NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

NHS Prescribing at request of private consultants

If individuals opt for private healthcare treatment or assessment, they are still entitled to NHS services. The Central Prescribing Team are often asked by GPs what they should do if a patient requests a medicine following consultation with a private healthcare provider.  This blog provides some advice.

When should a GP prescribe a medicine recommended by a private healthcare provider?

Where a patient has a private consultation for a chronic disease or investigations / treatment at a private establishment, the NHS GP may be asked to prescribe on an ongoing basis. Where the GP considers that the medication recommended is clinically necessary, that treatment is an ongoing responsibility for the GP and it is within their competency to prescribe, he or she would be required under the NHS terms of service to prescribe treatment within the NHS.

This does not mean the GP should always follow advice about a specific product; the issues are the same as those where a NHS consultant has asked the GP to prescribe a medicine. Where the recommendation is for a non-Formulary medicine or one not included within local guidelines, the GP may decide to follow local guidance unless there is a clear clinical justification for not doing so.

When should a GP NOT prescribe a medicine recommended by a private healthcare provider?

If the patient is receiving an episode of care from the private prescriber that the GP has no clinical input into, it is probably not suitable for the GP to prescribe. An example might be where the medicine is a specialist product which the GP feels they have no competence to prescribe or where the prescribing requires monitoring or assessment that can only be undertaken by the specialist. It is therefore suitable in these cases that the private prescriber prescribes this medicine as part of this episode of care. This might include ovarian stimulation for assisted conception or oral systemic anticancer therapy.

What’s the official guidance?

SGHD/CMO(2009)3 http://www.sehd.scot.nhs.uk/cmo/CMO(2009)private.pdf provides details on arrangements for NHS patients receiving healthcare services through private healthcare arrangements. This guidance notes that NHS and private care should be delivered separately and there should be clear separation in legal status, liability and accountability between NHS and private care provision.

The BMA have produced supporting guidance which notes that if the medication is specialised in nature and is not something GPs would generally prescribe, it is for the individual GP to decide whether to accept clinical responsibility for the prescribing decision recommended by another doctor.

Where can GPs get more information?

To discuss individual cases, contact your local prescribing support pharmacist.

 

Published 21/03/18