A thread on what people with ME/CFS need in the way of service

[Utsikt]

From the BMA:

Private practice and GP contracts

Private practice is significantly restricted for GMS and PMS contractors. Find out more about those restrictions as well as information about private referrals and private prescribing.

www.bma.org.uk

Private GP referrals to the NHS​

Section 8.2 of the Department of Health’s 'Guidance on NHS patients who wish to pay for additional private care' (2009) is still extant and was not altered by the Health and Social Care Act 2012.

The Department of Health clarified that "patients who have chosen to pay privately for an element of their care are entitled to receive NHS diagnostic tests free of charge as long as they are eligible. A referral by a private GP for an NHS diagnostic test should not be any different from an NHS GP referral".

Private GPs are free to refer their patients to the NHS in the same way as NHS GPs can refer their patients to the private sector.

The 1986 handbook 'Management of private practice in health service hospitals in England and Wales', which sets out the key principles that govern private practice in the NHS, clearly states:

"All fully registered general medical practitioners may refer patients to NHS hospitals irrespective of whether they are treating them under the NHS or privately."

This principle is also underpinned in paragraph four of the handbook: that patients wishing to be treated privately are entitled to the same NHS services as any other patient with the same clinical need. However, it should always remain clear whether the patient is receiving private or NHS care.

 

[Felis Catus]

Interesting that the cited headline says private providers. I wonder if some private GPs are in fact also NHS budget holders. If they are part of a large subcontracting provider they might well be.

My GP will see me either as an NHS or a private patient. She has an NHS budget code for me, which presumably she can use in either situation.

Sorry, I deleted that post because @Nightsong was quicker in providing a link.

For the sake of transparency, there was this bit from BMA, "General practice responsibility in responding to private healthcare":

Private providers making onward referrals to NHS provider​

Private providers can make referrals to NHS services, without referral back to the GP, provided the patient would be eligible for NHS referral. Any patients referred should be treated based on clinical need. Read NHS England guidance around consultant-to-consultant referrals within the NHS.

 

[Jonathan Edwards]

For the sake of transparency, there was this bit from BMA, "General practice responsibility in responding to private healthcare":

I still wonder whether this has the implication it seems to have. It indicates what is allowed in professional terms but the caveats about 'eligible' and 'need' may mean that in practice an authorisation code is needed from a budget holder.

In theory I could refer myself to lots of NHS units as a physician charging myself for the privilege but in practice I always get asked for a letter from my GP.

The referral may be made but the service provision may depend on the budget holder deeming it to fall under 'clinical need'. I imagine that GPs both in NHS and private practice are wise to the implications.

 

[EndME]

I am minded that time is ticking by. Do forum members think that it would be appropriate to send the draft as it is (in first post) to the ForwardME working group interacting with DHSC?

Is such a list not completely unrealistic even if it is not unreasonable? What exactly is the goal?

Is it sensible to ask for less than currently demanded in the hope of it being seen as more realistic or is it wiser to demand more in the hope that at least something comes across?

 

[V.R.T.]

s such a list not completely unrealistic even if it is not unreasonable? What exactly is the goal?

Appeasement has got us precisely nowhere. Why should we not advocate for the kind of services we actually need?

 

[Jonathan Edwards]

Is such a list not completely unrealistic even if it is not unreasonable? What exactly is the goal?

Is it sensible to ask for less than currently demanded in the hope of it being seen as more realistic or is it wiser to demand more in the hope that at least something comes across?

It is almost certainly unrealistic, although even that i am not entirely sure of. Things may suddenly start changing. I am assuming that it is unrealistic to think that policy will shift directly to what is suggested but the current DHSC proposal is actually extremely vague - so vague that in fact it could probably allow the suggested format to be set up by a commissioning group. I think there is at least a chance that the DHSC will shift to a position where it is more explicitly allowed.

If not, the goal is to try to get everyone involved to have some appreciation of the absurdity of the current DHSC wording of a rehab-ish service for mild/moderate and forget the others. And moreover, to appreciate the absurdity of the rehab model. I think that provides a chance for getting a better result from any local negotiations that follow. In one sense the whole thing is a juggernaut. But, as Suffolkres has established, it is also a fabric of individuals, some of whom can make sensible decisions.

There is a lever, in that if, as the DHSC say, they will look again at severe services, they may realise that you cannot really do that without a different format.

At the moment we have very few physician-run services, but there are just a few. There might be more soon. Getting physicians with a hospital base rather than community trusts may be the biggest sticking point but I don't think that should be allowed to slide without making it clear that it is not the best answer.

This suggested proposal is not a demand, or even an ask, so much as a suggestion of what seems to make sense. This is only a 'consultation' process. I see no point in watering anything down. That is what has happened up until now and it has been a disaster.