The Department of Health has rewritten its guidance on co-payments following fears of increased bureaucracy for primary care trusts and hospitals.

Concern arose after the Royal Marsden foundation trust wrote to commissioners warning it would have to make requests for exceptional case funding even where the patient was not an exceptional case, in order to “exhaust all reasonable avenues for NHS funding”.

The trust had said: “It is unavoidable that clinically non-exceptional cases may need to be submitted under this guidance.”

But in a document published today, the department says: “It is not our intention to require applications for exceptional funding where there is no basis for the application.”

Clinicians must now consider whether there are “specific aspects of the patient’s case which justify an application to the PCT for exceptional funding”.

Separating care

The revised guidance also clarifies policy on separating private and NHS care - managers and clinicians had questioned whether it would be possible to put this into practice.

The new guidance states:

  • private care should be carried out at a different time and place to NHS care, “as separate from NHS patients as possible”,
  • a different place could be part of an NHS hospital designated permanently or temporarily for this purpose,
  • trusts might want to consider using home healthcare providers,
  • trusts do not necessarily have to run a separate clinic or ward,
  • specialist equipment such as scanners may be temporarily designated for private use as long as there is no detrimental effect on NHS patients.

Speed and quality

It says patients will be able to receive NHS and private care from a single clinical team with different elements being delivered separately.

Strategic health authorities are to oversee the implementation of the guidance in order to overcome capacity issues.

The department has also issued guidance to PCTs aimed at improving the speed and quality of exceptional funding decisions.

Click here to read the consultation response and revised guidance.