Document Sample
					                         Private Patient Policy

                         Documentation Control

   Reference                        GG/FIN/008
   Date approved                    2 July 2009
   Approving Body                   Trust Board
   Implementation Date              2 July 2009
   Version                          1
                                    GG/FIN/004 - Private Patient
   Supersedes                       and Overseas Visitors Policy
                                    NUH version 1 - now withdrawn
                                    Private Patient Advisory Group,
                                    Directors’ Group, Operation
   Consultation Undertaken
                                    Group, LNC, Staff Side,
                                    Directors’ Group
                                    All staff involved in the delivery
   Target Audience                  of care and services to private
                                    patients in NUH.
                                    Management of Private Patients
   Supporting Procedures
   Review Date                      July 2012
   Lead Executive                   Mark Mansfield
   Author / Lead Manager            Helen Wilkinson
                                    Helen Wilkinson, Private Patient
   Further Guidance / Information   Business Manager - Ext 63379 /

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   Paragraph                                Title                     Page
   1.                    Policy Statement                        3

   2.                    Equality and Diversity                  3

   3.                    Introduction                            3

   4.                    General Principles                      4

   5.                    Finance                                 5

   6.                    Function of Private Patient Office      5

   7.                    Responsibilities of Clinical            6

   8.                    Responsibilities of Practitioners       7
                         undertaking private work on NUH

   9.                    Private Outpatient Appointments         8

   10.                   Private Inpatients / Day Cases          10

   11.                   Professional Liability Cover            11

   12.                   Private ‘Top ups’ to NHS Care           11

   13.                   Transferring from Private to NHS Care   14

   14.                   Monitoring Arrangements                 15

   Appendix 1            Employee record of Having Read the      16

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1. Policy Statement

1.1          NUH welcomes private patients and uses the additional income
             generated for the benefit of all patients within the Trust. NUH
             will have in place streamlined and simple systems for managing
             private patient work so as to encourage the development of
             private patient activity within NUH so long as there is no
             adverse impact on our core NHS business.

1.2          All NUH staff carrying out private work in the Trust must adhere
             to this Policy and the associated procedures.

1.3          For the purposes of this Policy, private patients are defined as
             those patients receiving private clinical care and who give an
             undertaking to pay charges to the Trust for accommodation and
             services. The policy also covers patients undergoing clinical
             assessment for medico-legal purposes.

1.4          NUH currently has no dedicated facilities for private patients.
             Should this change, this Policy and the associated procedures
             will be amended as appropriate.

1.5          Standards of clinical care, courtesy and confidentiality should
             be the same for all NUH patients, whether they are NHS or
             private. Private Patients will have comments, feedback and
             complaints dealt with via the same Trust mechanisms as NHS

2. Equality and Diversity

     Employees will not discriminate in the application of this procedure
     in respect of age, disability, race, nationality, ethnic or national
     origin, gender, religion, beliefs, sexual orientation, domestic
     circumstances,    social      and    employment     status,   gender
     reassignment, political affiliation or trade union membership. The
     Trust will assess the potential effects of a policy on particular
     populations in a rigorous way by undertaking an equality impact

3. Introduction

     This Policy has been written with reference to:
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          3.1.1          NHS Act 1977 (as amended by the Health Service
                         Act, 1980)

          3.1.2          A Code of Conduct for Private Practice – Guidance
                         for NHS Medical Staff (Department of Health, 2003)

          3.1.3          BMA Code of Practice for Private Patients (2006)

          3.1.4          NHS Finance Manual (2006)

          3.1.5          NUH Secondary Employment Policy (2007)

          3.1.6          Terms and Conditions - Consultants (England) (2003)

          3.1.7          NUH Consultant Job Planning Policy (2009)

4. General Principles

4.1       The basis for private patient services in NUH is the generation of
          additional income which can be re-invested at directorate level
          to improve NHS services.         Private work should therefore
          generate a level of income that exceeds total costs. If at any
          time private patient activities are found to be running at a loss,
          then the Trust may act ultra vires and cease this activity as not to
          do so would mean that commercial activities are being
          subsidised by NHS funds and potentially diverting resources
          away from the care of our NHS patients.

4.1       Similarly, if we are unable to negotiate prices with an insurance
          company that cover our costs and provide a reasonable
          element of profit the Trust will cease to carry out private work for
          that insurer.

4.2       The Trust is legally debarred from undertaking private services in
          a manner which compromises our ability to deliver services to
          NHS patients. The provision of services for private patients must
          not therefore prejudice the interests of NHS patients of the Trust
          or disrupt Trust NHS services.

4.3       All directorates must adhere to the broad principles and
          procedures described in this policy. However, managers will also
          need to establish local arrangements to ensure that the policy
          works well in practice at directorate level.
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5. Finance

5.1       NUH charges for private patients will be reviewed annually and a
          new tariff will come into effect on 1st April each year. The Private
          Patient Business Manager will conduct negotiations annually with
          private health insurers in order to agree the annual tariff. The
          tariff will be simple, competitive in relation to other providers and
          will include an element of profit for the Trust.

5.2       The basis of the NUH Private Patient Tariff will be the BUPA
          Schedule of Procedures which identifies procedures by OPCS
          code and then groups these by level of complexity. NUH
          procedure prices will be based on these levels of complexity i.e.
          a single base price across the Trust for all procedures regardless
          of the specialty, with additional charges for implants and certain
          consumables and a price differentiation between inpatients and
          day cases.

5.3       Directorates should not set their own prices for individual
          procedures as insurance companies may refuse to pay as these
          will not have been agreed in the annual round of negotiations.

5.4       The Private Patient Office will dispatch an invoice within 7 days
          of the patient’s discharge, as long as all information relating to
          the patient’s stay is available.

5.5       Self funding patients will be required to pay in full in advance for
          their treatment. There will be no facility for payment by
          instalments. This applies both to private patients and to NHS
          patients wishing to ‘top up’ their care / treatment. The Trust is
          able to accommodate various payment methods including cash,
          cheques, bankers’ drafts, BACS, credit / debit cards and on-line
          via the Trust website.

6. Function of the Private Patient Office

6.1       The Private Patient Office has bases on both campuses and
          provides support and advice to Directorates, maintains a
          database of private patient activity and income, generates
          invoices, takes and chases payments and liaises with insurance
          companies and patients as required.

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6.2        The Private Patient Office can advise directorates and patients
          about appropriate payment methods for self paying patients.

6.3       The Private Patient Business Manager will work with directorates
          to identify opportunities to increase private patient income.

7. Responsibilities of Clinical Directorates

7.1       Private patients bring additional income to directorates. Simple
          but robust systems must be in place at directorate level to
          enable consultants to see and treat private patients in a timely
          manner, in an appropriate environment and with appropriate

7.2       Directorate systems should facilitate the capture of all private
          patient activity and the provision of prompt and accurate
          information about the services and care provided to individual
          private patients in order that invoices can be raised and
          dispatched in a timely manner by the Private Patient Office. This
          will include length of stay, diagnostic tests, prostheses used,
          OPCS code(s) etc.

7.3       Directorate management teams should have a clear view of how
          they see private patient activity contributing to directorate income
          and this view should be communicated to the directorate.

7.4       Each directorate must have a nominated Private Patient Lead
          who co-ordinates the administration of all private patient activity
          in the directorate. The Lead will be the primary point of contact
          for consultants wishing to undertake private work and the link
          between the directorate and the Private Patient Office and other
          departments as required e.g. Theatres.

7.5       Directorate managers should ensure staff understand that private
          patients are not seen instead of NHS patients and that the
          income generated benefits not only individual consultants but
          also the directorate and Trust as a whole.

7.6       Directorate managers should, with guidance and support from
          their Directorate HR Manager, ensure that non medical staff
          involved in the delivery of private patient activity outside their
          normal working hours are paid appropriately – usually overtime
          recorded on the monthly summary sheets. Directorates must
          ensure staff are aware that they should not accept payment from
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          consultants for supporting private activity carried out during their
          contracted hours.

7.7       Directorates should not make any additional payment to
          consultants or any other staff for private work undertaken in
          contracted hours as this would constitute ‘double payment’.
          Where a consultant sees private patients during programmed
          activities the consultant must remit the fee to NUH or timeshift

8. Responsibilities of Practitioners Undertaking Private Work on
   NUH Premises

8.1       Detailed guidance for consultants on the management of private
          patients in NHS hospitals is laid out in ‘A Code of Conduct for
          Private Practice - Guidance for NHS Medical Staff’.
          Responsibilities are also outlined in consultants’ Terms and
          Conditions of Employment. Consultants who choose to practice
          privately within Trust facilities must comply with the Code  of
          Conduct, with their Terms and Conditions and with this Policy
          and associated procedures.

8.2       The key principles that all practitioners must adhere to are:

               • There must be no real or perceived conflict of interest
                 between private work and NUH NHS work. Practitioners
                 must declare in writing to the Trust Secretary any business
                 or professional interest or other non Trust work which may
                 directly or indirectly give rise to or may reasonably be
                 perceived to give rise to any conflict of interest.

               • With the exception of the need to provide emergency care,
                 NHS commitments in the Trust always take precedence
                 over private work where there is a conflict or potential
                 conflict of interests

               • Practitioners may only see patients privately within NUH
                 facilities with the explicit agreement of the Trust. For
                 medical staff, agreement of job plans that include an
                 element of private patient work can be taken as the
                 express agreement of the Trust.

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               • Practitioners should not use NUH NHS staff or facilities
                 without the express permission of the Trust. Entitlement to
                 use Trust staff and facilities is at the Trust’s discretion and
                 this entitlement can be withdrawn if a practitioner
                 consistently fails to follow procedures.

               • Under no circumstances should any practitioner make
                 payments directly to NUH staff for work carried out on NUH
                 premises as this potentially contravenes the Trust
                 Secondary Employment Policy. Where an NUH employee
                 provides support to private patient activity that brings
                 additional income to a directorate, the directorate will make
                 appropriate arrangements to remunerate that employee
                 (via overtime).

               • Where an NUH employee provides support to private
                 patient activity that occurs outside the Trust and brings no
                 financial benefit to the Trust but does so on NUH premises
                 (e.g. an NUH medical secretary who provides
                 administrative support to a consultant’s private practice for
                 another organisation), this arrangement must be approved
                 by the directorate and the consultant should be charged for
                 that employee’s time and use of Trust resources and
                 facilities. If it becomes clear at any point that NHS services
                 are being compromised as a result of the arrangement, the
                 Trust may withdraw its permission.

               • The practitioner responsible for arranging to see or admit a
                 private patient on NUH premises must inform the Private
                 Patients’ Office and / or their Directorate Patient Lead of
                 the patient’s status. While this task may be delegated to
                 someone else – typically a medical secretary – the
                 practitioner remains ultimately responsible.

9. Private Outpatient Appointments

9.1       Practitioners’ Roles and Responsibilities

          9.1.1 Practitioners must inform their Directorate Private Patient
                Lead of any arrangement they make to see private patients
                on NUH premises, including confirmation of whether this is
                likely to be for consultation only or for chargeable

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                    procedures / investigations. The process for doing this will
                    be subject to local arrangements.

          9.1.2 Under no circumstances will a practitioner cancel a Trust
                NHS patient’s outpatient appointment to make way for a
                private patient.

          9.1.3 Consultants seeing and / or treating private outpatients in
                NUH will be charged for the use of Trust facilities,
                equipment and staff. The charge will include a contribution
                to Trust overheads. This arrangement will ensure that NUH
                meets its statutory duty to recover all costs relating to the
                provision of private work.

          9.1.4 NUH will invoice patients separately for procedures and /
                or diagnostic tests undertaken on an outpatient basis e.g.
                Minor Procedures, Endoscopy, Pathology, Radiology,
                Audiology etc.

          9.1.5 Consultants are encouraged to use outpatient facilities for
                outpatient consultation and medico-legal work. If a
                consultant decides to use their office for private outpatient
                consultations they must inform the Directorate Private
                patient lead and will be charged for the use of Trust
                facilities, equipment and staff.

9.2       Directorate Responsibilities

          9.2.1 Directorate management teams must ensure that robust
                and locally appropriate systems are in place to facilitate
                private patient outpatient activity as long as this does not
                interfere with NHS outpatient activity and in particular
                achievement of waiting times targets.

          9.2.2 The Private Patient Lead will agree mutually acceptable
                arrangements with each practitioner wanting to see private
                outpatients in directorate accommodation. This will include
                clarification of when and where patients will be seen and
                what nursing, administrative, secretarial and other support
                is required.

          9.2.3 A private patient should never be given a slot in a clinic
                reserved for an NHS patient unless that slot would
                otherwise be left unfilled; if a consultant only sees small
                numbers of private patients directorates should usually
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                    agree to additional slots at the beginning ( e.g. over
                    lunchtime ) or end of the consultant’s normal clinic. Such
                    activity will not count towards the consultant’s PA.

          9.2.4 Private Patient Leads will ensure that self funding patients
                pay for any outpatient procedure in advance or on arrival.

10.       Private Inpatients / Day Cases

10.1 Consultant Responsibilities

          10.1.1         It is the medical practitioner’s responsibility to ensure
                         that the directorate Private Patient Lead has all the
                         essential details relating to a private patient prior to
                         admission. This will include an authorisation code from
                         the insurance company if appropriate. Some insurers
                         will not routinely fund admissions to NUH; consultants
                         must always advise patients to contact their insurer for
                         an authorisation code. Forms submitted to the Private
                         Patient Office without an authorisation code when one
                         is required will be returned.

          10.1.2         Consultants will typically book theatre slots for private
                         patients via the directorate Private Patient Lead or the
                         person to whom this task has been delegated e.g. a
                         waiting list co-ordinator.

          10.1.3         Private patients should not be listed on a consultant’s
                         NHS theatre list without the express agreement of the
                         Private Patient Lead.

          10.1.4         Consultants may negotiate to ‘timeshift’ an NHS theatre
                         session used wholly or in part for private work or agree
                         to remit their fee to NUH.

          10.1.5         Consultants may wish to include their professional fees
                         in self pay prices. These should be charged in line with
                         the BUPA Schedule of procedures. Consultants will be
                         reimbursed within 28 days, by cheque. Consultants who
                         choose to admit self payers before payment has been
                         received by the trust will not be paid until the Trust has
                         received payment from the patient.

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10.2 Directorate Responsibilities

          10.2.1         Directorate management teams must ensure that robust
                         and locally appropriate systems are in place to facilitate
                         private patient day case / inpatient activity as long as
                         this does not interfere with NHS day case / inpatient
                         activity, in particular achievement of waiting times

          10.2.2         If the patient is self funding, directorates must ensure
                         that payment in full for treatment is made before
                         admission. Self payers should be given written
                         information as to the likely cost of the planned treatment
                         / procedure. A payment will be taken based upon the
                         estimated charge and        if the actual charge is greater,
                         the balance will be paid on discharge.

11.       Professional Liability Cover

11.1 Consultants or clinicians who are personally taking a fee for
     service are required to have up to date indemnity insurance from
     a recognised defence organisation and should be able to
     provide evidence of this on request.

11.2 Consultants and clinicians will be deemed personally responsible
     for the care they give to patients when they are paid a fee, even
     if they opt to place that fee in an NUH account.

11.3 Consultants and clinicians providing top up NHS treatments
     funded by patients but with the agreement of the Trust will be
     covered by NHS Indemnity. A full guide to NHS Indemnity is
     provided at Appendix 3.

11.4 Where junior medical staff, nurses or members of professions
     allied to medicine are involved in the care of a private patient in
     NUH, they will normally be doing so as part of their NHS
     contract and will therefore be covered by NHS Indemnity.

12.       Private Top Ups to NHS Care

       12.1.1 From March 2009 patients wishing to ‘top up’ or
              supplement their NHS care have been able to do so
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                    without losing their entitlement to ongoing NHS care. This
                    will mainly have an impact on a small number of patients
                    with cancer who are now able to enhance their NHS care
                    by paying for drugs which are not currently funded by the
                    NHS. This section of the Private Patient Policy describes
                    the approach which will be taken to Top Ups within the
                    Trust in response to guidance from the SHA and
                    Department of Health. A detailed local procedure
                    describing how (and where) co-payment treatment will be
                    delivered and charges raised and collected is currently
                    being produced. There are some clear key principles:

               • Individuals who choose to access private healthcare now
                 retain the right to access NHS healthcare which is normally
                 funded by the patient’s PCT on the same basis as any
                 other individual; NHS care should not therefore be
                 withdrawn simply because a patient chooses to buy
                 additional private care.

               • The NHS must not subsidise private care. Therefore where
                 a patient wishes to ‘top up’ their treatment with medicines
                 not normally funded by the patient’s PCT, the patient must
                 pay in full for their purchase, preparation, administration
                 and all other associated costs of the private treatment,
                 including additional treatment needed for the management
                 of side-effects.

               • Clinicians and directorate managers should exhaust all
                 reasonable avenues for securing NHS funding before
                 suggesting that a patient’s only option is to pay for
                 treatment privately.

               • NUH clinicians should make all care options available to
                 patients, including those not offered by themselves or by
                 NUH, in line with GMC guidance.. Clinicians should not
                 make assumptions about the information a patient may
                 want or need. This includes deciding whether to tell a
                 patient about all available treatment options based on an
                 assumption of their financial circumstances. Consultants
                 should also continue to comply with the Code of Conduct
                 for Private Practice which states that: - ‘…consultants
                 should not initiate discussions about providing private
                 services for NHS patients, nor should they ask other NHS
                 staff to initiate such discussions on their behalf.’ However,
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                    there is a difference between providing information to
                    patients on all of the treatment options available to them,
                    including a top up drug, and advertising private practice to
                    NHS patients.

