Private Practice And GP Contract

Private Practice And GP Contract

Private Practice And GP Contract
11 Mar 2021

In terms of NHS registered patients, private practice is mostly restricted to GMS (General Medical Services ) and PMS (Personal Medical Service) contractors. This and more restrictions about private practice and referrals will be further explained when you contact us or when you visit London GP Clinic.

According to Part 5, Regulation 24 of the National Health Service ( General Medical Service Contractor) Regulation 2015, which sets out the basic exclusion in charging NHS patients for medical care, it states the following:

  • §  The terms relating to fees and charges must be stated in the contract, which has the same effect as those set out in paragraphs (2) and (4)
  • §  The contractor must not demand or accept payment, fee or any other remuneration from the patient, either by itself or through any other person, for its own benefit or for the benefit of someone else in respect of  the provision of any treatment whether it is under the contract or otherwise

In Regulation 25, the very limited circumstances whereby an NHS registered patient can be charged for services are outlined. Note that neither GMS nor PMS contracts can stop contractors from accepting private patients for medical care. However, the patients cannot be NHS registered patients with the practice holding the GMS or PMS contract under which they are being cared for.

In October 2019, new contractual regulations were introduced, and they restrict GP practices from offering or advertising private services to anyone during NHS working times and on NHS-funded property. It does not matter if the patient is registered or not, as long as those services fall within the scope of primary medical services. This also means that if an NHS commissioned a practice that provides service, they cannot charge for or host the same service during hours to provide those NHS services and on their premises.


Charging patients for medical services through private companies

The GP may decide to hold shares or become partners in private companies that provide medical services. The only question that may arise is whether the private company will charge the GPs' NHS patients for private services. This way, even though the GP does not charge the patients for the service, the company will charge the patient at arm's length, although there is a chance that the arrangement will fall foul of Regulation 24.

There is an argument that exists, and this is based on the fact that any GP's ability to charge patients through a private company hinges on the nature and definition of the person who holds a GMS contract. Such a person is called a contractor.

According to Part 2, Regulation 5 of the GMS regulation, it defines anyone who can hold a GMS contract as

  • §  A medical practitioner
  • §  A company limited by shares
  • §  Two or more persons practicing in a partnership

Anyone or any group falling outside of this group could be entitled to a fee or remuneration to provide treatment. For example, single-handed doctors can set up a partnership or company that would charge patients. However, the regulations would prohibit these entities or groups of persons from charging their NHS patients for private services.


Referrals of private GP to the NHS

The Department of Health has clarified that patients who chose to pay privately for an element of their care are entitled to receive free NHS diagnostic tests as long as they are eligible. This was proven by Section 8.2 of the Department of Health's Guidance on NHS patients who wish to pay for additional private care (2009), which is still extant and has not been altered.

Generally, private GPs are free to refer their patients to the NHS and vice versa. The 1986 handbook called the 'Management of private practice in health service hospitals in England and Wales', sets out the key principles that govern private practice in the NHS and clearly states that "If you consult a standard general practitioner then all fully registered general medical practitioners may refer patients to NHS hospitals irrespective of whether they are to be treated under the NHS or privately."

Also underpinned in paragraph four of the handbook is the principle that states that "patients wishing to be treated privately are entitled to the same NHS services as any other patient with the same clinical need. However, it should always remain clear whether the patient is receiving private or NHS care.


Private prescribing

Private GPs cannot issue NHS prescriptions, only private prescriptions. On the other hand, NHS GPs cannot charge NHS patients for prescriptions but can charge private patients who are not on their NHS list. Also, NHS prescriptions cannot be issued to private patients through NHS GPs. However, you should note that the NHS GPs can charge certain prescriptions for registered NHS patients.

The prescriptions are covered under Part 5, Regulation 25 of the National Health Service Regulations 2015, and they include medicines that will be required to treat an illness once the patient is abroad. Patients on a course of treatment that require an expensive course of drugs are more likely to opt for an NHS prescription. This could mean that some patients can have two GPs- an NHS GP and a private GP. This is to keep the management of their care cost-effective.


Special requirements for the private prescribing of controlled drugs

A special form (FP10PCD) was introduced for the purpose of the private practice of Schedule 2 and 3 controlled drugs will be dispensed to the public. It states that

  • §  It is strongly recommended that a prescriber writes a prescription that does not go beyond a maximum quantity of 30 days supply of Schedule 2, 3, and 4 Controlled drugs.
  • §  The private prescription form should include space for the person collecting a CD in schedule 2 or 3 to sign
  • §  Prescription printing software  should show 'CD' after the order for a controlled drug
  • §  The prescriber should obtain the patient's NHS number if possible and then enter it on the prescription form.

     You can visit London GP clinic for more information on private practice and GP contracts. Also, you can send us a mail or give us a call to book an appointment.