Three experts advise a GP who is wondering whether he can help patients save money by sometimes prescribing on a private basis.
One partner wants our practice to issue private prescriptions to NHS patients in certain circumstances on the basis that, with the prescription charge now being so high, it is a cheaper option for the patient. Is this ethically and contractually sound?
Professor Azeem Majeed: No, this is against NHS regulations
The NHS prescription charge in England is currently £8.40 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.
In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the GPC has recently sought legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.
The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge.
Furthermore, for private prescriptions, the pharmacist is free to add a dispensing fee to the cost of the drug and so the patient might end up paying the same or even more than the NHS prescription charge for their private prescription.
Finally, trying to explain NHS guidance on prescribing and its implications to the patient makes the issuing of a private prescription impractical in the time available.
Hence, I would advise GPs not to issue a private prescription to NHS patients in place of an NHS FP10 prescription in these circumstances. This advice should be communicated to the other prescribers in the practice so that they all follow the same policy.
Professor Azeem Majeed is professor of primary care at Imperial College London and a GP in south London
Dr Natasha Usher: Suggest they buy the medicine over the counter
Under the NHS contract, a GP is unable to supply a private prescription to an NHS patient, except under specific circumstances where the item is blacklisted, such as certain travel vaccines. It is also worth pointing out that most chemists will make an additional charge over cost price for private dispensing, so it might cost the patient more, even when it appears cheaper.
Many items will also be cheaper than a prescription charge to buy over the counter, and there is nothing to stop the practice suggesting this. In addition, the vast majority of patients will not pay a prescription fee, and this will not benefit them, so it might be worth speaking to the local pharmacy to find out what potential costs would be.
It is possible to offer private consultations to patients and supply a private prescription. However, the practice would then need to decide what the fee would be. The cost may deter patients from pursuing this simply to obtain cheaper prescriptions, although you could decide to offer a free private consultation.
There may then also be issues of documentation, particularly if these prescriptions are handwritten, which would also affect audit of prescribing patterns, which are based on use of FP10s. There may be an argument that says this would save the NHS money, but I would argue that you should consult defence unions and LMCs to obtain further advice.
Dr Natasha Usher is a GP in Montifieth, near Dundee, Scotland
Dr Edward Farnan: It could result in breach of contract
It is understandable that a GP will want to ensure patients being prescribed medications are not financially disadvantaged. However, when treating patients under the GP contract, the partner is obliged to act within the contract terms.
According to the GMS Contracts Regulations 2015, GPs are not allowed to issue a private prescription to NHS patients, except in cases where they are prescribing drugs that are not available on an NHS prescription (regulations 55 and 61).
If patients require treatment that is covered by a GMS or PMS contract, GPs are obliged to carry out the treatment on the NHS without charge. This includes prescriptions, with the contract allowing GPs to issue NHS patients with an NHS prescription (FP10 or electronic prescription).
Therefore, although the partner’s desire to offer patients a cheaper option is well intentioned, it is likely that doing so could result in the practice being in breach of its contract.
Dr Edward Farnan is a medicolegal adviser at the Medical Defence Union