We recognise that many of our patients are experiencing long waiting times for Health and Social Care (HSC) assessments. We understand the frustration this causes and why you may choose to seek a private assessment for more timely care.
Information for Patients
Private practitioners may suggest further simple tests – such as bloods, urine or stool tests etc – or more complex tests – such as x-rays, scans, scopes – depending on the problem. These tests should be undertaken within the private sector and be factored into total costs.
Private practitioners may suggest a prescription. We are often happy to do an NHS prescription if it is for a licenced use of a drug and is in the Northern Ireland formulary. However there are a number of circumstances where the GP would decline to prescribe and they retain the right to do this.
Please be aware that you may have to pay privately for any ongoing treatment or medications which are recommended by a private practitioner.
Sufficient post-operative medication, for instance pain relief or anticoagulation, should be provided at discharge following procedures carried out by private sector providers without needing a GP prescription.
Information for private practitioners
Please arrange for your tests/investigations including bloods to be done within the private system. It would not be best practice to request the NHS/GP to perform these procedures as it could potentially undermine fair treatment to other patients.
GPs are usually happy to prescribe medications you recommend for the patient if this falls within normal NHS GP practice. We would ask you to work within the same guidelines as GPs, using the NI formulary, found at: https://niformulary.hscni.net/formulary/chapter-summaries/
Anything that lies outside the formulary, including unlicensed, red and amber list (shared care) medications should not be presumed to be suitable for NHS GP prescribing. Your prescription advice may be returned if it isn’t suitable.
Please ensure that you complete onward referral/s for your patients that require this whether to yourself (on the NHS) or another consultant/service. Further guidance explaining this is found at: https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/management-private-practice-handbook.pdf
PRIVATE REFERRAL ADVICE
What happens when you are referred by your GP to see a consultant privately?
With the pressures of NHS waiting lists more patients are trying to speed up their care by seeing specialists in the private sector. This document explains what you can expect to happen if you ask your GP in Park Practice to refer you to see a Consultant Privately.
WHAT HAPPENS NEXT?
You should contact the Consultant’s team or Private Hospital directly to organise your own appointment. If you have private health insurance, your insurer may have a list of approved specialists. You may want to check with your insurer before you proceed. The specialist will almost always request information from your GP – so please contact your GP surgery to ask them to write a referral letter for the Consultant (or speciality if no name known). This letter will include any relevant medical details about you. If an insurance company wishes for a specific form to be completed to justify the referral, then your GP will have to charge a fee for providing this additional report.
SEEING THE CONSULTANT
WHAT HAPPENS IF YOU NEED A TEST OR PROCEDURE?
If the Consultant thinks that you need any tests (including blood tests), or a surgical procedure, the Consultant is responsible for:
Arranging the test and any medications (such as sedation) that may be needed for this.
Giving you the results and explaining what they mean (this may be done in a separate appointment with the Consultant or by letter). You should not visit or ring your GP surgery to discuss the results of tests organise by others – it is the Consultant’s responsibility to discuss this with you.
Please note that any tests required should be carried out privately. This may mean you need to travel to where you saw your Consultant. The cost of these tests should be paid for within the private sector, which will increase the total costs you incur unless covered by your insurance. GP practices cannot perform blood tests or other private investigations using NHS resources. Doing so would inappropriately use NHS resources to carry out private activity.
If a private Consultant informs you to arrange or to expect to hear from your NHS GP to arrange such tests, then this is incorrect. You should, at a time, remind the consultant that all tests need to be carried out privately. Avoiding inappropriate requests for your NHS GP to carry out tests will:
Avoid delay in having your tests
Ensure that the right person (your Consultant) gets the results directly
Avoid delays in your Consultant reviewing your results and planning a required follow up
WHAT HAPPENS IF YOU NEED NEW MEDICINES?
The Consultant might suggest prescribing new medicines for you or might want to make changes to the medicines that you are already taking. The Consultant is responsible for giving you either the first prescription for any new medicine or a written advice slip to bring to your GP. Your GP can only begin prescribing this medication if there is sufficient explanation on the written advice slip and the medication falls under the normal prescribing rules of the NHS. It will take at least 3 working days from receipt of this advice slip before a prescription is issued, and longer if further safety checks are needed.
Private Consultants may suggest that you should start an Amber class of drug. These are medications that are only prescribed in certain circumstances as they carry higher risk and need regular monitoring. We have recently updated our practice policy in this regard (see below) and we are now unable to prescribe these medications in Primary Care. Your Consultant can prescribe these medications privately and carry out any monitoring that is needed to do this safely.
