NHS Rules about private health insurance : shared care agreements

paintsketch

Correction needed on MSE site about private healthcare options.

The NHS has the policy now (not sure if this was always the case) that a patient cannot have shared healthcare; that is, you cannot have NHS and a private specialist for any specific health need (e.g. orthopaedics).

There is a rare possibility that an individual can have a 'shared care agreement' but this is at each GP practice's discretion.

I have a specific medical condition for which I see a specialist via my company's private healthcare scheme. My GP has had an implicit shared care agreement for over 10 years (I've only just discovered this). My specialist has finely tuned the medication I need, is always available when I need assistance, and always has the capacity to provide the time needed for my appointments.

My GP is amazing, though they aren't able to provide the care I need for this specific condition due to appointment and waiting times, and because they aren't specialist in the area of my need, which is why I have a private specialist for this condition.

Question:

Can anything be done to address the need for shared care agreements and change NHS policy? Is there a group/organisation already doing this?

MyRealNameToo

Must admit not fully following the situation or question… my GP did a referral for rheumatology to the NHS but my initial appointment was going to be in circa 9 months time. With their knowledge and consent I used the same referral letter with my PMI and so was sent to the local private hospital who diagnosed the condition, started medication and wrote to my GP asking them to takeover prescribing the meds.

Its a long term condition and my PMI like most only covers acute issues and so my NHS appointment was left in place and so after 9 months I saw the NHS consultant in the hospital across the road from the private one. The consultant actually works at both but I saw a different one under the NHS. They took the letter her colleague had given me, downloaded the MRI scans and report from the private hospital and then wrote to my GP saying she agreed with the care plan and would see me again in 6 months.

That was just over a year ago now. There is a big difference in that if I complain of a joint pain the private consultant puts me in an MRI and the NHS one says its probably the arthritis spreading but I now would only see the private one for an acute flair up of the condition and the NHS one deals with the routine maintenance. Didnt have any special conversations about this beyond the initial one with the GP who said it sounded sensible.

Not sure if you are talking about something similar or totally different?

Grumpy_chap

https://forums.moneysavingexpert.com/discussion/6658128/nhs-rules-about-private-health-insurance-shared-care-agreements

If you want to change NHS policy, you will be best to write to your MP.

wanttomove

NHS care (in England) follows NHS Englands contractual requirements based on evidence base and cost effectiveness, providers of NHS care (including GP's who are private contractors to provide NHS care) carry out services they are commissioned to provide.

Shared care agreements are generally between NHS providers, NOT private providers and NHS providers. foe example, you are referred by your GP to an NHS orthopaedic surgeon who determines you need medication X, medication X is a red drug that requires particular ongoing monitoring, Orthopaedic surgeon wants pt's own GP to undertake the ongoing monitoring associated with you being on X drug in the community once they ahve stabilised you on the treatment, GP's are not commissioned nor are they paid for the additional workload this extra monitoring creates therefore they can refuse to take over this, in the past they have generally done this kind of thing for patients as it's generally in the patient's best interest but due to years of inadequate funding GP's are now refusing to take on this unfunded workload. But we are still discussing NHS care here.

Your problem is you have a private provider who is more than likely providing you with non standard NHS care and your expectation is for your GP to take this over under a shared care agreement, they have no contractual requirement to do this as it's not NHS care, therefore if they agreed to do it, your GP could charge you for that service if they wanted to, but likely wouldn't as they don't have enough time to deal with NHS care let alone take on private care monitoring.

Shared care agreements exist for NHS to NHS care but not private to NHS care if the private care doesn't follow NHS commissioning.

To answer your direct question, you would need to discuss with NHS England who would likely just bat this back to you and say if you're not having NHS comissioned care your GP doesn't have to take that on, or you could lobby your MP for change

badmemory

I suspect it may depend on what kind of care. For example I had an op a couple of years ago quicker than expected so went via NHS & had district nurse visiting re dressings afterwards. My sister needing a more serious op & not liking the waiting times went privately with much harder to reach op site. No district nurse & had to taxi (not allowed to drive at that point) to another nearer private hospital for dressings.