Belfast Trust Guide to Paying Patients handbook - Belfast Health ...

ContentsIntroduction 3Objectives 4Categories of work covered by this Handbook 5Policy statement 6Consultant Medical staff responsibilities relating to private patients 7Restrictions on Private Practice applicable to medical staff 9Change of Status 10Trust staff responsibilities 11Operational arrangements 12Financial arrangements – private patients 15Financial arrangements – fee paying services and renunciation of private fees 16HSC patients who wish to pay for additional care 18Overseas Patients (Non UK) 20Glossary 221

AppendicesAppendix 1 Specific examples of fee paying services 23Schedule 10 – Consultant ContractAppendix 2 Code of Conduct for Private Practice 25Appendix 3 Undertaking to Pay Form 31Appendix 4 Change of Status Form 32Appendix 5 Principles governing the receipt of additional fees 33Schedule 11 – Consultant ContractAppendix 6 Notification of fee-paying services CAT 2 Form 34Appendix 7 Top up Determination of Cost Form 35Appendix 8 Top up of Additional Care Agreement Form 36Appendix 9 Amenity Request Form 37Appendix 10 Agreement for Voluntary Advance Renunciation of 38Earnings from Fee Paying ActivitiesAppendix 11 Provisions governing the relationship 39Between HPSS work and Private PracticeSchedule 9 – Consultant ContractAppendix 12 Private Practice Flowchart 42Appendix 13 Overseas Visitors Flowchart 432

IntroductionThe Trust came into existence on 1 April 2007 and is responsible for providingintegrated care across six sites namely• the Royal Group of Hospitals and Social Services Trust• the Mater Hospital Health and Social Services Trust• Belfast City Hospital Health and Social Services Trust• Green Park Health and Social Services Trust• North and West Belfast Health and Social Services Trust• South and East Belfast Health and Social Services TrustThe Trust welcomes additional income that can be generated from the followingsources• Private Patients• Fee Paying Services• HSC ‘top up’ patients• Overseas VisitorsAll income generated from these sources is deemed to make a valuedcontribution to the running costs of the Trust and will be reinvested to improveour facilities to benefit NHS and private patients alike.All Policies and procedures in relation to these areas will be carried out inaccordance with Trust guidelines.For further information please do not hesitate to contact the Paying PatientOffice.Eileen Murphyeileen.murphyppo@belfasttrust.hscni.net Senior Manager 028 9063 4390Jennifer Young BCH Site 028 9026 3656Martina Nugent-Corr Mater/Musgrave Site 028 9080 2392Lynda Weatherall RVH site 028 9063 5430Sarah Craig RVH site 028 9063 20863

ObjectivesThe purpose of this handbook is to:• Standardise the manner in which all paying patient practice is conducted inthe organisation.• Raise awareness of the duties and responsibilities within the health service ofconsultant medical staff engaging in private practice and fee paying serviceswithin the Trust.• Raise awareness of the duties and responsibilities of all Trust staff, clinical andnon clinical in relation to the treatment of paying patients and fee payingservices within the Trust.• Ensure fairness to both NHS patients and fee paying patients at all times.• Clarify for relevant staff the arrangements pertaining to paying patients andto give guidance relating too record keepingo chargingo procedures ando responsibilities for paying patient attendances, admissions and fee payingservices.• Clarify charging arrangements when consultants undertake fee paying serviceswithin the Trust.4

Categories of work covered by this handbookFee Paying ServicesAny paid professional services, other than those falling within the definition ofPrivate Professional Services, which a consultant carries out for a third party orfor the employing organisation and which are not part of, nor reasonablyincidental to, Contractual and Consequential Services. A third party for thesepurposes may be an organisation, corporation or individual, provided that theyare acting in a health related professional capacity, or a provider or commissionerof public services. Examples of work that fall within this category can be foundin Schedule 10 of the Terms and Conditions (Appendix 1).Private Professional Services (also referred to as ‘private practice’)• the diagnosis or treatment of patients by private arrangement (including suchdiagnosis or treatment under Article 31 of the Health and Personal SocialServices (Northern Ireland) Order 1972), excluding fee paying services asdescribed in Schedule 10 of the terms and conditions• work in the general medical, dental or ophthalmic services under Part IV ofthe Health and Personal Social Services (Northern Ireland) Order 1972 (exceptin respect of patients for whom a hospital medical officer is allowed a limited‘list’, e.g. members of the hospital staff).HSC Patients who Wish to Pay for Additional Private Care• From 2009 patients wishing to ‘top up’ or supplement their NHS care havebeen able to do so without losing their entitlement to ongoing NHS care,an example of which is patients with cancer, who are now able to supplementtheir NHS care by paying for drugs which are not currently funded by theNHS.Overseas VisitorsThe National Health Service provides healthcare free of charge to people whoare a permanent resident in the UK/NI. A person does not become an ordinarilyresident simply by having British Nationality; holding a British Passport; beingregistered with a GP, or having an NHS number. People who do not permanentlylive in NI/UK are not automatically entitled to use the NHS free of charge.RESIDENCY is the therefore the main qualifying criterion.5

Policy StatementMedical and Dental consultant staff have the right to undertake Private Practiceand Fee paying services within the Terms and Conditions of the new ConsultantContract as agreed within their annual job plan review.This Trust provides the same care to all patients, regardless of whether the costof their treatment is paid for by HSC Organisations, Private Medical Insurancecompanies or by the patient.Private practice and Fee Paying services at the Trust will be carried out inaccordance with:• The Code of Conduct for private practice, the recommended standard ofpractice for NHS consultants as agreed between the BMA and the DHSSPS(Appendix 2).• Schedule 9 of the Terms and Conditions of the Consultant contract which setsout the provisions governing the relationship between HPSS work and privatepractice (Appendix 11).• The receipt of additional fees for Fee Paying services as defined in Schedule 10of the Terms and Conditions of the Consultant contract (Appendix 1).• The principles set out in Schedule 11 of the above contract (Appendix 5).All patients treated within the Trust, whether private or NHS should:• be allocated a unique hospital identifier• be recorded on the Patient Administration System and• have a Belfast Health & Social Care Trust chart.The Trust shall determine the prices to be charged in respect of all income towhich it is entitled as a result of private practice or other fee paying serviceswhich take place within the Trust.6

Consultant Medical Staff ResponsibilitiesPrivate PracticeWhile Medical and Dental consultant staff have the right to undertake PrivatePractice within the Terms and Conditions of the new Consultant Contract asagreed within their annual job plan review, it is the responsibility of consultants,prior to the provision of any diagnostic tests or treatment to:• ensure that their private patients (whether In, Day or Out) are identified andnotified to the Paying Patients Officer• ensure full compliance with the Code of Conduct for Private Practice (seeAppendix 2) in relation to referral to NHS Waiting Lists• ensure that patients are aware of and understand ALL costs associated withprivate treatment including hospital costs and ALL professional fees which thepatient is likely to incur, to include Surgeon/Physician, Anaesthetist,Radiologist, Pathologist, hospital charges. Leaflets explaining charges areavailable and can be obtained from the Paying Patients Officer.• obtain prior to admission and at each outpatient attendance a signed,witnessed Undertaking to Pay form (Appendix 3) which must then be sent tothe Paying Patient Officer for the relevant hospital. This document mustcontain details of all diagnostic tests and treatments prescribed.• Establish the method of payment at the consultation stage and obtain detailsof insured patients’ private medical insurance policy information. The Trustrequires this information to be forwarded to the Paying Patient Officer prior toadmission so that patients’ entitlement to insurance cover can be established.• Ensure that all patients are referred by the appropriate channels, ie. GP/otherconsultant.• Ensure that private patient services that involve the use of NHS staff or facilitiesare not undertaken except in emergencies, unless an undertaking to pay fortreatment has been obtained from (or on behalf of) the patient, in accordancewith the Trust’s procedures.Fee paying services - see Appendix 1 for examplesThe Consultant job plan review will cover the provision of fee paying serviceswithin the Trust. Consultants are required to liaise with the Paying Patients Officerregarding the type of work undertaken so that agreement can be reachedregarding the amount due to the Trust and how it should be remitted.A price list for fee paying services will be available from the Paying PatientsOffice.It is the responsibility of the Consultant to ensure that the Trust is reimbursed forall costs incurred while facilitating fee paying services work undertaken. Thesecosts could include• use of Trust accommodation• tests or other diagnostic procedures performed.• radiological scansConsultants who engage in fee paying activities within the Trust are required toremit to the Trust on a quarterly basis the income due.7

