Lothian NHS Board 2-4 Waterloo Place EH1 3EG … · regardless of nationality, according to the...

Headquarters Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG Chair Brian Houston Chief Executive Tim Davison Lothian NHS Board is the common name of Lothian Health Board

Lothian NHS Board Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG Telephone 0131 536 9000 Fax 0131 536 9088 www.nhslothian.scot.nhs.uk

Date 07/08/13 Our Ref 3952 Enquiries to Richard Mutch Extension 35687 Direct Line 0131 465 5687 Email [email protected]

Dear FREEDOM OF INFORMATION – PRIVATE BEDS I write in response to your request for information in relation to private beds available within NHS Lothian. Question:- Is private care, or are private beds, available within any NHS facilities in the board

area? If so, please detail what is on offer at what facilities. I’d like to request a copy of any rules that govern the provision of private care/beds within NHS facilities.

Answer:-

I am advised by Mr Alisdair McDonald, Income Manager – NHS Lothian that the general premise is that the only thing available privately that is not available on the NHS at our sites is what is covered within the scope of the CMO letter on co-payments (http://www.sehd.scot.nhs.uk/cmo/CMO(2009)private.pdf), which with respect to NHS Lothian to date has only been chemotherapy drugs not approved for use on NHS patients by Scottish Medical Council (SMC).

I enclose with this response – The Management of Private, Overseas (Non-NHS) and Co-Payment patients in NHS Lothian

Please note that we do not have specifically designated private patient beds. There is a control document within the policy (appendix 8) to ensure that NHS capacity in the specialty is not compromised by treating Private Patients.

I hope the information provided helps with your request. If you are unhappy with our response to your request, you do have the right to request us to review it. Your request should be made within 40 working days of receipt of this letter, and we will reply within 20 working days of receipt. If our decision is unchanged following

http://www.sehd.scot.nhs.uk/cmo/CMO(2009)private.pdf

a review and you remain dissatisfied with this, you then have the right to make a formal complaint to the Scottish Information Commissioner. If you require a review of our decision to be carried out, please write to the FOI Reviewer at the address at the head of this letter. The review will be undertaken by a Reviewer who was not involved in the original decision-making process. FOI responses (subject to redaction of personal information) may appear on NHS Lothian’s Freedom of Information website at: http://www.nhslothian.scot.nhs.uk/YourRights/FOI/Pages/default.aspx Yours sincerely ALAN BOYTER Director of Human Resources and Organisational Development Cc: Chief Executive Enc.

PPO 07870 824536 or email: [email protected] 1

FINANCIAL OPERATING PROCEDURE

THE MANAGEMENT OF PRIVATE, OVERSEAS

(NON-NHS) AND CO-PAYMENT PATIENTS IN

NHS LOTHIAN


Contents

Executive Summary ........................................................................................................ 3

1. Introduction ................................................................................................................. 3

2. Principles of Conduct ................................................................................................. 4

3. Change of Status for Private Patients…………………………............................7

4. Consultant Use of Health Board Premises .............................................................. 7

5. STEP 1 – Is the patient a private patient? .............................................................. 8

6. STEP 2 – Is the patient entitled to free NHS care?................................................ 9

7. STEP 3 - Administration of Private Patients .......................................................... 9

8. Arrangements for patients who wish to make co-payments ..............................11

9. Appendices .................................................................................................................14

Appendix 1: Undertaking to Pay ................................................................................14

Appendix 2: Request for advice from doctors…………………….....…………..15

Appendix 3: Information for Practices…………………………………..………..16

Appendix 4: Process to identify possible overseas patients ....................................18

Appendix 5: Additional Information regarding Overseas Patients ......................19

Appendix 6: Process for elective private patients ....................................................21

Appendix 7: Referral Form .........................................................................................22

Appendix 8: Checklist for Consultant Staff…………………………….………...23

Appendix 9: Process for co-payment patients …………………………… ...……24

Appendix 10: UKBA Consent Form ………………….…………………………..25


EXECUTIVE SUMMARY

1. Principles of ConductThe provision of services to NHS patients shall not be compromised by the elective treatment of private or overseas patients. Funding for NHS services shall not be used to fund the care of those required to pay for treatment. The Board’s responsibilities to NHS patients shall take precedence over providing care to elective care for private or overseas visitors. The Board shall recover all costs borne in the provision of services to private and overseas patients.

2. Change of status for Private PatientsPrivate outpatients who are eligible for free NHS treatment are legally entitled to change their status at a subsequent visit and seek treatment the NHS. Private Inpatients have a similar entitlement to change status (e.g. when a significant and unforeseen change in circumstances arises), although in both cases the patient remains liable for charges for the period which he/she was a Private Patient. A change of status must be accompanied by an assessme of the patient’s clinical priority for treatment as an NHS patient.

3. Consultant use of Board PremisesWhere a Consultant uses Health Board premises for Private Patient consultations or clinics a charge will be levied to recover the full cost of providing these facilities, including any staffing support provided and any supplies or equipment used. The consultant must notify his Service Manager that he wishes to use Health Board premises for private work. Consultants should note that Private Patient work may not be covered by the Clinical Negligence Scheme for NHS Organisations. They will need to make their own arrangements for insurance.

4. Identifying and administration of private patientsWhen identified that a patient has elected to receive private healthcare the patient has to be admitted by a consultant and the Private & O t Team notified of the private patient. The patient needs to be identified on TRAK as a private patient.

