Private Referrals

Private Consultations and Onward NHS Prescriptions & Care

The Green & Fir Road Surgeries

At The Green & Fir Road Surgeries, we are committed to ensuring the highest level of care for all of our patients. This policy outlines our approach when patients choose to seek private medical consultations and the subsequent considerations for ongoing NHS care and prescriptions.

Seeking a Referral to a Private Provider

We understand that in some circumstances our patients might wish to see a specialist privately and respect your right to make this choice. If you believe a referral to a private practitioner is the right course of action for you:

· No Additional Charges: Please be reassured that there will be no charges from our practice for private referral letters when the referral is agreed by our clinicians and required for private insurance purposes. If you are self-funding an episode of private care without insurance cover, you do not require a GP referral, and may simply self-refer.

· Requests by ‘Patient Triage’: For our patients desiring a straightforward GP referral to a private specialist, we recommend using the Patient Triage section of our website. Here, you can detail your concerns and request the necessary referral. With sufficient information from you, our clinicians may then be able to generate this letter by reference to your clinical records without an additional appointment.

· Complex Issues: If you feel that your health concerns are more intricate and require a more detailed discussion, you may require an appointment with a member of our clinical team. In this instance too, you can initiate the process detailing your problem via the Patient Triage section of our website.

Ongoing Care After A Private Referral

Responsibility: If your follow-on care involves tests, investigations, or onward referrals, please be aware that the responsibility for organising and acting on each of these remains with your private specialist until such time as your care is transferred to an NHS service.

Results and Onward Actions: Any test or investigations carried out privately should be interpreted by the requesting clinician. If a private clinician suggests an onward referral to an NHS service based on their findings, this referral should be written and sent directly by the recommending clinician, whether the referral is back to our NHS GP service for GP-led care or to a specialist NHS provider for specialty care.

Documentation needed: All consultations you have with a private provider, GP or specialist, should be followed up by a clinical letter detailing the consultation and sent back to your NHS GP. Comprehensive clinical details and rationales should be provided for all referrals from private to NHS services. This is best clinical practice, ensures your records are complete and allows clinicians to make fully informed decisions with you, with respect to your onward care.

Onward NHS Prescribing Following Private Consultation

1. GMC & NHS Guidelines: Ensuring the safety and clinical appropriateness of any medication we prescribe is our paramount concern. All onward prescriptions whether recommended by NHS or private providers must be in line with our clinical expertise as General Practitioners according to GMC Good Medical Practice1 and consistent with established NHS prescribing guidelines for our region. For our Richmond borough-based practice, these guidelines inclusive of medication lists and their respective prescribing status are available in the Southwest London formulary.2

2. Most Requests are Honoured: The majority of requests for onward prescribing by our GMC-registered clinical colleagues in private practice can be honoured by our team with an NHS prescription. This is possible when (i) A rationale for treatment has been provided in full; (ii) The medication is clinically necessary; (iii) An NHS patient would routinely expect the same treatment; (iv) A clinician is prescribing within their expertise according to their normal practice; and (v) The drug is prescribed within its licenced indication. In some circumstances, a GP, pharmacist or nurse may substitute the recommended drug with a more cost-effective, clinically appropriate formulary alternative from the Southwest London formulary.

3. Higher-Risk Medications: Certain requested medications following on from private consultations, including many medications for ADHD and for hormone treatments from Gender Identity clinics, come with complex clinical implications that means onward prescription by NHS Primary Care practitioners is especially challenging. Some medications are monitored in a specialist setting. Some prescriptions continued in Primary Care require specialist initiation (can’t be started by a GP) and/or extensive monitoring under shared care agreements (SCAs) that NHS General Practitioners arrange in partnership with our specialist NHS colleagues. There are contractual arrangements with our local commissioning teams that support this work. The same shared care arrangements around prescribing and monitoring are not possible between our practice and private providers. These medication requests will not be prescribed by our team.

4. Referring to an NHS Specialist for Onward Prescribing Support: Where a GMC-registered private specialist has made a treatment recommendation that cannot be continued by the GP, our practice endeavours to support our patients by referral into an equivalent NHS service, when agreed and appropriate. Private prescriptions should continue if needed until an NHS assessment of onward care has determined the suitability of an onward prescription.

5. Non-GMC Practitioner Recommendations: Due to differences in regulation and licencing as well as in medical formulary equivalences, we are not in every instance able to continue prescriptions originating from outside the UK or initiated by private clinicians who may offer services within the UK but are not registered with the General Medical Council (GMC). Our practice does not prescribe following recommendations from Gender GP, as this practice falls outside of GMC regulation.

Onward NHS Care Following Overseas Procedures

Increasing trend Recently, there has been an increase in demand for follow-up investigations and care after private elective procedures performed overseas, including bariatric surgery for weight loss and IVF for fertility issues or surgery for cosmetic reasons, among others. Sometimes the surgical patient returns with a list of requests from a non-GMC registered overseas clinician, for GP observations and/or blood test monitoring that may not fall within our Primary Care team’s expertise, or is inconsistent with our local specialist teams’ practice. In such cases our clinicians may find it is appropriate to refer into specialist NHS services, but will not be able to act directly on the overseas clinic’s requests.

Need for timely, organised follow-up The Green & Fir Road Surgery team will put our patients’ needs first whenever seeking onward NHS care following an episode of private medical or surgical intervention, whether from within the UK or abroad. When care is necessary and appropriate, we will refer into our specialist teams for NHS review. However, we would urge any of our self-funding patients returning from procedures abroad to be aware of the need for timely and organised follow-up, and to ensure this is organised in advance with an appropriately specialist-led private clinic in the UK if they are not already under an NHS specialist team for this care.

Differences with local NHS clinic eligibility Patients who return from treatments abroad may have not been assessed for, or may not be eligible for equivalent local NHS treatment as per criteria for our commissioning region of Southwest London’s Evidence Based Interventions Policy3. Our practice urges patients considering such procedures to clarify their eligibility before seeking NHS aftercare, lest this may not be provided by our specialist local teams.

The Green & Fir Road Surgeries remains dedicated to serving our patients with compassion, professionalism and expertise. Through this policy document, we strive to maintain clarity and ensure that our patients understand the routes to referral and to follow-on NHS care including prescriptions and referrals following private consultations from providers in the UK and overseas.

References

1https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices

2https://www.swljointmedicinesformulary.nhs.uk/default.asp

3https://www.southwestlondon.icb.nhs.uk/wp-content/uploads/2022/07/NHS-South-West-London-evidence-based-interventions-policy-4.1.pdf