All patients seen for medical legal purposes must sign a notification of fee payingservices form and this should be retained and submitted by the consultant on aquarterly basis along with the corresponding payment. See relevant section forfurther details.Additional programmed activitiesConsultants should agree to accept an extra paid programmed activity in theTrust, if offered, before doing private work. The following points should beborne in mind:• If Consultants are already working 11 Programmed Activities (PAs) (orequivalent) there is no requirement to undertake any more work• A Consultant could decline an offer of an extra PA and still work privately, butwith risk to their pay progression for that or subsequent years• Any additional PAs offered must be offered equitably between all Consultantsin that specialty; if a colleague takes up those sessions there would be nodetriment to pay progression for the other Consultants.Consultant Medical Staff are governed by The Code of Conduct for PrivatePractice 2003 (at Appendix 2).8

Restrictions on Private Practice for ConsultantMedical StaffNew consultantsNewly appointed consultants (including those who have held consultant postselsewhere in the NHS, or equivalent posts outside the NHS) may not undertakeprivate practice within the Trust or use the Trusts facilities or equipment forprivate work, until the detailed arrangements for this have been agreed in writingwith their Clinical Director and/or Directorate Director and a job plan agreedwithin three months of commencement. New consultants permitted toundertake private work must make themselves known to the Paying PatientsOfficer.Locum consultantsLocum consultants may not engage in Private Practice within the first threemonths of appointment and then not until the detailed Job Plan has been agreedwith the relevant Clinical Director and subject to the agreement of thepatient/insurer.HPSS Joint Appointment consultant staffAll joint appointees are contracted to the Queens University of Belfast and areaccountable to the Trust for the HPSS component of their post. Accordingly thesame regulations apply to them as to NHS consultants.Honorary Contract holdersConsultants holding honorary contracts are not permitted to undertake PrivatePractice or Fee Paying Services.Non Consultant Grade Medical StaffNon-consultant medical staff practitioners such as associate specialists who donot have their own beds may treat patients of a consultant on a private basis, butonlya) by special arrangement and with the agreement of:• consultant concerned• the practitioner’s supervising consultant and• the private patient/insurerb) when the practitioner undertakes such work outside the his/her programmedactivities as per their agreed job plan.Other than in the circumstances described above, staff are required to assist theconsultant to whom they are responsible with the treatment of their privatepatients in the same way as their NHS patients. The charge paid by privatepatients to the hospital covers the whole cost of the hospital treatment includingthat of all associated staff.9

Change of Status between Private and NHSTreatment EpisodeA patient who sees a consultant privately shall continue to have private statusthroughout the entire treatment episode.Single statusAn outpatient cannot be both a Private and an NHS patient for the treatment ofthe one condition during a single visit to an NHS hospital.Outpatient transferHowever a private outpatient at an NHS hospital is legally entitled to changehis/her status at a subsequent visit and seek treatment under the NHS, subject tothe terms of any undertaking he has made to pay charges.Waiting listA patient seen privately in consulting rooms who then becomes an NHS patientjoins the waiting list at the same point as if his consultation had taken place as anNHS patient.Inpatient transferA private inpatient has a similar legal entitlement to change his status. Thisentitlement can only be exercised when a significant and unforeseen change incircumstances arises e.g. when they enter hospital for a minor operation and theyare found to be suffering from a different more serious complaint. He remainsliable to charges for the period during which he was a private patient.Clinical priorityA change of status from Private to NHS must be accompanied by an assessmentof the patient’s clinical priority for treatment as an NHS patient.Change of status formWhere a change of status is required a ‘Change of Status’ Form (Appendix 4)must be completed and sent to the Paying Patients Officer. This includes thereason for the change of status which will be subject to audit and must be signedby both the consultant and Paying Patients Officer.It is important to note that until the Change of Status form has beenreceived by the Paying Patient Office the patients status will remainprivate and they may well be liable for charges.10

Trust Staff Responsibilities relating to Private Patientsand Fee Paying ServicesA private patient is one who formally undertakes to pay charges for healthcareservices regardless of whether they self pay or are covered by insurance and allprivate patients must sign a form to that effect (The Undertaking to Pay form atAppendix 3) prior to the provision of any diagnostic tests or treatments. Truststaff are required to have an awareness of this obligation.The charge which private patients pay to the Trust covers the total cost of thehospital treatment excluding consultant fees. Trust staff are required to performtheir duties in relation to all patients to the same standard. No payment* shouldbe made to or accepted by any non consultant member of Trust staff for carryingout normal duties in relation to any patients of the Trust.* This excludes payments owed to professional staff under their terms andconditions or the regulations of their professional bodies. This could include forexample payments made by the Board to junior doctors and non consultantgrade medical staff who undertake family planning service work.11

Operational ArrangementsEach hospital within the Trust has a named officer who should be notified inadvance of all private patient admissions, day cases and outpatients. The PayingPatient Officer is responsible for ensuring that the Trust recovers all income dueto the Trust arising from the treatment of private patients.The Paying Patients Officer, having received the signed and witnessedUndertaking to Pay form will identify the costs associated with the private patientstay, will confirm entitlement to insurance cover where relevant and will raiseinvoices on a timely basis.All Directorates should advise the Paying Patients Officer as soon as any newconsultant agrees a job plan which includes private practice. The Paying PatientsOfficer will advise them of the procedures involved in undertaking privatepractice in the Trust.Clinical governance is defined as a framework through which NHS organisationsare accountable for continuously improving the quality of their services andsafeguarding high standards of care by creating an environment in whichexcellence in clinical care will flourish.This framework applies to all patients seen within this Trust. It is therefore afundamental requirement of Clinical Governance that all patients treated withinthe Trust must be examined or treated in an appropriate clinical setting .Any fee or emolument etc which may be received by an employee in the courseof his or her clinical duties shall, unless the Trust otherwise directs be surrenderedto the Trust.Record keeping systems and Private PatientsAll patients regardless of their status, NHS or Private, Medical Legal, OSV/NUKshould be recorded on Hospital Systems and their status classified appropriately.These systems include for example:• Patient Administration System (PAS)• Northern Ireland Maternity System (NIMATS)• Laboratory System (e.g.Lab Centre etc)• Radiology System(e.g. Sectra, NIRADS, RIS etc)The rule applies equally to:• private patients, medical legal patients, ‘top up’ patients and Overseas Visitors• in, day and out patients,• each of the hospitals within the Trust.12

Health Records of Private PatientsAll health records shall remain the property of the Trust and should only be takenoutside the Trust to assist treatment elsewhere:• when this is essential for the safe treatment of the patient• when an electronic record of the destination of the notes is made using thecase note tracking system• when arrangements can be guaranteed that such notes will be kept securely(not for example in a consultant’s car or brief case or during transportation)• provided that nothing is removed from the notesConsultants who borrow notes for private treatment of patients must agree toreturn the notes without delay.Since the Trust does not have a right of access to patient notes held in non NHSfacilities, when patients are seen privately outside the Trust their firstappointment within the Trust, unless with the same consultant, will be treated asa ‘new appointment’ rather than a ‘review appointment’.Booking arrangements for Admissions and AppointmentsA record of attendance should be maintained for all patients seen in the Trust. Allprivate in, day and out patients should as far as possible be pre-booked on to thehospital information systems. Directorates are responsible for ensuring that allrelevant information is captured and ‘booking in’ procedures are followed. Eachdepartment should ensure that all such patients are recorded on PAS etc withinan agreed timescale which should not extend beyond month end.Walk InsA private patient who appears at a clinic and has no record on PAS should betreated for record keeping purposes in exactly the same manner as an NHSpatient (walk in) i.e. relevant details should be taken, registry contacted for anumber and processed in the usual fashion. A record should be kept of thispatient and the Paying Patient Officer informed.RadiologyAll patients seen in Radiology should be given a Belfast Health and Social Carehospital number.Private Patient RecordsAll records associated with the treatment of private patients should bemaintained in the same way as for NHS patients. This includes all files, charts,and correspondence with General practitioners.Accurate record keeping assists in the collection of income from paying patients.13