5. Identifying Overseas Patients patient should initially be assessed at the point of admission or GP

registration when presenting for healthcare. Where registering patients at a GP practice please follow the guidance ‘Information for Practices, Patient Registration with a GP Practice’ (see Appendix 3). When admitting patients to hospital please refer to the two part questionnaire in the front of all case f s. This is referred to as the stage 1 questionnaire. If the questionnaire is not in the case file the questions still need to be asked.

6. Patients wishing to make co-paymentsWhere the decision is to access private services in co bination with the NHS, NHS Lothian wishes to ensure that:Individual clinicians remain responsible for clinical isions regarding care of individual patients. Clinicians must ensure that Service Managers provide written agreement with the decision to provide combined private and NHS care within NHS Lothian services. All avenues for obtaining care and/or medicines through the NHS are considered fully and exhausted by the clinician and the patient before the provision of combined NHS and private care is considered.

KEY MESSAGES

Every


1. Introduction

“Private Patient”

“Overseas Patient”

“NHS Patient”

“Co-Payment”

All staff

2. Principles of Conduct

2.1.General Principles

1.1. This procedure describes the issues to be managed and controls to be observed in relation to the management of Private and Overseas Patients.

1.2 This procedure is consistent with relevant legislation (Regulation 2(1) of theNational Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended), Government and professional guidance and NHS Lothianpolicy, including the Standing Financial Instructions (SFIs).

1.3 In this procedure, the following terminology shall be used:

is a patient who elects to receive private healthcare. Private patients can be further categorised as ‘private insured’, ‘self funding’ or ‘co-payments’ (see section 8).

is a patient who is not assessed as resident in the UK, regardless of nationality, according to the criteria set out in the stage one checklist. Overseas patients can be further categorised as ‘liable’ ‘non liable’. Liable patients are sub categorised as ‘insured’, self fundin co payments’.

is a patient who is assessed to be resident in the UK, regardless of nationality, that is not a Private or Overseas Patient

is a patient who wishes to receive NHS and private healthcare in combination (see section 8).

1.4 The procedure is designed to implement the requirements of the Standing Financial Instructions (SFIs) for this subject. must comply with the requirements of this procedure. Failure to comply with this procedure may be a disciplinary matter, which could result in dismissal.

Should you have any queries on the application of this procedure, please contact the Private & Overseas Patients Officer (PPO) on 07870 824536, or via email at [email protected]

The following principles relating to Private and Overseas patient activity are based on those endorsed by both the medical profession and the Scottish Government Health Department in relation to the management of Private and Overseas Patients.

The provision of services to NHS patients shall not be compromised by the elective treatment of private or overseas patients.

Funding for NHS services shall not be used to fund the care of those required to pay for treatment.

.


The Board’s responsibilities to NHS patients shall take precedence over providing care to elective care for private or overseas visitors.

For those private patients under the clinical care of Clinical Consultant rather than the Board, it is a matter for that Clinical Consu to define the level of clinical service provided to the patient.

Clinical requirement shall be the only factor for prioritising access to care. NHS waiting times for patients transferring from private to NHS treatment will be consistent with those for patients undergoing wholly NHS treatment.

Private and overseas patients are subject to different standards with respect to waiting times, and therefore must be recorded clearly as such on TRAK.

Where the Board makes available capacity for private practice, this capacity shall revert to the Board in the event of it not being required by the practice within the times prescribed by contract.

The Board shall recover all costs borne in the provision of services to private and overseas patients.

All consultants are responsible for maintaining a clear distinction between private practice and any other patient activity.

Consultants must send copies of private patient appoin ment letters to the PPO.

The consultant must keep the Private Patient Officer (PPO) informed of any changes in the patient’s status as a private, overseas or NHS patient as soon as they occur by either telephoning the number below or e iling the email address below. Following the completion of the clinical procedure, the consultant must confirm to the PPO within one week the details of the treatment provided.

Failure to advise the PPO of any private practice activity in this manner shall be regarded as fraudulent practice, and the matter shall referred to NHS Counter Fraud Services.

It is the responsibility of the consultant to ensure a non-NHS patient details are entered onto TRAK completely, correctly and on time. Consultants must ensure that all Private and Overseas Patient attendances, treatments and procedures are properly recorded. The patient’s records and referral ms etc should always be prominently marked.

The writing of medical, insurance and legal reports th generate a fee not passed on to Lothian NHS constitute non-NHS activity and any NHS session time lost whilst undertaking this activity must be reported to the relevant CMT as per below.

If the consultant is unclear at any time with regards his/her responsibilities relating to Private Patients they should refer to their terms and conditions of work and GMC and BMA guidance on this matter.

2.2.Responsibilities of the Consultants


The consultant is responsible for ensuring they have the relevant indemnity insurance in place before agreeing to undertake any private work.

Charitable cases – NHS Lothian is not funded to undertake charitable cases. Should any request be received then this must be referred to the Associate Medical Director and the CMT in the first instance. Agreement undertaking charitable cases must be sought from the Joint Management Team and no cases will be undertaken without their approval.

Within the Clinical Management Team, the Service Manager must ensure that there are clear guidelines in place to allow Consultants carrying out private patient activity during NHS funded sessions to ‘pay-back’ the NHS time lost or forgo the relevant portion of their NHS salary. A Consultant who undertakes private practice in anyNHS funded programmed time must reimburse the Board immediately.

