Kearsley Medical Centre does not accept shared care protocols with ANY private provider. This means that if a private provider is caring for a patient and requests to have a ‘shared care protocol’ with the practice for a medication that the patient is being prescribed, it is with regret that we will decline this offer. The patient’s care will need to remain with the private provider OR the care transferred to the NHS.

This includes patients who opt to see a private provider via the ‘right to choose’ pathway.

This includes, but is not limited to: ADHD medication, Gender medication and DMARD medication. These are the three most common areas where private shared care protocols are requested and declined.

This decision was not reached lightly, as the implication for patients is clearly understood and sympathised with. However, the risks of accepting shared care protocols for medications initiated by private providers remains significant – see below.

What is shared care?

Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care protocol’ setting out the position of each, to which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by the specialist with the necessary competence, under the shared care arrangement.

Whilst this is commonplace in the NHS, with clear guidelines around which medications are appropriate for ‘shared care’ with a specialist, we are increasingly receiving requests for ‘shared care’ from private providers.

Rationale for not accepting shared care protocols with private providers:

· GP’s do not have to accept shared care protocols with any specialist – it is not part of our GP contract.

· Our practice policy is that we decline all private shared care protocols, so it is equitable and non-discriminatory.

· The challenge of ensuring that the private specialist is appropriately regulated and qualified.

· Conceptually, the idea of if you go private- you stay private.

· Our GP practice is an NHS service and is unable to support private services as there is no additional time or funding available for this.

· The risk of being outside NHS indemnity as potentially acting outside of NHS guidance. This is a grey area, as it is not clear whether a GP would be covered by the national indemnity scheme to prescribe medication that was initiated privately and was outside of their remit.

· The risk of NHS guidance not being followed by the private sector. For example, some private providers have initiated 3rd line medication, or medication not accessible on the NHS, when 1st or 2nd line medications have not been tried, or are being prescribed at levels that would not be accepted within NHS prescribing parameters.

· There are often monitoring tests that need to be completed (eg blood tests, ECGs) and these would need to be completed by the private provider. These cannot be passed to the GP practice to complete as the interpretation of this information in the context of prescribing is outside of the remit of the GP and must remain with the specialist.

· The risk that the patient or insurance company stop paying for the private services meaning that the care is no longer shared and therefore, the practice are unable to continue prescribing the medication.

BMA guidance:

Shared Care with private providers is not recommended 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.

Information for patients:

Transferring care to the NHS: Any patient affected by this can request a GP appointment via the online triage form. The GP will assess the patient and if indicated, refer to the relevant NHS provider as we can ‘share care’ and accept shared care protocols with NHS providers.

PLEASE NOTE: We will only take over the prescribing of medications initiated by a private provider once the NHS specialist has seen you and a ‘shared care protocol’ is in place with them.

‘Right to choose’ pathway: If a patient chooses to see a private provider via the ‘right to choose’ pathway, they should be reminded of the following:

· They may be removed from the NHS waiting list if they proceed

· If they are started on a medication by a private provider that requires a shared care protocol, the practice are unable to accept the shared care protocol or prescribe the medication.

· The patient has the following options:

o They can ask the right to choose provider to keep them on long term (the provider may refuse and there is a risk of the private provider ceasing to operate).

o They can be referred to an NHS provider afterwards (there could be a delay during which time the practice are unable to prescribe/change any medication that may have been prescribed by the private provider).

o They can continue to self-fund any prescriptions initiated by the private provider.

o They can remain on the NHS waiting list rather than choosing to see a private provider via the ‘right to choose’ pathway.

References:

https://www.bma.org.uk/advice-and-support/gp-practices/managing-workload/general-practice-responsibility-in-responding-to-private-healthcare

We understand that some patients will chose to access health care privately, which is a choice you are entitled to make. Whilst we are grateful for the support of our private consultant colleagues and sympathise with the potential delays for hospital appointments, there are a few things that you need to be aware of before making this decision.

Please read the information below regarding our position on private work at Kearsley Medical Centre.

NHS guidance states:

Patients can pay for additional private healthcare while continuing to receive care from the NHS. However, in order 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

Organising tests requested by private providers:

Sometimes Kearsley Medical Centre receives requests from private providers asking for investigations such as blood tests or scans but complying with these requests is outside the scope of NHS primary medical services.

Our contract with the NHS states that a GP should only carry out investigations and prescribe medications for a patient where it is necessary for the GP’s care of the patient and the GP is the responsible doctor. These decisions would usually be made after the GP has had a consultation with the patient directly and agreed a plan.

At Kearsley Medical Centre, if we consider the proposed investigations to be clinically appropriate and feel competent to both interpret them and manage the care of the patient accordingly, then we may proceed with arranging the tests or investigations once we have done our own assessment in a consultation. However, if we do not have the knowledge or capacity to undertake these actions, we will decline and advise the patient and the private provider to make alternative arrangements.

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."

At Kearsley Medical Centre, if we prescribe a medication, we take over the full responsibility for that prescription, regardless of whether a private provider has requested it. If we feel competent to prescribe a medication suggested by a specialist and it is within the guidance, we are happy to do this. However, there are instances where we may not be able to prescribe medications recommended by your private provider. Examples include:

• Where the GP or practice does not have the expertise to safely prescribe and/ or monitor a specialist drug.
• Where we have been asked to prescribe a medication which would only be prescribed by a hospital consultant in the NHS. Common examples include ADHD medications, mood stabilisers such as Lithium and immunosuppressant medications such as Methotrexate/Hydroxychloroquine.
• Where there has been insufficient information from the private provider regarding the rationale for using a medication.
• Where the use of the proposed medication is not in line with local or national prescribing guidance.
• Where the proposed medication is not licensed for the medical condition described.

If we are unable to prescribe a medication requested by a private provider for one of these reasons, we will pass this back to the private provider. 

If we feel able to prescribe the medication requested by the private provider, we would expect them to provide the first prescription lasting at least 28 days (this is the same with NHS clinics), to give us time to receive, process and then action the request.