Shared Care – Seeking Clarification for Our Patients

Dear Tom Grinyer and Dr Valerie Vaughan-Dick,

I am writing to you, on behalf of GenderGP, a health and well-being clinic specialising in the care of transgender patients, to ask for clarity and guidance from the RCGP and BMA.

Specifically I would like to better understand the guidelines according to which GPs must operate in the following circumstances:

• NHS specialist waiting times exceed the 18 week referral limit
• The patient requires timely care
• The patient opts to supplement their NHS care with private provision
• The private service makes diagnosis and recommendations to the GP
• It was brought to our attention that a current nationally elected RCGP council member, BMA UK council member and practising GP, recently took to social media to highlight their frustrations at having to work with private healthcare providers as part of shared care agreements.

Their specific complaint was as follows: ‘A pet hate of mine are private ADHD clinics which then ask GPs to prescribe on NHS – and do all the follow up & monitoring’

Many patients worry that if they access private services while waiting for the specialised care on the NHS, they may be penalised. Sentiment such as that expressed in the public post detailed above, suggests that perhaps there is a disconnect between what is expected of GPs and what they feel obligated to do.

I wonder to what extent council members are aware of BMA, GMC, NHS England, and RCGP guidance relating to collaborating with private providers.

My understanding, in line with Guidance issued by the BMA Medical Ethics Department is as follows:

• Patients who are entitled to NHS-funded treatment may opt into or out of NHS care at any stage.
• Patients may pay for additional private health care while continuing to receive care from the NHS.
• Patients who have had a private consultation for investigations and diagnosis may transfer to the NHS for any subsequent treatment. They should be placed directly onto the NHS waiting list at the same position as if their original consultation had been within the NHS. All doctors have a duty to share information with others providing care and treatment for their patients. This includes NHS doctors providing information to private practitioners.
• The NHS Constitution states that patients in England have a right to start consultant-led treatment within a maximum of 18 weeks of being referred by their GP. Where patients have waited for more than 18 weeks, or are likely to have to wait for more than 18 weeks, the NHS has to arrange an alternative provision for treatment.

In its most recent analysis the BMA highlighted waiting time pressure points and the ‘huge pressures being placed on an overburdened healthcare system’. Whilst the recent management of COVID-19 cases has led to a large backlog of non-COVID-19 care, we note that waiting times for certain specialised consultations were already far in excess of the NHS’s own waiting time targets.

With patients having to wait several months or even years to access certain specialist consultations and treatments, they are often forced to seek help from private medical providers in the interim, we would like to understand the following:

1. Does the BMA and RCGP Feel that it’s appropriate for any council member to so publicly question established practices and guidance aimed at ensuring appropriate continuity of care for patients when working in partnership with private providers?
2. Is the BMA and RCGP taking steps to ensure that all practicing GP council members are aware of their obligation to ensure that they work in partnership with private providers and in the best interests of their patients?
3. What is the BMA and RCGP’s position on collaboration between NHS and private specialists? Can you comment on the specific benefits that shared care brings to both patient and GP, especially in the light of years-long NHS waiting lists for specialists and treatments?

As an organisation supporting the trans community we very much welcome any opportunity to engage with the BMA and RCGP. We are open to supporting both organisations with insights from our service users and learning gained from our experience of working successfully with many NHS primary care providers, if that is of interest.

We look forward to receiving an update on these points and to sharing this information with our service users.

Warm regards,

Aby Hawker

Chief Communications Officer

GenderGP