Swapping back and forth between NHS and private treatment

[PositivelyGlowing]

For the past couple of months I've been suffering from a medical condition for which I needed to see a specialist - the waiting list for my NHS (I live in Wales) was over 6 months so I opted to go private. I found somebody suitable, but in England - my GP wrote a letter of referral and the specialist, after seeing me and doing some physical tests, stated that I needed a couple of MRI scans to rule out some of the most likely causes.

So I had the MRI scans and no issues were found. All well and good but the cause of my condition remained unknown.

The specialist then recommended that I have quite a number of blood tests (testing about 12 different things) and he wrote to my GP with this recommendation.

On speaking to my GP he (politely) stated that he couldn't authorise the tests on the NHS because I was 'swapping and changing' between private and NHS treatment, I guess the NHS frown on this even though I am at least partly saving them time and money by seeing the specialist for the initial private consultation and MRI tests ........

I wasn't surprised by my GP's response but it was of course disappointing.

When I told the specialist about this he said that the response from my GP was very rare.

I guess that paying for the blood tests is my only option now? I could write to my GP and politely air my disappointment but I guess that won't get me anywhere.

@bluecurtains14 is actually correct, gps are not the dogsbodies of consultants, NHS or private. Some people think that consultants are gods, and gps are lesser minions, but they’re actually all doctors. They also assume that if a consultant suggests that a patient should be prescribed jelly babies, then the gp has to comply. Wrong!

That letter is a recommendation, not an order. The Gp is legally responsible for any prescription they write, so have to be comfortable writing it.

Similarity, with blood tests. If a private consultant requests the blood test, and will follow up the results, then why should the gp do the blood test. They don’t get paid for it.

No wonder waiting lists are so long.
All the consultants are spending their time making big bucks seeing patients privately.

it has no impact at all on waiting lists in the NHS - the consultants aren't seeing private patients during NHS time - it's all done in their 'off' time. If they weren't doing the private work they'd be at home doing housework or childcare or having a life, not ploughing through the waiting lists.

But the patient IS ALSO your nhs patient. They do not stop being your nhs patient simply because they have sought private care.

There was a thread a few weeks ago about the breakdown in the social contract and people perceiving themselves to not get anything out of public services. I’m one of the loons who is happy to pay higher taxes for better public services, but I find this approach such a turn off.

I can’t begrudge people limiting pain or illness because NHS waiting lists are excessive. Those people are not depriving other people of resources in the NHS. The consultants would not be doing more work in the NHS if they weren’t working privately so its not about access to services. Ultimately people paying for private medical care save the government money overall because the NHS now does not have to pay for their treatment removes people from waiting lists (irrespective of the incentives for individual GPs). Private consultants are largely the same people working in the NHS so it’s not the case they are causing additional work for the NHS by doing a bodge job.

I don’t understand a logical argument for them to be penalised (opposed to emotional or ideological arguments).

Yes. And I'll do any bloods that I think are necessary. As should the consultant.

@Itwasacceptableinthe80zzI agree. It’s the same mentality as taxing private school parents more, even though they’re already paying for a state school place they aren’t using so ultimately already paying for a service they won’t uptake. I think in that and in the case of GPs/ other people being churlish about mixed private and NHS care, it comes down to resentment that some people have the means to “skip the queue” ad many people see the NHS as something that should never be criticised or held to account. The mere act of choosing private healthcare is an implicit criticism of the NHS and that rubs a lot of people up the wrong way.

This. It's the follow up that is the issue.

So should childless people pay a smaller amount of tax, and those with more children pay more tax as they’re using more school places?

My parents have rarely used nhs healthcare throughout their lives, but are now needing now they’re elderly (hospital visits due to falls etc). When they were working, should they have paid less tax as they didn’t need it (not knowing they would need it later)?

@SteelworksNo, I’m saying that there is an ideological resistance from some GPs and members of the public when people have paid to access private healthcare. There are people who morally object to other people using their means to access “better” health or education that people who can’t afford to access can’t get. This drives some of the obstructive attitudes from some GPs working in the NHS.

I don’t think that’s what she said and it’s not what I think either for the record. I said I would pay more tax for better public services as it is the price of a well functioning society.

