As a private GP, can I make NHS referrals?

The principle

The BMA’s guidance on private practice says private GPs are free to refer their patients to the NHS in the same way NHS GPs can refer their patients to the private sector. Its guidance for NHS practices on responding to private healthcare adds that private providers can refer to NHS services without referring back to the GP, provided the patient would be eligible for NHS referral, and that treatment should be allocated on clinical need. Patients who choose private care are entitled to the same NHS services as anyone else with the same clinical need.

What varies is the mechanics. NHS referral systems are built around NHS GPs, so the route depends on urgency.

Routes by urgency

Situation	What to do
Emergency	Call 999 or send the patient to the emergency department with a handover letter
Same-day specialist assessment	Phone the on-call team at the local hospital, as an NHS GP would, and send a letter with the patient
Urgent suspected cancer	Use the local route for independent sector referrals. See urgent suspected cancer referrals
Routine outpatient referral	A referral letter to the trust’s route for non-e-RS referrals, or a private referral if the patient prefers
Direct access tests	Usually limited to NHS GPs. Arrange tests privately or ask the NHS GP if they will be managing the result

Emergencies and A&E

You can always send a private patient to A&E. Emergency departments treat anyone who needs emergency care, whoever referred them. For a patient who is acutely unwell:

• call 999 if they need an ambulance, and stay with them until it arrives if you are with them
• for less critical cases, phone the ED or the relevant on-call registrar so they are expecting the patient
• give the patient a handover letter with your findings, observations, medicines given and your contact number
• record the time, your assessment and the advice given, and follow up the next day where you can

Do not delay an emergency transfer to arrange a private alternative. For urgent problems that are not emergencies, NHS 111 can direct patients to the right service out of hours.

Routine referrals

This is where private GPs meet friction. NHS England’s elective access policy says GP referrals to consultant-led services should go through the NHS e-Referral Service, which private GPs cannot use. The same policy recognises that paper and email referrals exist and expects trusts to have procedures to process them. See why private GPs cannot use e-RS.

1. Check the trust’s referral criteria and any local pathway. Some services only accept referrals after certain tests.
2. Write a complete letter with the NHS number, NHS GP, history, findings, results, medicines, the question you want answered and the urgency.
3. Send it securely to the address the trust gives for non-e-RS referrals, and ask for acknowledgement.
4. Copy the NHS GP, with consent, and tell the patient how to chase if they hear nothing.

If a hospital rejects a referral only because it did not come through e-RS, raise it with the trust. LMC guidance says NHS practices should not routinely be asked to recreate referrals simply because local processes require e-RS.

When the NHS GP should refer

Sometimes it is better for the NHS GP to make the referral, for example when they will manage the patient’s long-term condition, or when the pathway needs tests only NHS GPs can request. In that case, send the NHS GP your findings and explain why you think a referral is needed, and make clear it is their clinical decision. Do not tell the patient their NHS GP "will refer" before the GP has agreed.

NHS waiting lists and moving between sectors

NHS England’s elective access policy says patients can move between NHS and private status at any point during their treatment without prejudice. For planned care, the referral-to-treatment clock starts when the NHS provider receives the referral, so time spent in private care does not count towards NHS waiting time. Explain this to patients who are weighing up private and NHS options.

Patients who are not ordinarily resident in the UK may be charged for some NHS hospital care. If you see overseas visitors, tell them this before you refer.

Letters from the record

Referral letters take less time if your record system can generate them from the consultation, with the problem list, medicines and results pulled in. Whatever system you use, keep a copy in the patient’s record and log where and when it was sent.

Scotland, Wales and Northern Ireland

The principle that private patients can be referred for NHS care applies across the UK, but referral systems and policies differ. Check with the local health board or trust how they accept referrals from private practitioners.