The rules for practising privately

private gpWith rising workload and falling income, private practice can be appealing and it’s by no means just the preserve of Harley Street. But you must follow certain rules to avoid falling foul of the regulations. Here we explain the main ones.

Who can I treat? 

Schedule 5 of the 2004 GMS contract sets out the only things practices are allowed to charge their patients for. You can charge your patients for some services not available on the NHS, but you cannot charge them for primary medical services or services covered in the contract.

You may choose to set up as a company to treat private patients. Whether a private GP can provide services to their NHS patients as part of a company hinges on the definition of a ‘contractor’ (as it is the contractor who cannot provide services to their registered patients).

The BMA recommends you inform your area team director or health board if you are providing services to patients through a separate private company to ensure you are on safe ground.

If as a GP you can refer your NHS patients to a private service you own, there is a potential conflict of interest and you need to disclose your financial interests to the patient before referring them, according to GMC guidance.

Does it make a difference if I am a locum GP without a set list of patients I normally treat? 

There is a case for saying locum GPs are not ‘contractors’, so could treat any patients privately. But the BMA says: ‘Where a locum is covering for a practice doctor on leave, they are temporarily contracted to care for a registered list and they cannot charge those patients’.

Do I need to register with the CQC?

A private provider needs to register with the CQC in England. If you are registered with the CQC as the provider in your NHS GP practice you do not need a different registration. This is because when the CQC registers an individual, partnership or body to carry out a regulated activity, it doesn’t distinguish between regulated activity done privately or under an NHS contract. There are some exceptions to this that you can find in CQC guidance.

However, the CQC says it should be informed if you start to provide care for a different group of patients.

What if I’m working shifts for a private company?

Doing private work for a company as a salaried GP (for example providing Skype services or on-demand GP appointments) has advantages as the income is steadier, the company will find patients for you and it will already have CQC registration.

However, the same rules apply whether you’re treating patients on a salaried basis or through your own company.

Can I refer private patients to NHS secondary care services or would such referrals have to be private too? 

You can refer patients for an NHS diagnostic test or to an NHS hospital in the same way as an NHS GP can.

The Department of Health says: ‘Patients who have chosen to pay privately for an element of their care are entitled to receive NHS diagnostic tests free of charge as long as they are eligible. A referral by a private GP for an NHS diagnostic test should not be any different from an NHS GP referral.’

If my private patient requested an NHS prescription to save money, could I provide one?

You cannot issue NHS prescriptions to private patients, in the same way that NHS GPs cannot provide private prescriptions for NHS patients.

A patient could go to their NHS GP to ask for the prescription on the NHS, which that GP could provide if they think it clinically appropriate.

How do I set my fees? 

You can’t discuss fees with other private doctors as this is against competition law unless you are in a business with them. Set your fees according to your skills, experience and the services you are providing.

Would my private work be appraised and revalidated?

Yes. It is your responsibility to ensure you are appraised annually in order to be revalidated with the GMC. If you still work in the NHS (splitting your time between private and NHS work), your appraisal will use NHS appraisal forms together with relevant data from your private work.

If you work wholly privately you will still need an appraisal but you must organise it yourself, for example through the Independent Doctors’ Federation.

What should I tell my indemnity provider? Will it increase my indemnity cost?

You should tell them if you are carrying out private work. The Medical Defence Union told Pulse that any change in indemnity fee would depend on the type of work being carried out, and your subscription might have to be adjusted. 

What are the rules on advertising a private service? 

According to the GMC, if you advertise your practice, you must comply with standards set by the Advertising Standards Authority and ‘make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge’.

The BMA warns that you shouldn’t give advertising material (such as business cards) to NHS patients at your practice as it could be perceived as promoting private practice.

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