It should be noted that• any work associated with private patients who are not treated within this Trustor consultants private diary work and correspondence associated with patientsseen elsewhere should not be carried out within staff time which is paid for bythe Trust.Tests Investigations or Prescriptions for Private PatientsThe consultant must ensure that the requests for all laboratory work, ie.radiology, prescriptions, dietetics, physiotherapy etc are clearly marked as Private.Consultants should not arrange services, tests investigations or prescriptions untilthe person has signed an undertaking to pay form.Medical ReportsIn certain circumstances Insurance Companies will request a medical report fromthe consultant. It is the consultant’s responsibility to ensure that this report iscompleted in the timeframe required by the insurance company otherwise theTrust’s invoice may remain unpaid in whole or in part until the report has beenreceived and assessed.14

Financial Arrangements - Private PatientsCharges to patientsWhere patients who are private to a consultant are admitted to the hospital, orare seen as outpatients, charges will be levied by the hospital. A full list ofcharges is available from the Paying Patient Office on request.Prices are reviewed regularly to ensure that all costs are covered.Basis of pricingCharges are based on an accommodation charge, cost of procedure, includingany prosthesis, and on a cost per item basis for all diagnostic tests andtreatments e.g. physiotherapy, laboratory and radiology tests, ECGs etc. They donot include consultants’ professional fees. Some package prices may be agreed.Uninsured patients - DepositsA deposit, payable on admission, is required from uninsured patients undergoinghigh cost procedures. Consultants should advise patients that this is the case.The patient should be advised to contact the Paying Patients Officer regardingamounts etc.Insured PatientsThe Undertaking to Pay Form also requires details of the patient’s insurancepolicy. The Paying Patients Officer will raise invoices direct to the insurancecompany where relevant, in accordance with the agreements with individualinsurance companies.Consultants, as the first port of contact and the person in control of thetreatment provided, should ensure that the patient has obtained their insurancecompany’s permission for the specified treatment to take place within thespecified timescale.Billing and PaymentThe Paying Patients Officer co-ordinates the collation of financial informationrelating to patients’ treatment, ensures that uninsured patients pay deposits andthat invoices are raised accordingly. The financial accounts department willensure all invoices raised are paid and will advise the Private Patient Officer in theevent of a bad debt.AuditThe Trust’s financial accounts are subject to annual audit and an annual report isissued to the Trust Board, which highlights any area of weakness in control.Adherence to the Paying Patient Policy will form part of the Trust’s Audit Plan.Consultants are reminded that they are responsible for the identification andrecording of paying patient information. Failure to follow the procedures willresult in investigation by Audit and if necessary, disciplinary action under Trustand General Medical Council regulations.15

Financial Arrangements for fee paying servicesConsultants may see patients privately or for fee paying services within the Trustonly with the explicit agreement of the Management, in accordance with theirJob Plan. Management will decide to what extent, if any, Trust facilities, staff andequipment may be used for private patient or fee paying services and will ensurethat any such services do not interfere with the organisation’s obligations to NHSpatients. This applies whether private services are undertaken in the consultant’sown time, in annual or unpaid leave.In line with the Code of conduct standards, private patient services should takeplace at times that do not impact on normal services for NHS patients. Privatepatients should normally be seen separately from scheduled NHS patients.Fee Paying Services Policy (Category 2)Fee Paying Services (Category 2) work is distinct from private practice, however itis still non NHS work as outlined in the ‘Terms and Conditions for HospitalMedical and Dental Staff’. Refer to schedules 10 and 11 (Appendices 1 & 5respectively) for further details.There are a number of occasions when a Category 2 report will be requested,and they will usually be commissioned by, employers, courts, solicitors,Department of Work and Pensions etc, the report may include radiologicalopinion, blood tests or other diagnostic proceduresIt is the responsibility of the Consultant to ensure that the Trust is reimbursed forall costs incurred in undertaking Category 2 work, this not only includes the useof the room but also the cost of any tests undertaken.The charge for each attendance is intended to reimburse the full cost to the Trustof providing facilities for consulting purposes. Where a patient attends hospitalfor a specific treatment or test only the cost of that treatment/test is chargeable.In order to comply with the Trusts financial governance controls it is essential thatall Fee Paying services are identified and the costs recovered. It is not theresponsibility of the Trust to invoice third parties for Category 2 work, it is theresponsibility of the Consultant to recover the cost from the third party andreimburse the Trust, on a quarterly basis, for any Category 2 services they haveundertaken, including the cost of any treatments/tests provided.The Category 2 (room only) charge per patient will be reviewed annually.(*) A per session rate may be available subject to agreement with the Paying PatientManagerIt is an audit requirement that the Trust verifies that all income associated withFee Paying services has been identified and collected. Accordingly, Consultantsare required to submit a quarterly return to the Paying Patient office with thenames of the patients seen (including Category 2 work), together with details ofany treatment or tests undertaken. This information should accompany thepayment for the relevant fees of Category 2 work as outlined above.In order to comply with Data Protection requirements, Consultants musttherefore inform their Category 2 clients that this information is required by theTrust and obtain their consent by completing a notification of Fee Paying Servicesform (Appendix 6).16

Category 2 activity should be recorded on the Patient Administration System(PAS) as ward attendees using the ward code MLW and category PPG.Compliance to this policy will be monitored by the Paying Patient Manager andthe Medical Director’s Office.The Consultant is responsible to HM Customs and Revenue to declare for taxpurposes all Category 2 income earned. The Trust has no obligation in thisrespect.Any Category 2 work undertaken for consultants by medical secretaries must becompleted outside of their normal NHS hours. Consultants should be aware oftheir duty to inform their secretaries that receipt of such income is subject totaxation and must be declared to the Inland Revenue. It is recommended thatConsultants keep accurate records of income and payment.Renunciation of private feesIn some departments, consultants may choose to forego their private fees forprivate practice or for fee paying services in favour of a Charitable Fund managedby the Trust.For income tax purposes all income earned must be treated as taxable earnings.The only way in which this income can be treated as non taxable earnings of theconsultant concerned is if the consultant signs a ‘Voluntary AdvanceRenunciation of Earnings form’ (Appendix 10) and declares that the earningsfrom a particular activity will belong to a named charitable fund and that theearnings will not be received by the consultant. In addition a consultant shouldnever accept a cheque made out to him or her personally. To do so attractstaxation on that income and it cannot be subsequently renounced. Therefore allsuch income renounced in advance should be paid directly into the relevant fund.Income can only be renounced if it has not been paid to the individual. Therenunciation form can be obtained from the Finance Department and a Registerof these will be maintained by the Charitable Funds Officer.The Trust will be required to demonstrate that income renounced in favour of aCharitable Fund is not retained for the use of the individual who renounces it.Thus, in the event of any such consultant subsequently drawing on that fund,any such expenditure approval must be countersigned by another signatory onthe fund.17

HSC Patients who wish to pay for additional private carePLEASE NOTE THIS IS ONLY A BRIEF GUIDE THE FULL POLICY CAN BEOBTAINED FROM THE PAYING PATIENT OFFICE ON REQUESTGuiding PrinciplesAll actions must be carried out within the principles as outlined below:Entitlement to HSC Care must RemainA patient’s entitlement to HSC care should not be withdrawn as a result ofpurchasing additional drug treatments privately.Clarity of Distinction between HSC and Private CareIt should always be clear whether an individual procedure or treatment isprivately funded or HSC funded. HSC resources must never be used to subsidisethe use of private care.Separation of Provision between HSC and Private CarePrivate care should be carried out at a different time and in a different place tothe HSC care, ie as separate from those receiving HSC care as possible. Adifferent place could include the facilities of a healthcare provider, or part of anHSC organisation which has been permanently or temporarily designated forprivate care, or the services of home healthcare provider. Departing from thisprinciple should only be considered where there are overriding concerns ofpatient safety rather than mere issues of convenience.It would be good practice that the Consultant delivering the private aspect of thecare is a different Consultant to that delivering the publicly funded component ofthe care. This may not be feasible in every circumstance.HSC Funding Options must first be ExhaustedDoctors, working with managers, should exhaust all reasonable avenues forsecuring HSC funding before suggesting a patient’s only option is to pay for careprivately.Governance / Risk ManagementTransferring between private and HSC care should be carried out in a way whichavoids putting patients at unnecessary risk.It is the consultants responsibility to follow the process below and inform thePaying Patient Office of any patient who is considering this option so that thepatient is made fully aware of all costs involved prior to any treatmentcommencing.ProcessStep 1A patient indicates their desire to pay for additional private care to theirConsultant.18

