ࡱ> FHEy #bjbjEE *.''%%%% 1$%"tUUUUU000b"d"d"d"d"d"d"$W$&"00000"UU"0.UUb"0b"!|."UpٹM%^ "N""0""''$."'." 0000000""000"0000'000000000 :  LMC Position Paper on Private Referrals for Specialist Care 1.0 Background It remains a key principle of the British medical system that patients seeking or requiring a specialist opinion should do via referral by a general practitioner except in certain defined circumstances such as accidents and emergencies or the treatment of sexually transmitted diseases. Although this can be regarded as a restrictive practice, there are good economic and clinical reasons why it should continue and it is unlikely to change. The current GMC guidance Good Medical Practice maintains this principle (page 13, paragraph 42). Very few patients have a private GP but some seek private secondary care either directly or through a health insurance policy 2.0 NHS Obligations of a GP The GPs Terms of Service require an NHS GP to provide services of the type normally provided by GPs and specifically say that this includes an obligation to make an appropriate NHS referral. 3.0 Private Referrals However, a significant minority of patients wish to see a consultant privately, and it is important that we can identify where NHS care ends and private care begins. Co-funding, top-up arrangements and mixed funding are presently not permitted under the NHS Regulations. 4.0 The Scope of a Referral It is not possible to define exactly what is encompassed in a referral from a GP to a specialist, but there are 4 broad categories: To obtain an opinion or diagnosis To undertake investigations not available to the GP For specific treatment For reassurance In each of these categories the content of the referral contract will be different, but in essence the GP remains responsible for the care of the patient except in respect of the condition for which referral was made. Once the patient is discharged this responsibility too reverts to the GP. 5.0 Definition of An Episode of Care Any investigation, consultation or treatment may in itself be an episode of care, or it may be part of a longer course of medical intervention. A patient may elect to have a single part of the process undertaken privately for example an MRI scan, or a consultant appointment. The LMC view is that this is acceptable so long as the following criteria are met: All 3 parties (GP, patient and specialist) have at least an implicit understanding of the limits of the private episode The purchase of private care does not directly influence any other part of the care process. For example, a patient may wish to have a private consultation to short circuit an outpatient waiting list, but that following this consultation he or she will join the in-patient waiting list at the same level as patients seen in NHS clinics on the same day for the same condition. The purchase of partial private care does not transfer to primary care work that is normally undertaken as part of secondary care; for example pre-operative anaesthetic assessments. Any other party affected by this decision (Pathology laboratory, NHS physiotherapy department) is prepared to provide the relevant care. 6.0 NHS Responsibilities in Private Referrals The foregoing means that it is not possible to draw a hard and fast line between NHS and private care because every case is different. However, with rising numbers of patients turning to the private sector because of long NHS waits and the perception that the Service offers a lower level of care, it is important that both the patient and the clinicians involved understand who is responsible for what. GPs will clearly wish to avoid being party to the fraudulent use of NHS resources for private care. 6.1 National Guidelines The most recent DH guidance The Mangagement of Private Practice within the NHS (generally referred to as The Green Book) was issued in 1986. This states that: an out-patient cannot be both a private and an NHS patient for the treatment of one condition during a single visit to a health service hospital. A private out-patient at an NHS hospital in nonetheless legally entitled to change his/her status at a subsequent visit and seek treatment under the NHS Elsewhere is states a change of status from private to NHS must be accompanied by an assessment of the patients clinical priority for treatment as an NHS patient and it is important that any private patient who wishes to become an NHS patient should gain no advantage over other NHS patients by doing so. However, it concludes: there is nothing legally to prevent people who have made full NHS contributions from moving between the private sector and the NHS. 7.0 Costs to Patient of Private Care Where patients are not insured the provision of drugs, investigations, and perioperative care may be unexpected costs, and certainly some patients are not made aware of these from the outset. Also, consultants