Primary care trusts have received few requests from patients wishing to 'top up' their care but are concerned that hospitals are doing so without their permission.
An HSJ survey of 60 PCTs reveals that in the past two years 17 received requests from patients wanting to supplement their NHS-funded care with private treatments or drugs.
The 17 PCTs received 43 top-up requests. The most requested was IVF or infertility treatment - 18 out of 43 requests - followed by cancer drugs, which were requested on 11 separate occasions.
Lifestyle cosmetic treatments also featured. There were at least three requests during the period, including for replacement breast implants and facial hair removal.
All but four requests were refused. Leeds PCT allowed two patients to pay the difference to receive cancer care at a private centre. West Essex and Westminster both agreed to pay up to the NHS price for patients seeking IVF elsewhere in the EU and let the patients pay the extra.
Three patients tried unsuccessfully to use EU law to force PCTs to fund their treatment abroad.
Mid Essex PCT and West Sussex PCT received the highest number of requests of the 60 - 15 and eight respectively. Sixteen PCTs said they were unable to confirm whether they had received any and 27 said they had received no requests at all.
Almost all PCTs stated it was their clear policy - following Department of Health guidance - not to allow patients to mix NHS and private funding.
But freedom of information releases from acute trusts indicate that a number have allowed patients to make co-payments to cover the cost of drugs not normally funded by the NHS.
The commissioning manager at one PCT said this could constitute fraud if the PCT was not aware it was going on.
Leeds PCT recently discovered local nursing homes had charged NHS-funded residents a top-up fee. The PCT suspended any additional placements at those homes.
The DH has tasked the national cancer director, Mike Richards, with reviewing policy on top-up payments. It is due to report in October.