The Walton Medical Centre will follow the BMA and LMC Guidance on patient referrals from A GP for private services. These include requesting tests and prescribing medication.

Organising tests requested by private providers

If the practice receives requests from private providers to arrange tests or investigations, it is important to note that complying with such requests – regardless of the GP’s management and treatment of the patient – is outside the scope of NHS primary medical services.

The NHS GMS Regulations define essential services as services which are delivered in the manner determined by the GP in discussion with the patient. Therefore, a GP provider should only carry out investigations and prescribe medication for a patient where it is necessary for the GP’s care of the patient and the GP is the responsible doctor.

If the GP considers the proposed investigations to be clinically appropriate, is competent to both interpret them and manage the care of the patient accordingly, then the GP may proceed with arranging the tests or investigations.

However, if the GP does not have the knowledge or capacity to undertake these actions, they should decline to organise the investigation and advise the patient and the provider that the services do not fall within NHS primary medical services and to make alternative arrangements.

Patients are of course entitled to access their medical records, so GPs can provide access to the results of any such investigations for the patient to take back to the private provider.

NHS guidance states:

Patients may pay for additional private healthcare while continuing to receive care from the NHS.

However, to ensure that there is no risk of the NHS subsidising private care:

• It should always be clear whether an individual procedure or treatment is privately funded, or NHS funded.
• Private and NHS care should be kept as clearly separate as possible.
• The patient should bear the full costs of any private services. NHS resources should never be used to subsidise the use of private care.
• The arrangements put in place to deliver additional private care should be designed to ensure as clear a separation as possible of funding, legal status, liability and accountability between NHS care and any private care that a patient receives.

Prescribing Medication requested by a private provider

GMC Good Medical Practice states that doctors in the NHS and private sector should “prescribe drugs or treatment, including repeat prescriptions, only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.”

If requested by a private consultant to initiate or continue prescribing medications, and if the GP agrees with this advice, then this could be appropriate. However, if the GP does not feel competent to prescribe the requested medication, or they do not know if the medication best serves the patient’s need, the GP should inform the private provider that the prescriptions should be provided by a specialist.

LMC guidance states:

The GMC Good Medical Practice 2024 states:

• You must recognise and work within the limits of your competence.
• The signatory on a prescription is the person clinically responsible for that drug.

Considering this, the doctor and practice must only participate in a SCA if they have the competence and safe infrastructure to prescribe and fulfil responsibilities such as those described above within the SCA.

GPs are under no obligation to participate in a shared care agreement. If the GP decides not to participate, the clinical responsibility for the patient remains with the specialist service.

Shared Care with private providers

Shared Care with private providers is not recommended by The BMA (British Medical Association) due to the general NHS constitution principle of keeping as clear a separation as possible between private and NHS care. Shared Care is currently set up as an NHS service, and entering into a shared care arrangement may have implications around governance and quality assurance as well as promoting health inequalities. A private patient seeking access to shared care should therefore have their care completely transferred to the NHS. Shared care may be appropriate where private providers are providing commissioned NHS services and where appropriate shared care arrangements are in place.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.

Private providers making onward referrals to NHS provider

Private providers can make referrals to NHS services, without referral back to the GP, provided the patient would be eligible for NHS referral. Any patients referred should be treated based on clinical need. Read NHS England guidance around consultant-to-consultant referrals within the NHS.