View from a private GP: How should independent GPs communicate with NHS GPs?

Our view in one paragraph

Most of us in the forum have worked as NHS GPs, and we remember what it was like to receive a letter from a private clinic. The good ones were short, told us what had been done and said clearly whether anything was being asked of us. The bad ones were either missing entirely or quietly handed us work. Private GPs have a chance to be the good kind every time, and it is one of the easiest ways to earn trust from NHS colleagues.

The principles

Good medical practice says you must promptly share all relevant information about patients with others involved in their care, and that continuity matters most when care passes between providers. It also asks you to check, where practical, that someone has taken over when your role ends. For a private GP, that comes down to two things:

• Share by default. With consent, send a summary after every episode of care, not just when something is abnormal.
• Be clear about responsibility. Every letter should say who is following up what.

The NHS GP record is the one most clinicians will see. NHS England’s records management code describes it as the primary record of care, and says most other services must inform the GP when a patient has received care from them.

Talking to patients about sharing

Some patients do not want their NHS GP to know they have gone private. They worry the practice will be offended, or they do not want a diagnosis on their NHS record. In our experience most agree once you explain the reason: the next doctor they see, perhaps in A&E at night, will be looking at the NHS record.

If a patient with capacity still declines, respect it and record it. Then ask yourself whether you can still treat safely. GMC prescribing guidance is clear that if you cannot share information needed to prescribe safely, you should not prescribe. That applies particularly to medicines needing monitoring or open to misuse.

Letters that get actioned

An NHS practice receives dozens of documents a day, and each is read, coded and filed by someone with little time. Help them:

1. Put the NHS number and date of birth at the top.
2. Start with one line: why the patient came and what you found.
3. List diagnoses in plain clinical terms that are easy to code.
4. List medicines started, stopped or changed, with dose and duration.
5. Say what you are doing next, such as tests you will chase or a review you have booked.
6. End with "Action for GP: none", or one specific, reasonable request.

Avoid sending the full consultation note. It is harder to read and can bury the important line.

Asking the NHS GP to take something on

This is where relationships sour. BMA guidance for NHS practices says:

• private providers should arrange the tests they think are needed, and the patient pays
• a GP should only investigate and prescribe where it is necessary for the GP’s own care of the patient
• shared care with private providers is not recommended, and all shared care is voluntary
• where a private provider starts a medicine with an immediate clinical need, it should supply enough to last until the GP can take over, and the guidance recommends at least 7 days.

So if you want an NHS GP to take on prescribing or monitoring, ask before you start, explain why, and send what they need to decide. Accept a no gracefully, and tell the patient from the outset that you may need to continue the treatment privately. See managing patient expectations.

Getting information from the NHS side

Communication runs both ways, but private GPs usually cannot see the NHS record directly. With the patient’s help you can often see what you need, for example through the NHS App. See accessing a patient’s NHS record. If you need to speak to the NHS GP about a patient, ask for consent and keep it brief and specific.

How to send it

Secure electronic transfer into the practice’s document workflow over MESH is the most reliable route, through your own mailbox, a document transfer service or a record system that sends over MESH. Encrypted email and the patient themselves are fallbacks. Two corrections to what is often said: not every independent GP can get an NHSmail account, because eligibility depends on providing or supporting publicly funded care, and private GPs cannot write directly into the NHS record. See how to send consultation notes back to a patient’s NHS GP for the routes in detail.

These routes are built around NHS England. GP practices in Wales, Scotland and Northern Ireland sit within NHS Wales, NHS Scotland and Health and Social Care (HSC) in Northern Ireland, and electronic routes to them differ. Ask the practice how it prefers to receive letters, and use secure email or the patient where you cannot reach it electronically.

Build relationships locally

• Introduce yourself to the practices your patients most often use, with a direct contact for queries.
• Make it easy to reach you when an NHS colleague has a question about something you did.
• Know your LMC’s local guidance on the private and NHS interface. Several LMCs publish it.
• If something goes wrong between you and a practice, pick up the phone before writing.