Reimbursement may be made through:

- Undertaking an additional clinic or theatre list- Arrange for NHS pay to be withheld for the session or annual leave to be taken.- Maintain a record of additional SPA activity undertaken

The Service Manager must be informed by the consultant of the reimbursement to be made and how it is to be made. The Service Manager st ensure that the reimbursement is honoured.

It is the responsibility of the Service Manager within each Clinical Management Team to work with the Consultant to ensure that all Private and Overseas Patients are managed in an appropriate manner in line with existing policies and guidelines and to ensure that any costs associated with the use of facilities for the treatment or diagnosis of non-NHS patients are recovered.

The writing of medical, insurance & legal reports that generate a fee not passed to Lothian NHS constitute non-NHS activity and any NHS session time lost whilst undertaking this activity must be reported to the relevant CMT as above.

The CMT must check with each consultant opting to do private patients work that they have the relevant indemnity insurance.

Charitable cases – if agreed by NHS Lothian then the CMT must ensure that all they do not make payment for donated items and the Private and Overseas Team are made aware of the cases and to whom any invoices are to be raised to.

When staff donate time to work on charitable cases, the CMT must keep a clear record that each staff member has taken annual leave equivalent to the donated time, or has worked additional hours to compensate for any hours worked during NHS scheduled time.

Where the above steps have not been followed, the Associate Medical Director for Acute Services must be informed by the Service Manager. Breaches that are considered to be intentional fraudulent practice will reported to NHS Counter Fraud Services and could result in internal discipline leading to dismissal or in extreme cases criminal prosecution.

2.3.Responsibilities of the Clinical Management Team


2.4.Responsibilities of Private Patient Officer

2.5.Responsibilities of Admission Staff / Ward Staff / Community Midwives

Q1:

The Private Patient Officer (PPO) will act as the central contact point for all Consultant staff, CMT staff and patients in relation to the management of Private and Overseas Patients. The main responsibilities of the PPO will be,

Liaise with the consultant and CMT to find the most appropriate date for admission/treatment

Secure signed documentation prior to admission/treatment taking place to ensure payment is secured in advance

Monitor and follow up payments

Monitor costs to ensure adequate funds have been secured

Provide reports to monitor activity and income recovery

Refer instances of fraud to Counter Fraud Services (CFS)

Provide reports for SFR 18 return

Charges should be explained by the PPO to Private and elective Overseas Patients in advance of treatment. Charges payable by Private and Overseas Patients are the full average cost for providing accommodation and services at the relevant hospital, including elements for the accommodation, nursing and other staff costs, basic drugs, dressings and equipment. High cost drugs, dressings and equipment may be charged separately. These charges will be defined by the Director of Finance and can be found on the intranet in the Finance section.

Patients identified as Private or Overseas, or someone acting on their behalf, will be asked to sign an “Undertaking to Pay” form (see Appendix 1). The signature must be obtained and witnessed where possible by the designated Private Patient Officer, or by a member of staff acting on their behalf.

Except in an emergency, no treatment or care will proceed until the patient has been recorded as a Private or Overseas Patient within Health Boards Patient Administration System by the Medical Records Department and/or activity systems by the Private Patient Officer (PPO) and when payment d.

Where a patient declares that they will not be able to pay for treatment provided, thepatient’s consultant should be asked to complete a “Request for advice from doctors” form (Appendix 2). Where a consultant indicates that immediately necessary or urgent treatment will be given, details should be brought to the attention of the appropriate Service Manager.

Admitting staff and community midwives have a responsibility to ensure that the Stage 1 questionnaire is carried out for all patients presenting for NHS care.

Have you been living in the UK for 12 months?

•

•

•

•

•

•

•


Admitting staff, ward staff and community staff have a responsibility to ensure that the information input onto TRAK or other PIS is as accurate as possible. This includes input of address and postcode correctly. They need to ensure that the patient is flagged as either non NHS or Private Patient if applicable.

If at any point staff becomes aware that a patient may be liable for care they must inform the Private and Overseas Officers as soon as possible.

If the patient is from the European Union but not resident in the UK for more than 12 months staff must obtain the details of the EHIC if the patient is admitted and likely to be discharged out of hours. If the patient is admitted or likely to still be in during Private and Overseas Team working hours then Private and Overseas Team will collect the details. If the EHIIC details are not available please contact Private and Overseas Team.


3 Change of Status for Private Patients

4 Consultant Use of Health Board Premises

3.1 Private outpatients who are eligible for free NHS treatment are legally entitled to change their status at a subsequent visit and seek treatment the NHS. Private Inpatients have a similar entitlement to change status (e.g. when a significant and unforeseen change in circumstances arises), although in both cases the patient remains liable for charges for the period during which he/she was a Private Patient.

3.2 A change of status from Private patient to NHS patient must be accompanied by an assessment of the patient’s clinical priority for treatment as a NHS patient. Private patients must take the place appropriate to their clin l priority on the waiting list. For example, a patient who sees a consultant privately for an outpatient appointment, and who subsequently decides to become an NHS patient, should join the waiting list at the same point as if his or her initial consultation had taken place as an NHS patient.