Step 2The Consultant completes a ‘Determination of Cost’ form (Appendix 7) with thefollowing information:- Patient Details- Additional Chemotherapy Treatment, Frequency, Care Setting- Pharmacy Costs- Diagnostic Tests- Toxicity Grading reflecting Increased Risk of AdmissionStep 3The Consultant emails the Determination of Cost form to the Private PatientOfficer who generates an estimated cost for the patient / Consultant as required.Step 4If the patient agrees to go ahead with the additional private care, the patient andConsultant both sign the Additional Private Care Agreement form (Appendix 8).This is then sent to the Paying Patients Office as it acts as an Undertaking to Payform. The Paying Patients Office will retain a copy, give a copy to the patient, topharmacy and to the Consultant for filing in the patient’s notes.Billing and Recouping CostsThe patient will pay per cycle of chemotherapy, with each payment beingreceived in advance of the treatment being administered. Where treatment hasbeen authorised and preparation of a drug has been commenced for a patientwho becomes too unwell to proceed, the cost of the drug will be charged to thepatient for whom it was originally prepared, and where payment has alreadybeen received, the cost will not be refundedIf a decision is taken during or after treatment that the drug in question is to beprovided on the HSC, costs will not be refunded.Where treatment has been authorised and a drug preparation commenced whichdoes not result in administration for non patient reasons, the costs of repeat drugpreparation, where required, will be covered by the Trust.The process of billing and recouping payments will be managed via the Trust’sPaying Patients Office.19

Overseas visitors - Non UK patients(Republic of Ireland, EEA, Foreign Nationals)PLEASE NOTE THIS IS ONLY A BRIEF GUIDE FOR FURTHER INFORMATIONPLEASE CONTACT THE PAYING PATIENT OFFICEThe NHS provides healthcare free of charge to people who are ordinarily residentin the UK. People who do not permanently live in the UK lawfully are notautomatically entitled to use the NHS free of charge.RESIDENCY is the therefore the main qualifying criterion, applicable regardless ofnationality, being registered with a GP or having been issued a HC/NHS number,or whether the person holds a British Passport, or lived and paid taxes or nationalinsurance contributions in the UK in the past.Any patient attending the Trust who cannot establish that they are an ordinaryresident and have lawfully lived in the UK permanently for the last 12 monthspreceeding treatment are not entitled to free non ED hospital treatment whetherthey are registered with a GP or not. A GP referral letter cannot be acceptedsolely as proof of a patient’s permanent residency and therefore entitlement totreatment.For all new patients attending the Trust, residency must be established. Allpatients will be asked to complete a declaration to confirm residency, (regardlessof race/ethnic origin. If not the Trust could be accused of discrimination.Where there is an element of doubt as to whether the patient is an ‘ordinaryresident’ eg no GP/ H&C number or non UK contact details, the Paying PatientsOfficer must be alerted immediately.Emergency DepartmentTreatment given in an Emergency Department, Walk in clinic or minor casualtyunit is free of charge if it is deemed to be immediate and necessary.The Trust should always provide immediate and necessary treatment whether ornot the patient has been informed of or agreed to pay charges .There is noexemption from charges for ‘emergency’ treatment other than that given in theaccident and emergency department. Once an overseas patient is transferred outof Emergency Department their treatment becomes chargeable.All patients admitted from Emergency Department must be asked to completedeclaration of residency status.This question is essential in trying to establish whether the patient is an overseaspatient or not and hence liable to pay for any subsequent care provided.If the patient is not an ordinary resident or there is an element of doubt eg noGP/ no H&C, the patient should be referred to Paying Patients Office todetermine their eligibility.If the person has indicated that they are a visitor to Northern Ireland, theoverseas address must be entered as the permanent address on the correctPatient Administrative System and the Paying Patients Office should be notifiedimmediately.20

Outpatient AppointmentsIn all cases where the patient has not lived in Northern Ireland for 12 months orrelevant patient data is missing such as H&C number, GP Details etc the patientmust be referred to the paying patient office to establish the patient’s entitlementto free NHS treatment. This must be established before an appointment is given.Review AppointmentsWhere possible follow up treatment should be carried out at the patient’s localhospital, however if they are reviewed at the Trust they must be informed thatthey will be liable for charges.If a consultant considers it appropriate to review a patient then they must sign astatement to this effect waiving the charges that would have been due to theTrust.Elective AdmissionA patient should not be placed onto a waiting list until their entitlement to freeNHS Treatment has been established. Where the Patient is chargeable, the Trustshould not initiate a treatment process until a deposit equivalent to the estimatedfull cost of treatment has been obtained.Referral from other NHS TrustsWhen a Consultant accepts a referral from another Trust the patients’ statusshould where possible be established prior to admission. However, absence ofthis information should not delay urgent treatment.The Trust will operate a policy of ‘Stabilise and Transfer’.Amenity bed PatientsWithin The Trust’s Maternity Service, a number of beds are assigned AmenityBeds. It is permissible for NHS patients who require surgical delivery and anovernight stay to pay for any bed assigned as an Amenity Bed. This payment hasno effect on the NHS status of the patient. All patients identified as amenity willbe recorded on PAS as APG and an amenity form (Appendix 9) should becompleted ideally before obtaining the amenity facilities.21

GlossaryUndertaking to Pay FormPrivate Patients may fund their treatment, or they may have private medicalinsurance. In all cases Private Patients must sign an ‘Undertaking to Pay’ form(Appendix 3).This is a legally binding document which, when signed prior to treatment,confirms the patient as personally liable for costs incurred while at hospital andconfirms the Patients Private status.ALL private patients, whether insured or not are obliged to complete and sign an‘Undertaking to Pay’ form, prior to commencement of treatment. Consultantstherefore, as the first point of contact should ensure that the Paying PatientsOfficer is advised to ensure completion of the ‘Undertaking to Pay’ form.Fee Paying ServicesAny paid professional services, other than those falling within the definition ofPrivate Professional Services, which a consultant carries out for a third party or forthe employing organisation and which are not part of, nor reasonably incidentalto, Contractual and Consequential Services. A third party for these purposes maybe an organisation, corporation or individual, provided that they are acting in ahealth related professional capacity, or a provider or commissioner of publicservices. Examples of work that fall within this category can be found inSchedule 10 of the Terms and Conditions (Appendix 1).Private Professional Services (Also referred to as ‘private practice’)• the diagnosis or treatment of patients by private arrangement (including suchdiagnosis or treatment under Article 31 of the Health and Personal SocialServices (Northern Ireland) Order 1972), excluding fee paying services asdescribed in Schedule 10 of the terms and conditions (Appendix 1).• work in the general medical, dental or ophthalmic services under Part IV of theHealth and Personal Social Services (Northern Ireland) Order 1972 (except inrespect of patients for whom a hospital medical officer is allowed a limited‘list’, e.g. members of the hospital staff).Non UK patientsA person who does not meet the ‘ordinarily resident’ testJob PlanA work programme which shows the time and place of the consultant's weeklyfixed commitments.22

