Dr Ellie Mein
If patients have questions about alternatives to NHS treatment, would you be able to provide the right answers for them – and for yourself?
Setting the scene
Imagine the following scenario: you're an orthopaedic surgeon and you've just reviewed an elderly man in your NHS clinic, advising that the patient needs surgery. The patient is keen to proceed but when he learns of the waiting times he asks you if there's any benefit to paying for private care.
You explain that the waiting list for private surgery is indeed shorter and give the patient a card with your private secretary's number. You don't document this discussion with the patient in the notes.
A few days later you get a message via your secretary from the patient's daughter, saying that she's reporting you to the medical director and to the GMC for trying to coerce her father into paying for private treatment.
You're understandably upset by this development, as you felt you had simply responded to the patient's query and had acted in keeping with the GMC's guidance.
Gauging the guidance
Situations like this can arise more easily than you might expect, as there's a certain amount of tension between the main guidance available on the subject.
In the GMC's 'Consent; patients and doctors making decisions together' (2008), the most relevant paragraphs are:
9. You must give patients the information they want or need about:
i. any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.
12. You must answer patients' questions honestly and, as far as practical, answer as fully as they wish.
However, Schedule 9 of the Terms and Conditions - Consultants (England) (2003) and the Department of Health's 'A Code of Conduct of Private Practice' (2004) both outline the following points:
- if an NHS patient asks about private care the consultant can only provide standard advice that has been agreed with their NHS employer
- consultants should not initiate discussions about private care nor should they ask other staff to do this on their behalf
- if an NHS patient asks about waiting times for the NHS and the private sector then the consultant should ensure that only accurate and up-to-date information is given.
As demonstrated in the example scenario above, navigating the interface between NHS and private health services can be challenging for doctors, especially given the possible repercussions should any misunderstandings arise.
There is potential for patients, relatives or even a patient's GP to complain if they feel that a doctor has inappropriately tried to recruit NHS patients to their private lists. Such complaints might be resolved locally if there is just a simple misunderstanding, but could lead to NHS disciplinary proceedings and GMC investigation if there are concerns about a doctor's probity.