I saw my GP with what he says is an ingrowing toenail, but he just told me to get it seen to privately. I don’t have health cover and am on a low wage – can I insist on a referral?.

A GP should never tell a patient to seek treatment privately. If it is relating to a specific medication or treatment that your GP agrees you should receive and the PCT is refusing to fund it, you can apply for a special funding request. This is strongest when it goes through your GP, but you can apply as many times as you like. If you intend to apply, look at your PCT website under “Individual Funding Request” (IFR) for contact details of who to apply to, with guidelines covering the most common conditions appealed over. For your IFR to succed, you must show that the patient (you or your family member) is significantly different to others with the condition; and so is likely to gain significant more benefit. After you’ve applied, you will be invited to attend the appeal hearing if you wish. These is a chance to appeal again in most cases if your IFR fails first time.

Description: A GP should never tell a patient to seek treatment privately.

A GP should never tell a patient to seek treatment privately


Look up the NICE treatment recommendations (nice.org.uk, under the “For Guidance” section) for a particular condition. If NICE approves, the PCT must make it available within three months. Contact your local PALS (Patient Advice and Liaison Service; pals.nhs.uk) for help.

Private And NHS Partnerships

·         I’m having a knee op and have been told it will be done by the NHS surgeon but at the local private hospital. How does this arrangement work?

·         Some private hospitals have spare capacity, especially during the working week as private patients prefer to be seen in the evenings and weekends. They offer the local NHS Hospital Trust cut-price deals to take on straightforward work, say ten hip replacements. NHS managers assess if they can save money by contracting this work out. Complicated procedures and emergencies are still carried out at NHS hospitals, but it can make financial sense to the PCT to send simple operations elsewhere. The plus for patients is a private room, better surroundings and a better menu.

I have been told by a receptionist that my operation is being delayed as I have been “re-badged”. What does that mean?

This is hospital slang for someone whose waiting list status has changed. If you are on a waiting list for an operation, and you are told you are no longer considered urgent but routine, you may have been re-badged. It should be a clinical decision taken by your specialist either as your condition has changed, or because there are more urgent cases that need to be seen before you. There has been some controversy about whether re-badging is being done to save money on tightly stretched NHS budgets.


 If you can’t understand why, and feel your condition hasn’t changed, talk to your GP. If you feel you are being treated unfairly, contact the Government watchdog, ombudsman.org.uk.

I’ve been to my GP with the same problem three times and would like a second opinion

If it’s the GP you are registered with, you are entitled to see another GP in the practice. Tell them your problem won’t go away and they’ll make their own diagnosis and recommendation. If you want a second opinion after a consultation with a specialist, ask if they are willing to “let a colleague take a look”. You wouldn’t have to be re-referred by your GP. If they refuse, you can return to your GP and ask to be referred elsewhere, but you will go to the end of the waiting list for the new hospital.


Rather than ask for a second opinion, say you want to “confirm the diagnosis”.

Get The Best From Ann Nhs Consultation

·         Write down your key question in advance. List current medicines or supplements, or take them with you.

·         Make a note of when you started to feel unwell, symptoms and contributing factors such as a recent holiday or injury.

·         Ask a friend or family member along if you need support.

·         Share all information with your doctor and don’t be embarrassed. They really are trained to deal with the intimate and uncomfortable.

I’ve been approved for a hysterectomy, but I’d like the operation to be carried out near my daughter’s home, 300 miles away. Can I ask for that under Choose and Book?

Description: Can I ask for that under Choose and Book?

Can I ask for that under Choose and Book?

Under the NHS Constitution, patients have the right to choose where they are treated, within certain parameters. In practice, however, this is not happening, with some PCTs refusing to fund outside their area. As funding is cut throughout the NHS, there is often a disconnect between good intension and delivery.


Speak to your GP as they may be willing to help. If you do get referred and the PCT refuses, write to the chief executive of the PCTT (find their name under “About Us” on the PCT website), explaining your circumstances and ask them to reconsider. Reasonable requests for common procedures (such as a hysterectomy) are more likely to succeed than requests for expensive or experimental treatments.

Make Life Easier!

Description: Make Life Easier!

1.    Learn how your practice works when you are well – not in an emergency. Check how to book an urgent (on the day) appointment; does the practice have email booking; does it always use GPs to see acutely ill patients – or a specialist nurse practitioner, who will be highly trained and experienced, and possibly allowed to prescribe too. Don’t assume every surgery in the same.

2.    Get written permission in place: a simple letter that says “It is okay for X to discuss my medical care “can be left on patient notes. Set one up for an elderly relative. It means, for example, you can phone for test results.

3.    Keep a list of any medications or herbal or vitamin supplements (which may cause interactions) you take regularly in your purse, plus a repeat prescription, if you have one. Then, if you need to register with a GP on a temporary basis (eg on holiday), they can help more efficiently.

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