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Private to NHS

Private Referrals/’Episode’:

Patients seen privately should usually have any medication or treatment intervention provided privately as part of that episode of care. The private Clinician recommending a medicine should provide a private prescription.

Patients who request to be referred privately are expected to pay the full cost of any treatment they receive in relation to the ‘episode of care’ that is provided privately, this includes any: consultation fees, drugs prescribed or treatment provided by a Clinician in the course of a private consultation should be funded by the patient. This also includes any associated investigations/tests required.

In certain situations we may be able to prescribe some medications recommended privately via the NHS however in order to do so we need to know the indications for each drug and any relevant results IE we need a detailed clinic letter from the specialist recommending these medications. We are not able to prescribe without a clinic letter. Please be aware, therefore, that private prescriptions submitted without a full clinic letter will be automatically rejected- if the medications are needed prior to a clinic letter being available they will need to be obtained privately. If you are unsure about the urgency with which the medication is required please liaise with your private specialist- again we cannot advise on whether medications are urgent untl we have a full clinic letter detailing why they are required and the indication. 

Apart from the initial private referral any further administration associated with a private referral ie insurance forms and reports are chargeable. Please refer to our ‘Private Fees’ section for further details.

An ‘episode of care’ ends when the patient is discharged back into the NHS.

We would appreciate a full clinic letter after each visit to keep us updated of tests or treatment recommendations ensure your record is complete and accurate.

Private to NHS care:

If a patient wishes to transfer to NHS care, for reasons of equity, they should be prepared to accept the same treatment offered to any other NHS patient with the same condition.

In practice this means for specialist medications/investigations/treatment we would refer the patient to an NHS specialist for review/ongoing management.

For non-specialist medication we would prescribe according to our local formulary which is based on cost effectiveness ie you may not get the exact medication prescribed if there are similar more cost effective alternatives.

Please be aware the NHS prescribing guidelines state that we need to prescribe generic medications except for a few circumstances like inhalers, antiepileptics and contraceptive medications.

All private to NHS referrals are subject to the same usual NHS pathways with the usual associated waiting times. Unfortunately, we have no control over the waiting times. We do appreciate that they waiting times may often appear long.

Please be aware that on the NHS all normal referrals are vetted locally by a panel of doctors from Camden Clinical Assessment Service (CCAS). CCAS GP reviewers may send back your referral with comments for you to review if it doesn’t fit these guidelines or they feel we should do or try more things first. 

They (CCAS) may not authorise our referral for other reasons. This may be as or as this condition may not be covered by the NHS or that the condition may be covered but that we need to apply for funding and get approval first (EBICS).

Evidence Based Interventions and Clinical Standards (formerly PoLCE) is the referral process for patients needing a procedure where certain criteria or a threshold must be met before funding is approved. Please be aware the name of this program changed from PoLCE on 8 October 2019. Please see the Policy document from September 2019 and the application form attached (EBICS).

Please refer to the link https://gps.camdenccg.nhs.uk/referral-management/procedures-of-low-clinical-effectiveness-polce for further details.

 

 

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