Appendix 1Specific examples of Fee Paying Services - Schedule 101. Fee Paying Services are services that are not part of Contractual orConsequential Services and not reasonably incidental to them. Fee PayingServices include:a. work on a person referred by a Medical Adviser of the Department ofSocial Development, or by an Adjudicating Medical Authority or aMedical Appeal Tribunal, in connection with any benefits administeredby an Agency of the Department of Social Development;b. work for the Criminal Injuries Compensation Board, when a specialexamination is required or an appreciable amount of work is involved inmaking extracts from case notes;c. work required by a patient or interested third party to serve the interestsof the person, his or her employer or other third party, in such nonclinicalcontexts as insurance, pension arrangements, foreign travel,emigration, or sport and recreation. (This includes the issue ofcertificates confirming that inoculations necessary for foreign travel havebeen carried out, but excludes the inoculations themselves. It alsoexcludes examinations in respect of the diagnosis and treatment ofinjuries or accidents);d. work required for life insurance purposes;e. work on prospective emigrants including X-ray examinations and bloodtests;f. work on persons in connection with legal actions other than reportswhich are incidental to the consultant’s Contractual and ConsequentialDuties, or where the consultant is giving evidence on the consultant’sown behalf or on the employing organisation’s behalf in connection witha case in which the consultant is professionally concerned;g. work for coroners, as well as attendance at coroners' courts as medicalwitnesses;h. work requested by the courts on the medical condition of an offender ordefendant and attendance at court hearings as medical witnesses,otherwise than in the circumstances referred to above;i. work on a person referred by a medical examiner of HM Armed ForcesRecruiting Organisation;j. work in connection with the routine screening of workers to protectthem or the public from specific health risks, whether such screening is astatutory obligation laid on the employing organisation by specificregulation or a voluntary undertaking by the employing organisation inpursuance of its general liability to protect the health of its workforce;k. occupational health services provided under contract to other HPSS,independent or public sector employers;l. work on a person referred by a medical referee appointed under theWorkmen's Compensation (Supplementation) Act (Northern Ireland)1966; work on prospective students of universities or other institutionsof further education, provided that they are not covered by Contractual23

Appendix 1and Consequential Services. Such examinations may include chestradiographs;m. Appropriate examinations and recommendations under Parts II and IV ofthe Mental Health (Northern Ireland) Order 1986 and fees payable tomedical members of Mental Health Review Tribunals;n. services performed by members of hospital medical staffs forgovernment departments as members of medical boards;o. work undertaken on behalf of the Employment Medical Advisory Servicein connection with research/survey work, i.e. the medical examination ofemployees intended primarily to increase the understanding of thecause, other than to protect the health of people immediately at risk(except where such work falls within Contractual and ConsequentialServices);p. completion of Form B (Certificate of Medical Attendant) and Form C(Confirmatory Medical Certificate) of the cremation certificates;q. examinations and reports including visits to prison required by the PrisonService which do not fall within the consultant’s Contractual andConsequential Services and which are not covered by separatecontractual arrangements with the Prison Service;r. examination of blind or partially-sighted persons for the completion ofform A655, except where the information is required for social securitypurposes, or by an Agency of the Department of Social Development, orthe Employment Service, or the patient's employer, unless a specialexamination is required, or the information is not readily available fromknowledge of the case, or an appreciable amount of work is required toextract medically correct information from case notes;s. work as a medical referee (or deputy) to a cremation authority andsigning confirmatory cremation certificates;t. medical examination in relation to staff health schemes of localauthorities and fire and police authorities;u. delivering lectures;v. medical advice in a specialised field of communicable disease control;w. attendance as a witness in court;x. medical examinations and reports for commercial purposes, e.g.certificates of hygiene on goods to be exported or reports for insurancecompanies;y. advice to organisations on matters on which the consultant isacknowledged to be an expert.24

Appendix 2A Code of Conduct for Private PracticeNovember 2003Recommended Standards of Practicefor NHS ConsultantsAn agreement between the BMA’s Northern Ireland Consultants andSpecialists Committee and the Department of Health, Social Servicesand Public Safety for consultants in Northern Ireland.A CODE OF CONDUCT FOR PRIVATE PRACTICE:RECOMMENDED STANDARDS FOR NHS CONSULTANTS, 2003ContentsPage 40Part I – Introduction- Scope of Code- Key PrinciplesPage 41Part II - Standards of Best Practice- Disclosure of Information about Private Practice- Scheduling of Work and On-Call Duties- Provision of Private Services alongside NHS Duties- Information for NHS Patients about PrivateTreatment- Referral of Private Patients to NHS Lists- Promoting Improved Patient Access to NHS Careand increasing NHS CapacityPage 6Part III - Managing Private Patients in NHSFacilities- Use of NHS Facilities- Use of NHS Staff25

Appendix 2Part I: IntroductionScope of Code1.1 This document sets out recommended standards of best practice for NHSconsultants in England about their conduct in relation to private practice .The standards are designed to apply equally to honorary contract holders inrespect of their work for the NHS. The Code covers all private work,whether undertaken in non-NHS or NHS facilities.1.2 Adherence to the standards in the Code will form part of the eligibilitycriteria for clinical excellence awards.1.3 This Code should be used at the annual job plan review as the basis forreviewing the relationship between NHS duties and any private practice.Key Principles1.4 The Code is based on the following key principles:NHS consultants and NHS employing organisations should work on apartnership basis to prevent any conflict of interest between privatepractice and NHS work. It is also important that NHS consultants and NHSorganisations minimise the risk of any perceived conflicts of interest;although no consultant should suffer any penalty (under the code) simplybecause of a perception;The provision of services for private patients should not prejudice theinterest of NHS patients or disrupt NHS services;With the exception of the need to provide emergency care, agreed NHScommitments should take precedence over private work; andNHS facilities, staff and services may only be used for private practice withthe prior agreement of the NHS employer.26

Appendix 2Part II: Standards of Best PracticeDisclosure of Information about Private Practice2.1 Consultants should declare any private practice, which may give rise to anyactual or perceived conflict of interest, or which is otherwise relevant to thepractitioner’s proper performance of his/her contractual duties. As part ofthe annual job planning process, consultants should disclose details ofregular private practice commitments, including the timing, location andbroad type of activity, to facilitate effective planning of NHS work and outof hours cover.2.2 Under the appraisal guidelines agreed in 2001, NHS consultants should beappraised on all aspects of their medical practice, including private practice.In line with the requirements of revalidation, consultants should submitevidence of private practice to their appraiser.Scheduling of Work and On-Call Duties2.3 In circumstances where there is or could be a conflict of interest,programmed NHS commitments should take precedence over private work.Consultants should ensure that, except in emergencies, privatecommitments do not conflict with NHS activities included in their NHS jobplan.2.4 Consultants should ensure in particular that:private commitments, including on-call duties, are not scheduled duringtimes at which they are scheduled to be working for the NHS (subject toparagraph 2.8 below);there are clear arrangements to prevent any significant risk of privatecommitments disrupting NHS commitments, e.g. by causing NHS activitiesto begin late or to be cancelled;private commitments are rearranged where there is regular disruption ofthis kind to NHS work; and private commitments do not prevent them frombeing able to attend a NHS emergency while they are on call for the NHS,including any emergency cover that they agree to provide for NHScolleagues. In particular, private commitments that prevent an immediateresponse should not be undertaken at these times.2.5 Effective job planning should minimise the potential for conflicts ofinterests between different commitments. Regular private commitmentsshould be noted in a consultant’s job plan, to ensure that planning is aseffective as possible.2.6 There will be circumstances in which consultants may reasonably provideemergency treatment for private patients during time when they arescheduled to be working or are on call for the NHS. Consultants shouldmake alternative arrangements to provide cover where emergency work ofthis kind regularly impacts on NHS commitments.2.7 Where there is a proposed change to the scheduling of NHS work, theemployer should allow a reasonable period for consultants to rearrange anyprivate sessions, taking into account any binding commitments enteredinto (e.g. leases).27

