This is an official Northern Trust policy and should not be edited in any way Private Practice by Medical Staff - Code of Conduct Reference Number: NHSCT/12/511 Target audience: These standards apply to medical practitioners who are Trust employees and who undertake private practice:- In Trust facilities; Privately, or In independent facilities Sources of advice in relation to this document: Dr Peter Flanagan, Director of Medical and Governance Services Replaces (if appropriate): N/A Type of Document: Trust Wide Approved by: Policy Committee Date Approved: 2 May 2012 Date Issued by Policy Unit: 2 May 2012 NHSCT Mission Statement To provide for all the quality of services we would expect for our families and ourselves 1
Private Practice by Medical Staff Code of Conduct 2
1. Introduction and General Principles 1.1 The following set of key principles underpins the relationship between the Trust s Medical Practitioners, the Trust and private practice. The provision of service for private patients should not prejudice the interest of the Trust or disrupt Trust services. There should be no real or perceived conflict of interest between private work and Trust work. With the exception of the need to provide emergency care, fixed Trust commitments should take precedence over private work where there is a conflict, or potential conflict, of interests. With the exception of emergency care, medical practitioners should not provide private patient services that will involve the use of Trust staff or facilities, unless an undertaking and authority to pay for those facilities has been obtained from (or on behalf of) the patient. 1.2 These standards apply to medical practitioners who are Trust employees and who undertake private practice:- In Trust facilities; Privately, or In independent facilities. 2. Disclosure of Information about Private Patients 2.1 Medical practitioners will declare in writing any business, professional interest, or other non Trust work, which may directly or indirectly give rise to or may reasonably be perceived to give rise to any conflict of interest, or which is otherwise relevant to the medical practitioner s proper performance of their contractual duties. This information will include details of private practice commitments, including the timing, location and broad type of activity, to facilitate effective planning of Trust work and out of hours cover. Relevant business or professional interests should also be disclosed at least annually as part of the annual Job Plan Review; information will be provided in advance about any significant changes to this information. In line with the requirements of revalidation and best practice, a medical practitioner should submit evidence of private practice to an appraiser. 3
3. Scheduling of Work and Job Planning 3.1 Where there would otherwise be a conflict or potential conflict of interest, Trust commitments must take precedence over private work. Subject to Paragraph 4.2 (below) the medical practitioner is responsible for ensuring that private commitments do not conflict with Trust activities scheduled as part of the Trust s job plan. 3.2 Regular private commitments must be included in the Job Plan. 3.3 Medical practitioners engaging in private practice are expected to provide emergency treatment for their Trust patients, should the need arise. Circumstances may also arise in which medical practitioners need to provide emergency treatment for private patients during time when they are scheduled to be working for the Trust. Medical practitioners will make alternative arrangements to provide cover if emergency work of this kind regularly impacts on the delivery of Trust commitments. 3.4 Medical practitioners should ensure that they have arrangements in place such that there can be no significant risk of private commitments disrupting Trust commitments. 3.5 Where there is a proposed change to the scheduling of Trust work, the Trust will allow a reasonable period (at least 3 months) for medical practitioners to rearrange any private sessions, taking into account any binding commitments that the practitioner may have entered into (eg leases). Where a medical practitioner wishes to reschedule private commitments to a time that would conflict with scheduled Trust work, they should raise the matter with the relevant manager at the earliest opportunity. 4. Scheduling Private Commitments whilst on call 4.1 Medical practitioners should never schedule private commitments that would prevent them from being able to attend a Trust emergency whilst they are on call for the Trust. 4.2 Where a medical practitioner is asked to provide emergency cover for a colleague at short notice and the medical practitioner has previously arranged private commitments, the medical practitioner should only agree to do so if these commitments would not prevent them from returning at short notice to attend to an emergency. If the medical practitioner is unable to provide cover at short notice it will be the Trust s responsibility to make alternative arrangements. 4.3 Medical practitioners may exceptionally be required to provide emergency care for private patients whilst they are on call for the Trust; where medical practitioners find that this is a regular occurrence, they should reschedule their private commitments to prevent such occurrences. 4
5. Provision of Private Services alongside NHS Duties 5.1 Where a patient pays privately for a procedure that takes place at a Trust facility, outwith clinical requirements, it should typically take place at a time that does not impact on normal services for Trust patients. Such procedures should only occur when the patient has given an undertaking to pay any relevant charges to the Trust. 5.2 Except in emergencies, medical practitioners will not initiate private patient services, which involve the use of Trust staff or facilities unless an undertaking to pay for those facilities has been obtained from (or on behalf of) the patient, in accordance with the Trust s procedures. 5.3 Private patients will normally be seen separately from scheduled Trust patients. Under no circumstances will a practitioner cancel an NHS patient appointment to make way for a private patient. 