There is some confusion as to whether private healthcare insurance holders require an NHS referral to a consultant and then a private hospital. When you consider that the average private healthcare insurance costs upwards of £1000 per annum, it is important to know exactly where you stand.
While many people see the NHS and private hospital sector in competition, in many ways, they should be seen as complementary and capable of working together for the good of patients.
We will now take a look at the NHS referral system, which will open the door to private healthcare via a private consultation & at the routes that you can take to private medical treatment and what role the NHS plays.
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The vast majority of private healthcare insurance companies will offer an optional “self-referral” if, for some reason, you are unable or unwilling to see your GP. The BMA advice is that where possible, all referrals to private healthcare should come from your GP.
It is also worth remembering that because GP services are provided by the NHS, they are free at the point of delivery. As a consequence, using the services of your GP to examine and talk to you about any relevant medical conditions, before referral, will help to keep your insurance premiums down.
There is a general misconception that the NHS and the private healthcare sector don’t mix. In reality, this is not the case with many NHS patients referred to private healthcare facilities as NHS patient.
The NHS patient choice scheme allows you, where possible, to choose various facilities which may be NHS based, or those in the private sector working with the NHS, that is perhaps more convenient/applicable to your situation. If there is a clinical reason as to why you should not have this level of choice, it is up to your GP to discuss this with you.
Yes. As soon as you have been referred by your GP, you should contact your private health insurance provider and check that the consultation and any potential treatment are covered under your policy.
You will find that various medical conditions/ailments are excluded, which may mean the consultation charge will not be covered. It is very dangerous to assume that you are covered for “all medical conditions” when quite frankly this is not the case.
After being referred by your GP, you will receive an appointment date fairly quickly – normally within the following two weeks. This is one of the main benefits of the private healthcare system, the ability to circumnavigate the growing waiting lists of the NHS.
If we compare the two-week timescale for a private consultation against an 18-week target in the NHS, this perfectly illustrates yet another benefit of private healthcare insurance cover.
Whether or not you have private health insurance, there are no restrictions and limitations to your access to NHS facilities. In many cases, it can prove very useful to take up a private consultancy, via your private health insurance policy, to obtain an early assessment of your condition.
If treatment is required, then your consultant can refer you back to the NHS at which point you would be put on the waiting list. If the waiting list for your particular treatment was lengthy, then it may be worthwhile organising treatment via the private sector using your private healthcare insurance.
In theory, as a private healthcare customer, you are eligible to request a specific time and date for your consultations. In reality, it may come down to the availability of a consultant who perhaps specialises in your particular ailment/injury.
The close relationship between the NHS and the private sector is illustrated by the fact that many NHS consultants will split their time with the private sector. So, in theory, you can pick the date and time and even the location, but you may have to adjust your plans to accommodate a consultant.
If your consultant believes that treatment is required then they have the option to refer you back to the NHS or undertaking treatment in the private sector under your private healthcare insurance.
If you are referred to the private sector, then you have the opportunity to pick the date, time and hospital of your choice with some constraints. These constraints involve issues such as the need for specialist hospitals and specialist surgeons.
You will find that when using private healthcare facilities, you will have a private room, much more extensive menu compared to the NHS, access to doctors on a more regular basis and less restricted visiting times.
It is also fair to say that private healthcare facilities often have the latest medical equipment, and sometimes they will be able to fund treatment/drugs which may not be available on the NHS.
It is possible that certain elements of your treatment could be undertaken under the NHS umbrella while others are under the private sector umbrella. So, yes, it is possible to mix and match various services in the NHS and private sector to tackle your medical ailments/injuries.
You will often find that some NHS facilities also offer services to the private sector. In this situation, there needs to be a clear separation between NHS treatment and private sector treatment (even though it may be on the same NHS premises).
In the vast majority of cases, it will be your GP who refers you to a private consultant/specialist for further advice. You could be referred back to the NHS for treatment or proceed with treatment via a private healthcare facility covered by your private healthcare insurance.
Many people are looking towards private healthcare insurance as a means of circumnavigating what can be extensive waiting times for consultations/treatment on the NHS.
Here at Money Savings Advice, we have partnered with some of the UK’s leading Private Medical Insurance companies. They have already helped thousands of people get the best PMI cover, and, they can do the same for you.
Choosing an independent adviser means they won’t recommend a policy unless they are sure it is in your best interests. Their advice is also regulated by the FCA, which gives you an additional layer of protection.
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