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Mr James W Fairley BSc MBBS FRCS MS ( London )   Consultant ENT Surgeon

Mrs Sylvia A Fairley RGN RCNT Dip Nurs ( London )   Practice Manager

Primary Care Trusts tighten access rules for NHS Choose & Book patients

New Restrictions on Consultant Specialists in UK Private Hospitals, financial penalties threatened

Low Priority Procedures not funded, patients to wait longer for treatment

© 2011 JW Fairley Last updated 7 January 2011

Choose and Book, a flagship policy of the previous UK government, has allowed many patients to see Consultant Specialists in UK Private Hospitals, and have surgical operations, without paying private fees. All that was needed was for the General Practitioner (GP) to agree to a referral, and the patient was given an access code that allowed them to book an appointment online, with the hospital of their choice. Well informed patients quickly realised that, if they chose a private hospital, they would be virtually guaranteed to see a Consultant, as opposed to NHS hospitals where a variety of other grades of doctor see referrals. And if a surgical operation were required, this would also take place in the Private Hospital. In 2011, with austerity measures implemented, new rules have been introduced which place considerable restrictions on access to specialist services by NHS patients under the Choose and Book scheme.

Low Priority Procedures (LPP)

Introduced in 2010, Low Priority Procedures include common operations such as tonsils and grommets. These are not routinely funded, and are not to be undertaken in Private or NHS Hospitals, unless the relevant threshold criteria are met. There is an appeal mechanism, to the Individual Funding Request Panel.

Financial Risk to Private Hospitals and Consultants: NHS won't pay if LPP criteria not met

Any NHS procedure carried out in a Private Hospital that does not meet LPP Guidelines will not be funded. This means a significant financial risk, that neither the Hospital, nor the Consultant, would be paid for work done.

Appointments to be confirmed?

Consultants now to scrutinize letters and reject if not in compliance with Primary Care Trust (PCT) Rules

Private Hospitals are now asking Consultants to undertake a scrupulous review of NHS referral letters. If the referral may result in a Low Priority Procedure (and often it is not possible to know this until the patient has been seen and diagnosed), and if compliance to any relevant LPP thresholds are not clearly defined, the referral is to be rejected and sent back to the GP. This was not the way Choose and Book was supposed to work. It should now be made clear that any appointment offered on Choose and Book is provisional, and depends on whether the criteria are met.

Deliberate delays to be introduced in treatment pathways

Average Referral to Treatment Time to increase from eleven to sixteen weeks

NHS Referrals into one East Kent Private Hospital increased by 300% in 2010. Private hospitals do tend to run efficiently, resulting in short waiting times. The time from Referral to Treatment (RTT) averaged eleven weeks. But the Hospital have been asked, by the PCT, from January 2011, to slow this down to an average of sixteen weeks. Even though surgical teams may be available, they are no longer allowed to see and treat patients as quickly as possible. There are exceptions (for suspected cancer) but the general rule is sixteen weeks.

Standard Acute Contract from April 2011 introduces penalties for non-compliance with PCT requirements

Private Hospital Consultants may retreat to core business of treating Private Patients

In view of the burdensome nature of complying with arbitrary and changing restrictions, and with financial penalties threatened for non-compliance, it will be not be surprising if more Private Consultants pull out of Choose and Book work altogether. This is especially likely in specialities such as ENT where so-called Low Priority Procedures make up a significant proportion of the work.

We do not offer Choose and Book in Private Hospitals

We have never signed up to Choose and Book work in Private Hospitals, and are unlikely to do so in future. At present, we only offer Private Appointments in Private Hospitals.

How much will it cost for private treatment?

Of course, NHS treatment is quite expensive. But as an individual patient, you don't normally see the bill. The overall cost of private treatment is not vastly more than NHS, and may be less than you think. Investing in a private consultation might even save you money. Experienced doctors working in well-equipped clinics tend to reach a diagnosis and treatment plan much more efficiently, so you know where you stand and can get on with your life.