Private Referrals
A private provider is any consultant, hospital or other organisation that charges for healthcare.
If the GP was going to refer you to an NHS hospital, but you wish to go private instead, we can supply the referral letter that we would have sent to the NHS hospital; this is free of charge.
Did you know you do not need a GP referral letter for a private referral? Any patient can self-refer to any private provider without any input from a GP. You do not need a GP referral letter. Simply ring up the provider and ask to be seen. If you need, we can supply a summary printout of your record free of charge to take with you to your appointment.
If you decide to be seen by a private provider and that provider requests an insurance form completing before they can see you, we can fill out a form for you, but there will be a charge as this constitutes as Non-NHS work. For more information see our Non-NHS Services page
We are unable to a recommend or direct you to a private provider as this could be seen as competitive behaviour.
Where a GP has made a referral to a private provider, whether at your own request or at the GP’s instigation, this does not obligate the GP to carry out any tests, monitoring or prescribing of any medications requested by the private provider. Please see sections below for more information.
If you are concerned you might not get the investigations and medications you need as part of the care from your private provider, you are advised to purchase or negotiate an inclusive package with your private provider. If your private provider tells you not to worry, your GP will do the monitoring and/or prescribe your medication, they are providing you with false assurance.
A private provider themselves can request tests or supply medication to the patient for the appropriate fee.
Acorn Surgery respect the right of any patient to choose and pay for a private provider, but it is not the responsibility of an NHS GP to request tests or prescribe medications on behalf of that provider to reduce the cost burden of private care for the patient or for the purposes of reducing waiting times. Due consideration must always be given towards proper clinical oversight and patient safety.
NHS guidance states that private and NHS care should be kept as clearly separate as possible, so that funding, legal status, liability and accountability are appropriately defined, the patient should bear the full costs of any private services, and that NHS resources should never be used to subsidise the use of private care www.bma.org.uk.
Tests and Medication Requests
NHS GPs are not commissioned and have no obligation to perform any investigations or prescribe medications following attendance at a private provider. The following section describes each type of request in more detail.
Investigations
Acorn Surgery GPs are not commissioned nor obliged to perform or request any tests that are required as a result of a patient attending a private provider. This is especially so, if such a test falls outside ordinary care usually provided by the GP and where the interpretation of the result of such test would fall outside the GPs knowledge, skills and competence. Such tests can be requested and actioned by the private provider themselves.
Medications
Acorn Surgery is not commissioned nor required to prescribe medications that are needed as a result of a patient attending a private provider, nor are they obliged to convert privately issued prescriptions to a GP issued ones.
However, where such requested medications are within the scope of ordinary care from a GP and where we would normally issue such medications, we will consider such requests on an individual basis and if agreed, prescriptions will be processed in line with our non-urgent medication process and timescale. It must be emphasised, if agreed the prescription will be processed as non-urgent. If the private provider indicates that there is an urgent need for the medication, they must supply it themselves, in line with usual hospital processes.
Shared Care Agreements
Shared care is when the responsibility for a patient’s medication and monitoring is shared between the GP and consultant. In these situations, the consultant will decide a patient’s suitability for the medication, perform any necessary baseline investigations, counsel the patient fully regarding the medication and then prescribe the medication, making adjustments to the dose until the patient is stable.
Once the patient is on a stable dose, the consultant then writes to the GP to ask them to consider a shared care agreement. If the request is appropriate and the GP accepts the shared care agreement, they then take over the prescribing and monitoring of the patient, notifying the consultant should any problems arise. It is important to note that the GP signing the prescription is responsible for the decision to prescribe and not the consultant. However, the patient must remain under the care of the consultant. For shared care to be valid, there must also be a written agreement on the duties and responsibilities of each party.
The process of shared care is in the patient’s best interest, to facilitate appropriate clinical oversight and to maintain patient safety.
Having said the above, it must be noted that shared care is entirely voluntary for GP’s and GP’s are NOT obliged or commissioned to enter into this type of agreement, for whatever reason.
Whilst we are supportive of our patients, we need to ensure we are safe and not acting outside of our clinical competencies therefore we generally do not take on a shared care agreement with a private provider if ANY of the following conditions apply (most of these describe situations that are, by definition, not shared care):
- There is no written shared care agreement
- There is a shared care agreement, but it does not match the equivalent NHS shared care agreement for the same cohort of patients
- The private provider is an assessment or diagnosis only service, that does not prescribe medication at all
- The private provider has not completed an appropriate assessment of patient’s suitability for the medication, performed baseline investigations or provided counselling for the medication (for example, information on side effects, interactions)
- The private provider has not initiated the patient on medication and/or has not adjusted dosage accordingly and/or has not stabilised the patient on the medication.
- The private provider has discharged the patient back to sole GP care
- The medication being recommended is one that falls outside the GP’s knowledge, experience or competence to prescribe.
- The private provider is recommending use of medication that falls outside its licensed indications (for instance, it is being used for a different age group or different reason from the manufacturer’s recommendations)
Post Op Bariatric Monitoring
The bariatric surgical provider is responsible for the organisation of structured, systematic, and team-based follow-up of patients for 2 years post-surgery.
After 2 years if all is well the patient can be discharged from bariatric surgery service follow-up, into the care of the GP for monitoring of nutritional status and appropriate supplementation according to need in line with recommendations made in NICE clinical guidelines.
Private patients who’ve had surgery in the UK
Private patients who have had their surgery in the UK should be receiving the same 2 year follow up from their provider as NHS patients. Acorn Surgery will not take on care of any private patient within two years of surgery.
What about private patients who have had surgery abroad?
NHS bariatric services are not able to provide routine follow up to patients who had their surgery done overseas but will manage any surgical bariatric emergencies. Patients are advised to seek a private bariatric follow up programme in the UK for a two-year period, these are available, and many accept self-referrals. After this, the monitoring process is the same as for any other patient and can pass into the care of the GP.
Hormone Therapy Shared Care Agreements with Private providers
Whilst we are supportive of our patients who are trans, we need to ensure we are safe and not acting outside of our clinical competencies therefore we generally do not take on a shared care agreement with a private provider.
There is no guarantee that patient will continue to remain under the private clinic which would then leave the patient and the GP in a difficult situation. In order to support our patients, we can arrange blood monitoring at the practice (provided these are bloods that are typically done by a similar NHS clinic). The patient would be responsible for obtaining the results (which can be done electronically) and ensuring that the private provider interprets them, as again, we do not have the clinical expertise to do so.
It is important to note that Acorn Surgery will be happy to take on shared care agreements when their care is under NHS care but appreciate and sympathise that there is a prolonged wait for this. Sadly, we as GP’s are not able to make up for the lack of adequate commissioning of these services as we would be working outside our competence.