Private Healthcare

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Increasing numbers of patients are now using private healthcare to address some of their health issues.  Given long waiting times and some treatments/services not being available on the NHS this is entirely understandable.

Many private healthcare providers offer safe and effective care and this can integrate well with General Practice.  Sadly however that is not always the case and problems can emerge which we think would be helpful for patients to understand.

Moving between NHS and Private healthcare

Patients have the right to have their care transferred back to the NHS at any point and the practice will attempt to support you in this however there can be circumstances where this is not possible in practice.  NHS services are often restricted with conditions being placed upon referrals.  For example on the NHS varicose vein surgery is heavily restricted to those with specific complications and we cannot refer if you dont have these.  

Where patients can be referred they would still be subject to NHS waiting lists which can be very long and previous private treatment doesnt alter the position on the waiting list.

Prescribing

If a private specilaist starts you on a drug this would usually initially be prescribed by the private healthcare service and that would be done under a private prescription for which patients have to pay.  Once stabilised on a prescription this can often be continued by your GP on an NHS prescription however that is not always the case.

As NHS GP's we can only prescribe certain drugs that have been approved for use in the NHS and further approved by NHS Lothian.  If the private healthcare provider reccomends a drug that is not approved we cannot continue to prescribe it on the NHS.  A common current example of this is weight loss drugs.

Some drugs are restricted to specialist use only and in those circumstances these can sometimes be prescribed by the GP under something called a Shared Care Agreement - see below

Shared Care Agreements (SCA)

Shared care agreements (SCA) are often reserved for complicated specialist medications which GP's wouldnt usually prescribe themselves.  Shared care agreements make it clear what the GP and the specialist have to do in order for the prescription to be supplied by the GP safely.  This is a complicated and time consuming process for the practice and within the NHS practices receive funding for this work.  That is not the case if the SCA is being proposed by a private healthcare provider.  As a result many practices are unable to engage in these shared care agreements with private healthcare providers.  A common example that we encounter privately is with medications for ADHD - given the NHS waits for assessment are many years in length.

We recognise the challenges patients face under very long NHS waiting lists and have always tried to accomodate such requests when we are able to do so.  We do not get any funding for this work but at present are still trying to accomodate such requests where possible.  We do however set a number of conditions that need to be met in order to agree to safely share care with private healthcare providers:

• The medication must be one the the GP is competent to prescribe safely. 
• The medication would have to be avilable on the NHS in similar circumstances.
• The private healthcare provider would have to agree to share care using the NHS Lothian shared care agreement.
• The private specialist has to follow up the patient as would happen within the NHS.  The patient would likewise have to agree to continue seeing the specialist in order for the prescription to be continued.  If a patient decided to stop seeing the specialist we would not be able to continue prescribing the medication.
• We need to be satisfied that the private specialist is suitably qualified and experienced.  This can be difficult but in general there is rarely an issue with any major private healthcare provider.  If we cannot be certain the private specialist is suitably qualified we cannot agree to a SCA with that provider.
• The practice needs to have capacity to do this work.  As above this is not work GP's are required to do, and are not paid to do.  We try and support our patients as best we can but with all the pressures in GP there may come a time when we cannot take on any more of these SCA if the work involved got so much that it was affecting core NHS work.