may try to help patients reduce the financial burden of care by suggesting that treatment or investigation be obtained via the GP. On the other hand, by electing to obtain private care the patient has ultimately reduced the total cost to the NHS. The guiding principle should be that it is not appropriate that a patient who has chosen to obtain faster or different treatment in the private sector should be able to use disproportionate NHS resources to do so. It is generally not appropriate to treat self funded and insurance funded private referrals differently 8.0 Principles for a Pragmatic Solution The LMC endorses the following policy position: 8.1 Patients who have made full NHS contributions are entitled to move between private and NHS care. 8.2 For the avoidance of doubt, all costs that are involved in an episode of care should be met either by the NHS or privately, and not by mixed funding. 8.3 Unless otherwise agreed, an episode of care will include all the investigations and treatments which would normally be undertaken in secondary care following an NHS referral. For a surgical procedure these include: Preoperative screening for anaesthetic fitness Postoperative rehabilitation including physiotherapy A weeks supply of discharge medication (if altered) 8.4 Where a patient is referred privately by a GP for an opinion it will normally be appropriate for the GP to undertake any investigations or treatments advised by the consultant on the NHS, provided that the GP feels that these are within his or her competence. We consider that this would not be the case if a patient self refers, other than as under paragraph 1.0. 8.5 Patients should have it made clear at the time of referral that the costs of a procedure may be more than the consultants and hospital fees, and this information needs to be repeated by the relevant specialist before any procedure in undertaken. 8.6 NHS Patients who have had private secondary care should subsequently be treated using exactly the same practice protocols as all other NHS patients. 8.7 Clearly there may be exceptions but these should be raised by the consultant with the GP on a case by case basis. Harry Yoxall Medical Secretary Revised November 2002 >N$ ; ;f11Jf"6[r(*1!4!W#]#^#t####¹hw56CJ hw5CJ hw56 hw6 hw5 hw6CJ hw5CJ hwCJ hw>*hwjhwU<>?Nm n  ;<$]a$ & F]]  %&#$/<=>?fGw1)*I!"Z[()*h^h $ & F]a$$]a$*Rp ~!!z"{"###### ^`^ 8^8` & F ^`$]a$ "^`"###(/ =!" #$% DdP  <  C AbA&(0[ "\$MDn&(0[ "\$MPNG  IHDRP *gAMAPLTE# pHYsbcbm,<8 IDATx[ Ds $$HBJTlߦ                oz>) tP(XGN@u7Qm`ՁV Y8z1@kYK3yLϦ,ΑUл;7N8 L&ed(6;!ُMR1DE 4U^Tä֯}lWN9_ ='L48cPfic-MiCn` KHI4B\O!7гAJޕ0D$nHFz942%W%l4C6:Y81@~p `8dHي18yEꎣ`Gڕ\z/r^!-YXE%~1a]k^C4˛/9EރCHzz7B.@4χЂ'_Թ/>}z-\$r&xR#$SR81c3)I,9dlZ8Egh9=".8-]T>p:l3N-ՠPe<l.H?VQvyQ/EhTo8h}x20[)#[gyFGQ{p=3, gC RtxW̜|{@K&:({KN#b5bv5܇+΃N{w0{Pԁ!%\ YzO C@VgW?V&kzmQo3ae sʀƸv) > hµuZw01ȫX.)tM J@9Px[Pk{X} )p U]sWs#'7݁jEh&(kRJ6Pml_H PqY P]` j.@|C1^(S c8c<j-b8ߛ4t tw: sYCJjwfg~8Mu>ў7w=IWkx/@6-Df@-_(({([xuϷ"jik즽8^lNh0f#XVC4a짾8/! L-m$.\OINFxxzzZN86.ٳ^81R}AxGiuZ ԝǣmr!gZB7BJk_tG]}~2u3גz]sZ@ў [N@sYVؤxN3Ѯ҈eY> aNW]Y{J/&4s,?|DT9WhZ@_m\I[dֳxvW -.z&62a[\=ٻH3L@10ԡՁV{HMwzZ/yeI@JADk=J`7;k],V6aj m\ ;{fQ@ O_& .AvxpF!6Enf_@OU/ -ܡ̔,Z}oȿʤaqGG/H8ͨлӗSO"ĨӀ8}` nM}y։"yzս}:_߹P pd6:8IsTO]y@&Ge[U{a(s5@ >( CGe]tYOI󥩏eI<ȤlSy66Yl;ُrPRTFm^h4Cr5;b<ՙ6ќC,^)+ԟ<^us<il2PWY+;3"L w y Po׹S 4W4}ΎusQVB*-?K&m@3WD7@D%!nI 9S9/>9hi .X68KŘ$#)@˼lKެp&rs-Y.j2 *$=9tV]h>:sxV\ hnxYRy<ϠO6‡)@FXf/TsF(Ѫ)z(ܞ3#q5;6@ۛhy!;п$P+bҟ lRkE<1'7h>iPKv9{X_FHx"*![peG4}*[5=Q^\ gۉ^%vյMP #@D qY$ gMݷ Krg"@-.ߪ{f_G*K?Erg>.O ?3uRԬw~SIE/͛AfAX(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X&l IENDB`^ 666666666vvvvvvvvv66666686666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH JJ  Heading 1$$@&]a$5CJ>@>  Heading 2$@& 5CJ\F@F  Heading 3$@&] 5CJ\L@L  Heading 4$$@&]a$ 5CJ\DD  Heading 5$@&56CJ\]DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List :B@:  Body Text ]CJ<"@< Caption ] 5CJ\6P@6  Body Text 2CJDQ@"D  Body Text 3$]a$CJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] D.#<*##8@0(  B S  ?kvjw#7AT _ RZ333333333333u :xzx^TX /7cNtL=g h>zIOh hh^h`OJQJo(h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo(h ^`OJQJo(h pp^p`OJQJo(oh @ @ ^@ `OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h PP^P`OJQJo(oh   ^ `OJQJo(hh^h`o(.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(L=g^TXxzu /7ch>zw@h @UnknownG* Times New Roman5Symbol3. * Arial?= * Courier New;WingdingsA BCambria Math"Ah&&sk%2%2!20d2HX $P2!xx#Position Paper on Private Referrals harry yoxall Dr Anne Hicks$      Oh+'0 , L X d p|$Position Paper on Private Referralsharry yoxall Normal.dotmDr Anne Hicks2Microsoft Office Word@@"@c2@c2%՜.+,0 hp  Somerset LMC2 $Position Paper on Private Referrals Title  "#$%&'()*+,-./012346789:;<>?@ABCDGRoot Entry FP1MIData 1Table!'WordDocument*.SummaryInformation(5DocumentSummaryInformation8=CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q