Keep clear separation between NHS and private treatment


For immediate release: Wednesday, 21 August 2013

Doctors cannot be perceived to have a conflict of interest when dealing with NHS patients requesting private prescriptions, warns UK-wide medical defence organisation MDDUS.

MDDUS has dealt with calls from GP members unsure of the boundaries when dealing with patients wanting to mix NHS and private care, with many doctors asking if they can see their own NHS patient privately.

MDDUS medical adviser Dr Naeem Nazem reminds GPs of their obligations when their NHS patients request information or advice on private treatment options. “One common query we encounter is doctors asking if they can prescribe privately for their NHS patients,” says Dr Nazem. “One example is a doctor wanting to prescribe a flu vaccine privately for a patient who is not eligible to receive it on the NHS criteria.

“In short, the answer is no, with the only exception being when the appropriate treatment is not available on the NHS.

“It can be a potentially serious ethical issue if the correct steps aren’t taken. Any act of perceived dishonesty can lead to GMC sanctions and the risk of erasure.

“Doctors should keep a clear separation between NHS and private treatment and must act openly and honestly to ensure there can be no perceived conflict of interest. This includes providing the patient with all the necessary information to help them make their choice of treatment.

“If the doctor believes a private assessment or treatment is required, then they are obliged to refer the patient and cannot make any financial gain from the patient – either directly or indirectly,” adds Dr Nazem.

“If a patient wishes to seek treatment privately, then they should be referred, with all relevant information about the patient including medical history being provided.”

Patients are entitled to opt in and out of NHS treatment at any stage – as long as they are entitled to the NHS treatment and they are treated in the same way as those receiving all of their care within the NHS.

“Doctors should ensure a patient has all the relevant information when choosing private or NHS treatment, with any private treatment being delivered separately from NHS care,” says Dr Nazem. “Some MDDUS members have received complaints from patients who believed they were being treated on the NHS, only to find themselves being billed for private treatment.

“Furthermore, doctors who have a financial or commercial interest in, for example, a pharmacy, pharmaceutical or medical devices company, must ensure they do not allow that interest to affect decision making regarding patient care.”

GMC guidance Financial and commercial arrangements and conflicts of interest states that: “You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals. You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.”

Crucially, the guidance also says: “If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally and you should be prepared to exclude yourself from decision making. Conflicts of interest may rise in a range of situations. They are not confined to financial interests and may also include other personal interests.”

“Conflicts of interest are not always avoidable,” says Dr Nazem. “MDDUS dealt with one case where a patient was referred to a specialist orthopaedic surgeon who happened to be the doctor’s husband.

“In this case, the specialist was perceived as being the most suitable person to assess the patient so, in order to avoid any problems, the doctor would need to ensure the patient was aware of this information and other options available to them. Any potential conflict of interest should be recorded in the patient’s records.

“If in doubt, contact your medical defence organisation or speak to a colleague. An alternative solution may be to refer the patient to a practice colleague for a second opinion prior to referral. Ultimately, you should ensure the potential conflict does not affect patient care.”


For further information contact Richard Hendry on 0845 270 2034 or 07976 272266, or email

Note to editors

MDDUS (The Medical and Dental Defence Union of Scotland) is a medical and dental defence organisation providing access to professional indemnity and expert medico- and dento-legal advice for doctors, dentists and other healthcare professionals throughout the UK. For further information on MDDUS go to

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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