A regular window into the world of private general practice

🚨 Private GP In The News

• Pulse - Greater use of private healthcare is increasing workload, GPs warn
• Pulse - England GP leaders vote in favour of general practice waiting lists

🆘 Useful Resources

• BMA guidance - General practice responsibility in responding to private healthcare
• Private GP Forum - As a private GP, can I make NHS referrals?
• NHS Guidance for patients - If I pay for private treatment, how will my NHS care be affected?

👩‍⚕️ Life On The Ground

A series of articles and editorials about real world challenges and thinking - (we welcome submissions!). Read more here.

Advice and Guidance… please!?

“Greater use of private healthcare is increasing workload, GPs warn”
Pulse, 30.10.23

A thousand years ago, or maybe only ten, I sat in a room with about one hundred NHS GPs, partners, locums, salaried GPs and a scattering of practice managers. We were there to discuss GP referrals, testing requests and the implementation of a new advice and guidance service. We were told that, from one point of view, we were making too many referrals across the borough. This was certainly the view held by those paying for the room, the tea and the coffee. I do hope they didn’t pay too much for the coffee.

One GP stood up, in their turn, and made the speech I precis below. I think it important to note that this GP was one of the most caring and dedicated NHS GPs I have had the privilege of knowing and working with. They were also entirely capable of using words and ideas to deliberately impact and disrupt… So, with that proviso, read on!

Dr W began: “Let us all be clear here, and honest with ourselves – we, Primary Care GPs, are the front end of a financially limited healthcare system that isn’t currently set up to focus on preventative care. For all our training, knowledge and honed instincts, our value to that system is in our ability to manage risk for as long as public perception of our clinical judgement holds. If we were to be blindfolded and then to see 1000 patients [I did imply that this GP was happy to make a dramatic point] and in each case, whatever the patient story and indications were, we said ‘Ok, go home, see how things are for three days, and then come back and see me if it gets worse’, we would be performing our system role ideally. Yes, even allowing for the outliers within that group of 1000 who become significantly ill or even worse. Our job has been to hold risk knowing that all will be well, and then when sometimes it isn’t, that is also ok. We are covered. We are indemnified. So we hold and the system lives on to care for those with the most acute needs.”

Dr W went on to conclude “This holding of risk, and this alone, is why GP partnerships are allowed to operate profit sharing whilst funded by public monies. It is not for our qualifications or expertise. It is because we hold risk, we guard the gates to secondary care. It is because we hold the line. When this changes, when GPs are no longer comfortable holding risk or when the public are no longer happy to ‘go home and wait for three days’ to see if they get better… Well, then the NHS partnership system will be done. And that is where meetings like today are taking us”.

Why so much focus on this ‘NHS GP problem’? Because it gives some context to headlines like that at the top of this article. As GPs, we are only one of the groups of independent sector groups mentioned in the article. The area I think that is interesting here is that of referral and test requests.

Should we as PGPs be prepared and able to make referrals to the NHS, to request NHS tests? Yes, of course we should. And of course we are able to. The NHS and the BMA agree too. There is wording, crucial wording, about the referring GP needing to know a patient’s medical history – more on that shortly (and links to the NHS and BMA advice at the bottom of the article).

One problem can be that some GPs (both private and NHS) are not aware of this guidance, or perhaps don’t believe it should be so, or if they think it’s a great idea, they genuinely don’t know how to do it or to advise patients about it.

Another thing to address is that some of you may not be hugely interested in this approach at all! After all, why direct a patient away from your own network of services? Am I proposing a foolish and damaging change in business model? No, I do not believe I am – In fact I maintain that if you wish to grow, if you wish to be a player in the next ten years of UK healthcare as part of the NHS and independent provider landscape, you will likely see many more patients who come for GP appointments, but whose main care remains within the NHS system. And this system actually does provide ways for you, as a Private GP, to have a responsible and positive voice on behalf of your patients within it. Those of us who engage with this reality will increasingly form genuine partnerships within our own discipline, General Practice, across the private and public sectors. and Understanding how to navigate this system on behalf of our patients will be a major part of driving growth and managing demand within the world of Independent General Practice.

What will be the enabler? What is the implication of the BMA and NHS guidance on this subject? An old favourite here on the Beat – access to or understanding of the NHS patient record. And I would say that NHS compatible systems and NHS mail addresses only add to that too. And if you are feeling like Michael in Godfather Part 3 after all that… “Just when I was out, they drag me back in…” – I am sorry – but I find this future exciting and firmly believe that it will be good for patients, good for our businesses, and good for us to be part of the wider private and public healthcare economy. No more blindfolds for us!