How do I combine private work with NHS work?
If you work for the NHS, it is likely that you will have a minimum obligation to inform your employer of your private work. During the job planning process with them, you should discuss the type of private work that you intend to undertake and the proposed commitment. It is also important to ensure that supporting evidence is provided in relation to your entire scope of practice at appraisal.
Your NHS work should not be prejudiced by your private practice and therefore it is prudent to consider options for protection in the event of diary clashes or emergencies arising. Consideration should also be given as to whether you are going to be providing the patient’s care individually or as part of a consortium. The former is likely to have a larger time involvement and should be factored in. For example, an anaesthetist working alone privately may need to consider who is going to be responsible for the patient’s postoperative care and for how long, whereas this may already be organised when working as part of a consortium.
Is indemnity a legal requirement?
Doctors are legally required to have adequate and appropriate insurance or indemnity. For doctors working within the private sector or undertaking voluntary work, there is a requirement to ensure you have adequate protection for the type and nature of work undertaken. The GMC has regulatory powers to check whether a registrant has adequate protection in place. The NHS provides indemnity for its employees for work carried out on its behalf within the terms of your NHS contract, but it is advisable to check your indemnity for private work undertaken, even if on behalf of the NHS.
It should not be assumed that you have the correct indemnity in place, if in doubt refer to your contract and discuss with the membership department of your medical defence organisation, such as Medical Protection.
Do I need insurance to undertake private work?
As a private practitioner, you will need to consider Public Liability insurance (PL). PL is important if a member of the public claims they have been injured or suffered damage to their property while visiting your practice, or during a house call. It covers the cost of claims made by members of the public for incidents that occur in connection with your business activities, such as personal injuries, loss of, or damage to property.
How do I manage private patient records?
The Data Protection Act 2018 sits alongside and supplements General Data Protection Regulation (GDPR). Healthcare data is classed as ‘Special Category Data’ and there are financial penalties for non-compliance, in addition to the possibility of litigation.
Under GDPR, anyone who determines the purposes for which personal data is collected or used is known as a ‘data controller’. Therefore, by default, private consultants are data controllers, and as such, need to be registered with the Information Commissioner’s Office. If you have practising privileges at a private hospital, you may share responsibilities with the private hospital and be a ‘shared data controller’.
Data controllers have legal responsibilities to have policies and processes in place, maintain a record of processing, audit security arrangements, and ensure lawful processing of data. Dependent upon the size of your practice, you may need a Data Protection Officer in place. More information is available at the Information Commissioner's Office, which has a helpful data protection self-assessment resource.1
How long should I store private patient records?
In line with GDPR, there is a requirement to not store information longer than necessary. Article 5(1)e states personal data shall be kept in a form that permits identification of data subjects for no longer than is necessary for the purposes for which the personal data are processed.
There is no definitive guidance relating to retention periods for private clinical records, however the GMC’s Good Practice in Managing and Protecting Personal information at paragraph 130 states, “you should follow this guidance even if you do not work within the NHS”2. The NHS England Transformation Directorate has also published a Records Management Code of Practice 2021, that sets out details regarding public and statutory enquiries, record retention schedules, and specific record types (including adoption, witness protection, and transgender records) respectively.3
It is important to highlight that the Record Retention Schedule provides minimum retention periods. Medical Protection recommends that if you are aware of a complaint, adverse event, or possible litigation, it is prudent to extend the retention period. Complaint files should be kept separate from the medical records and retained for ten years, from closure of the complaint or other processes. The absence of medical records can make it very difficult to mount a successful defence should this be required.
What happens to the records when I retire?
If you are the data controller for patient information, there remains a requirement for you to remain registered with the ICO and comply with data protection requirements. You will also have to be able to process Subject Access Requests (SARs).
Death does not remove the statutory requirements in relation to the data that you hold, including Special Category Data. It is therefore important to plan and consider who will fulfil your duty after death. It is recommended that this is discussed with a solicitor and provisions are made within your will.
Are there any other registrations I need to be aware of?
If you provide or intend to provide health or social care activities in England, there is a legal requirement under the Health and Social Care Act 2008 to be CQC registered.
Can I accept patients without a referral?
If, as a specialist, you accept patients without a GP referral, you should inform the patient’s GP before providing treatment unless the patient objects. If the GP is not involved, then the specialist is responsible for ongoing treatment until another doctor agrees to take over, according to paragraphs 44 and 45 of Good Medical Practice4.
While private practice is undoubtedly an attractive undertaking for doctors practising in the NHS, there are a number of key considerations to keep in mind. The usual GMC guidance still applies even in private work, and it is vital to ensure you have suitable indemnity in place for any work you undertake.