We understand that the average waiting times for many NHS specialist clinics can range from a few months to many years. As GPs, we feel this is an unacceptable level of service, and we continue to campaign for more equitable care to reduce health inequalities. This would involve not only more timely access to specialist care, but also continued resources to fund and train GPs to maintain prescribing and monitoring.
As a result of these long NHS waiting times, people are seeking private treatment, sometimes through on-line providers. Many private clinics will initiate medication but then request that further prescriptions and monitoring are accessed from the GP.
We review each request for prescribing and monitoring from a private clinic individually to ensure that is falls within our local NHS formulary and is within our scope of practice.
Shared care requests from a private provider
Guidance from BNSSG ICB states:
Principles of Shared Care:
- Shared care is with agreement of all parties i.e. specialist, GP and patient,
- The appropriate stabilisation period has occurred before prescribing is handed over; duration determined by the shared care protocol e.g. 3 months,
- There is a structure in place to access on-going advice and support, detailed in the shared care arrangement e.g. side-effects, abnormal blood tests etc.
Note: a prescriber can choose not to accept clinical responsibility because of lack of familiarity or competence in the use of a medicine or if it is used outside agreed guidance. Prescribers may not refuse clinical responsibility solely on grounds of cost. Distance is not a reason for requiring transfer of care.
When shared care requests are received from a private provider, it is reasonable for GPs to ask the private provider to meet the principles of shared care for NHS pathways. Quite often point 3 above is not in place or provided by a private provider however, requests are still made for GPs to take over prescribing responsibility. Prescribing a medicine is often just a part of the package of care required, however is requested without other care/support in place.
It is reasonable for GPs to ask the private provider to demonstrate that it has the necessary expertise to diagnose and initiate therapy before responding to the provider’s request to continue treatment. In addition to this a prescriber must feel that they are clinically competent to prescribe the requested medicines before accepting clinical and prescribing responsibility for the patient.
The GP can decide on a case-by-case basis whether they accept the clinical and prescribing responsibility for a patient. A GP would be under no compulsion to continue maintenance treatment for any specialist medication, especially if initiated through a private clinic where there is no guarantee of clinical governance or quality assurance.
New patients joining the practice who have previously received prescriptions or monitoring by the NHS which was initiated or recommended by a private clinic, should make an appointment with our pharmacy team. We can review these requests against our policies to determine if we can continue. This also applies to any shared care agreements.