What I asked and Frankygoestobollywood replied to is why logically it’s a problem to pay for their care, when the people doing it are not damaging the NHS. I’m inclined to think she’s right that the only reason people object is because they think someone else is getting 1 up on them even if it’s not true and just means someone else is able to do something which limits there medical problems and overall reduces costs to the NHS. I have never used so much as a private dentist but I cannot fathom a logical case to do this.

Ok. I missed understood what she was trying to say then.

But all these people are also entitled to free NHS care. All, everyone. You cannot refuse to see a patient or refuse to continue care just because they happen to having paid extra to see a private specialist, who probably also works for the NHS too. What happens when they run out of money or lose their job for example?

So the GP refers back to the same consultant but under his NHS clinic.

Hello Martin, you saw this patient privately, they have had further blood tests under our care, which have highlighted the following..... but now wish to be referred back to you under your NHS clinic. Can you please add them to your list. Yours & etc

Absolutely. On the NHS they get me and they get an NHS specialist (who requests his or her own blood tests). I'm happy to refer anyone on the NHS who started down the private route then realises they can't afford it.

Actually the way it works is that private consultants can and should refer back direcrly into the Nhs if they know that it is needed. They are often quite poor at doing this though.

Myself and my children have had private surgery with surgeons who also do NHS work. I am privileged to have healthcare through my job. We also came off a waiting list. Struggling to see the issue

Oh how odd. I had an issue and went to my GP, I was seeing a gynae for another reason privately. My GP said let me do some bloods and take them to your appt and ask the gynae with the blood results what we should do and ask them to to write to me!

I had a minor procedure at a private hospital today as an NHS patient. The consultant to whom I was originally referred at my local hospital told me my condition was cosmetic and handed me his business card, presumably in the knowledge I would need an operation at some point in the future.

Three weeks later I had to use 111 to access an emergency appointment at my GP surgery because my condition was red, swollen and causing me a lot of pain. A 7-day course of antibiotics was prescribed by a clearly shocked GP, who took photos in order to find another consultant able and willing to operate. Five NHS hospitals refused the referral; one private hospital accepted.

I got lucky, I think. Google searches revealed the consultant willing to help me holds a substantive post at an NHS hospital is a leading specialist with over 20 years' experience in what seems to be quite a small field.

There's more to this, but two points seem relevant:

My job is specialised and my remuneration includes private health insurance, but the word "cosmetic" gave the insurers a get-out clause. Something I intend to pursue.

In the run-up to today's surgery, I received a copy of a letter sent to my surgery by the consultant requesting a nurse appointment to remove stitches and change dressings. Today, however, I was advised the stitch removal and dressing change would take place at the hospital.

In the light of the comments above, I think I understand why the change has been made - and, although I can walk to my GP surgery in five minutes as opposed to driving 30 miles to the private hospital, I honestly don't mind. I'm just so grateful the operation has taken place, and also for my GP's initial perseverance in finding someone to do it.

I am in the same boat. I paid to get a diagnosis privately because of nhs wait times. The consultant recommended blood tests. My GP says I have to pay privately for them. I want to complain about this. It seems so totally unfair.

How is it unfair? Your private consultant recommended blood tests therefore it is said consultant’s job to get these done privately. The GP has nothing to do with it

Incorrect - the GP has EVERYTHING to do with it - the private consultant stated that, in England, he regularly recommends tests to his patients who then approach their GP (in England) and, without exception, the GP orders the tests, so costing the patient nothing.

That said, the NHS is even worse in Wales than in England so I guess I shouldn't be surprised that my GP doesn't want to order the tests.

I think you're a bit quick off the mark to go private.

You went private and they haven't found anything wrong. If you'd waited 6 months for the NHS they would have found nothing wrong. You'd have had longer waiting lists for the MRI etc.

Six months isn't a massive amount of time to be waiting. The NHS has never had particularly short waiting lists for non urgent conditions.

The blood tests will be a drop in the ocean compared to the money you spent on the consultant and the MRI

Some GPs agree, some don’t as they are categorically under no obligation to do carry out tests recommended by private consultants and receive no funding to do so. I’m a private HCP and find it bothersome that the consultant you spoke to expects GPs and the NHS to carry out his work for him! He should be arranging all tests and personally going through the results privately.

I explain this to my own patients day in, day out.

I'm a GP in England and we 100% dont do this. Some do but it's not advisable. Consiltant either bullies his local GPs or is talking bollocks.