4.1 Where a Consultant uses Health Board premises for Private Patient consultations or clinics a charge will be levied to recover the full cost of providing these facilities, including any staffing support provided and any supplies or equipment used. The consultant must notify his Service Manager that he wishes to use Health Board premises for private work. The Service Manager must ens that the charge is made to the consultant for the use of the premises. Normal credit control procedures will apply if the consultant does not pay the invoice. If Private Patients are to be seen on a regular basis a license must be drawn up between the Board and the Consultant.

4.2 Consultants should note that Private Patient work may be covered by the Clinical Negligence Scheme for NHS Organisations. They will need to make their own arrangements for insurance. The Clinical Management Team (CMT) service manager must ensure that before Consultant staff can carry out non-NHS activity the correct insurance cover for staff is in place. The correct insurance must include cover for claims made against the consultant by a third party arising from negligent acts, errors or omissions occurring in the course of their business and which demonstrably result in the third party suffering from:

a financial loss

bodily injury (including death, disease, illness and/or mental anguish)

damage to their property

4.3 Where the private work is only a component of the patient’s care and is delivered alongside NHS care on NHS sites, NHS indemnity will be valid.

4.4 Category 2 work – as defined and listed below. It is the responsibility of the CMT to monitor consultant’s time on this work and to raise charges where appropriate.

Category 2 or medical legal work is distinct from private practice; however it is still non NHS work.There are a number of occasions when category 2 or medical legal reports as they are sometimes known as will be requested, and they will be commissioned by employers, courts, solicitors, Department of Work and Pensions etc, the report may include radiological pinion and bloods.

•

•

•

•

•


This work is commissioned direct with the consultant and not with NHS Lothian and the responsibility lies with the Consultant. NHS Lothian charges the Consultant for the facilities by the Consultant to undertake the report plus any tests etc line with the private tariff. Category 2 reports and correspondence are not part of medical record and must not be filed in the notes for legal reasons. Category 2 work is permitted in NHS Lothian provided it does not; in the opinion of NHS Lothian interfere adversely with NHS hospital activities or with the proper discharge of the practitioner’s NHS contractual duties. Category 2 work should normally be undertaken outside the practitioners contracted NHS hours/session, although it is accepted this may not always be practical due to the need to undertake x-rays, scans etc. Whenever Category 2 work is undertaken during NHS hours/sessions, practitioners are advised to alert their CMT and record when the NHS time has been made up. NHS Lothian recognises that on occasion there will be a requirement for some staff to be involved with the patient’s journey (e.g. outpatient registration clerk, radiographer) as part of their NHS work. It is expected that this should be a minimal input and the fees charged by NHS Lothian cover the cost. NHS Lothian expects that Consultant will make a private arrangement for secretarial support such as report typing, and this mu not take place within NHS paid time. The Consultant is responsible for any amounts due to NHS Lothian and the account must be paid to terms. It is the Consultants responsibility to bill the third party for all costs incurred. The Consultant is responsible to HM Customs and Revenue to declare for tax purposes all category 2 income earned. NHS Lothian has no obligation in this respect. Any Category 2 work undertaken for consultants by medi secretaries for which the secretary is receiving additional income from the Consultant, must not impact on NHS work and must be done out of hours. Consultants should be aware of their duty to inform their secretaries that such income is subject to taxation and must be declared to the Inland Revenue. It is strongly recommended that Consultants keep accurate records of income and payment.

Has the patient elected to receive private healthcare?

If patient should be assessed for eligibility for free care – see STEP 2.

If notify the PPO, and go to STEP 3.

•

•

•

•

•

•

•

•

•

•

•

•

5. STEP 1 – Is the patient a private patient?

“No”,

“Yes”,


6. STEP 2 – Is the patient entitled to free NHS care?

Every

Q1:

“Yes”

“No”,

Q2:

“Yes”

“No”,

Appendix 4

Appendix 5

7. STEP 3 - Administration of Private Patients – Secondary Care

Question 3.1

patient should initially be assessed at the point of admission or GP registration when presenting for healthcare.

Where registering patients at a GP practice please follow the guidance ‘Information for Practices, Patient Registration with a GP Practice ppendix 3).

If referring a patient to Secondary care where a patient has not demonstrated for whatever reason, their entitlement to free NHS care please state this in the referral letter. An example could be where an urgent referral is required and the patient has not had sufficient time to produce the necessary documentation.

When admitting patients to hospital please refer to the two part questionnaire in the front of all case files. This is referred to as the stage 1 questionnaire. If the questionnaire is not in the case file the questions still need to be asked. For GP referrals the absence of reference to overseas status that the stage one questionnaire should not be carried out.

Have you (your husband / wife / mother / father) been living in the UK for 12 months? (Mother and father in the case of dependant children)

If , no further action required – patient is eligible for free NHS care and no further evidence is required.

If go to question 2 below.

Are you (your husband / wife / mother / father) going to live in the UK permanently? (Mother and father in the case of dependant children)

Notify the PPO when this question is being considered, ensure appropriate evidence is obtained.

If , the patient is eligible for free NHS care, and no further action is required with respect to this procedure.

If the patient may not be eligible for free NHS care. Please contact the PPO, who shall handle the matter.

If at any point during the procedure you have reason to believe that the patient may not be eligible for free NHS care (for example there are inconsistencies in their answers to questions) you must contact the PPO – you are not expected to challenge the patient.