Appendix 2Provision of Private Services alongside NHS Duties2.8 In some circumstances NHS employers may at their discretion allow someprivate practice to be undertaken alongside a consultant’s scheduled NHSduties, provided that they are satisfied that there will be no disruption toNHS services. In these circumstances, the consultants should ensure thatany private services are provided with the explicit knowledge andagreement of the employer and that there is no detriment to the quality ortimeliness of services for NHS patients.Information for NHS Patients about Private Treatment2.9 In the course of their NHS duties and responsibilities consultants should notinitiate discussions about providing private services for NHS patients, norshould they ask other NHS staff to initiate such discussions on their behalf.2.10 Where a NHS patient seeks information about the availability of, or waitingtimes for, NHS and/or private services, consultants should ensure that anyinformation provided by them, is accurate and up-to-date and conformswith any local guidelines.2.11 Except where immediate care is justified on clinical grounds, consultantsshould not, in the course of their NHS duties and responsibilities, makearrangements to provide private services, nor should they ask any otherNHS staff to make such arrangements on their behalf unless the patient isto be treated as a private patient of the NHS facility concerned.Referral of Private Patients to NHS Lists2.12 Patients who choose to be treated privately are entitled to NHS services onexactly the same basis of clinical need as any other patient.2.13 Where a patient wishes to change from private to NHS status, consultantsshould help ensure that the following principles apply:a patient cannot be both a private and a NHS patient for the treatment ofone condition during a single visit to a NHS organisation;any patient seen privately is entitled to subsequently change his or herstatus and seek treatment as a NHS patient;any patient changing their status after having been provided with privateservices should not be treated on a different basis to other NHS patients asa result of having previously held private status;patients referred for an NHS service following a private consultation orprivate treatment should join any NHS waiting list at the same point as ifthe consultation or treatment were an NHS service. Their priority on thewaiting list should be determined by the same criteria applied to other NHSpatients; andshould a patient be admitted to an NHS hospital as a private inpatient, butsubsequently decide to change to NHS status before having receivedtreatment, there should be an assessment to determine the patient’spriority for NHS care.28

Appendix 2Promoting Improved Patient Access to NHS Care and increasingNHS Capacity2.14 Subject to clinical considerations, consultants should be expected tocontribute as fully as possible to maintaining a high quality service topatients, including reducing waiting times and improving access and choicefor NHS patients. This should include co-operating to make sure thatpatients are given the opportunity to be treated by other NHS colleagues orby other providers where this will maintain or improve their quality of care,such as by reducing their waiting time.2.15 Consultants should make all reasonable efforts to support initiatives toincrease NHS capacity, including appointment of additional medical staff.29

Appendix 2Part III – Managing Private Patients in NHS Facilities3.1 Consultants may only see patients privately within NHS facilities with theexplicit agreement of the responsible NHS organisation. It is for NHSorganisations to decide to what extent, if any, their facilities, staff andequipment may be used for private patient services and to ensure that anysuch services do not interfere with the organisation’s obligations to NHSpatients.3.2 Consultants who practise privately within NHS facilities must comply withthe responsible NHS organisation’s policies and procedures for privatepractice. The NHS organisation should consult with all consultants or theirrepresentatives, when adopting or reviewing such policies.Use of NHS Facilities3.3 NHS consultants may not use NHS facilities for the provision of privateservices without the agreement of their NHS employer. This applieswhether private services are carried out in their own time, in annual orunpaid leave, or – subject to the criteria in paragraph 2.8 - alongside NHSduties.3.4 Where the employer has agreed that a consultant may use NHS facilities forthe provision of private services:the employer will determine and make such charges for the use of itsservices, accommodation or facilities as it considers reasonable;any charge will be collected by the employer, either from the patient or arelevant third party; anda charge will take full account of any diagnostic procedures used, the costof any laboratory staff that have been involved and the cost of any NHSequipment that might have been used.3.5 Except in emergencies, consultants should not initiate private patientservices that involve the use of NHS staff or facilities unless an undertakingto pay for those facilities has been obtained from (or on behalf of) thepatient, in accordance with the NHS body’s procedures.3.6 In line with the standards in Part II, private patient services should takeplace at times that do not impact on normal services for NHS patients.Private patients should normally be seen separately from scheduled NHSpatients. Only in unforeseen and clinically justified circumstances should anNHS patient's treatment be cancelled as a consequence of, or to enable,the treatment of a private patient.Use of NHS Staff3.7 NHS consultants may not use NHS staff for the provision of private serviceswithout the agreement of their NHS employer.3.8 The consultant responsible for admitting a private patient to NHS facilitiesmust ensure, in accordance with local procedures, that the responsiblemanager and any other staff assisting in providing services are aware of thepatient’s private status.30

Undertaking to Pay Chargesfor Fee Paying PatientsAppendix 3Patient StatusInpatientDay caseOutpatientNon- UKName: ____________________________________________________________Address: _______________________________________________________________________________________________________________________________________Post code: ________________ Tel. no.: ____________________________________DOB: ______________ Email: ____________________________________________Royal BCH Mater MusgraveHospital No.: ______________________________________Ward: _____________________________________________Room No.: _________________________________________Consultant: ________________________________________Insurance/Self pay: _________________________________Membership No.: __________________________________Cost centre: ____________________________________Deposit paid: ___________________________________Receipt No.: ____________________________________Requisition No.: ________________________________Invoice No.: ____________________________________Authorisation No./Claim No.: ____________________Admission date: ____________________________Discharge date: _______________________________________________________________________Procedure date: ___________________________________________Procedure name: __________________________________________Procedure code: ___________________________________________Test date Test name etc. Code PricePlease read this document carefully before signing below. This is legally bindingI undertake to pay Belfast Trust in respect of accommodation and services provided to me as a private patientThe charges which I pay to the Belfast Trust will, unless otherwise stated, be based on a length of stay, theatrecharges, implantables, and other diagnostic tests and treatments as they occur. I understand that such chargesrelate to only hospital costs and do not include any fees for the private services of the consultant, or fees from anyother consultant practitioner who may provide services relating to my care (eg. radiologist, pathologist, andanaesthetist)Please Note YOU will remain liable for any part of your account not settled by your insurer. It is yourresponsibility to check insurance cover.If you are a self funding/non UK patient you are required to pay an 80% deposit before your treatment takesplace.The Trust reserves the right to suspend treatment should any payment not be made as requested.PLEASE NOTE: Should payment not be made the Trust reserves the right to bring this to the attention of otheragencies such as the Police, Immigration Department and professional bodies.I understand I am being treated as a Fee Paying Patient in the BHSCT and agree to the terms above.Signed: _______________________________________________Date: _________________________________________________Witnessed: ________________________________________________ Date: _______________________31

Appendix 4Application for the Transfer ofPrivate Patient to NHS StatusPatients name: ___________________________________________Hospital number or DOB: ___________________________________I hereby state that the above patient will be transferred to NHS status from: ___________________________________The change in status has been requested because of:I wish to confirm that from the aforementioned date, no charges have been / will be levied by me.Signature: _______________________________________(Consultant) please print nameDate: __________________________In agreement with the consultant I do/do not approve the transfer of the above patient from private to NHSstatus.Signature: _______________________________________Eileen Murphy - Paying Patient ManagerDate: __________________________A patient who is initially seen privately and who then becomes an NHS patient joins the waiting list at the samepoint as if his consultation had taken place as an NHS patient, the consultant can refer that patient to himself inhis NHS clinic rather than referring the patient back to their GP. NB: until this form is received by the privatepatient office the patient will remain private and may be liable for charges.32