AMBER LIST DRUGS REQUEST BY PRIVATE PROVIDER
When patients see a Consultant in outpatient clinic they are often given a Treatment Advice Note (TAN), requesting that a GP prescribe medication in the community. Your GP will review this request and if felt appropriate and it is safe, will normally prescribe the medication.
Some medications are more complicated and fall into the category of Amber list drugs (Red list drugs are only ever prescribed by hospitals). These Amber list drugs usually are potent medications with the potential for harm if prescribed incorrectly and have specific monitoring requirements such as regular blood testing or physical checks that have to be carried out in order for the medication to be prescribed safely. There are agreed Shared Care Guidelines which outline the responsibilities of the NHS Consultant and the GP. Many of these responsibilities are relatively onerous and carry medico-legal risk. A full list of these medications and the agreed Shared Care Guidelines can be found at
https://ipnsm.hscni.net/red-amber/
Within Northern Ireland NHS the Shared Care arrangements are uniform and a voluntary agreement is sought between the consultant and the GP. Where a GP is unable to undertake safe prescribing for whatever reason, the responsibility for prescribing remains with the hospital consultant. Patients then receive their medications from hospital pharmacy and have monitoring undertaken at their hospital clinic. Shared care prescribing in primary care is always voluntary on the part of the GP.
In recent years there has been a huge growth in Private consultants seeing patients in Private hospitals and asking NHS GPs to take over the prescribing of higher risk Amber medications using NHS shared care arrangements. This has created significant problems for us for a number of reasons which include:
We are unable to confirm the credentials of private practitioners easily, occasionally correspondence from private practitioners can be lacking in detail or clarity to assure us reviews are happening as stipulated.
Regular review is difficult as patients must pay each time they see the consultant and this has meant the reviews are not as often as required.
When issues arise the process for contacting private doctors to obtain advice is not commensurate with that in the NHS and this raises significant safety concerns.
There is no funding or resource allocated to Primary Care to cover the work private practitioners generate. Time spent dealing with these issues directly impacts on our ability to provide the NHS care we are actually funded for.
We are aware that most GPs in Northern Ireland are declining to get involved in shared care arrangements with private providers. We have discussed the issue among all of the Partners in Park Practice and have decided that in the interests of safety and our ability to provide an equitable NHS service for all our patients that we will not be able to prescribe Amber list drugs suggested by a private doctor.
Patients who choose to pay privately to see a Consultant and are advised that they need an Amber list medication will have to pay for this medication as part of their private treatment. These prescriptions will need to be privately prescribed by the Consultant concerned. We cannot make exceptions.
If patients hold private medical insurance this may cover the cost of the medication. Any patient can be referred into the NHS at any time and if they are seen by an NHS Consultant and the advice remains that an Amber list drug is needed, we will prescribe this under the NHS Shared Care arrangements where it is safe to do so. We know there are long waiting lists for NHS treatment and we share your frustration with these delays. If you feel you are directly disadvantaged by the poor provision of NHS care we would encourage you to speak to your MLA to try to improve things.
If any of our patients are receiving medication from a private doctor, we would advise that they let us know in case there are any interactions with other treatment
WHAT HAPPENS IF I NEED TO TRANSFER MY CARE BACK TO THE NHS?
If after seeing the Consultant privately you want to be back under NHS care, regulations allow for transfer must be done by the private Consultant who is overseeing your care and you should not be passed back to the GP for this to be done. There are a few reasons why:
It delays your ongoing care.
Your consultant knows the full details of your condition and where best to refer you to.
It wastes precious NHS appointments with your GP and adds unnecessary administration to the process.
The Consultant should arrange for you to be seen in the appropriate NHS clinic by writing a referral letter to this clinic.
WHAT IF I NEED A FOLLOW-UP APPOINTMENT?
The Consultant will discuss with you whether you should attend hospital for ongoing follow-up care or whether you should be discharged back to your GP. If the Consultant thinks you do not need to be seen again, he will give you another appointment or tell you when to make one in future. If you do not hear anything, please contact the Consultant’s office, rather than your GP surgery.
WHAT DO I DO IF I HAVE ANY QUESTIONS?
If you have any specific questions related to your care, you should contact the Consultant’s team directly. It is important that you make sure you know how you can contact your Consultant’s secretary.
WHAT IF I JUST WANT TO ARRANGE A SCAN PRIVATELY?
In some cases patients wish to arrange scans (such as an MRI scan of spine in cases of back pain) directly in the private sector. Often your GP has no expertise in interpreting the results of complex scans and will normally ask that you see a consultant in that area who can decide if a scan is needed and provide the appropriate interpretation of the results.