What are the ethical considerations when transitioning NHS patients to private care?

The short version

You can offer private care to people who are NHS patients. Almost everyone in the UK is. What you cannot do is let your own financial interest shape the advice you give, blur the line between free NHS care and paid private care, or use NHS access and NHS data to recruit private patients.

Most of the ethical risk sits in three places: patients you already look after in the NHS, the information you hold about them, and the moment you tell a patient something is available faster or better if they pay.

Your own NHS patients

If you work in an NHS GP practice, the contract rules come first. In England, a GMS or PMS practice must not charge its own registered patients for treatment, apart from a short list of exceptions, and it cannot see its patients privately through a linked company to get round that. The detail is in the restrictions on seeing private patients in NHS practices and which private services a practice can offer its own patients.

Even where the contract does not stop you, for example a salaried GP who also works for a separate private clinic, ask whether the arrangement would look right to the patient and to your NHS colleagues. Good practice is:

• Do not suggest private care to a patient during an NHS consultation as a way to get quicker or fuller care from you.
• If a patient asks about seeing you privately, explain what the NHS can offer them first, and that choosing NHS care will not affect how you treat them.
• Keep the two relationships separate: separate appointments, separate records and separate premises where possible.
• If in doubt, talk to your practice, your employer or your medical defence organisation before you start.

Honesty and your financial interest

The GMC’s Good medical practice (2024) says you must not allow any interests you have to affect, or be seen to affect, the way you propose, provide or prescribe treatments, refer patients or commission services. Its guidance on conflicts of interest adds that you should treat a perceived conflict the same as an actual one.

A GP who sees a patient in the NHS and then offers to see them privately has an obvious interest in the answer. Manage it openly:

• Tell the patient plainly that you would be paid for private care.
• Give balanced information about the NHS route, including realistic waiting times where you know them.
• Record the discussion in the notes.
• Never overstate NHS delays or understate what the NHS can do.
• If the test or treatment you offer privately is free on the NHS and the patient may not know, tell them. The GMC’s conflicts of interest guidance says you should.

For how to identify, declare and record interests in your private work more generally, see handling conflicts of interest in private practice.

Fees and informed choice

GMC guidance says that if you charge fees, you must tell patients about them before starting any investigation or treatment, and be clear how much they will pay for each part and when. If you do not know the total cost, for example hospital or laboratory fees, say so and tell the patient how to find out.

A patient moving into private care is making a financial decision as well as a clinical one. Before the first private appointment they should know:

• the consultation fee and what it includes
• what tests, prescriptions and follow-up are likely to cost
• that private prescriptions are charged in full and are not covered by NHS prescription exemptions
• whether their insurance, if they have any, will pay

Choosing private care is part of informed consent. See informed consent in private practice and managing patient expectations.

Patients keep their NHS rights

Paying for some care privately does not take away a patient’s entitlement to NHS care. The Department of Health’s 2009 guidance on NHS patients who pay for additional private care says that entitlement remains and may not be withdrawn, and that private and NHS care should be kept as clearly separate as possible.

The detailed parts of that guidance cover hospital care in England, but its general principles apply to all NHS care. In practice:

• A patient who sees you privately stays registered with their NHS GP and can go back to NHS care at any point.
• Do not ask the NHS GP to fund private care by the back door. Whether the NHS GP will prescribe or refer after your consultation is their decision.
• Write to the NHS GP after each episode of care, with the patient’s consent, so the NHS record stays complete. See sending notes back to the NHS GP.

Records, data and contacting patients

This is where well-meaning GPs most often go wrong. GP practices are the data controllers for the records they hold about their patients. The records, and the patient list, belong to the practice, not to the individual doctor.

• Do not copy NHS records, lists or contact details for use in your private service.
• Do not use the practice’s text messaging, email or letters to tell NHS patients about your private work.
• If a patient chooses to see you privately, start a new private record and ask the patient for the information you need, or ask for their consent to request a summary from their NHS GP.
• If you are leaving a practice, the practice decides how patients are told. You may not contact its patients yourself using its data.

Once a patient is yours privately, you become responsible for their private record. See registering with the ICO.

Advertising without soliciting

You can tell the public about your private service, within the advertising rules. NHS practices must not promote private services in the materials they use for NHS services. Keep your private marketing on your own channels, and make sure it does not suggest that NHS care is unsafe or unavailable. See the rules on advertising medical services.

Scotland, Wales and Northern Ireland

The GMC guidance applies across the UK. The NHS contract rules on charging your own patients, and the government guidance on mixing NHS and private care, are set separately in each nation. The BMA publishes a separate Scottish edition of its guide to the interface between NHS and private treatment. Check the rules for the nation you work in before you offer private care to anyone you also see in the NHS.

A quick self-check

1. Would this patient have been offered private care if I did not stand to earn from it?
2. Have I explained the NHS option fairly?
3. Does the patient know the full likely cost before we start?
4. Am I using only information the patient has given me for their private care?
5. Will the NHS GP know what I have done?

If any answer is no, pause and fix it before you go further.