We are happy to refer you under the “right to choose”, but you need to be aware beforehand that if you are given a diagnosis by a private provider, or a “right to choose” provider who is not commissioned by Gloucestershire ICB, then Stoke Road Surgery will not enter a shared care prescribing arrangement for specialist medicines.
If you are just being seen to get a diagnosis, and not treatment, that is fine. If you are hoping to get treatment, you need to know that we will not prescribe specialist treatments without a local, fully funded, shared care agreement.
Prescribing a medicine for patient is a very complex activity. Professional bodies for healthcare clinicians advise doctors, and other prescribers, that they should assess every situation individually and only prescribe if they are competent to do so. This means that prescribers are not obliged to prescribe on behalf of other prescribers and cannot be “told” they must prescribe against their clinical judgment. This patient’s management and treatment require specialist knowledge and input.
Whilst we would sometimes enter into shared care agreements with NHS providers, (in line with shared care guidelines published and agreed locally), we do not do this for private providers. This is because shared care requires (amongst other things) ongoing input from specialists, and if patients decide they cannot afford to pay for the specialist input any longer, or feel unable to travel to assessments, then the GP practice is put into an extremely difficult position.
Referrals where a private provider is locally commissioned to provide the service may be managed slightly differently, as the local commissioners are responsible for ensuring long term specialist follow up is available locally.
However, where a private provider has not been commissioned locally, (for example where a patient has gone to an out of county private provider under the “right to choose” pathway), we do not enter into shared care agreements.
In the areas where some of these service have been commissioned, elsewhere in the country, the local ICB have funded the extra appointments needed for general practice to continue to safely prescribe, and have arrangements in place for follow up of the patients. This is not funded locally, and we do not have the capacity to take on unfunded work.
We will, of course, always be happy to refer our patients on the local NHS commissioned pathway to an appropriate provider.
Gloucestershire ICB Guidance on the Transfer of Private Healthcare Professional Recommended Prescribing into the NHS
It is a patient’s choice if they wish to access healthcare advice or treatment from the private sector. This may lead to requests for NHS prescribing, from either private healthcare professionals or relayed by patients themselves, to a GP or other NHS prescriber. However, the NHS is not under any obligation to automatically accept requests for the transfer of private healthcare recommended treatments onto the NHS, whilst recognising the need to support and maintain NHS standards of care for all patients.
If the privately recommended item is required urgently or would benefit from immediate initiation, then it is the responsibility of the relevant private specialist to issue a prescription accordingly to enable the patient to access the medication privately but without an expectation of automatic transfer to NHS prescribing. This will allow adequate time for the relevant clinical information to be processed in the NHS.
Whilst GPs and other NHS prescribers are under no obligation to issue an FP10 for patients who have had medicines, nutritional supplements or appliances and devices prescribed or recommended following private healthcare consultations, they can do so at their discretion if they accept the transfer of clinical responsibility involved and consider the prescribing to be appropriate for NHS provision.
When deciding on the transfer of such prescribing to the NHS the primary care prescriber should consider the following factors:
- Has the practice received information directly from the private healthcare professional which provides an acceptable clinical rationale for the treatment and any necessary supporting details?
- Is it clear that the medication is clinically necessary and if so, are you in a position to agree with the recommended treatment plan?
- Is the medicine one which you would normally prescribe for your NHS patients, and falls within relevant guidelines stipulated for NHS Patients, and within the limits of your knowledge and competence? (GMC guidance)
- Is the rationale for prescribing in accordance with NHS recommended treatments, including NICE guidance and Gloucestershire treatment guidance and practice?
- Is the medicine recommended in the Gloucestershire formulary for primary care prescribing?
- Is the medication unlicensed or being requested to be prescribed outside of its licensed indications?
- Is an equivalent but equally effective medicine available at a lower cost?
- Does the medication need special follow up or monitoring which would be outside the normal scope of the primary care practice’s activities or beyond a primary care prescriber’s usual clinical competence?
- Does the medicine require shared care guidance to support its effective NHS prescribing care prescribing and if so, has suitable guidance been provided or is it available?
If the NHS clinician decides that it would not be appropriate for them to initiate NHS prescribing, the patient will need to decide on the option of either purchasing the medicine involved via a prescription from their healthcare professional in the private sector or accepting the alternative NHS treatment pathway or alternative NHS recommended medicine if available. If a patient discusses their intention to go private, this potential outcome should be explained to the patient before they make arrangements for private intervention.
Private prescribers should ensure that patients are clearly advised that the decision to adopt any prescribing recommendation lies with the individual NHS prescriber, and where this is refused, private prescribers will be required to provide ongoing private prescriptions if the patient chooses to continue with the recommended treatment.