How to Use PMI for Shared Care With NHS and Private Providers
Navigating healthcare in the UK can feel like a choice between two worlds. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we find many clients asking how to get the best of both. Using private medical insurance (PMI) for a "shared care" approach with the NHS is the answer.
Blending NHS efficiency with private convenience and speed
The UK is unique in having the National Health Service (NHS), a world-class institution providing comprehensive care, free at the point of use. It’s the backbone of our nation's health. However, as demand has grown, so have waiting times for certain procedures.
This is where private medical insurance UK comes in, not as a replacement for the NHS, but as a powerful partner. "Shared care" is an intelligent approach that blends the strengths of both systems. It allows you to use the NHS for what it excels at—emergency services, managing chronic conditions, and initial GP consultations—while leveraging your private cover to bypass queues for diagnosis and treatment of acute conditions.
This guide will walk you through exactly how to use your PMI policy to create a seamless healthcare journey, combining the reliability of the NHS with the speed, choice, and convenience of the private sector.
What is Shared Care and How Does it Work with PMI?
Shared care is a collaborative model where your healthcare is delivered by a mix of NHS and private providers. Instead of choosing one system exclusively, you use them in sequence to optimise your treatment path.
Think of it as a relay race for your health:
- The Start: Your journey almost always begins with your NHS GP. They are the gatekeepers and the central point of your long-term health record.
- The Handover: If your GP suspects an issue that needs further investigation or treatment, they can provide an "open referral." This is your key to unlock the private sector.
- The Private Leg: You use your private health cover to see a specialist quickly, get diagnostic tests like MRI or CT scans done in days (not weeks or months), and receive treatment or surgery at a time and hospital of your choice.
- The Final Stretch: After your private treatment, your care is seamlessly handed back to your NHS GP for any necessary aftercare, ongoing medication, or long-term monitoring.
This model is incredibly effective, but it’s vital to understand a fundamental rule of UK private medical insurance.
Critical Note: Standard PMI policies are designed to cover acute conditions—illnesses or injuries that are new, unexpected, and likely to resolve with treatment (like a hernia, cataracts, or a joint replacement). They do not cover pre-existing conditions (symptoms or medical advice you received before your policy started) or chronic conditions (long-term illnesses like diabetes, asthma, or Crohn's disease that require ongoing management).
An Example of a Shared Care Journey
| Stage | Provider | Action | Funded By |
|---|---|---|---|
| 1. Symptom | You | You experience persistent knee pain after a sporting injury. | N/A |
| 2. Initial Consultation | NHS GP | You see your GP, who examines you and suggests a referral to an orthopaedic specialist. | NHS |
| 3. Authorisation | Your PMI Provider | You call your insurer with your GP's open referral. They authorise a private consultation and diagnostics. | PMI |
| 4. Diagnosis | Private Hospital | You see a private specialist within a week and have an MRI scan a few days later, revealing a torn meniscus. | PMI |
| 5. Treatment | Private Hospital | You have keyhole surgery (arthroscopy) two weeks later in a private hospital with an en-suite room. | PMI |
| 6. Aftercare & Rehab | NHS Physiotherapy | Your private consultant sends a full report to your NHS GP. Your GP refers you to an NHS physiotherapist for rehabilitation. | NHS |
In this scenario, you bypassed a potentially lengthy wait for both the specialist appointment and the surgery, allowing for a much faster recovery, while the NHS handled the initial and final stages of your care.
The Key Advantages of a Shared Care Approach
Blending the two systems offers a range of compelling benefits that give you greater control over your health.
1. Speed: Beating the Waiting Lists
This is perhaps the most significant driver for people considering private health cover. While the NHS provides excellent care, waiting lists for elective treatment can be long.
- The Data: According to NHS England figures from mid-2024, the overall waiting list for consultant-led elective care stood at around 7.5 million treatment pathways. The target is for 92% of patients to wait no more than 18 weeks from referral to treatment, but this target has not been met for several years.
With PMI, the wait for a specialist consultation can be a matter of days. Diagnostic scans often happen within the same week, and if surgery is needed, it can be scheduled within a few weeks. This speed can be crucial not only for your physical comfort but also for your peace of mind.
2. Choice and Control
A shared care approach puts you back in the driver's seat. Your PMI policy typically gives you:
- Choice of Specialist: You can research and choose a consultant renowned for their expertise in your specific condition.
