NHS Enhanced Services and Private Care Guidance
We are frequently asked about the provision of private care alongside NHS enhanced services. These principles are designed to support clear and consistent decision-making, while protecting patient choice and maintaining a clear distinction between NHS-funded and private care.
No private diagnostic tests or charges may be made within an NHS enhanced service.
Any investigation that forms part of a commissioned NHS service must be provided free of charge to the patient.
Practitioners may use information from tests undertaken outside the NHS enhanced service, such as an OCT purchased by the patient privately as part of their eye examination (sight test). This is provided the patient was fully informed and chose to purchase that test separately from the NHS service.
If a practitioner decides that they would like to perform an OCT or other diagnostic test that is not part of the service to support:
- assessment
- diagnosis
- monitoring
- management
within the NHS enhanced service, then the test must be provided without charge.
Under no circumstances should a patient be required to pay for a diagnostic test within the delivery of the commissioned NHS pathway.
The NHS pathway must always be offered first.
Patients must be offered all clinically appropriate NHS-funded options before any private alternatives are discussed.
Private care must only be offered as an additional choice at the patient's request and must never replace, restrict, delay, or create a barrier to NHS care. A patient's ability or willingness to pay must never influence access to NHS services.
The NHS episode must be formally concluded before any private care begins.
The patient must be informed, in clear and understandable language, when the NHS service has ended and any subsequent care is being provided on a private basis. The transition from NHS to private care must be clearly documented in the patient record.
Patients may choose to purchase services, treatments, or products that fall outside NHS commissioning arrangements.
Examples may include:
- over the counter medications following NHS guidance
- medications where FP10 prescribing is not commissioned
- additional diagnostic tests requested by the patient outside the NHS pathway
Such services must be clearly separate from the NHS episode, entirely optional, supported by informed consent, and understood by the patient not to form part of the NHS enhanced service.
Clear records must be maintained.
Practices should document discussions regarding private options, confirmation that NHS-funded alternatives were offered where applicable, the patient's decision, and that appropriate consent was obtained for any private treatment or investigation.
Transparency of fees and services is essential.
Patients must be informed in advance of any costs associated with private services. Practices should ensure that private services are described separately from NHS-funded care in patient information, consent processes, and billing arrangements to avoid any misunderstanding.