All of us as GPs will likely carry out at least some paid-for services, but expansion of or an outright switch to private delivery is, obviously, a wide-reaching decision.
It’s one thing to provide HGV medicals and firearms reports that don’t conflict with NHS services and another to step into a for-profit frame of mind.
Whether you are debating joining an existing private practice or forming one yourself these six preliminary considerations may be helpful thought prompts.
1. Moral arguments
Few GPs considering branching out into offering private services will do so without some consideration of the moral arguments.
The debate is one that only individuals can come to a conclusion on but it’s worth remembering with this emotive issue that you’re likely to face strong views in opposition to your own. You may need to be patient with others and develop a thick skin.
As well as the wider conflict over whether or not private services are detrimental to the NHS, there are personal considerations around adjustments to dealing with profit being a factor in care.
If you are seeking to work for a private practice, rather than establish one, close scrutiny of procedures and practises, such as prescribing processes, will allow you to evaluate if your personal beliefs align.
2. Robust division between private and NHS work
Should you be considering running a private practice or perform private work alongside an NHS practice you’ll need to ensure you have robust procedures to keep the two distinct.
The 2019/20 NHS contract prevents signed up GP practices from hosting or advertising paid-for services that fall within the scope of NHS funded primary medical services.
3. Financial arrangements
In private practice you’re likely to need to deal with the priorities and expectations of investors or shareholders either in a direct or indirect way.
For those setting up private practice themselves, specialist accountancy and business advice may need to be tabled, not least in relation to dealing with private medical insurance companies.
Marketing also requires investment and expertise.
4. Revalidation and appraisal arrangements
In private practice you’ll have the same revalidation and appraisal obligations in order to retain and protect your registration.
Processes to allow effective completion are vital.
5. Patient expectations
Patients’ expectations among the privately funded bring different demands to those experienced in the NHS.
Some paying patients might well demand tests or treatments that may be clinically ambiguous.
6. Indemnity cover
A move into private practice brings the need for further consideration of indemnity cover for yourself and staff if you’re employing them.
While the 2019 introduction of the Clinical Negligence Scheme for GPs (CNSGP) did not negate the need for indemnity cover even in traditional, majority NHS practices, in private practice cover must be robust.
The state-backed scheme offers automatic cover for liabilities relating to acts or omissions relating to the diagnosis, care or treatment of a patient in relation to NHS services only. It’s worth remembering that even private actions that are permissible in NHS practice are not covered by this scheme, which can cause confusion where there are grey areas, in relation to travel vaccinations, for example.
Terms of engagement should be among other legal considerations.