Mixing Private and NHS Treatment

The fundamental principle is that NHS treatment and private treatment should be provided in separate episodes of care. An NHS trust cannot charge you for NHS care simply because you are also paying for private care at the same time or in the same facility.

In practice this means:

• If you choose to pay for a private room ("amenity bed") in an NHS hospital, the clinical care (operations, drugs, nursing) must still be provided free on the NHS.
• If you are receiving NHS treatment for one condition and private treatment for a different condition simultaneously, these are separate episodes and neither affects the other.
• A hospital cannot make NHS treatment conditional on you accepting private services.

If you believe you have been charged for NHS care you were entitled to receive free, complain to PALS or make a formal complaint, and contact NHS England.

Since 2009, NHS England guidance has permitted patients to pay privately for treatments or drugs that the NHS does not fund (for example, a drug not approved by NICE), while still receiving their NHS care. These are sometimes called "top-up payments" or "co-payments."

Key rules:

• The additional private treatment must be clearly separated from NHS care and delivered in a distinct private episode where possible.
• NHS staff may administer the privately funded drug in the same clinical setting, but this must be clearly documented and contracted separately.
• The NHS cannot withdraw or reduce the NHS elements of care because you are funding additional private treatment.

The rules are complex and implementation varies between NHS trusts. Always request a clear written agreement setting out what is NHS-funded and what you are paying privately before starting.

Many patients use private healthcare for diagnostics or initial consultations (where NHS waits can be longest) and then return to NHS care for treatment. You are fully entitled to do this:

• Your private specialist can write to your GP with their findings, and your GP can then make an NHS referral for treatment.
• If you have already been seen privately, an NHS consultant may accept a copy of private test results to avoid duplication — though they are not obliged to do so.
• Your 18-week NHS waiting time clock starts from the date of the NHS referral, not from any private appointments.

The main risk is that you spend money privately on diagnostics and then still face a significant NHS wait for treatment. Consider whether a private referral directly to a surgical team (who can also operate privately) may be more efficient.

If you have private health insurance (PHI), check your policy carefully before proceeding with any treatment:

• Most policies require pre-authorisation before elective treatment — failing to get this may mean the insurer refuses to pay.
• Exclusions often apply to pre-existing conditions, chronic conditions, and some mental health treatments.
• Your insurer may have a network of approved hospitals and consultants — using providers outside this network may not be fully covered.
• If your insurer refuses to fund treatment, you have the right to complain internally and then to the Financial Ombudsman Service (FOS).

Private health insurance does not affect your right to NHS care — you can always choose to use the NHS instead of or in addition to your private coverage.