Follow-Up of Patients Receiving Private Care
General practice responsibility in responding to private healthcare
GPC England has published guidance on general practice responsibility in responding to private healthcare, to help practices reduce this extra workload.
Due to nearly 7.5 million people on NHS waiting lists in May 2023, patients are increasingly resorting to seeking private healthcare to deal with their health problems, which is adding extra workload for general practices. Our guidance covers what the responsibilities are for general practices in response to private providers making requests, such as making private referrals, providing medical information about patients, organise further tests, issuing prescriptions, and onward NHS referrals.
Template letter for practices when asked to make an onward referral
Follow-Up of Patients Receiving Private Care
What is the practice’s responsibility?
The general principal underlying the delivery of all care in general practice lies within the definition of essential services: basically, if someone is ill (or believes themselves to be ill) you must provide them with the care they need in a manner to be determined by you. That means either delivering the care yourself or ensuring that a referral has been made. This has often been misinterpreted to read that the GP is the free deliverer of care of last resort. She is not.
Responsibility for investigations is similarly determined. Arranging, say, a TFT, in one person might well be my responsibility, because I have decided that they need one so I can make a diagnosis for the patient for whom I am clinically responsible. Alternatively, another patient might require a TFT because an eating disorder clinic has decided it is part of their work up. That is not my responsibility. It is theirs. Of course, we often help out, but that does not make it my job.
This may help us understand who has what responsibility when it comes to private consultant referrals.
If Mr Smith develops arthropathy his GP has a responsibility to make an appropriate referral if the two agree that a consultant opinion would be helpful. If the patient chooses to go privately the GP cannot charge for that referral.
Once the consultant has seen the patient then it is the consultant’s responsibility to arrange the required tests: it is not the GP’s responsibility to do this as she did not decide they were required. In the private case there is often even more pressure for the GP to do this as a) the consultant may find it logistically difficult or inconvenient to organise them, and b) they cost the patient more money so they are usually told to get the GP to organise the tests “which I’ll detail in my letter”. The GP is under no obligation to do this. The argument is often used that the patient has the right to access “free” tests, but that is a slightly but crucially inaccurate reflection of what the GP is contractually required to do. The patient actually has a right to access via the practice and free of charge those tests which the GP initiates.
An extension of this is the sort of informal shared care agreement that a private consultant may request for patients needing longer term care in the form of regular prescriptions or investigations usually provided under an NHS shared care agreement. The GP may agree to this (but not, of course, to prescribe red traffic light drugs), though she needs to be certain that the patient continues to receive specialist follow up: without that guarantee you are no longer engaging in shared care. I would certainly not agree to an arrangement where I was expected to order investigations that falls outside of the NHS shared care ES for the condition. Always remember that shared care agreements are voluntary and you have no obligation to agree.
Some follow up care is not funded and is not an essential service, for example, for patients who have had bariatric surgery, particularly if done abroad. The risks with this condition are high and we are not trained in what to do or look for. I would refer to the NHS service and keep on referring, even to the point of appearing very irritating. I would also copy in commissioners, pointing out that there is a serious commissioning gap that is putting a patient at risk. Those referrals are likely to be rejected, but the point of continuing to refer is to ensure there is a very clear audit trail that shows that you did everything reasonably possible to arrange the required care for your patient. Once you accept any responsibility for providing the care yourself, then you are liable should something go wrong. Courts are not minded to accept the argument that if you did not step into the breach then the patient would receive no care.
Challenging this “all you can eat buffet - with extra pudding” mentality is not being grumpy. It is increasingly becoming the only way of ensuring our patients receive the care they need.
With thanks to Mark Sanford-Wood from Devon LMC
