The Department of Health has published final guidance for NHS patients wishing to pay for additional private care. The Guidance came into force on 23.03.09 and is not retrospective.  

This follows publication of Professor Mike Richards’ report (4.11.09), entitled “Improving access to medicines for NHS patients” and subsequent announcement of a package of measures in response to the report, from the Secretary of State for Health, to make more drugs available to NHS patients free of charge. The measures include the National Institute for Clinical Excellence’s introduction of greater flexibility of its appraisal of more expensive drugs for end of life conditions, which should minimise the number of patients wanting to pay for additional private care.  

Professor Richards’ report highlighted there was a great deal of confusion relating to the existing guidance, which was being interpreted differently. Many patients were unclear as to whether they would still be entitled to NHS care if they purchased additional drugs privately. He recommended revised guidance be issued as soon as possible.  

For the few patients that may still wish to purchase additional private care, the new Guidance clarifies that where a patient opts to pay for private care, their entitlement to NHS services remains.  

The key points within the Guidance are:  

  • NHS care should not be withdrawn simply because a patient chooses to buy private care
  • Any additional private care should be delivered separately from NHS care  
  • It should always be clear whether an individual procedure or treatment is privately funded or NHS funded  
  • Private care should be carried out at a different place and time to NHS care  
  • The NHS should never charge for NHS care (except where there is specific legislation in place to allow charges)  
  • The NHS should continue to provide free of charge, all care that the patient would have been entitled to had he or she not chosen to have additional private care  
  • The NHS should never subsidise private care with public money
  • Strategic Health Authorities and Primary Care Trusts should work together to ensure that the guidance is being implemented properly in their local areas  

Departing from the principles of separation will be allowed only where there are overriding concerns for a patient’s safety. Such decisions must be agreed in advance with the Medical Director. However if prior approval is not possible then the Medical Director should be informed as soon as possible afterwards. In any event a record must be kept of the decision.  

Case Study Examples given within the Guidance:  

  • Where a patient in specialist isolation care on a bone marrow transplantation unit wishes to pay for an unfunded drug in addition to NHS treatment, and in the opinion of his doctor it would be unsafe to move him, then with agreement of the Medical Director he will be allowed to have the drug at the same time as undergoing NHS treatment. He will however have to pay the full cost of his private treatment.
  • Where a patient needs cataract surgery but wants a multifocal lens inserted to reduce the need for wearing glasses instead of a single focus lens available on the NHS, he will not be allowed to have the additional private treatment (replacing the single focus lens with a multifocal lens). This is because the NHS element and private element cannot be delivered separately even though he is willing to pay for the alternative lens. He can have the single focus lens free of charge or pay for an entirely private operation if he wants the multifocal lens.  

The Guidance further recommends that transferring between private and NHS care should be carried out in a way that avoids putting patients at any unnecessary risk. Protocols should be put in place to ensure effective risk management, sharing of information and coordination between NHS and private care. The NHS should continue to treat any patients in an emergency.  

NHS Trusts and Foundation Trusts should have clear policies in place in line with these principles to ensure effective implementation of this guidance within their organisations. This includes protocols for working with other NHS providers where the NHS Trust or Foundation has chosen not to provide additional private care.  

To read more click here for the full guidance document: