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GPs go forth

Can we issue private prescriptions to NHS patients?

Three experts advise a GP who is wondering whether he can help patients save money by sometimes prescribing on a private basis

One partner wants our practice to issue private prescriptions to NHS patients in certain circumstances on the basis that, with the prescription charge now being so high, it is a cheaper option for the patient. Is this ethically and contractually sound? 

Prof Azeem Majeed

Professor Azeem Majeed: No, this is against NHS regulations

The NHS prescription charge in England is currently £8.40 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the GPC has recently sought legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge.

Furthermore, for private prescriptions, the pharmacist is free to add a dispensing fee to the cost of the drug and so the patient might end up paying the same or even more than the NHS prescription charge for their private prescription.

Finally, trying to explain NHS guidance on prescribing and its implications to the patient makes the issuing of a private prescription impractical in the time available.

Hence, I would advise GPs not to issue a private prescription to NHS patients in place of an NHS FP10 prescription in these circumstances. This advice should be communicated to the other prescribers in the practice so that they all follow the same policy.

Professor Azeem Majeed is professor of primary care at Imperial College London and a GP in south London 

Dr Natasha Usher

Dr Natasha Usher: Suggest they buy the medicine over the counter

Under the NHS contract, a GP is unable to supply a private prescription to an NHS patient, except under specific circumstances where the item is blacklisted, such as certain travel vaccines. It is also worth pointing out that most chemists will make an additional charge over cost price for private dispensing, so it might cost the patient more, even when it appears cheaper.

Many items will also be cheaper than a prescription charge to buy over the counter, and there is nothing to stop the practice suggesting this. In addition, the vast majority of patients will not pay a prescription fee, and this will not benefit them, so it might be worth speaking to the local pharmacy to find out what potential costs would be.

It is possible to offer private consultations to patients and supply a private prescription. However, the practice would then need to decide what the fee would be. The cost may deter patients from pursuing this simply to obtain cheaper prescriptions, although you could decide to offer a free private consultation.

There may then also be issues of documentation, particularly if these prescriptions are handwritten, which would also affect audit of prescribing patterns, which are based on use of FP10s. There may be an argument that says this would save the NHS money, but I would argue that you should consult defence unions and LMCs to obtain further advice.

Dr Natasha Usher is a GP in Montifieth, near Dundee, Scotland

dr edward farnan

Dr Edward Farnan: It could result in breach of contract

It is understandable that a GP will want to ensure patients being prescribed medications are not financially disadvantaged. However, when treating patients under the GP contract, the partner is obliged to act within the contract terms.

According to the GMS Contracts Regulations 2015, GPs are not allowed to issue a private prescription to NHS patients, except in cases where they are prescribing drugs that are not available on an NHS prescription (regulations 56 and 61).

If patients require treatment that is covered by a GMS or PMS contract, GPs are obliged to carry out the treatment on the NHS without charge. This includes prescriptions, with the contract allowing GPs to issue NHS patients with an NHS prescription (FP10 or electronic prescription).

Therefore, although the partner’s desire to offer patients a cheaper option is well intentioned, it is likely that doing so could result in the practice being in breach of its contract.

Dr Edward Farnan is a medicolegal adviser at the Medical Defence Union 

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Readers' comments (20)

  • Hello friends,
    Private prescriptions are a contentious area. Unless a complaint is made and heard the truth will not be known. Dr Paul Hartley is PROBABLY correct, but to be sure, the BMA advice would be correct. The anonymous letter from an APPRAISER is strange. He or she seems to have no idea of the regulations. Knowledge of the regulations is the basic requirement for the GP. General practice is not only CLINICAL but a BUSINESS as well. How did he or she become an appraiser?
    Retired 6years GP in the Welsh Valleys.Not anonymous.

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  • Azeem Majeed

    Indrajit Mukherjee | GP Partner24 Aug 2016 10:46pm

    I agree that is would be sensible for GPs to stick to the legal advice given to the BMA, as that is the most recent available. If DH want to allow GPs to issue private prescriptions in place of NHS prescriptions, they should amend the NHS regulations on this and send out a letter to GPs to say this is permissible and not a breach of NHS regulations.

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  • EMIS can beastly be configured to print the cost of the drug on the right hand side.Might provoke some interesting conversations with patients who are effectively being taxed twice for NHS services.Before I retired, I was happy to offer patients the choice of scripts.

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  • If patient is exempt from paying prescription charge because of age or certain medical conditions - then I issue FP10 on NHS
    However,if patient is paying £8.40 while medication is costing £0.90 pence, then it is reasonable to issue private prescription ( I do not charge a fee for it)

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  • Can a irish Gp, not on GMC specialist register or Performer list prescribe a private prescription to NHS/ private patient

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  • Appraisers rarely have a good grasp of regulations in my experience

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  • Patients can get pre-payment certificates. I don't think 100 quid for a potentially unlimited number of prescriptions is unreasonable. Nor do I think it unreasonable for patients who are able to be asked to pay a little more towards their care. Let's face it, if more realistic and sustainable funding isn't found for the NHS soon then they'll be paying a whole lot more for their medical care.

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  • The main point of this article is important and I think needs to be highlighted more obviously.

    Until recently we were told that we could issue a private script so long as we issued same medication on an FP10. GMC legal advice has confirmed this has changed in the last year or so. The advice now is that NHS GPs cannot issue a private prescription to an NHS patient of theirs.

    That is an important change in legislation that shouldnt be buried in political debate about NHS prescription costs. The latter is worth debating separately though.

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  • Azeem Majeed

    Julian Mead | GP Partner01 Sep 2016 3:20pm

    Thank you for your comments. I agree that this point needs reinforcing and that GPs need to be aware of the recent legal advice obtained by the BMA.

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  • There has been no change in legislation, just a different flawed opinion from the BMW. We should not be slaves to the apparent letter of the law that causes injustice and is anti free-market Conservatism

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