6. Patient Enquiries about Private Treatment 6.1 Where, in the course of their duties, a medical practitioner is approached by a patient and asked about the provision of private services, the practitioner may provide only such standard advice as has been agreed by the Trust for such circumstances. 6.2 During the course of their Trust duties and responsibilities the medical practitioner will not make arrangements to provide private services, or ask any other member of staff to make such arrangements on their behalf, unless the patient is being treated as a private patient by the Trust. 7. Promotion of Private Services by Consultants 7.1 In the course of their Trust duties and responsibilities medical practitioners will not initiate discussions about providing private services, or ask any other Trust staff to initiate such discussions on their behalf. 7.2 Where a Trust patient seeks information about the availability or waiting time for Trust and/or private services, practitioners should ensure that any information provided by them, or provided by other Trust staff on their behalf, is accurate and up to date. 8. Promoting Improved Patients Access to NHS Care 8.1 Subject to clinical considerations, medical practitioners will be expected to contribute as fully as possible to reducing waiting times and improving access and choice for Trust patients. This should include ensuring that patients, as far as practical, are given the opportunity to be treated by other Trust colleagues or by other providers where this will reduce their waiting time and facilitating the transfer of such patients. 5
9. Increasing NHS Capacity 9.1 Medical practitioners will make all reasonable efforts to support initiatives to increase Trust capacity and develop Trust services to the benefit of the public. This will include supporting the Trust in appointing additional medical staff where appropriate. 10. Managing Private Patients in Trust Facilities 10.1 Medical practitioners may only see patients privately within Trust facilities with the agreement of the Trust and in accordance with the general principles set out in Sections 1 and 5. 10.2 Medical Practitioners who practice privately within Trust facilities must comply with the Trust s policies and procedures for private practice. The Trust will consult with such medical practitioners when adopting or reviewing such policies. 10.3 Where it has been agreed that a medical practitioner may use the Trust s facilities for the provision of private services: (i) (ii) (iii) The Trust will determine and make such charges for the use of its services, accommodation or facilities as it considers reasonable. Any charge will be collected by the Trust, either from the patient or a relevant third party. A charge will take full account of any diagnostic procedures used, the cost of any laboratory staff that have been involved and the cost of any Trust equipment that might have been used. 10.4 The above issues should be made clear to the patients at the time of decision to treat in Trust facilities. In situations when there are difficulties with the recovery of Trust costs associated with the provision of private medical care, the medical practitioner should assist Trust staff in the recovery of these costs. 11. Use of Trust Staff 11.1 If Trust staff are asked to assist a medical practitioner in providing private services, or to provide private services on behalf of a medical practitioner, it is the medical practitioner s responsibility to ensure that relevant staff (e.g., the Facility Manager and Private Patient Officer) are aware that the patient or service user, on whose behalf the service is being provided, has private status. 11.2 Trust staff who are asked and agree to undertake supporting work for a medical practitioner who is undertaking private patient work, must not do so in their NHS work time or use any NHS equipment or facilities without prior agreement from the Trust. 6
12. Identification of Private Patients 12.1 Medical practitioners practicing privately within Trust s facilities must comply with the Trust s policies and procedures for private practice. This includes a personal obligation by any medical practitioner responsible for admitting a private patient to the Trust s facilities to ensure, in accordance with local procedures, that they identify that patient as private and that the responsible manager is aware of that patient s status. 13. Transfer of Patients between Private and NHS Status 13.1 Patients have a right to transfer from private healthcare to NHS care without detriment or privilege. However, it is not permitted for a patient to transfer back and forward between private and NHS status in respect of the same episode / medical condition. 13.2 In order to ensure that there is an appropriate audit trail in respect of the transfer of status from private healthcare to NHS status, all changes in status should have a timed, dated entry in the clinical notes clearly indicating that the patient has ceased being a private patient and that on-going treatment will be NHS status. The notes must clearly indicate the reason for the change of status. The Trust s Private Patient Officer must be notified of the change of status on the next working day. 13.3 Medical Practitioners who resume the care of any patient who wishes to revert to private status during the same treatment episode, having previously opted to change from private to NHS status, could be in breach of this code of conduct. 13.4 It is recognised that there may be exceptional circumstances where reversion to private treatment could be justified. In such circumstances the agreement of the Medical Director and the relevant Director must be obtained prior to recommencement of private treatment. Equality, Human Rights and DDA This policy has been drawn up and reviewed in the light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. It has been screened to identify any adverse impact on the 9 equality categories and no significant differential impacts were identified, therefore, an Equality Impact Assessment is not required. Alternative formats This document can be made available on request on disc, larger font, Braille, audio-cassette and in other minority languages to meet the needs of those who are not fluent in English. Sources of Advice in relation to this document The Policy Author, responsible Assistant Director or Director as detailed on the policy title page should be contacted with regard to any queries on the content of this policy. 7