 2010 http://www.wmsc.nhs.uk/uploaded_media/WM13%20policy%20-%20Defining%20the%20boundaries%

Some patients who make use of private medical services for hospital care might argue that they are saving money for the NHS overall and therefore asking for some NHS support is only fair. Unfortunately NHS finance is related to the whole population with fixed annual limits on that expenditure and not related to an individual's health costs; as a consequence expenditure for the NHS is increased, if over and above the planned-for provision, it has to supplement private health care provision.

Many patients need drug treatments advised by hospital specialists. The NHS makes an exception about drugs advised by the private health care system in that patients are entitled to have their medication needs met by the NHS provided that the drugs advised meet the following criteria;

1. The advised drugs are consistent with usual GP prescribing and levels of clinical responsibility
2. The advised drugs are consistent with the practice formulary and local NHS prescribing policies
3. The advised drugs are consistent with the clinical needs of the patient as assessed by the GP
4. That the GP is given sufficient timely information to make a clinical judgment to allow full prescribing responsibility
5. Prescribing when undertaken will usually be on a generic basis
6. That any routine monitoring that is required is undertaken by the private health care system

The following scenarios demonstrate our principles

•  A patient has a first epileptic fit and needs to be seen by a Consultant Neurologist as an outpatient. The patient says that they would like to do this privately. The GP makes an appropriate referral. The patient sees the consultant who advises a number of investigations including an MRI scan that will be very expensive. The patient is not privately insured and decides that they would like to have the MRI done on the NHS. After discussing this with their GP the patient is referred on the NHS to the same consultant who arranges to put the patient on the appropriate part of the waiting list. The patient waits (alongside other NHS patients), has their scan and is followed up under the NHS at the hospital out-patient clinic.
• A patient is seen by a consultant privately for a medical problem. The consultant advises the patient that he would like a number of investigations performed which he will write to their GP about to arrange and will see the patient privately after these have been done. The patient rings their GP who explains that using NHS resources to support private medicine is inappropriate and unfair on other patients waiting. The patient agrees to continue with private health care and the consultant arranges the investigations and continued follow-up privately.
• A patient is seen on the NHS and joins a waiting list for a joint replacement. The patient decides that they would like to see the consultant privately to discuss paying entirely for the procedure. After discussion with their GP, the patient removes their name from the NHS waiting list and arranges an admission date for the operation as a private patient. Follow-up outpatient care is at the local private hospital.
• A patient sees a consultant privately who decides that they need an operation. The operation proceeds but on discharge the patient is advised that they need specific physiotherapy to aid recovery and they should approach their GP 'who will arrange this.' The patient approaches their GP when they get home. The GP advises that this care is really part of the package for recovery from the operation and that this should be arranged privately and not by re-directing already hard-pressed NHS resources. The patient is advised that that they can either be referred to a local private physiotherapy clinic or that the consultant surgeon should arrange this for the patient (which is what ultimately happens).
• A patient sees an oncologist (cancer specialist) privately who advises a specific drug to control blood pressure, and additionally an anti-cancer drug for the patient to take following in-patient care. The patient returns to see their GP for a prescription. The blood pressure drug is a member of a straightforward group of drugs well used in general practice and the patient is prescribed the practice formulary equivalent which satisfactorily controls their blood pressure. The anti-cancer drug is well outside the scope of usual GP prescribing and is usually prescribed to NHS patients when they attend out-patient clinics by the oncologist in charge. The private oncologist is faxed immediately and the practice policy is explained; arrangements are made for the patient to receive a private prescription and the patient (or their insurance company) has to pay for the cost of the drug themselves. Given this expense, the patient ultimately opts for transfer to the local NHS provider and the anti-cancer drugs are prescribed in out-patients.