Why Our Practice Is Changing the Way We Handle Certain Requests
At Wilmslow Health Centre, our priority is to provide safe, high-quality, and timely NHS care for all our registered patients. Over recent years, we have seen a significant increase in requests from hospitals, community services, and private providers asking GPs to carry out work that those services are already commissioned and paid to do themselves.
This includes:
• issuing prescriptions started by other clinicians
• arranging blood tests and scans requested by hospital or private teams or asking patients to attend for examinations the original doctor has been unable to undertake
• providing follow-up for private treatments
• issuing fit notes linked to hospital or specialist care
We understand it can sometimes feel as though we are being unhelpful when we cannot take on certain tasks. In reality, the hospital and community teams requesting these tasks are already funded and resourced to complete them themselves.
When this work is redirected to us, it takes GP time away from caring for NHS patients and creates an unfair and unsustainable burden on general practice.
Although we have supported these requests for many years, the volume has now grown to a point where it directly affects our ability to provide safe, timely NHS care. After careful discussion — and in line with national BMA and LMC guidance — we can no longer carry out work that is unfunded, inappropriate, or the responsibility of another service.
We know this may sometimes feel frustrating, and we genuinely share that frustration. Please be assured that we will always aim to communicate clearly and compassionately. These boundaries are there to ensure that care remains fair, safe, and sustainable for all our patients.
WHAT THIS MEANS FOR NHS PATIENTS
1. Prescriptions
To ensure safe and consistent prescribing:
· Community clinicians must issue prescriptions for any medication they recommend (for example, podiatrists requesting antibiotics or midwives advising vitamins). Your GP will not be able to provide the prescription just on their say-so. These clinics have a prescriber who can prescribe such medication.
· If a hospital specialist starts a new medication, they must:
i) provide at least two weeks’ supply,
ii) write to us formally with the prescribing plan, being aware that it may take up to 4 weeks depending on clinical capacity for us to review and then agree to issue the medication.
iii) only prescribe in line with the Cheshire formulary -Medicines not permitted within the Cheshire formulary cannot be prescribed in primary care Drugs that require shared care will be reviewed and only accepted if we have the resources to undertake their prescribing.
· Please be aware it may take us a minimum of two weeks to take over prescribing once all paperwork is received and the clinician agrees to do so.
· Shared care requests will be declined unless there is previous agreement and adequate resources to enable this.
· If your specialist wants you to start medication sooner, they can and should provide a NHS prescription directly.
2. Tests and Investigations
For patient safety, the clinician requesting a test must be the one who reviews and acts upon the results. This is guidance set out by the GMC and the local ICB.
Therefore:
· We cannot arrange post-discharge tests or scans unless formally commissioned and accompanied by appropriate hospital request forms.
· Pre-clinic and follow-up blood tests must be arranged directly by the hospital team using their own forms. We may be able to accommodate having the blood test here if the patient has the form the hospital has provided.
NOTE: Our local lab may REFUSE to undertake blood tests of non-local specialists.
· GPs cannot request MRI, CT, or ultrasound scans on behalf of hospital consultants.
· Consultants remain responsible for interpreting all results linked to their own treatment plans.
This prevents delays, result-handling errors, and ensures clear clinical responsibility.
3. Fit Notes (Sick Notes)
If you have had a procedure, admission, or outpatient treatment:
· The hospital or specialist team must issue fit notes for the duration of your recovery or treatment.
· Once the hospital has formally discharged you back to GP care, we can provide any further notes if needed.
This ensures that the clinician who best understands your recovery provides the correct certification.
4. Referrals Between Hospital Teams
If you are already under specialist care:
· Any further referrals connected to that condition should be made directly by the hospital team, not by your GP. (e.g., If an orthopaedic consultant recommends the pain clinic, they must make that referral themselves.)
This avoids unnecessary delays and keeps your care joined up.
WHAT THIS MEANS FOR PATIENTS RECEIVING PRIVATE CARE
We respect that some patients choose private healthcare for parts of their treatment. However, NHS GP practices are not funded to undertake work generated by private providers. Private clinics are set up to provide a complete package of care, which includes prescribing, monitoring, investigations, and follow-up.
1. Private Blood Tests
We cannot provide NHS-funded blood tests for private monitoring purposes, including:
• testosterone or hormone therapy
• fertility testing
• cortisol or T3
• any investigations linked solely to private treatment
Private clinicians are responsible for requesting, interpreting, and acting upon such tests. They must arrange these through private phlebotomy or pathology services.
To keep the process of blood test ordering reasonable and fair for all our patients, we can only offer the following NHS blood tests once every six to twelve months (e.g., FBC, U&E, LFT, thyroid, HbA1c, ferritin, B12/folate, lipids, bone profile, GGT).
Unfunded specialist tests cannot be offered.
Please ask your private consultant to arrange to have these done.
2. Dressings, Suture Removal, ECGs, and Examinations
We cannot provide NHS time or resources for private aftercare, including: • dressing changes • suture removals • ECGs • physical examinations requested by private ADHD or other clinics
Private providers must offer or arrange the appropriate aftercare as part of your package.
3. Prescriptions Started Privately
Your GP may take over prescribing only when:
· it is clinically appropriate and safe,
· it aligns with NHS prescribing policies, and
· proper shared-care arrangements are in place.
Until then, your private clinician must continue to prescribe and monitor your medication.
4. Fit Notes Related to Private Treatment
Private clinicians must issue: • any fit note needed for recovery from private procedures • certification related to conditions they are treating privately
These cannot be provided on the NHS.
Why These Boundaries Matter
We know these changes may sometimes feel inconvenient. We understand, and we will always try to help by directing you to the correct service. These boundaries are in place to ensure:
• safe and accountable care • fairness across NHS patients • appropriate use of NHS resources • protection of GP time for essential NHS clinical work
We continue to raise these issues with local hospitals and NHS leaders so that services work together more effectively.
Frequently Asked Questions
1. What should I say if another provider asks me to get my GP to arrange something?
Explain that your GP follows BMA and NHS guidance, and the requesting clinician must arrange prescriptions, tests, and fit notes themselves. They can contact our management team for clarification if needed.
2. What if I don’t know who to contact at the hospital?
Your clinic letter will list a secretary or admin line, or you can ring the hospital switchboard and ask for your consultant’s secretary. You can also ask to the hospitals Patient Liaison and Advice service who will assist.
3. Can I have a private monitoring test done at the GP surgery?
Unfortunately not. Your private clinician must arrange this through private phlebotomy or laboratory services.
4. What about suture removal or dressings after private surgery?
These must be arranged through your private provider or a private nursing service.
5. Can my GP prescribe medication started privately?
Only once it is safe, appropriate, and covered by NHS arrangements. Until then, your private clinician will need to continue to prescribe.
6. What if I’m unsure where to turn?
Our reception team can help signpost you to the appropriate service, but some requests must be handled by the treating clinician. Please note we have limited time to manage these requests and there may be a wait before you hear a response to them.
In Summary
These changes ensure:
• the clinician who starts treatment remains responsible for it
• NHS resources are reserved for NHS work
• safe, fair, and sustainable care for all
Thank you for your understanding and continued support.
