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Arrangements for NHS patients receiving healthcare services through private healthcare arrangements

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Annex C
Framework to Guide Decisions

NHS Boards should develop local processes, in the context of this guidance, to support clinicians and patients in reaching decisions about the appropriateness of combining NHS and private healthcare, including the provision of medicines, and the associated clinical management arrangements. In applying the local processes, NHS Boards will wish to take the following factors into consideration in order to establish the feasibility or level of risk in individual cases:

  • Have all avenues for NHS funding been exhausted as appropriate in the individual circumstances of the case?
  • Where it is a medicine being sought, does the patient understand that it has been determined that the medicine is not considered to offer sufficient benefit in relation to the cost in their particular case?
  • If a decision is made to allow combined NHS and private care, will the patient continue to receive the elements of NHS care to which they are entitled?
  • Would the arrangements breach any of the core principles of the NHS?
  • Can the private and NHS elements of care be fully delineated and delivered separately?
  • Are there any substantive risks to patient safety, clinical accountability, governance and probity 3?
  • Is there any doubt about which clinician is accountable for the private and NHS elements of care?
  • Is there any doubt about which elements of care are to be provided by the NHS or privately?
  • Is the NHS able to provide the facilities and staff necessary to manage the NHS elements of care in combination with the private elements of care?
  • Are the wider interests of NHS patients protected?
  • Is it possible to fully establish referral and transfer arrangements, including clear accountability, between the NHS and private provider?
  • Is there any doubt about the sustainability and continuity of care and would this expose the NHS to additional risk or exposure?
  • Do all parties understand that opting to pay for private treatment for a particular condition would not automatically bar individuals from access to NHS services for the condition in question or other, unrelated conditions?
  • Does the patient fully understand that the particular intervention, including the provision and administration of a medicine (or medicines), may have a number of associated clinical management requirements such as scans, blood tests, follow-up treatments or arrangements to deal with complications and that, due to clinical reasons, it may not be possible to disassociate these from provision of the medicine obtained privately?
  • Does the patient fully understand the basis on which the decision has been reached?

NHS Boards should maintain accurate records of all decisions regarding combining NHS and private healthcare and how these were reached. The above factors provide a helpful checklist against which to record decisions and NHS Boards should consider making use of these in this way.