The National Health Service (NHS) provides most healthcare to the majority of people free of charge, but there are some exceptions. GPs are self-employed and are contracted to provide NHS General Medical Services for their patients. Because they are self-employed, they have to cover their costs - staff/buildings/heating/lighting etc, in the same way as any small business. If GPs are asked to provide additional services which fall outside their contract, in these circumstances, they are entitled to make a reasonable charge for providing them.
Non-NHS Services
Some services provided are not covered under our contract with the NHS and therefore attract charges. Examples include the following:
- Medicals for pre-employment, sports and driving requirements (HGV, PSV etc.)
- Insurance claim forms
- Prescriptions for taking medication abroad
- Private sick notes
- Vaccination certificates
Click here for our list of fees
The fees charged are based on the British Medical Association (BMA) suggested scales and our reception staff will be happy to advise you about them along with appointment availability.
Surgery Abroad
An increasing number of patients are opting to have surgery done privately or overseas. Please read the following advice if are considering doing this.
Surgery abroad without NHS referral
NHS Scotland does not recommend choosing to pay to travel abroad for surgery as part of a packaged holiday. This is sometimes called surgical or cosmetic tourism.
Surgical options in Scotland can appear more expensive. But you should think about the potential savings against the potential risks of travelling for surgery.
Decisions about surgery
The most important decision to make about any operation is whether it is the right one for you.
You should always talk to the surgeon who would carry out your operation about the best way to get the results you want.
To help you make an informed choice, you should ask:
- what are the benefits?
- what are the risks?
- what are the alternatives?
- what if I do nothing?
Read more about asking the right questions
Many clinics abroad do not offer a consultation with your surgeon until the day of surgery. This does not allow enough time for you to make decisions. You should have time to think about what was said, and to decide what's right for you.
A common alternative offered by these clinics is an appointment with an advisor. The advisor may or may not be medically qualified. This is unsafe, as the only person who can advise you properly is the surgeon who will operate.
You may also be offered video consultations. Video consultations do not allow for a proper physical examination, which is key to deciding the best operation for you. In the UK, the medical regulators (General Medical Council) require a face-to-face consultation before planning cosmetic surgery.
Packages of care
You should fully understand what's included in any private treatment package, either at home or abroad.
The operation is only one part of treatment. You'll need routine care before and after the actual operation. NHS Scotland is under no obligation to provide this.
Complications of having surgery abroad
Most surgical procedures go well but there can always be complications. You should understand what's included in your treatment package in the event of complications.
One cause of problems after surgery abroad is the holiday that comes with the surgical package. A key part of recovery after surgery is rest. Taking part in activities such as swimming and sunbathing can have a negative effect on healing.
You should not fly soon after surgery as the risks of clots in the legs is much greater. It's possible for clots in the legs to spread to the lungs, which can be life threatening.
NHS Scotland recommend you do not fly for:
- 5 to 7 days after procedures such as breast surgery and liposuction
- 7 to 10 days after facial cosmetic procedures or tummy tucks (or any abdominal surgery)
NHS Scotland will always provide emergency care where needed. But there's no obligation for NHS Scotland to provide further routine treatment. It's important that you know where to go for the routine care needed before and after your operation, and in the event of any complications.
Why does UK treatment cost more?
The benefit of using UK services if you're choosing to pay for treatment is that hospitals and clinics are all regulated. This means that they may appear to be more expensive than abroad. But you do not have the reassurance that services outside the UK are regularly inspected. Meeting regulatory requirements comes at a cost, and contributes to the relatively higher price of UK treatment.
Also, most UK centres provide all required aftercare as a part of the package, including follow up visits with your surgeon. In the event of complications, your surgeon is available to deal with any issues if they happen.
You should ask what is included in any package abroad compared with one available locally. All extra care before and after surgery should be provided. Any tests or appointments not included within the original package of care you pay for may prove more expensive to buy later as extras.
Recommendation
Choosing to pay to travel abroad for surgery is not recommended by NHS Scotland, or by the surgical specialist associations in the UK.
If you still wish to do this, be aware that NHS Scotland is under no obligation to provide pre and post-operative care other than emergency care.
From the Scottish Government:
Private bariatric Surgery
An increasing number of patients are opting to have complex bariatric surgery done privately or overseas. We have been advised by the Scottish Government that “while NHS Scotland will always provide emergency care where necessary, ALL PRE AND POST OPERATIVE CARE SHOULD BE PART OF THE PACKAGE OF CARE PURCHASED BY THE PATIENT.”
Patients should be followed up every two to three months for the first two years by a bariatric multidisciplinary team. They undertake specialist blood tests, nutritional monitoring and support. This is essential post-op care and should be part of the surgical care package. In the case of overseas surgery, this specialist follow-up should be arranged privately with an appropriate bariatric multidisciplinary team in the UK. Once stabilised, usually at 2 years after surgery, yearly monitoring can be undertaken by general practice.
Croyard Medical Practice is unable to offer post-op monitoring in the initial 2-year period.
Further information can be found on the following links:
British Obesity and Metabolic Surgery Society
https://bomss.org/wp-content/uploads/2023/01/BOMSS-Statement-on-Bariatric-Tourism-Jan-2023-v2.pdf
https://www.nhsinform.scot/tests-and-treatments/surgical-procedures/surgery-abroad-without-nhs-referral
Information for patients attending private hospitals and clinics
Due to long waiting times for investigations, specialist appointments and operations within the NHS, some people are deciding to attend private hospitals and clinics, locally and abroad.