Appendix 5Principles Governing Receipt of Additional Fees -Schedule 111. In the case of the following services, the consultant will not be paid an additionalfee, or - if paid a fee - the consultant must remit the fee to the employingorganisation:• any work in relation to the consultant’s Contractual and Consequential Services;• duties which are included in the consultant’s Job Plan, including any additionalProgrammed Activities which have been agreed with the employingorganisation;• fee paying work for other organisations carried out during the consultant’sProgrammed Activities, unless the work involves minimal disruption and theemploying organisation agrees that the work can be done in HPSS time withoutthe employer collecting the fee;• domiciliary consultations carried out during the consultant’s ProgrammedActivities;• lectures and teaching delivered during the course of the consultant’s clinicalduties;• delivering lectures and teaching that are not part of the consultant’s clinicalduties, but are undertaken during the consultant’s Programmed Activities.This list is not exhaustive and as a general principle, work undertaken duringProgrammed Activities will not attract additional fees.2. Services for which the consultant can retain any fee that is paid:• Fee Paying Services carried out in the consultant’s own time, or during annual orunpaid leave;• Fee Paying Services carried out during the consultant’s Programmed Activitiesthat involve minimal disruption to HPSS work and which the employingorganisation agrees can be done in HPSS time without the employer collectingthe fee;• domiciliary consultations undertaken in the consultant’s own time, though it isexpected that such consultations will normally be scheduled as part ofProgrammed Activities 1 ;• Private Professional Services undertaken in the employing organisation’s facilitiesand with the employing organisation’s agreement during the consultant’s owntime or during annual or unpaid leave;• Private Professional Services undertaken in other facilities during the consultant’sown time, or during annual or unpaid leave;• lectures and teaching that are not part of the consultant’s clinical duties and areundertaken in the consultant’s own time or during annual or unpaid leave;• preparation of lectures or teaching undertaken during the consultant's own timeirrespective of when the lecture or teaching is delivered.This list is not exhaustive but as a general principle the consultant is entitled to thefees for work done in his or her own time, or during annual or unpaid leave.1 And only for a visit to the patient’s home at the request of a general practitioner and normally in his or hercompany to advise on the diagnosis or treatment of a patient who on medical grounds cannot attend hospital.33

Appendix 6Notification of Fee Paying Services- Category IIName: __________________________________________________________________________________Address: __________________________________________________________________________________________________________________________________________________________________________Post code: _________________ Telephone number: __________________________________________DOB: ______________________Site: Royal BCH Mater MusgraveHospital number:Consultant:Date of attendance:Test where applicable:Any professional service that a consultant carries out for a third party or for the employing organisation andwhich are not part of their contractual services must be declared to the Trust. Therefore in order to comply withfinancial governance controls all consultants as part of their contractual obligations and with the patient consentare required to identify anyone who falls into this category.I understand I am being treated as a category II patient and that my information may be shared within the Trustto comply with financial governance controls. As a category II patient I am also aware that I am not personallyresponsible for any costs incurred and will not be billed personally.Signed: ____________________________________________________Date: ____________________________________Consultant: ________________________________________________Date ______________________________________Return completed forms to:Private Patient Officer BHSCT- Site Telephone numberLynda Weatherall RVH (028) 9063 5430Sarah Craig RVH (028) 9063 5283Jennifer Young BCH (028) 9026 3656Martina Nugent-Corr MIH/MPH (028) 9090 202834

Additional Private CareDetermination of CostAppendix 7Use addressograph-otherwise write in capitalsSurname:First names:Consultant:Hospital no:Cycle Number:Ward:DOB:Check identityDefine additional treatment to be paid for (PLEASE COMPLETE IN BLOCK CAPITALS)Chemotherapy Frequency of cycles Care setting Drug cost per cycleEg. IRINOTECAN / CETUXIMAB EVERY 2 WKS BRIDGEWATER SUITE -Determination of costs per cycle (see attached notes)PharmacyDrug procurementDispensingAdministrationCare deliveryDay case / InpatientDiagnostic testsa.b.c.Consulting room fee*Surcharge for treatment of toxicityAdministrative overheadsFlat rateTotalCost per cycle*Excludes Consultant fee - as separate contract betweenpatient and ConsultantAdditional notes (for internal use only)1. Pharmacy dispensingTo be advised by Pharmacy, dependenton complexity banding2. Day case/Inpatient rateThe proportionate increase in time withthe additional treatment should beapplied to the Trust’s agreed privatepatient rate, but should never exceedthat value3. Diagnostic testsThe patient’s Consultant must list out theadditional diagnostic tests associatedwith the additional treatment. PayingPatients Office will advise as to the Trust’sagreed private patient rate4. Consulting room feeThe Trust’s agreed private patient ratefor a consultation should be used5. Administrative overheadscharged at £30/cycle of chemotherapy6. Surcharge for treatment of toxicitythe patient’s Consultant to adviseregarding the % increase of risk ofadmission for Grade 3 or greater toxicity,over and above the risk with standardcare. Low (5%), medium (10%) or high(20%) to be applied35

Appendix 8Additional Private Care AgreementUse addressograph-otherwise write in capitalsSurname:First names:Consultant:Hospital no:Cycle Number:Ward:DOB:Check identityThis agreement must be completed for all patients opting to pay for additional private care. Itmust be counter signed by both the patient and the Consultant responsible for the additionalcare, to confirm understanding and agreement of the statements below.Charges1. The patient understands that the additional treatment andany associated costs are not being funded by the NHS.2. The patient has been advised of outline costs of theadditional care although it is recognised that these costsmay alter. Any changes to the costs will be discussed withthe patient by the Paying Patients Office.3. The patient understands that if he/she is no longer able tofund the additional treatment, the treatment will cease.4. The patient understands that if he/she becomes too unwellto proceed, the cost of the drug will be charged, and wherepayment has already been received, the cost will not berefunded.5. The patient understands that where treatment has beenauthorised and a drug preparation commenced which doesnot result in administration for non patient reasons, thecosts of repeat drug preparation, where required, will becovered by the NHS.6. The patient understands that if the NHS funds thistreatment in future, the NHS will not refund the cost of anyadditional treatment already provided.Additional treatment1. The patient has received information aboutthe proposed treatment as well as all othertreatment options.2. The patient has been given full informationabout the potential benefits and risks ofthe proposed treatment and othertreatment options and this information hasbeen recorded on the consent form.3. Informed consent has been obtained in linewith GMC guidance.4. This treatment is currently not available inthe NHS.5. The outcome of this treatment willcontribute to relevant local and nationalaudits.6. The outcome of this treatment may bediscussed at multi disciplinary clinicalgovernance meetings.7. The patient understands that the NHS is not responsible andhas no legal liability for the quality of services where utilised8. These costs do not affect all patients’ right to access toemergency care.Chemotherapy Print name Sign name DatePatientConsultantPrivate Patients office36Please send to Paying Patients Office who will sign, and will arrange for a copy to be given to the patient,to pharmacy and a copy to be returned for filing in the patient’s notes.

Appendix 9Amenity Request FormPlease note amenity accommodation is only available to patients who require surgicaldelivery and an overnight stay. Completion of this form does not guarantee you aroom these are allocated on availabilityPatient name: ______________________________________________Address: ________________________________________________________________________________________________________________________________________________________________________________________Post code: _________________DOB.: _____________________________________Hospital number: _______________________________Contact number: _______________________________Details of person paying account (if different from above):Name: _____________________________________________________Address: ________________________________________________________________________________________________________________________________________________________________________________________Contact number: _______________________________Accommodation typeCostEnsuiteSingle roomSingle roomJohnston HouseJohnston HouseOther wardsPlease read this document carefully before signing it is a legally binding document.• Any concerns MUST be voiced during your stay as these will not be considered once you have beendischarged.• All rooms where possible should be vacated no later than 12.00 o’clock on the day of discharge.• Your account must be settled on the day of discharge either by cash/cheque or visa/debit card.Patients are also reminded that it may be necessary to vacate accommodation if it is needed on medicalgrounds for another patient.I undertake to pay the Belfast Health and Social Care Trust in respect of my amenity accommodation:Signature: ________________________________________________________ Date: _______________________________Signed (Witness):__________________________________________________ Date: _______________________________If you have any queries relating to this please do not hesitate to contact the Paying Patients OfficeOn the following numbers (028) 9063 4257 or (028) 9063 4390.37

Appendix 10Agreement for the voluntaryadvance renunciation of earningsfrom fee paying activitiesI (name): _________________________________________________________request that any monies due to me from patients in relation to fees from (description of activity)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________shall be transferred to (Charity title and reference) ______________________________________________________________for its sole use in the advancement of its aims in accordance with the Trust Deed until directed otherwise by mein writing.This request is to take effect fromdate: ______________________________________________________________________Signed, sealed and delivered by:_____________________________________________________________________________(Full name in Block Capitals)Date: ____________________________________________________________________________In the presence of:(Full name in Block Capitals)_____________________________________________________________________________Date: ____________________________________________________________________________Address: _________________________________________________________________________________________________________________________________________________________________________________________Post Code: ________________________________38

