Starting from September 2024, we will no longer be able to: prescribe specalist medications including the prescribing or monitoring of "shared-care medications" or provide specialist monitoring in collaboration with private sector (non-NHS) services.

These medications and conditions require specialist input. Many of these medications are either only licensed for specialist prescribing or are prescribed outside their licensed use, which again should be managed by and prescribed by a specialist. This is beyond the scope of the practice.

Examples of services we are sometimes asked to do, but cannot provide include: medications for ADHD, treatments for gender incongruence, isotretinoin for severe acne and monitoring after private bariatric surgery.

GPs and Private Healthcare: What You Need to Know

GPs work closely with hospital consultants, but due to long NHS waiting lists, more patients are turning to private healthcare. This shift is adding extra workload for general practices because private providers will sometimes request:

• Private referrals
• Medical information about patients
• Further tests
• Prescriptions
• Onward NHS referrals

While seeking a quicker private specialist opinion can be reassuring and helpful, GPs will agree to a private referral only when it is clinically appropriate. They will also provide medical information to private healthcare providers with the patient’s consent.

For a GP to organize a medical test, they must be clinically competent to interpret the results and manage the patient’s care. The test must also align with usual NHS practices. Although tests advised by private providers fall outside the NHS primary medical services contract, GPs can potentially agree to tests they would typically perform in NHS general practice though this needs to be discussed on a case-by-case basis.

According to the General Medical Council’s Good Medical Practice, doctors in both the NHS and private sectors 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.” (1)

Some health conditions require a hospital specialist to make a diagnosis, request the appropriate tests and establish someone on treatment before handing aspects of their care back to the GP. In some situations the NHS has developed a “shared care agreement” for such conditions. This “shared care agreement” is a document developed through collaboration between General practice, NHS specialties and pharmacy teams. It outlines the roles of all clinicians, recommended monitoring, and investigations. All the clinicians involved in a patient’s care must agree that standards are met before the GP can agree to prescribe. “Shared care” is an NHS service and unfortunately, private providers have not developed robust shared care pathways with the NHS and they do not have the required communication structures and safety netting available to NHS specialist services. We are therefore not able to enter into shared care arrangements with private providers (2).

If you seek a private medical opinion and an investigation or medication is recommended, your GP will consider if it falls within NHS primary care (GP) services. If not, they will review your condition and assess if it is appropriate to refer you to the NHS equivalent specialist service.

If a private specialist recommends a non-formulary or unlicensed medication, GPs can only agree to ongoing prescribing if they have experience and expertise with the medication. Otherwise, you will be directed back to the private provider or offered a suitable, formulary-based alternative within the NHS GPs’ remit, in line with GMC’s Professional Standards (3).

For patients already receiving prescriptions under a shared care agreement, failure to comply with recommended monitoring may result in prescriptions being stopped, as patient safety is paramount.

General Practice is receiving more requests from private healthcare providers. At Bruntsfield Medical Practice, we aim to clarify what we can offer regarding NHS GP and private healthcare interfaces and explain our limitations to ensure our patients are safely cared for by clinicians with appropriate expertise.

For more information about the challenges of general practice, please see the article by the Lothian Local Medical Committee here.

1. GMC Good Medical Practice
2. BMA General practice responsibility in responding to private healthcare
3. GMC Shared care - professional standards