Information about Private Referrals
If a patient has chosen to pay for private healthcare because
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- a) their treatment is not available on the NHS or
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- b) they do not wish to be treated on the NHS
the patient is responsible for paying for all costs, including tests, and the private provider is responsible for managing every aspect of their healthcare (unless the patient chooses to transfer back to the NHS at a later date to continue treatment).
For that reason, private providers should not be asking GPs to arrange any tests that they deem necessary, and intend to use, to make a diagnosis and recommend a course of treatment with.
It is the private provider’s responsibility to arrange tests for patients whose care they are managing, and the patient’s responsibility to pay for them.
Private Tests and Investigations
If a test or investigation is recommended by a private provider, the private provider retains responsibility for this test. This would include x-rays, scans and blood tests as well as procedures such as an endoscopy. This is the same as the guidance applied to the rest of the NHS in Wales.
This includes responsibility for:
• Arranging the test and any medications you may need to take before or after, including pain relief.
• Explaining what the test entails and what you need to do on the day of the test.
• Providing you with the results and explaining what this means for your care or condition. This may involve a letter or follow-up appointment with the specialist.
• Arranging any follow-up required after the test including onward referral to other private or NHS services.
It is important to consider the cost of these tests, if they are not covered by your health insurance. Please do not contact the practice to discuss the results of tests organised by practitioners outside the practice. Please contact your private provider for these results.
Medication
The medication GP practices can prescribe fall within strict guidance. This includes, but is not limited to, national medication licenses, NICE guidance, local protocols and the Health Board formulary. These guidelines are in addition to the prescriber's responsibility to their regulator, such as the General Medical Council, Nursing and Midwifery Council and the General Pharmaceutical Council, to ensure they are prescribing safely. This means your GP practice may not be able to take over prescribing a medication from a private provider.
Usually when patients are seen by a private provider for a single, short-term episode of care any medication should be prescribed by them and paid for either by the patient or their medical insurance. This is because the private provider has clinical responsibility for the treatment of that particular condition.
Where longer term treatments are recommended, medication may be added to a patients repeat prescription providing it would be available from a GP for that condition under the NHS and the GP practice team are comfortable to prescribe it.
Examples where the practice would not be able to prescribe a medication includes:
• Its use is restricted to hospital specialists.
• The medication is not licensed for the indication it has been given.
• Insufficient detail has been given regarding dose, duration, indication or monitoring requirements for the drug.
• It interacts with other medications you are prescribed or is contraindicated due to your other medical conditions.
• A more cost-effective treatment is appropriate for the management of your condition.
• The medication is available to purchase, for example from a supermarket or pharmacy.
In every case, the private provider is responsible for providing you with enough medication until the practice can take over prescribing. This is usually considered at least 7 days.
Some medications require particularly close monitoring to ensure patients remain safe while taking them and would only be provided by GP practices following a ‘shared care’ agreement with a hospital team. These include medications used for arthritis such as Methotrexate, and medications for ADHD. These are not available for GPs to prescribe on their formulary and require ongoing monitoring from a specialist team. If these treatments are started, they will need to continue being prescribed by the private provider until you are seen by an NHS specialist team who can continue the treatment if they feel it is appropriate for you. Unless this medication is covered by your health insurance you will need to pay for this treatment up until an NHS specialist takes over prescribing for you.
Referrals to Other Services
If your private provider recommends you be referred to another private specialist or NHS team, they are responsible for making this onward referral and should not ask your GP practice to do this. This is the same as the guidance that applies to specialists working within the NHS.
Request for a ‘Sicknote’
If your private provider recommends a period off work, the private provider is required to provide a sicknote that covers the entire duration of this period, as well as any extensions they recommend after this. This is the same as the guidance that applies to specialists working within the NHS.
Do I need a GP referral for private treatment?
No. You can get private treatment from a consultant or specialist without being referred by your GP.
But the British Medical Association (BMA) believes it's best practice for patients to be referred for specialist treatment by their GP because they know your medical history and can advise you if a referral is necessary.
A referral is also needed by many private practitioners and private medical insurance policies. If you have private medical insurance, ask your insurer if they need a referral.
Getting a referral from your GP
It's best to see your GP first if you're unwell or have symptoms. Talk to them about whether you might need a specialist assessment or treatment.
If your GP thinks you need to see a specialist and you want to pay for it privately, they can write a letter of referral to a private consultant or specialist explaining your condition and your medical history.
Your GP will only refer you to a specialist if they believe that specialist assessment or treatment is necessary. If they do not think it is, they do not have to refer you – either privately or on the NHS.
If you want to see a private specialist, you're still advised to get a letter of referral from your GP. This is usually discussed following a consultation with your GP.
Whether you see a private specialist, with or without a GP referral, or are referred to an NHS specialist, your GP is not obliged to accept the specialist's recommendations.