Appendix 11Provisions Governing the Relationship betweenHPSS Work and Private Practice - Schedule 91. This Schedule should be read in conjunction with the ‘Code of Conduct forPrivate Practice’, which sets out standards of best practice governing therelationship between HPSS work and private practice.2. The consultant is responsible for ensuring that their provision of PrivateProfessional Services for other organisations does not:• result in detriment to HPSS patients;• diminish the public resources that are available for the HPSS.Disclosure of information about Private Commitments3. The consultant will inform his or her clinical manager of any regularcommitments in respect of Private Professional Services or Fee PayingServices. This information will include the planned location, timing andbroad type of work involved.4. The consultant will disclose this information at least annually as part of theJob Plan Review. The consultant will provide information in advance aboutany significant changes to this information.Scheduling of Work and Job Planning5. Where a conflict of interest arises or is liable to arise, HPSS commitmentsmust take precedence over private work. Subject to paragraphs 10 and 11below, the consultant is responsible for ensuring that private commitmentsdo not conflict with Programmed Activities.6. Regular private commitments must be noted in the Job Plan.7. Circumstances may also arise in which a consultant needs to provideemergency treatment for private patients during time when he or she isscheduled to be undertaking Programmed Activities. The consultant willmake alternative arrangements to provide cover if emergency work of thiskind regularly impacts on the delivery of Programmed Activities.8. The consultant should ensure that there are arrangements in place, suchthat there can be no significant risk of private commitments disrupting HPSScommitments, e.g. by causing HPSS activities to begin late or to becancelled. In particular where a consultant is providing private services thatare likely to result in the occurrence of emergency work, he or she shouldensure that there is sufficient time before the scheduled start ofProgrammed Activities for such emergency work to be carried out.9. Where the employing authority has proposed a change to the scheduling ofa consultant’s HPSS work, it will allow the consultant a reasonable period inline with Schedule 6, paragraph 2 to rearrange any private commitments.The employing organisation will take into account any binding commitmentsthat the consultant may have entered into (e.g. leases). Should a consultantwish to reschedule private commitments to a time that would conflict withProgrammed Activities, he or she should raise the matter with the clinicalmanager at the earliest opportunity.39

Scheduling Private Commitments Whilst On-Call10. The consultant will comply with the provisions in Schedule 8, paragraph 5 ofthese Terms and Conditions.In addition, where a consultant is asked to provide emergency cover for acolleague at short notice and the consultant has previously arranged privatecommitments at the same time, the consultant should only agree to providesuch emergency cover if those private commitments would not prevent himor her returning to the relevant HPSS site at short notice to attend anemergency. If the consultant is unable to provide cover at short notice it willbe the employing organisation’s responsibility to make alternativearrangements and the consultant will suffer no detriment in terms of payprogression as a result.Use of HPSS Facilities and Staff11. Where a consultant wishes to provide Private Professional Services at anHPSS facility he or she must obtain the employing organisation’s prioragreement, before using either HPSS facilities or staff.12. The employing organisation has discretion to allow the use of its facilitiesand will make it clear which facilities a consultant is permitted to use forprivate purposes and to what extent.13. Should a consultant, with the employing organisation’s permission,undertake Private Professional Services in any of the employingorganisation’s facilities, the consultant should observe the relevant provisionsin the ‘Code of Conduct for Private Practice’.14. Where a patient pays privately for a procedure that takes place in theemploying organisation’s facilities, such procedures should occur only wherethe patient has given a signed undertaking to pay any charges (or anundertaking has been given on the patient’s behalf) in accordance with theemploying organisation’s procedures.15. Private patients should normally be seen separately from scheduled HPSSpatients. Only in unforeseen and clinically justified circumstances should aconsultant cancel or delay an HPSS patient’s treatment to make way for hisor her private patient.16. Where the employing organisation agrees that HPSS staff may assist aconsultant in providing Private Professional Services, or provide privateservices on the consultant’s behalf, it is the consultant’s responsibility toensure that these staff are aware that the patient has private status.17. The consultant has an obligation to ensure, in accordance with theemploying organisation’s procedures, that any patient whom the consultantadmits to the employing organisation’s facilities is identified as private andthat the responsible manager is aware of that patient’s status.18. The consultant will comply with the employing organisation’s policies andprocedures for private practice40

Patient Enquiries about Private Treatment19. Where, in the course of his or her duties, a consultant is approached by apatient and asked about the provision of Private Professional Services, theconsultant may provide only such standard advice as has been agreedbetween the employing organisation and appropriate local consultantrepresentatives for such circumstances.20. The consultant will not during the course of his or her ProgrammedActivities make arrangements to provide Private Professional Services, norask any other member of staff to make such arrangements on his or herbehalf, unless the patient is to be treated as a private patient of theemploying organisation.21. In the course of his/her Programmed Activities, a consultant should notinitiate discussions about providing Private Professional Services for HPSSpatients, nor should the consultant ask other staff to initiate suchdiscussions on his or her behalf.22. Where an HPSS patient seeks information about the availability of, orwaiting times for, HPSS services and/or Private Professional Services, theconsultant is responsible for ensuring that any information he or sheprovides, or arranges for other staff to provide on his or her behalf, isaccurate and up-to-date.Promoting Improved Patient Access to HPSS Care23. Subject to clinical considerations, the consultant is expected to contribute asfully as possible to reducing waiting times and improving access and choicefor HPSS patients. This should include ensuring that, as far as is practicable,patients are given the opportunity to be treated by other HPSS colleagues orby other providers where this will reduce their waiting time and facilitate thetransfer of such patients.24. The consultant will make all reasonable efforts to support initiatives toincrease HPSS capacity, including appointment of additional medical staffand changes to ways of working.41

Appendix 12Flowchart for Private PracticeConsultant agrees programmed activities and fee payingpractice as part of the annual job plan reviewPrivate patient appointmenttakes place consultant informspatient of hospital costs or referspatient to Paying Patient Officeon relevant site for furtherinformationNeed for patient treatmentestablishedUndertaking to Pay formcompleted by consultant,countersigned by patientPatient booked on waiting listPaying Patient Officer informedby either consultant/waiting listofficeUndertaking to Pay form sent topatient at home in advance ofadmissionConsultant enters diagnostic testsand treatments requested orcompleted on Undertaking toPay FormForm signed and returned toPaying Patient Officer by patient– Entitlement to insurance coverchecked by Paying Patient OfficerPaying Patient Officer visitspatient on day of admission,advises details of charges andcollects depositUndertaking to pay form sent toPaying Patient Officer whochecks entitlement to InsurancecoverPaying Patient Officer collatescharges from all relevantdepartments and Invoice sentout to patient/insurer42

Overseas Visitors (Non-UK) Flow ChartAppendix 13Patient attends Trust, eg. ED/Walk-in/MUI/Outpatients/InpatientsDoes the patient need furthertreatment other than that givenat ED that could not wait untilthe patient return home?NoDischarged and no further action.YesTwo baseline questions and registration form completedResidency is the criterion forentitlement and must beestablished.Patients required to be residentin UK for the last 12 months?NoIs this patient a visitor to the UK/NI?NoYesYesIs the patient statingthat he/she lives hereon a permanentsettled basis?Patients should be able toprovide proof of NI residence.If there is an element of doubteg. these details cannot begiven. Alert the Paying PatientOfficer.No immediate and necessarytreatment can be delayed whilststatus is being determined butall patients identified as non UKshould be made known so thattheir entitlement to NHS isestablished.ED: Only Treatmentgiven in an EmergencyDepartment walk incentre or minor casualtydepartment is free ofcharge This exemptionfrom charges ceases oncethe patient is admittedto a ward or given anout patientappointment. PayingPatient Officer must benotified in this caseNOTEAll reviews outside EDare chargeable.YesAlert the PayingPatient Officer todetermine residencyPatient should beidentified as NUKand is most probablychargeable. Contactthe Paying PatientOfficer as certainexclusions apply43

Belfast Health and Social Care Trust August 2012