This site is intended for health professionals only

Greater use of private healthcare is increasing workload, GPs warn

Greater use of private healthcare is increasing workload, GPs warn

More than four in ten GPs say their workload has increased as a result of people using more private healthcare.

In all, 46% of GPs responding to a Pulse survey said they were doing more work as a result of patients opting for private healthcare.

Some reported being expected to provide follow-up care after patients had paid for fertility treatment or surgery abroad.

Others said poor shared care arrangements were generating more workload as GPs are expected to take on prescribing and monitoring, with ADHD being a particular issue.

Dr David Coleman, a GP in Doncaster, said private ADHD queries alone seemed to be generating a ‘couple of hours extra work every week for the practice at the moment’.

Interpreting tests done privately, expediting referral letters and organising bloods and scans when private providers had not done them were also listed by those answering the survey as ways their workload was creeping up.

Patients could also get disgruntled if the GP refused to do unnecessary tests or prescribe unlicensed medications, one respondent said.

In total, one in ten said their workload had significantly increased and 311 of the 860 respondents said it was causing a slight increase in work.

During the LMCs annual conference in May, local GP leaders called for practices to be remunerated appropriately for requests from private healthcare or insurance providers relating to their patients.

A Pulse investigation last year found private health services were thriving as a result of long NHS waiting lists with demand for self-pay healthcare rocketing.

Dr Nigel Fraser, a GP in Herefordshire, said he had seen a rise in workload related to private healthcare use but some specialities were more of an issue than others.

In his experience, private ADHD and gender dysphoria clinics were causing a ‘great deal’ of added workload because of poor shared care arrangements.

‘The issues about poor shared care are not limited to ADHD and gender dysphoria but private providers in this area are repeat offenders,’ he said.

He added that issues GPs faced included that diagnosis may not have been done in line with NICE or best practice guidelines and that organisations were often unregulated.

In addition, there were issues with companies wanting to share care corporately and not via a named specialist and not seeking local approval of shared care guidance.

‘Whilst falling short in above they often paint the responsible GP as the villain with the patient,’ he said.

Dr Emma Nash, a GP in Portchester, Hampshire has also seen a massive increase in workload related to private healthcare. ‘Private providers often ask to arrange investigations or prescribe because patients are self-funding. Requesting tests is more than just ticking boxes – we become legally responsible for reviewing, interpreting and acting on results which is time-consuming. Although we are not obliged to do these tests or prescriptions, it can be very difficult when a patient has been told what to expect.’

She agreed that ADHD was a particular issue where GPs end up in a very tough situation as the correct thing is to not prescribe without shared care in place.

‘Private bariatric surgery is a nightmare too. NHS includes a couple of years follow up and monitoring and advice but privately we’re on our own as often patients don’t realise the package may not include the monitoring and don’t want to, or can’t afford to, pay more.’

Dr Zishan Syed, a GP in Kent, said: ‘NHS general practice is being abused and subsidising lucrative private practice that is charging patients extortionate fees whilst expecting GPs to soak up the complicated administrative work pro bono. This is ridiculous and makes a farce of the NHS and the tax payer.  

‘It is risible when an NHS consultant works in the private sector and expects NHS GPs to do the administrative work of rereferring back to their own NHS clinic with the pathetic excuse that they don’t have the means or IT to do so in 2023.’

He added: ‘NHS England guidance about the private and NHS interface is laughable permitting patients to hop in and out of private and NHS care so much so that any limited protections it claims the NHS has all but evaporates.  If the government plans to use more private sector work to deal with Covid backlog, NHS GPs will be swamped with administrative work from that sector.’

Dr David Wrigley, deputy chair of BMA’s England GP committee, said the NHS backlog is being driven by a ‘a combination of chronic underfunding and a lack of focus on retention’ adding that ‘understandably’ patients on ‘very long waiting lists’, who are ‘often in pain and distress’, are ‘considering if they can be seen sooner by paying for treatment’.

‘We would urge patients considering this to check that the doctor is qualified, will provide follow-up care and ideally a member of a professional association, which makes sure they have the relevant qualifications, experience and insurance,’ he said.

‘As the doctors tasked with managing the care of patients’ conditions in communities, we know long waiting lists means that patients rely even more on their GP as their needs can become more acute and complex the longer they wait.’

Adding that the BMA has ‘developed guidance for GPs to help reduce any extra workload that may be generated by requests from private providers’, he said it is ‘on our leaders to listen to doctors’ and ‘do all they can to tackle the waiting lists without burning out the NHS’ greatest resource, its staff’.

RCGP chair Professor Kamila Hawthorne said that ‘no patient should need to pay for care and services that they are entitled to free of charge on the NHS’ and that ‘we must guard against creating a two-tier system that favours those who can afford to pay and disadvantages those who can’t’.