See for a flowchart of this process.

See for more information regarding Overseas Patients.

Has the patient been admitted by a consultant?


If , go to question 3.2. If ”, the patient cannot be admitted, and you should not proceed further with this procedure.

Has the PPO acknowledged that he/ she has been notified of the proposed private patient?

send copies of private patient appointment letters to the PPOwhen they send the letter out to the patient. The consultant must keep the Private Patient Officer (PPO) informed of any changes in the patient’s status as a private, overseas or NHS patient as soon as they occur by either telephoning the number below or emailing the email address below.

If , go to question 3.3. If , the patient cannot be admitted unless it is a clinical emergency, and you should proceed further with the proposed episode of care.

Has the standard referral form (Appendix 7) and checklist (Appendix 8) been completed by the consultant, reviewed and authorised by the CMT, and sent to the PPO?

If , go to question 3.4. If , the patient cannot be admitted unless it is a clinical emergency, and you should not proceed further with the propose de of care.

Have you received confirmation from the PPO that the undertaking to pay form (Appendix 1) has been completed by the patient?

If , procedure can be carried out privately. If the patient cannot be admitted unless it is a clinical emergency, and you should not proceed further with the proposed episode of care.

Following the completion of the clinical procedure, the consultant must confirm the details of the treatment provided to the PPO within one week. Income will not be recognised until confirmation of treatment has been received by the PPO.

See for a flowchart of this procedure.

“Yes” “No

Question 3.2

Consultants must

“Yes” “No”not

Question 3.3

“Yes” “No”

Question 3.4

“Yes” “No”,

Appendix 6


8. Arrangements for patients who wish to make co-payments

Question 4.1

“Yes” “No”

Question 4.2

“Yes” “No” only

Question 4.3


Question 4.4


Question 4.5

“Yes” “No”

Question 4.6

“Yes” “No”

8.1. Where a patient has requested a non-approved treatment NHS and private healthcare can be provided in combination.

8.2 This procedure does not cover:

- patients who request transfer of their care from the NHS to the private sector, or vice versa (see section 3);

- purchasing of services in the private sector by the NHS for NHS treatment

8.3 Please follow the following questions for patients considering co-payments in the first instance. Where patients then choose to opt for co-payment, please follow the questions above for elective private patients.

Has the patient requested non-approved treatment?

If – go to question 4.2. If - this section does not apply.

Has the patient, upon being informed that the treatment is not considered to offer sufficient benefit in relation to NHS cost in their case, elected to privately fund the element of care that is not being provided by the NHS?

If – go to question 4.3. If - patient continues with NHS treatment and no co-payment required.

Has a copy of the relevant appointment letter been sent to the PPO (see page 10)?


Where appropriate, has the consultant discussed with the patient eligibility for exceptional cases panel (ECP) and where eligible the patient has been made aware of the benefits and drawbacks of the process?


Is the case eligible and appropriate for ECP?

If – case submitted to exceptional cases panel and go to question 4.6. If -go to question 4.7.

Is the case deemed exceptional by the ECP?

If – case funded by Board and no co-payment required. If - go to question 4.7.

Consultants must fully record the above discussions an conclusions in the patient’srecords.


Question 4.7

“Yes”

“No” only

Has case been deemed not exceptional and non-NHS element to be funded by patient?

If – provision of course of treatment that would have been offered by NHS to be clearly documented on referral form (Appendix 7) and process for elective private patient to be followed. If - patient continues with NHS treatment and no co-payment required.

Where the decision is to access private services in co ion with the NHS, NHS Lothian wishes to ensure that:

1. Individual clinicians remain responsible for clinical decisions regarding care of individual patients. Clinicians must ensure that Service Managers provide writtenagreement with the decision to provide combined private and NHS care within NHS Lothian services.

2. Clinical care and medicines will be provided normally through the NHS where there is evidence that patients will benefit from a particular intervention, that care and/or medicine is provided by the NHS and that patients are le to access that care through the NHS.

3. All avenues for obtaining care and/or medicines through the NHS are considered fully and exhausted by the clinician and the patient before the provision of combined NHS and private care is considered.

4. Patients, and where appropriate their family and carers, are provided always with comprehensive and accurate written information about their options for treatment in the NHS, including NHS treatment not available in NHS Lothian.

5. Clinicians must ensure that a complete, accurate and up to date record of all decisions regarding combined NHS and private healthcare were made, and the grounds on which these were reached, in the patient's notes.

6. Clinicians and managers must assess the proposed combined care for any risks to patient safety, clinical accountability, governance and probity including the risks associated with sustainability and continuity of care.

7. NHS and private care are, where possible, delivered separately with clear separation in legal status, liability and accountability; the dis elements of NHS and private care are agreed and understood by clinicians and patients in advance. If there is any dubiety over any aspects of the separation of elements of care, a decision must be sought from the Medical Director.

8. Clinicians and managers need to be confident that clin l accountability for private and NHS components of care is clear and agreed, and the staff and the facilities necessary are available to manage a combination of NHS and private care.

9. Managers must ensure that an accurate record of these combined treatment episodes is maintained. Summaries of these decisions must be reviewed within the directorate at regular intervals (during multi-disciplinary team (MDT) meetings) and used in the planning and delivery of services. (Appendix 7 allows a record of planned NHS treatment, including possible complications relating to alternatives to be maintained).


