Search the website

Interface between NHS and private treatment

Guidance from the Ethics Department
February 2004

Summary
Although some doctors feel unhappy about their patients switching between the NHS and private sector, this is not unethical as long as the patient – when rejoining the NHS – is treated in the same way as those receiving all of their care within the NHS. Doctors should not put pressure on patients to seek private treatment or use their NHS patient lists to initiate discussion about private practice. At all times doctors’ primary concern should be for the safety and wellbeing of their patients.

A large numbers of patients opt to have some or all of their investigations and treatment privately. Some use private health insurance whilst others are willing to pay to be seen more quickly or for the added convenience or comfort of receiving their care in private facilities. In addition to increasing emphasis on patient choice within the NHS, it is also increasingly recognised that patients are entitled to choose whether to receive their treatment within the NHS or privately. In addition there has been a general blurring of the boundaries between NHS and private treatment, with patients switching freely between the two sectors. As a consequence of these developments, the BMA receives a large number of enquiries from doctors about the interaction between NHS and private treatment and how this should be managed at a practical level.

Concerns are sometimes expressed about real, or perceived, conflicts of interest when NHS patients ask their doctor about private treatment for example, or where doctors believe they are being asked to help patients to “jump the queue” for treatment. Many consultants are unsure about the limits of what they may tell patients about their private practice and how they may advertise their services. General practitioners frequently ask about their obligations to facilitate private treatment by making a private referral or sharing information with those providing the treatment. This guidance addresses the most common scenarios raised with the BMA. Consultant staff in the NHS should also familiarise themselves with the code of conduct for private practice in England,[reference 1] Scotland [reference 2] and Northern Ireland [reference 3] and guidance on private practice within the new consultant contract for Wales.[reference 4]

General principles

• Patients who are entitled to NHS funded treatment may opt into or out of NHS care at any stage.
• Patients who have had a private consultation for investigations and diagnosis may transfer to the NHS for any subsequent treatment. They should be placed directly onto the NHS waiting list at the same position as if their original consultation had been within the NHS.
• It would be inappropriate for consultants to pressure or encourage patients to transfer from NHS funded treatment to private care.
• Where clinically appropriate treatment is not funded by the NHS, patients should be informed of this in order to consider the options open to them, including the option of seeking the treatment privately.
• Consultants should not spend time during NHS consultations discussing private treatment with patients nor should they use their NHS patient lists to promote their private practice.
• All doctors have a duty to share information with others providing care and treatment for their patients, this includes NHS doctors providing information to private practitioners.
  • Feedback
  • Equal opportunities
  • Privacy policy
  • Terms and conditions
  • Accessibility
  • Help

  © British Medical Association 2008