- Choice of Hospital: Insurers have "hospital lists," and policies often allow you to choose from hundreds of high-quality private hospitals across the UK.
- Choice of Timing: You can schedule appointments and procedures at times that suit your work and family life, rather than being given a fixed date.
3. Cost-Effectiveness
Using a shared care model can make your private medical insurance more affordable. Many people assume you must go "fully private," but by using the NHS for GP services and some aftercare, you can choose a PMI policy with specific features that lower your premium. For example, some policies have a small excess or are designed to work alongside the NHS.
Furthermore, many policies include an NHS Cash Benefit. If you choose to have your treatment on the NHS, even though it was eligible for private cover, your insurer will pay you a fixed cash amount for each day or night you spend in an NHS hospital. This can help cover lost earnings or other expenses.
4. Comfort and Environment
While clinical outcomes are paramount, the environment in which you recover plays a big role in your wellbeing. Private hospitals typically offer:
- A private, en-suite room.
- More flexible visiting hours.
- A la carte menus.
- A quieter, more relaxed atmosphere.
This added comfort can make the experience of undergoing treatment significantly less stressful.
Navigating the Shared Care Pathway: A Step-by-Step Guide
Understanding the process is key to a smooth experience. Here is a detailed breakdown of the typical journey.
Step 1: The NHS GP Consultation
Your NHS GP is the cornerstone of your healthcare in the UK. Always start here.
- What to do: Book an appointment and explain your symptoms clearly. Be honest about your concerns and the impact they are having on your life.
- The Magic Key: An "Open Referral": If your GP agrees you need to see a specialist, ask for an "open referral" letter. This means they are referring you to a type of specialist (e.g., a cardiologist or a dermatologist) rather than a specific named doctor within the NHS system. This letter is your passport to the private sector.
- Do I tell them I have PMI? Yes, it's a good idea. Being transparent helps them understand your intentions and they can write the referral letter accordingly. It does not affect your right to NHS care in any way.
Step 2: Contacting Your PMI Provider
Once you have your referral letter, it's time to get your private treatment authorised.
- What to do: Call your insurer's claims or pre-authorisation line. This number will be on your policy documents and membership card.
- What to have ready:
- Your policy number.
- Your open referral letter from your GP.
- Details of your symptoms and when they started.
- The Process: The insurer will check that your condition is covered under the terms of your policy. They will then give you an authorisation number and often provide a list of approved specialists or hospitals in your area. An expert PMI broker like WeCovr can be invaluable here, helping you understand your policy's rules before you even need to claim.
Step 3: Choosing Your Private Specialist and Hospital
With authorisation, you now have the freedom to choose.
- Finding a Specialist: Your insurer may recommend specialists from their approved network. You can also do your own research online to find consultants with expertise in your condition.
- Hospital Lists: Your PMI policy will have a specific "hospital list." This is the list of private hospitals where your treatment will be covered. Cheaper policies may have a more restricted list, while comprehensive policies offer a nationwide choice. It's crucial to check this when you buy your policy.
- Booking the Appointment: Once you've chosen, you simply call the specialist's private secretary to book a consultation, quoting your PMI authorisation number.
Step 4: Undergoing Private Diagnosis and Treatment
This is the phase where you experience the speed of the private sector.
- Consultation: You will meet the specialist, who will discuss your case and recommend the next steps.
- Diagnostics: If tests like an MRI, CT scan, or endoscopy are needed, they are usually scheduled within days at the same private hospital.
- Treatment Plan: Once a diagnosis is made, the specialist will propose a treatment plan. You'll need to get this approved by your insurer before proceeding. This is usually a quick formality handled between the hospital and the insurer.
- Treatment: Your surgery or procedure will be carried out in the private hospital.
Step 5: Transitioning Back to the NHS
After your successful private treatment, the loop is closed by returning to the NHS for ongoing management.
- Discharge Report: Your private consultant will write a comprehensive discharge report and send it to your NHS GP. This report details the diagnosis, the treatment performed, and recommendations for aftercare.
- NHS Aftercare: Your GP will then manage your recovery. This may involve prescribing medication, referring you for NHS physiotherapy, or scheduling routine follow-up checks.
- Chronic Care: If your condition turns out to be chronic, its long-term management will be handled by the NHS, as this falls outside the scope of standard PMI.
Understanding What Your Private Medical Insurance Covers (and What It Doesn't)
Managing your expectations is vital. PMI is a specific tool for a specific job, and understanding its limitations is as important as knowing its benefits.