10. Where the decision is to access a complete service outside NHS Lothian services, then the standard referral arrangements should apply (normally through GPs or referral to another clinician). Clinicians must not advise patients to transfer to private healthcare provided by the same clinician or business associates.

11. Clinicians and local managers must ensure that patients, and where appropriate their family and their carers, understand that the particular elements of private healthcare (e.g. the provision of a medicine) will have a number of associated clinical costs. NHS Lothian will charge at full cost recovery for the private care provided within an NHS service, as described in the Principles of Conduct.

12. What should be expected under the NHS is to be documented prior to treatment on Appendix 7. Any subsequent complications not listed at the outset, but recognised as being applicable to both the treatment given privately and the NHS alternative mustbe submitted on an updated version of Appendix 7, stating that treatment of the complication is covered by the NHS.

13. The ethical, professional and legal standards required of NHS clinicians are not compromised by these arrangements Adherence to existing regulatory clinical controls regarding the treatment of the patient must be observed at all times.

The arrangements under this procedure are compliant with existing law in Scotland

See for a flowchart of this procedure.Appendix 9


9 Appendices

Appendix 1: Undertaking to Pay

UNDERTAKING TO PAY FOR INVESTIGATION/TREATMENT FORM

PART 1: TO BE COMPLETED BY MEDICAL STAFF TREATING THE PATIENT

PART 2: TO BE COMPLETED BY THE PATIENT OR HIS/HER REPRESENTATIVE

I hereby undertake to pay you the appropriate charges respect of the services provided as

specified above.

I understand that in addition to these charges I am required to pay any fee that the Consultant may

negotiate with myself separately for the work that he/ undertakes.

I consent to any information on this form being passed on to and/or communicated with the insurer

named below

NOTIFICATION OF CHARGES DUE IN RESPECT OF THE PROVISIO OF NHS FACILITIES (SECTION

58 NATIONAL HEALTH SERVICE (SCOTLAND) ACT 1978)

The following treatment(s)/investigation(s) is/are requested at: …………………Hospital

Treatment/Investigation/OPCS 4(Consultant)

Tests/Units/Days/etc Fin Code (Consultant) (PPO)

Estimated Charges

………………………………….. ……………………… ………….. ……………

………………………………….. ……………………… ………….. ………………

TOTAL ESTIMATED CHARGE ……………………

Admission Date………..…… Treatment/Investigation Date……...……..

Consultant………..…………………………Signed……………………….. Date…...…….….

CMT…………………....……………………Signed…………………..….. Date…...…….….

I……………………………………………… of.………………………………………………

…………………………………………………………POSTCODE …………………………

Date of Birth………………………Contact Telephone Number……………………………….

Signed………………………………………………….. Date…………………………………

Please indicate if: Private Insurance Self Funded Other

If Private Insurance/Other please state: Name of Provider….………………………………...

Policy No……………………………………. Authorisation No………………………….……

Contact Details…………………………………………………………………………………..

…………………………………………………………………………………………………...

Patient UHPI:……………………………………………………………………………………


Appendix 2: Request for advice from doctors

Request for advice from doctors

Dear Doctor/Mr……………………………………………………………

Name of Patient……………………………………………………………

Date of Birth…………………………Hospital Number…………………

This patient is an overseas visitor as defined in the National Health

Service (Charges to Overseas Visitors) Regulations 1989, as amended.

Having interviewed the patient we found him/her to be liable for charges

as an overseas visitor.

Government advice to safeguard NHS resources is to obtain payment

where possible before treatment is given. In this case the patient also

declared that he/she will not be able to pay for the treatment to be

provided prior to receipt of the treatment. Would you therefore please

tick one of the declarations below:

? ?I intend to give treatment which is immediately necessary to save

the patient’s life.

? ?I intend to give urgent treatment which is not immediately

necessary to save the patient’s life but cannot wait until the patient

returns home.

? ?No treatment will be given unless payment is made.

Where treatment is given (or has been given already), Lothian is obliged to raise an

invoice for the cost of any such treatment, and to pursue debt recovery procedures if

necessary.

Date……….………Signed………………………….……...…… (Doctor)

Date……….………Signed……………………………………... (Private & Overseas Officer)


Appendix 3: INFORMATION FOR PRACTICES

PATIENT REGISTRATION WITH A GP PRACTICE

all new patients

Essential Documents Required 1. NHS medical card (1st choice and alternative to photo ID) 2. Birth certificate accompanied by photographic ID.*3. Proof of address** *(passport, ID card or driving licence)** (Mortgage/rental agreement, utility bill within last 6 months, bank statement, current employment documents)

Newly resident in the UK from European Economic (EEA)

Newly resident in the UK out with EEA

EEA Visitors

Temporary Residents

Reciprocal Agreement visitors

Out with EEA and reciprocal visitors

Visas

In order to ensure the same patient registration proce is in place for all practices in Lothian and to avoid the potential for claims of discrimination, detailed below is the registration process that is advised and recommended as best practice for each individual practice in Lothian and to avoid practices being found in breach of statutory requirements to patients that are entitled to Primary Medical Services (PMS).

A poster/leaflet describing the registration process should be displayed within your practice and where appropriate be included on the practice website.

It should be made clear to patients that they cannot be registered without proof entitlement and GP practices should ask to provide the following evidence when registering as a new patient.

If proof of address is not available then 2 out of 3 of the above must be provided and one must be photographic (Passport, ID card or driving licence only).

If a patient is newly resident in the UK or is an overseas visitor then additional documentation is required:

- Patient must provide evidence** that it is their intention to permanently reside in the UK

- Patient is required to produce letter from the home office confirming residency in the UK, or “No time limit” stamp on passport.

- Patient needs to provide European Health Insurance card (EHIC) to be eligible for free NHS treatment during their visit. If the patient is unable to produce this then charges are applicable.

- Patients that are seen as temporary residents (TR’s) remain as TR’s for 3 months. They may then register as permanent providing the practice is agreeable and they can produce the required documentat that they are entitled to work e.g. work permit or contract of employment.

Temporary residents requiring controlled drugs should be advised to contact CDPS.

- Patient to provide passport or ID card to be eligible for free NHS treatment during the visit.

– charges apply

-To be entitled to free NHS treatment, students, workers, voluntary workers, missionaries, are required to have a current and valid visa. If eligibility to free NHS


treatment is established, patient’s spouses and dependants are also eligible (this applies to wives, husbands and children only. Grandparents, un ’s aunts etc are not eligible unless they are in possession of a Dependant Visa) Patients who have “Academic visa” are NOT eligible for NHS treatment as these are for people on sabbaticals and they are therefore not participating in a degree course.

- Treatment for all visitors to the UK with an infectious disease is free. Medication should only be provided for the duration of the visit.

- This can be sourced from the shortened Overseas Patient eligibility Guidance issued by the Scottish Government on April 2010

-If a patient complains regarding the process of patient registration then they should be referred to NHS Lothian complaints department at Waverley Gate. NHS Lothian Complaints officer can be contacted on 0131 465 5708

- A full interpretation of the current regulations on overseas visitor’s guidance is available at:

http://www.scotland.gov.uk/Topics/Health/OverseasVisitors

General enquiries for practice staff regarding overseas visitors can contact Jacqueline Keogh (Primary Care Contracts Team) on 0131 537 8419

Infectious diseases

Other categories of overseas visitors

Patient complaints

Useful contacts


Appendix 4 Process to Identify Possible Overseas Patients

YES NO

YES NO

Evide nce w ill ne e d to be pre se nte d to confirm reside ncy

PROCESS TO IDENTIFY POSSBILE OVERSEAS

PATIENTS

The patient is eligible for free care, and not further action is required with regards to this procedure.

.

The patient may not be eligible for free care. Please contact the PPO who will handle the matter.

Have you been living in the UK for 12 months?

No further action required

Are you goung to live in the UK permanently?


Appendix 5: Additional Information regarding Overseas Patients

Under the NHS Act 1977, visitors to the United Kingdom who are not exempt from the requirement to pay should be treated in accordance with Sections 1 to 6 of this procedure. A visitor is someone not ordinarily resident in the United Kingdom. If the patient is from within the European Community he/she should be asked to provide a completed European Health Insurance Card (EHIC) to enable free treatment to be given. The Public Health Division of the Scottish Government (SG) has lead responsibility for matters relating to entitlement or ise to NHS services. A full copy of the SG manual for overseas patients can be found at:

http://www.scotland.gov.uk/Topics/Health/OverseasVisitors

This section is intended only to provide a guide for the management of overseas patients, for full guidance please refer to web address quoted above.

The overseas visitor’s regulations do not permit charging for emergency care. Patients are not liable unless admitted to a ward. If patients are still in St John’s A & E observation ward, or RIE Combined Assessment Unit or the Western General Hospital ARAU after 24 hours they will become liable for care.

It should be noted that possession of a Community Health Index (CHI) number does not necessarily preclude an overseas visitor from paying NHS charges. Healthcare providers are strongly advised to check the residency status of all patients seeking treatment. Referral by a GP is not in itself proof that an individual is exempt from NHS hospital charges.

The overseas visitor’s regulations do not permit charging for NHS primary care services other than certain dental and optical services. It is for GP practices to exercise their discretion as to whether to register an overseas visitor or to treat them privately (including the provision of private prescriptions), taking into account the terms of the National Health Service (General Medical Services Contracts (Scotland)) Regulations 2004.

Stage 1 questionnaires as printed on the inside cover medical records folders must be carried out on all patients. The Stage 1 boxes within TRAK must be completed appropriately. If staff are unable to make a decision based on what they’re hearing from the patient, if for example the patient contradicts their answers whilst giving their medical history, then a PPO should be contacted to carry out a Stage 2 interview.

During the Stage 2 interview all patients will be asked to complete a UK Border Agency (UKBA) Consent Form (See Appendix 10). After the Stage 2 interview the PPO will check with UKBA via CFS as appropriate the patient’s status.

1.1.Patients Who Are Not Eligible for Free Treatment.

Patients who are liable for NHS charges should be identified as “Overseas –Liable“on TRAK, and should have their permanent overseas addres entered on TRAK in the permanent address field.The principles that apply to private patients in sections 1 to 9 apply equally to overseas patients liable for NHS charges.


1.2.Patients Who Are Eligible for Free Treatment.

Patients for whom the requirement to cover costs does apply are set out in the PPO Stage 2 interview questionnaire. Patients exempt from charges should be entered into TRAK as “Overseas – Non Liable”.


Appendix 6: Process for elective private patients

Decision made to treat patient privately at NHS facility.

Standard referral form and checklist completed by consultant and sent to CMT.(See Appendices 7&8)

CMT assess checklist (Appendix 8) and form (Appendix 7) and authorise

CMT assess checklist and form and authorise private procedure.

Procedure not carried out privately.

CMT sends referral form (Appendix 7) to PPO.

PPO obtains authorisation from insurer, or payment from self-funding patients.

PPO returns undertaking to pay form (Appendix 1) to CMT with confirmation of funding approval for signature by CMT, Consultant and patient.

Procedure carried out privately.

Procedure not authorised, or self-funder does not pay.

Consultant confirms details of actual treatment to PPO

PPO raises invoice.

Copy of Private Patient appointment letter sent to PPO

do not


Appendix 7: Referral Form

PRIVATE PATIENTS

NAME:

Patient UHPI/CHI:

ADDRESS:

CONTACT TELEPHONE NO:DOB:

CONSULTANT RESPONSIBLE:

INSURANCE COMPANY:

POLICY NUMBER: Authorisation No (if provided):(a) DATE OF PROCEDURE / ADMISSION

(b) TYPE OF PROCEDURE & PROCEDURE CODE (if applicable)

(c) FOR CO-PAYMENTS ONLY – ANTICIPATED COURSE OF NHS TREATMENT

(d) FOR CHARITABLE CASES ONLY – DETAIL ALL DONATED ITEMS

NHS Lothian

DIRECTORATE______________________________

TO BE SENT TO DIRECTORATE OFFICE WITH THE CHECKLIST (APPENDIX 8)


Appendix 8: Checklist for Consultant Staff

NHS LothianDirectorate of PRIVATE PRACTICE: CHECKLIST FOR CONSULTANT STAFF

INFORMATION REQUIRED FOR AUTHORISATION

i. PRIVATE PATIENT AGREEMENT TO PROCEED: NOTE AGREEMENT TO PROCEED MUST COME FROM A MEMBER OF THE MANAGEMENT TEAM

Please complete and return to The Directorate Office.

Please note: Private Cases will not be authorised until the appropriate documentation is completed. There

must be written confirmation from the Clinical Management Team (CMT) before the case proceeds.

Consultant requesting the case

Date of proposed case

Routine or urgent case

Date of referral to CMT a.

NHS Workload:Are Waiting Times on target for delivery

Annual Leave required

Patient details attached (Appendix 8)Yes / No

Predicted Length of Stay in hospitalb. Note: Any anticipated delays in

critical care

Approval: Yes / No

Date

Associate Director of Ops

Clinical Director

Service Manager

Note: A photocopy/scan of this form will be returned to the requesting consu nt, Clinical Lead and the appropriate Waiting List Coordinator. This form will be subject to ongoing review and clinical audit.

oNote: This should be discussed with the

appropriate Clinical Lead

Note: If No explain NHS payback arrangements which have been put in place

Note: If appropriate details not attached there may be a delay in the decision to proceed

Note: If not approved reasons why


Appendix 9: Process for co-payment patients

Patient requests non-approved treatment

Patient informed that treatment not considered to offer sufficient benefit in relation to NHS cost in their case.

Patient opts to continue with NHS treatment.

No co-payment.

Where appropriate, eligibility for exceptional cases panel (ECP) discussed with patient.Where eligible for ECP, patient made aware of benefits and drawbacks of process, including potential delay to treatment whilst panel convenes.

Case submitted to exceptional cases panel.

Case deemed exceptional and funded by Board.

Case deemed not exceptionaland non-NHS element to be funded by patient.

Provision of course of treatment that would have been offered by NHS clearly documented on referral form. (Appendix 7)

Process for elective private patient followed.

Case not eligible for ECP

Copy of relevant appointment letter sent to PPO


Appendix 10: UKBA Consent Form

NHS IMMIGRATION CONSENT FORM

TO: UK BORDER AGENCY VIA NHSSCOTLAND COUNTER FRAUD SERVICES

Patient name ………………………………………………………………………………...

Date of Birth ………………………………………………………………………………..

Country of Origin …………………………………………………………………………….

Date of Arrival in Country ……………………………………………………………………

Purpose for being in UK …………………………………………………………………….

Home office Reference or ARC number (If applicable) …………………………………..

The patient authorises this request:

Signature of patient …………………………………………………………………………

FROM:

Name of Hospital …………………………………………………………………………….

Name & Job title ……………………………………………………………………………...

----------------------------------------------------------------------------------------------------------------

Please advise what this person’s immigration status is

…………………………………………………………………………………………………...

…………………………………………………………………………………………………..OR

Please advise whether this person’s ARC is still valid …………………………………..

If no longer valid, has asylum been

Granted ……………………………. OR Refused………………………………………

Essential – Ensure patient understands the following:- The information you provide will be passed to the UK Border Agency for ascertaining your immigration status and therefore your eligibility for NHS hospital treatment. The UKBA is responsible for securing the UK border and controlling migration for the benefit of the UK. The information provided will be used and retained by the UKBA for its functions, which include enforcing immigration controls overseas, at the ports of entry and within the UK. The information may also be passed to other law enforcement organisations for purposes including national security, the investigation and prosecution of crime, and the collection of fines and civil penalties.

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