We are testing a new beta website for gov.scot go to new site

Arrangements for NHS patients receiving healthcare services through private healthcare arrangements


The Scottish Government
Chief Medical Officer and Public Health Directorate

T: 0131-244-2235 F: 0131-244-2989
E: veronica.moffat@scotland.gsi.gov.uk

Dear Colleague



This guidance replaces CMO(2007)3 1. It has been developed following a period of consultation with key stakeholders. Responses to the consultation reflected the importance of maintaining the integrity of the founding principles of the NHS and ensuring that patient safety, clinical accountability, governance and probity arrangements are robust.


The key purpose of this guidance is to provide a framework to support decisions concerning the possible combination of elements of NHS and private care for individual patients. Where such decisions relate to the provision of medicines, these can be extremely complex and therefore where possible, the parameters in which these can be taken are made explicit within the guidance. NHS Boards and clinicians should ensure that in all situations, where consideration is given to combining elements of NHS and private care, these are handled in a way which protects the interests of the patient and the NHS more widely. Further guidance in relation to improved access to new medicines will be issued separately.


The principles contained in this guidance apply to all aspects of care - i.e. it is not restricted to access to medicines.

However, where it applies to medicines, this guidance focuses on situations regarding:

  • medicines not recommended by the Scottish Medicines Consortium or NHS Quality Improvement Scotland (for NICE Multiple Technology Appraisals); and
  • in relevant cases, where exceptional prescribing arrangements (including any appeals) have determined that the medicine in question would not be of demonstrable benefit in the particular circumstances of individual patients. However, it is recognised that in some cases, it may not be clinically appropriate for clinicians or patients to utilise the exceptional prescribing arrangements.

This means that normally all avenues for obtaining the medicine via the NHS will have been fully considered and exhausted. Wider developments intended to improve access to new medicines should mean that the number of patients receiving NHS and private care will be small in number and by exception.

This guidance does not require any clinician to provide private healthcare; nor does it require NHS Boards to make facilities available for the provision of private healthcare. However, where a clinician and NHS Board agree that it might be appropriate to provide NHS care in combination with private healthcare then existing legal powers and contractual requirements provide the basis for putting the necessary arrangements in place, subject to issues set out in this guidance being addressed.

How to use the Guidance

The guidance provides a framework to support local decisions concerning the possible combination of elements of NHS and private care for individual patients. Decisions regarding the provision of NHS services remain matters for NHS Boards; and clinicians remain responsible for clinical decisions regarding the care of individual patients.

The guidance comprises three Annexes:

  • Annex A sets out a series of key principles and requirements;
  • Annex B provides areas which should be considered in making decisions regarding combined NHS and private healthcare in the individual circumstances of particular patients; and
  • Annex C offers a framework to guide decisions.

Actions for NHS Boards

NHS Boards should seek to ensure that:

(a) where there is evidence that a patient will benefit from a particular intervention, including medicines, that full consideration is given to providing it through the NHS;

(b) any arrangements which they may wish to facilitate for patients to receive elements of NHS and private healthcare in combination are lawful, maintain the integrity of the founding principles of the NHS, can be fully separated for delivery purposes and do not compromise patient safety, clinical accountability, governance and probity;

(c) clinicians understand what arrangements may be possible on a case by case basis, and that where appropriate they are supported and provided with training to help manage such situations;

(d) patients understand that while some elements of combined NHS and private healthcare may be possible, it is also the case that there are circumstances which may prevent the NHS from offering particular types of care in combination with care from the private sector for clinical reasons;

(e) any arrangements are determined in accordance with the principles set out in this guidance;

(f) NHS patients continue to receive the NHS care to which they are entitled.

This guidance will be reviewed by the end of 2011, or earlier if required.

Yours sincerely

Harry Burns


From the Chief Medical Officer

Dr Harry Burns MPHFRCS(Glas) FRCP(Ed) FFPH


Enquiries to:

Veronica Moffat
St Andrew's House

Tel: 0131-244-2235
Fax: 0131-244-2989


25 March 2009


SGHD/ CMO(2009)3



For action

NHS Board Chief Executives
NHS Board Directors of Public Health
NHS Board Medical Directors
NHS Board Directors of Pharmacy

For information

Chief Executive, Care Commission
Chief Executives, Independent Sector
Chair, Scottish Medicines Consortium
NHS Board Chairs of Area Drugs and Therapeutics Committees
NHS Board Exceptional Prescribing Leads
Area Clinical Forum Chairs