‘This survey shows the consequences if things go wrong and how this can add to the pressures on hardworking GPs and hospital staff, rather than alleviating them.

‘Many private clinics pass back results to the NHS, often via general practice, to be assessed and followed up. Some private companies routinely advise clients to routinely speak with their NHS GP about their results or treatment, even when this has gone well, further adding to workload and leaving other patients facing even longer waiting times for a GP appointment.’

And she warned this comes as ‘GPs are buckling under the strain of more than a decade of under-investment and poor workforce planning’.

Recently, Pulse revealed that LMCs have told GP practices they can decline patient requests for routine aftercare in the first two years after private bariatric surgery undertaken abroad.

Pulse’s survey was open between 9 and 15 June 2023, collating responses using the SurveyMonkey tool. A total of 860 GPs from across the UK responded to the specific question. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.


Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.


Please note, only GPs are permitted to add comments to articles

Dave Haddock 30 October, 2023 4:14 pm

The scandal is that patients are obliged to pay for NHS care that is not accessible in any reasonable timescale, and then to pay again for Private treatment.

Truth Finder 30 October, 2023 5:21 pm

Clearly there is a demand that the NHS is not meeting. The NHS like any other system is not perfect and there are some patients coming 1-2 times a week. Private care is a double edged sword. It can in some cases help us in some increase workload. At least we won’t get a complaint for delayed diagnosis or not being able to se a doctor.

John Graham Munro 30 October, 2023 6:51 pm

How can ‘follow up’ be described as ‘work’ by G.Ps?———after all the initial diagnosis and treatment has already been done for them.

GEORGE QUITTNER 30 October, 2023 7:28 pm

Hey dear colleagues ..YOU SHOULD CHARGE PRIVATELY to follow-up private services!
here in Australia we have public and private health care. The most successful model for patient satisfaction and professional reward is a private contract between doctor and patient…ESPECIALLY in general practice. After that it is the job of the government to support those who cannot afford a car, a house and private medical care. Perhaps that is where nurse practitioners have a role while waiting for more doctors to be produced.

Alastair Gibb 30 October, 2023 8:55 pm

JG Munro, if not ‘work’ how would you describe the ‘follow up’ expected of general practice (consultations, investigations and monitoring) generated through the private sector?

Simon Braybrook 30 October, 2023 9:33 pm

Fortunately our health board have advised us not to enter shared care agreements with private providers, so we don’t. If people go private, they go private all the way or we start the ball rolling again within the NHS.

David jenkins 30 October, 2023 11:17 pm

very sorry – you should tell the patient “this test is being requested by dr…………, whose gmc number is…………., according to this letter (give copy). suggest THEY phone dr responsible, or secretary. i promise you, there is NOTHING the private sector hate more than actual patients clogging up their system with disatisfied queries. as always, advise staff manning the phones that you can’t talk to the private hospital on the phone…………you are too busy with patients, and you will ring them later.

SUBHASH BHATT 31 October, 2023 5:34 am

If that additional work was not offered via private, you need to deal it fully.. Patient does not enjoy going private . They contribute on both side.. being rude to our gmc registered gp who also work in private sector is totally out of order.

John Graham Munro 31 October, 2023 9:06 am

Alastair Gibb———–meeting a patient at church on a Sunday and mentally noting that they are still alive would be described as ‘work’ by some G.Ps

Slobber Dog 31 October, 2023 10:27 am

Double standards?
Post- operative care and prescribing to patients who have private ortho/ gynae surgery is expected, but extend that to post op care of private bariatric surgery and there is a problem.

Dave Haddock 31 October, 2023 2:13 pm

Perhaps time to review whether of “free at the point of use” needs to go?

Truth Finder 31 October, 2023 3:47 pm

Free at the point of use really need a rethink in this day and age. The waiting lists and appointment demands would disappear overnight. They can suddenly think, self manage and buy OTC medication.

Helen Horton 1 November, 2023 4:46 pm

John Graham Munro, I find your comments about GPs deeply insulting and showing your complete lack of understanding of the profession.

James Weems 6 November, 2023 10:37 am

@slobber dog.
These things are also unacceptable. The whole system needs a re design.
Perhaps private GPs to follow up private secondary care work? And perhaps private GP could be their own GP but picking up the extra work the private sector generates at a cost? Seems fair to me.

Imogen Bloor 9 November, 2023 6:08 pm

I note Dave Haddock’s comment above but in practice some requests for private referral or investigations are for things we wouldn’t refer for on the NHS or not at the same threshold, ditto investigations… ie: which are not necessarily aligned with local and national pathways. This is tricky to navigate with patients .
A bit of a tangent but I am very concerned that some of ( maybe all) the providers of Patient Access , actively & advertise/ promote/signpost ( call it what you will) patients to private services, some of which patients would be eligible for on the NHS … I think this is misleading & scaremongering…