If you are thinking about using a private health provider, either by self-funding or private health insurance, we strongly advise you to consult one of our doctors beforehand to discuss things such as your expectation of treatment and follow up. Your GP will not usually be in a position to recommend a specific specialist and you are advised to do some research when deciding whether a healthcare provider is safe and suitable.
Please be aware that Croyard Medical Practice is contracted to provide health services, in line with our General Medical Services contract, on behalf of NHS Highland and is not under any obligation to follow any requests from private health providers.
What happens when you are referred by your GP to see a Consultant/Specialist/Clinician Privately?
This leaflet describes what you can expect to happen if you ask your GP to refer you to see a Specialist privately. This might be a Consultant Doctor, Surgeon, Private GP, specialist nurse, or allied health professional. This leaflet uses the terms clinician and specialist interchangeably to denote a person or team you are seeing privately.
What happens next?
You should contact the Clinician’s team directly to organise an appointment. Contact them directly if you have any future appointment issues. If you have private health insurance, your insurer may have a list of approved specialists. You should check with your insurer before you proceed.
The specialist may request information from your GP; please contact your GP practice to ask them to provide a referral letter. This will include relevant medical details about you. If an insurance company or specialist wishes a specific form to be completed, then your GP will charge you for providing this additional work.
What happens if you need a test or procedure?
If the Specialist thinks that you need any tests (including blood tests), or a surgical procedure, they are responsible for:
• arranging the test and any medications (such as sedation) that might be needed for this. They should also explain how and when you will receive a date of any procedure and what to do if the date is not suitable for you.
• giving you the results and explaining what they mean (this may be done in a separate appointment with them or by letter). You should not contact your GP surgery to discuss the results of tests organised by others, it is the specialist’s responsibility to discuss this with you.
This is also true of NHS care; secondary care clinicians should organise tests and have results returned directly to themselves rather than pass tasks to the GP practice to carry out.
The cost of these tests should be paid for within the private sector, which may increase the costs you incur. You may also need to travel to where you saw the specialist.
GP practices should not be asked to perform blood tests or other private investigations using NHS resources. A private GP or specialist can refer to NHS secondary care services but should not expect your GP practice to do this for them. If a private specialist informs you to arrange or to expect to hear from your NHS GP to arrange such tests, then this is incorrect. You should, at the time, remind the specialist that all tests need to be carried out privately. Avoiding inappropriate requests for your NHS GP to carry out tests will:
• Avoid delay in having your tests
• Ensure that the right person (your specialist) gets the results directly
• Avoid delays in your Specialist reviewing your results and planning any required follow up
What if my NHS Clinician has referred me for a scan and I want to get it done privately?
Please discuss this directly with the NHS clinician who recommended the test. They are responsible for interpreting and explaining the results to you; do not ask your GP to refer you for the scan. You may need to see a specialist privately to have them request a scan.
What happens if you need new medicines?
The Consultant might suggest prescribing new medicines for you or might want to make changes to the medicines that you are already taking.
The Consultant is responsible for giving you the first prescription for any new medicine that you need to start taking straightaway.
If the consultant recommends a new medication be started, they should write to the GP outlining the reasons for treatment. In some circumstances, the GP may be able to continue prescribing the medication. It usually takes two weeks for these letters to be received and actioned by practices.
Private Clinicians may suggest medications to patients which would not normally be prescribed by NHS GPs. This particularly relates to medications which are not included in NHS Highland’s Formulary, medications that require regular monitoring (for example disease modifying anti-rheumatoid drugs, some psychiatric medications, medications for ADHD), medications for
sedation before procedures, medications used outside of their license and medications restricted for specialist or hospital use only. If either the specialist, or your GP, informs you that this is the case for your medication then you will need to continue to receive it from the private service. Please contact the private service directly to organise this.
What happens if I need to transfer my care back to the NHS?
If after seeing the specialist privately you want to be back under NHS care, regulations allow for you to transfer back. You should be transferred back into the NHS system where you would have been at the point you left the private sector (eg. you do not go back to the start of the queue).
This transfer must be done by the private clinician who is overseeing your care, and you should not be passed back to the GP for this to be done. There are a few reasons why;
• it delays your ongoing care
• your Consultant knows the full details of your condition and where best to refer you to
• it wastes precious NHS appointments with your GP and adds unnecessary administration to the process
The consultant should arrange for you to be seen in the appropriate NHS clinic by writing a referral letter to this clinic. This might include passing on results of tests and data that has been used to reach a diagnosis; NHS teams may not always agree with diagnoses or treatment plans made elsewhere. If I pay for private treatment, how will my NHS care be affected? - NHS (www.nhs.uk)
What if I need a Fit Note (previously known as Sick Note)?
If you need to be certified as unfit for work following treatment by a clinician:
Fit notes can and should be issued by doctors and nurses working in the private sector-
• the specialist is responsible for issuing you with a Fit Note.
• the Fit Note should cover the period they expect you to be unfit to work, or until your next contact with the Specialist. You should not need to see or contact your GP to get a Fit Note following hospital treatment unless your inability to work is unexpectedly prolonged. Getting a fit note | NHS inform
What if I need a follow-up appointment?
The private provider will discuss with you whether you should have ongoing follow-up care or whether you should be discharged back to your GP.
If the Specialist thinks you do need to be seen again, they will give you another appointment or tell you when to expect this. If you do not hear anything, please contact the Specialist’s office, rather than your GP surgery.
What do I do if I have any questions?
If you have any specific questions related to your care, you should contact the Specialist’s team directly. It is important that you make sure you know how you can contact your private provider.
This leaflet has been developed using information from the British Medical Association and NHS Information sources.