Autonomy: patient choice, shared decision-making, consent, confidentiality
Beneficence: patient finance, health benefits, access
Non-maleficence: side effects, harm, delayed care
Equity: equitable, NHS fraud,
https://primarycare.northeastlondon.icb.nhs.uk/home/meds/prescribing-information/ - 2024
Shared care is normally between a GP and an NHS specialist. They agree on a plan to manage a condition, with clear roles for each doctor. This might involve the GP handling prescriptions and basic tests, while the specialist takes care of more complex aspects.
Shared care with private doctors is generally discouraged by the NHS. They prefer a clear separation between private and NHS care. However, there can be exceptions if the private doctor is working for the NHS on a specific case.
In all cases, shared care requires agreement from everyone involved, including the GP. Even with an agreement, the GP can refuse due to workload or other medical reasons. If this happens, the private doctor would remain responsible for your care.
https://www.lmc.org.uk/resources/shared-care-pathways/
https://assets.publishing.service.gov.uk/media/5a74ccb340f0b61df4778971/patients-add-priv-care.pdf
Page 6 in the ''Guidance on NHS patients who wish to pay for additional private care'', outlines the principles. There should be as clear a separation as possible between private and NHS care.
Guidance on NHS patients who wish to pay for additional private care states that:
2.3 As overriding rules, it is essential that:
the NHS should never subsidise private care with public money, which would breach core NHS principles; and
patients should never be charged for their NHS care, or be allowed to pay towards an NHS service (except where specific legislation is in place to allow this) as this would contravene the founding principles and legislation of the NHS.
2.4 To avoid these risks, there should be as clear a separation as possible between private and NHS care.
https://cfa.nhs.uk/fraud-prevention/what-is-nhs-fraud
''On a basic level, fraud is deception carried out for personal gain, usually for money. Fraud can also involve the abuse of a position of trust. By 'NHS fraud' we mean any fraud where the NHS is the victim''.
If you are requesting the NHS GP to take action, then you are either delegating or making a referral to the NHS GP. This activity comes under the GMC guidance. The ethical guidance on Delegation and referral states that:
Delegation involves asking a colleague to provide care or treatment on your behalf (paragraph 3)
Referral is when you arrange for another practitioner to provide a service that falls outside your professional competence (paragraph 6)
When you delegate care you are still responsible for the overall management of the patient ( paragraph 5)
Where this is not the case, you must be satisfied that systems are in place to assure the safety and quality of care provided – for example, the services have been commissioned through an NHS commissioning process or the practitioner is on a register accredited by the Professional Standards Authority (paragraph 8)
Gmc-uk.org. (2023). Delegation and referral. [online] Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/delegation-and-referral/delegation-and-referral#referral [Accessed 12 Oct. 2023].
Decline
GP does the complete assessment and shared decision-making (eg depression and sertraline)
Refer to NHS specialist.
Prescribe (ensure clear separation, governance, registration with GMC, CQC etc, meets NHS standards).
ADHD Medication: A private psychiatrist diagnosed a child with ADHD but wants the GP to handle the ongoing prescriptions.
Osteoarthritis Pain: A private specialist suggests codeine for osteoarthritis, but wants the GP to handle repeats.
Antibiotics: A private doctor diagnosed an infection but wants your GP to prescribe the antibiotics.
Affordability: A child needs acne medication (Roaccutane) from a private dermatologist, but it's expensive privately. They prefer the GP to prescribe it (through the NHS).