The NHS Community pharmacist

Some services provided are not covered under our contract with the NHS and therefore attract charges. Examples include the following:

• Medicals for pre-employment, sports and driving requirements (HGV, PSV etc.)
• Insurance claim forms
• Prescriptions for taking medication abroad
• Private sick notes
• Vaccination certificates

The fees charged are based on the British Medical Association (BMA) suggested scales and our reception staff will be happy to advise you about them along with appointment availability.

Your payment must be paid prior to the appointment. Payment must be made by cash or cheque. We do not have the facility to accept payment by credit card / visa.

Whitemoor Medical Centre and non NHS healthcare providers

Introduction

With nearly 7.5 million people on NHS waiting lists in May 2023, patients are increasingly resorting to seeking private healthcare to deal with their health problems. Whilst it is perfectly understandable that people may want to seek private care it is adding extra workload for general practices due to private providers making requests in several areas:

• to make private referrals
• to provide medical information about patients
• to organise further tests
• to issue prescriptions
• for onward NHS referrals.
• To enter into shared care agreements

This guidance is written to help support patients understand how they can help reduce that extra workload and our policies on working with non NHS healthcare providers.

Patient referrals from a GP for private services

If a patient chooses to seek private treatment, they can self-refer. However, some consultants will only see patients that have a referral from a GP.

If a private provider requires medical information about a patient, this can be provided by the patient by supplying copies of hospital letters received by the patient or by sharing their medical records via the NHS app or online medical records system. Patients can make a SAR (subject access request) to obtain a free of charge printed summary of their medical record.

If a private provider requests more information from a general practice, this can be provided, following consent, and the cost of preparing the report can be charged to the private provider who may pass the cost on to the patient.

Organising tests requested by a private provider.

If general practices receive requests from private providers to arrange tests or investigations, it is important to note that complying with such requests – regardless of the GP’s management and treatment of the patient – is outside the scope of NHS primary medical services.

NHS regulations define essential services as services which are delivered in the manner determined by the GP in discussion with the patient. Therefore, a GP provider should only conduct investigations and prescribe medication for a patient where it is necessary for the GP’s care of the patient and the GP is the responsible doctor.

If the GP considers the proposed investigations to be clinically appropriate, is competent to both interpret them and manage the care of the patient accordingly, then the GP may proceed with arranging the tests or investigations.

However, if the GP does not have the knowledge or capacity to undertake these actions, they should decline to organise the investigation and advise the patient and the provider that the services do not fall within NHS primary medical services and to make alternative arrangements.

Patients are of course entitled to access their medical records, so GPs can provide access to the results of any such investigations for the patient to take back to the private provider.

NHS guidance states

Patients may pay for additional private healthcare while continuing to receive care from the NHS.

However, in order to ensure that there is no risk of the NHS subsidising private care:

• It should always be clear whether an individual procedure or treatment is privately funded or NHS funded.
• Private and NHS care should be kept as clearly separate as possible.
• The patient should bear the full costs of any private services. NHS resources should never be used to subsidise the use of private care.
• The arrangements put in place to deliver additional private care should be designed to ensure as clear a separation as possible of funding, legal status, liability and accountability between NHS care and any private care that a patient receives.

Prescribing medication requested by a private provider.

GMC Good Medical Practice states that doctors in the NHS and private sector should “prescribe drugs or treatment, including repeat prescriptions, only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.”

If requested by a private consultant to initiate or continue prescribing medications, and if the GP agrees with this advice, then this could be appropriate. However, if the GP does not feel competent to prescribe the requested medication, or they do not know if the medication best serves the patient’s need, the GP should inform the private provider that the prescriptions should be provided by a specialist.

It should also be remembered that NHS guidance states that

“Where a patient has an immediate clinical need for medication as a result of attending an outpatient clinic, the secondary care provider must supply medication sufficient to last at least until the point at which the outpatient clinic’s letter can reasonably be expected to have reached the patient’s GP, and when the GP can therefore accept responsibility for subsequent prescribing. Consideration should be given to providing a minimum of 7 days’ supply to allow patients sufficient time to contact staff at their general practice.”

This applies equally to private and NHS providers.

“Shared care” with private providers

Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care agreement’ setting out the position of each, to which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by clinicians with the necessary competence under the shared care arrangement.

Most shared care arrangements are commissioned by NHS commissioners and may not be funded for patients seeking private treatment. If this is not funded by local commissioners, the prescriptions and investigations should remain the responsibility of the private provider.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.

Caring for patients who have had private treatment abroad.

Patients can transfer their care from private to NHS as per the NHS Constitution. Thus, if a patient would normally receive follow up in general practice following specialist treatment, they should receive this if they transfer from private care, whether in the UK or not.

However, if follow up is of a specialist nature, or not within normal general practice remit, the patient should be referred to the appropriate service in the UK for this follow up.

If an appropriate service is not available, or rejects the referral, this should be directed to the local commissioner whose responsibility it is to commission the service.

Private providers making onward referrals to NHS provider.

Private providers can make referrals to NHS services, without referral back to the GP, provided the patient would be eligible for NHS referral.

If your injury is not serious, you can get help from a Minor Injuries Unit (MIU), rather than going to an A&E department. Minor Injuries Units can treat sprains and strains, broken bones, wound infections, minor burns and scalds, minor head injuries, insect and animal bites, minor eye injuries, injuries to the back, shoulders and chest.

There are nearby MIUs at Ripley Community Hospital and Ilkeston Community Hospital and no appointment is normally necessary as they offer a walk in service.

In addition Whitemoor also offers a limited minor injuries service. This is not a walk in service and is subject to appointment availability.

We are able to treat minor injuries that may not be suitable for normal domestic first aid and these include things such as

• Bites/Stings
• Sprains/Strains
• Sunburn
• Splinters
• Bad bruises
• Whiplash
• Minor head injuries (where there has been no loss of consciousness.

Please remember this is not a walk in service and is strictly subject to appointment availability

If you haven’t had your Flu vaccination yet, please ask at Reception to see if you are eligible.

We may be able to do it while you are in the surgery.

The surgery have specially trained nurses to provide this service. If you need to attend this clinic you will be initially sent an appointment date and time through the post. Our clinics are held on a Monday &Tuesday and we do have provision for a home visit for those patients who are physically unable to come to the practice.

Please call the surgery as soon as you book your holiday to discuss what travel vaccinations you may need and how soon you may need them with the reception staff. Most of these vaccinations are considered non-NHS and will need to be paid for. Please be aware that you will need to pay for your holiday vaccine before this is administered. Please note we only take cash or cheques. See the above tab for more information.

Please note that we no longer carry out yellow fever vaccinations.

In certain circumstances you may need to see a counsellor. You can now self refer yourself to these services. Please discuss with your doctor.

Some of the doctors carry out certain minor operations at the surgery. In the first instance, please make an appointment with your doctor.

Your baby will be seen by your doctor in surgery at 6-8 weeks while you have your post-natal check.

This is provided by the practice community midwife in combination with your usual doctor. Appointments to see the midwife are made through reception. Appointments are best booked between eight and ten weeks of pregnancy if possible. The midwife will advise you about antenatal classes later in your pregnancy. The doctors do not offer to supervise home deliveries