NHS and Private Care: Different Settings, Shared Principles
I am a strong believer in the NHS, and I remain a full-time NHS consultant in rheumatology and acute & general medicine at the Royal Free.
The founding principles of the NHS — equality of access, care based on clinical need, and treatment free at the point of delivery — are not abstract ideals. They are practical principles that underpin everyday clinical decision-making and are a central reason I chose to work in medicine.
What the NHS Does Exceptionally Well
The NHS delivers specialist care at a scale and level of complexity that is difficult to replicate elsewhere. In rheumatology, this includes:
Access to specialist multidisciplinary teams
Long-term management of complex, multi-system disease
Robust clinical governance and safety frameworks
Access to advanced therapies, including biologics
Access to clinical trials where appropriate
Continuity of care for chronic inflammatory conditions
For many patients, particularly those with long-term inflammatory disease, the NHS provides comprehensive, sustainable care over many years, supported by specialist nurses, allied health professionals and subspecialty input when required.
Private Care: A Different Setting, Not a Different Standard
Alongside my NHS work, I also see patients in private practice. The standard of care does not change.
NHS and private patients are assessed and managed in exactly the same way:
Investigations are requested based on what is clinically appropriate
Diagnoses are made using evidence-based criteria
Treatment decisions follow personalised interpretation of national and international guidelines
Risks, benefits and alternatives are discussed openly
There is no “NHS version” and “private version” of care. There is simply good medical practice, wherever it is delivered.
What Private Care Can Offer
Private care does not replace the NHS. What it can offer, in certain circumstances, is time, continuity, flexibility and speed of access.
For some patients, private consultations allow:
Faster access to specialist assessment
Longer appointments to explore complex or evolving symptoms
Continuity with the same consultant
Time to discuss uncertainty, investigations and treatment options in detail
Greater flexibility with evening or weekend appointments, where needed
The option of remote consultations for follow-up, advice or discussion of results
This can be particularly valuable early in the disease course, when symptoms are unclear or evolving, or when work, family or health circumstances make standard clinic hours difficult to attend.
Recognising the Limitations of Both Settings
It is also important to be realistic about the limitations of both NHS and private care. Within the NHS, service pressures can lead to longer waiting times, reduced continuity with the same clinician, overbooked clinics, and sometimes limited opportunity to address every concern in a single appointment.
In the private sector, while access and consultation time are often improved, there is a recognised risk of over-investigation if care is not carefully guided, and most private medical insurance in the UK is not designed to support long-term chronic disease management in the same way as the NHS. Being open about these limitations helps ensure that care is used appropriately and in a way that best serves a patient’s long-term interests.
A Common Question: Will My GP Prescribe Medications Started Privately?
This is an important and very reasonable question. The short answer is: it depends on the medication and the clinical context.
Specialist-Only Medications
Many medications used in rheumatology are, at least initially, prescribed only by specialists because they require careful dose adjustment and regular monitoring. For example:
methotrexate
mycophenolate
romosozumab (always specialist prescribing)
denosumab
All ‘biologic’ medications and JAK inhibitors (always specialist prescribing)
In private practice, I would typically continue to prescribe these medications and arrange appropriate monitoring, rather than expecting a GP to take this on prematurely.
Medications Commonly Continued by GPs
Other treatments are more commonly prescribed in primary care once initiated and stabilised. These include:
Steroids
Colchicine
Alendronic acid
Allopurinol
Very often, I initiate these medications and provide clear guidance, after which a patient’s NHS GP is willing to continue to prescribe.
What About Access to Biologic Treatments?
Access to biologic therapies is another area where patients often seek clarity.
Many insurance providers are willing to fund six months or longer of biologic treatment when this is prescribed in line with NICE and British Society for Rheumatology guidance. In these situations, patients often start treatment privately and then transition into NHS care for long-term continuation and monitoring.
Some insurance providers will fund biologic therapy on a longer-term basis, and a small number of self-funding patients choose to meet the costs themselves and remain under private care. Each pathway is different and is guided by clinical need, funding arrangements and patient preference.
How NHS and Private Care Work Together in Practice
In reality, NHS and private care are not separate systems. Many patients move between the two over time.
It is common for patients to:
Seek private care for assessment, diagnostic clarification or early treatment decisions
Then receive ongoing care within the NHS for long-term disease management
Clear communication and careful planning are essential to ensure continuity and safety during these transitions.
Does Seeing a Consultant Privately Affect My NHS Care?
Choosing to see a consultant privately does not make a patient ineligible for NHS care, either now or in the future.
Patients remain fully entitled to NHS assessment, treatment and follow-up regardless of whether they have sought private advice or treatment. In practice, many people move between private and NHS care over time, and this is both accepted and well established. The key requirement is clear communication, so that care is coordinated safely and appropriately across settings.
A Consistent Approach to Care
Whether a patient is seen in the NHS or privately, my approach remains the same:
Careful listening
Thorough clinical assessment
Evidence-based decision-making
Clear communication
Thoughtful long-term planning
The aim is to help patients understand what is happening, why particular treatments are being recommended, and how care will be coordinated over time.
In Summary
The NHS provides high-quality, equitable specialist care and remains central to the long-term management of rheumatological disease
Private care does not offer a different standard of medicine, but a different setting, with greater flexibility, continuity and time
Patients may move between private and NHS care without affecting their entitlement to NHS treatment
Some medications and treatments must be initiated and monitored by specialists, regardless of setting
Biologic and advanced therapies are commonly started privately and then continued safely within NHS pathways
The most important determinant of good outcomes is careful assessment, evidence-based decision-making and coordinated care
When used appropriately, NHS and private care are best seen not as alternatives, but as complementary parts of a single healthcare system focused on patient outcomes.
Please note, these posts are for general information only and do not constitute medical advice. Dr Singh would encourage you to speak to your healthcare professional to be assessed and managed for your specific symptoms.