What is the role of private GPs in private healthcare?
A GP’s job is to provide medical care for their registered patients. Whether the patient has PMI (private medical insurance) or not is irrelevant to the doctor’s duty of care but it does make a difference to some of the decisions that are made. It is helpful for patients to know the issues that face GPs when making those decisions.
Private patients are broadly split into 2 categories- those with PMI and those who self-pay. Those who have PMI will mostly be using corporate policies but many also buy PMI personally. There are so many policies available with different terms and conditions that generalising is difficult but, whether insured or self-pay, in nearly every circumstance your first port of call will be your NHS GP.
GPs are very much the gatekeepers of the private health care system without really realising it. They do a very important job for insurers in filtering unnecessary requests for specialist opinion in the same way they do for the NHS. Without them the system would clog up and insurers would struggle to balance their books.
Most PMI providers will require a referral from your GP before authorising a consultant appointment and indeed most private consultants insist on referrals on the grounds of safety- a referral will contain important information about your past medical history, your medications, allergies as well as the reasons for your referral. The consultant doesn’t then have to spend a large chunk of your appointment time asking these things and can spend more time focusing on the problem. There are exceptions to this such as cosmetic medicine and sexual health assessments where most specialists will accept self referrals without the need to go to your GP.
From a patient’s perspective, seeing a GP at the outset of an illness treated in the private sector can be very beneficial as they are often the only source of independent advice they may have access to. Nearly every PMI policy has an excess and most users will pay for the initial consultation themselves. It can be very difficult depending on your symptoms to know which type of specialist you should see and GPs are experts at making this decision. For example, if you were to self refer to a consultant you may waste time and money seeing a general surgeon when your problem turns out to be related to a different specialty.
From the GP’s perspective, the major benefit of referring to a private specialist is the speed at which the appointment takes place. Where non-urgent NHS referrals take months, many private referrals are seen within a week. This is simply down to the capacity of the doctors with more available appointments than there are patients (although this may vary depending on the specialist and the location).
If you are not insured but choosing to pay for private care from income or savings, it is worth asking your GP whether simple investigations such as blood tests or X-rays can be done through the NHS prior to private referral. This will not only save you money but can speed up your diagnosis if your specialist already has results available at your first appointment, rather than having to arrange tests and review you a second time. Even if you are insured, it is reasonable to ask the same.
The most obvious question a GP is asked is “who do you recommend?” This is not always easy to answer. Your GP may be happy to recommend someone they know but how are you to know this is on merit and not on the basis of their pre-existing friendship? GPs are not allowed to receive any financial incentives for referring you to the private sector and any hint that is occurring should prompt an official complaint.
If you’re GP is unable to recommend anyone specific where do you got to find out more? The answer is almost nowhere. The recent investigation by the OFT and ongoing inquiry by the Competition Commission have both commented on the lack of information available to allow patients to choose a doctor. For most patients the ability to see a doctor of their own choosing is crucial to their decision to pay for private care. Others are less concerned about the actual doctor and more concerned about choosing a particular hospital. There are a few directory sites on which some doctors advertise but the quality of information is poor. Some consultants have personal websites which are more informative but they are effectively advertising brochures which give no independent assessment. A few review sites have been attempted but they do not generally have enough users to be reliable and it is impossible to know how genuine the reviews are.
GPs are sometimes reluctant to recommend particular doctors to their patients. If a GP recommends someone who the patient goes on to see but is unhappy with the outcome then they also tend to be unhappy with the GP for recommending them in the first place. This can have an adverse effect on the future relationship between the patient and the GP. Many therefore refer on an open basis to a particular hospital who then decide which doctor will see the patient, usually on the basis of who has the first available appointment. This may be acceptable to you but many feel that there should be more information to allow them to make an informed choice. Unfortunately this information is limited.
Some insurance policies stipulate that you will have no choice of specialist and that your only option will be to see a doctor of their choosing. This is usually because they have doctors tied to exclusive contracts who are guaranteed more business if they offer reduced rates to the insurer. This is a good situation for the insurer and the doctor but not necessarily for the patient. There is the possibility of bias towards the interests of insurers under these arrangements and there is concern that some insurers may use this as a means to influence treatment. This is one of the points currently under scrutiny by the competition commission.
In summary, don’t forget your GP as a useful source of advice when using private health care and remember that the terms and conditions of your policy may not allow you to see a specialist of your own choosing. If this is important to you, discuss the terms of your policy with your broker. If there are any questions you have about any part of the process please ask in the comments below. We are also keen to hear your experiences of private health care both good and bad.