               •     If a patient seeks information about a top up drug,
                    consultants should provide full and accurate information
                    about the drug including the costs and the potential
                    benefits, risks, burdens and side effects.

               • A brief record should be kept of all discussions with
                 patients about care not routinely funded on the NHS in the
                 patient’s NHS medical notes.

               • There should be as clear a separation as possible between
                 private and NHS care. The top up element of the patient’s
                 care should be carried out at a different time and place.
                 Facilities ( such as side rooms or treatment rooms ) and
                 equipment can be temporarily designated for private care.
                 Departing form these principles of separation should only
                 be considered where there are overriding concerns of
                 patient safety. Such decisions should usually be agreed in
                 advance with the Medical Director. Where a decision has
                 to be made without gaining prior approval from the Medical
                 Director on the grounds of clinical urgency, the Medical
                 Director should be informed as soon as possible
                 afterwards. A record should be kept of all decisions to
                 depart from these principles.

               • Where NUH decides to provide additional private care as
                 one of the services we offer as an organisation, staff
                 including consultants will be covered by NUH indemnity as
                 they will be providing private care in the course of their
                 NHS employment. In this scenario the expectation is that
                 the patient will be treated in the consultant’s NHS time and
                 no fee will be levied.

12.2 Patients wishing to pay for additional private care must be
     informed in advance of the likely costs of the treatment, An
     Undertaking to Pay form should be completed and signed and
     payment in full taken before the treatment is given, month by
     month if required. Top up medicines will be given on a strictly
     ‘pay as you go’ basis; payment by instalment will not be
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12.3 Some patients will only have the resources to fund the top up
     drug for a limited period. It is vital that patients have complete
     understanding of:

                • The costs of the treatment (including additional charges
                  that may be made in the event of the patient needing
                  treatment for side effects)

                • The Trust Terms and Conditions (i.e. payment in full up

                • The NUH position in the event of the patient being unable
                  to continue funding their treatment i.e. NUH can only
                  continue to provide and administer the drug as long as
                  they can pay for it, regardless of how beneficial the drug
                  turns out to be

12.4 In all cases an exit strategy must be agreed by all parties.

13.       Transferring from Private to NHS Care

13.1 Patients who choose to be treated privately are entitled to NHS
     services on exactly the same basis of clinical need as any other
     patient. Where a patient wishes to change from private to NHS
     status, the following principles apply:

               • A patient cannot be both a private and an NHS patient for
                 the treatment of any one condition during a single visit to
                 the Trust.

               • Any patient seen privately is entitled to subsequently
                 change his or her status and seek treatment as an NHS
                 patient. However, the patient is still liable for the cost of
                 treatment already received privately.

               • When a patient is seen privately and they make a request
                 for their care to be transferred to the NHS, a new referral to
                 the NHS must be arranged by the patient’s general
                 practitioner. This allows the patient to choose their NHS
                 provider and allows the Trust to recover the full cost of their

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               • A consultant may not refer a private patient directly to the
                 NHS for investigation, treatment or follow up unless the
                 patient is need of immediate care (initiation of
                 investigations or treatment within 24 hours).

14.        Monitoring

14.1 Private Patient activity will be monitored to ensure that all the
     income due to the Trust is recovered and to identify trends and
     potential opportunities. Reports will be produced regularly to
     allow the Private Patient Manager to monitor income and debt

14.2 The Income section of the Finance Department will provide the
     Private Patient team with the following information on a monthly

               • List of all private patient invoices raised

               • Analysis by consultant, insurance company and OPCS

               • Notification of what invoices have been paid

               • Aged debtor’s analysis including status of debts being
                 managed by Debt Collection Agency.

14.3 Theatres will send a monthly list to the Private Patients’ Office of
     all private patients seen in Theatres (extracted from ORMIS)
     and this will be cross referenced with invoices sent out to
     ensure that no activity is being missed.

14.4 All practitioners carrying out private work in the Trust will be
     required to complete a quarterly private patient return declaration
     which will enable the Private Patient Office to check that all
     private patient activity has been invoiced.

Helen Wilkinson
Nigel Beasley
Simon Linthwaite
May 2009

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Appendix One


                  Title of Policy/Procedure: Private Patient Policy

I have read and understand the principles contained in the named

PRINT FULL NAME                   SIGNATURE                 DATE

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