The Golden Rule: Acute vs. Chronic Conditions
This is the single most important concept to grasp.
- Acute Conditions (Covered): These are conditions that have a clear start date, are short-term, and are expected to be cured with treatment. Your PMI policy is designed to get you diagnosed and treated for these conditions quickly.
- Examples: Cataract surgery, joint replacements (hip, knee), hernia repair, removal of gallstones, most cancer treatments (subject to policy limits).
- Chronic Conditions (Not Covered): These are long-term conditions that cannot be "cured" in the traditional sense and require ongoing management, monitoring, and medication. The NHS is set up to provide this lifelong care.
- Examples: Diabetes, high blood pressure, asthma, epilepsy, arthritis, Crohn's disease, multiple sclerosis.
Other Common Exclusions
Besides chronic and pre-existing conditions, most standard private medical insurance UK policies do not cover:
| Typically Covered by PMI (for Acute Conditions) | Typically Not Covered (Handled by NHS or Excluded) |
|---|---|
| Specialist consultations | Management of chronic conditions (e.g., diabetes) |
| Diagnostic tests (MRI, CT, PET scans) | Pre-existing conditions |
| In-patient and day-patient surgery | A&E / Emergency services |
| Cancer treatment (chemo, radiotherapy, surgery) | Routine pregnancy and childbirth |
| Mental health support (often with limits) | Cosmetic surgery (unless medically required) |
| Therapies (e.g., physiotherapy post-surgery) | Organ transplants, dialysis |
An experienced PMI broker can help you find a policy with the most comprehensive cover for your potential needs, including options for enhanced mental health or cancer care.
How to Choose the Right PMI Policy for Shared Care
Not all policies are created equal. When your goal is to use PMI in tandem with the NHS, certain features become more important.
Key Policy Features to Look For:
- A Good Out-patient Limit: Your initial diagnosis journey (specialist fees, scans, tests) falls under your "out-patient" cover. A low limit (e.g., £500) might not be enough to cover a consultation and an expensive scan like an MRI. Look for policies with a full-cover option or a generous limit (e.g., £1,500+).
- Flexible GP Referral: Most policies require a GP referral. Ensure the policy doesn't restrict you to only using their own virtual GP service, as an open referral from your trusted NHS GP is often the most powerful tool.
- A Suitable Hospital List: Don't just go for the cheapest option. Check that the hospital list includes reputable private hospitals near you. At WeCovr, we help clients balance cost against access to the best facilities.
- NHS Cash Benefit: As mentioned, this is a great feature for a shared care model. It gives you a financial reward if you opt for NHS treatment, providing ultimate flexibility.
- Therapies Cover: Check if the policy includes cover for post-operative physiotherapy. Some policies cover this, while for others, you might rely on the NHS. Having private physio can speed up your recovery even further.
Choosing the best PMI provider and policy can be complex. This is where a broker's expertise becomes invaluable.
Wellness, Health, and Making the Most of Your Cover
Modern private health cover is about more than just reacting to illness; it's about promoting a healthy lifestyle to prevent it. Many leading providers now include a wealth of wellness benefits designed to keep you healthy.
These can include:
- Discounted gym memberships.
- Wearable tech deals (e.g., Apple Watch, Fitbit).
- Access to virtual GP services 24/7.
- Mental health support lines and therapy sessions.
- Smoking cessation programmes.
- Nutrition consultations.
At WeCovr, we believe in this proactive approach. That's why all our clients who take out a PMI or Life Insurance policy receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you stay on top of your diet.
Furthermore, being a WeCovr client has added perks. Once you purchase a policy through us, you can often access discounts on other types of insurance cover, such as life insurance or income protection, helping you build a complete financial safety net.
A few simple tips can also support your health journey, whether you're using the NHS, private care, or both:
- Eat for Recovery: A balanced diet rich in protein, vitamins, and minerals is crucial for healing after surgery. Focus on whole foods, lean proteins, and plenty of fruit and vegetables.
- Prioritise Sleep: Sleep is when your body does its most important repair work. Aim for 7-9 hours of quality sleep per night, especially during a period of recovery.
- Move Mindfully: Follow your doctor's and physiotherapist's advice on activity. Gentle, consistent movement is key to regaining strength and mobility without causing further injury.
The Role of an Expert PMI Broker Like WeCovr
The UK private medical insurance market is vast and complex. Trying to compare dozens of policies, each with different hospital lists, benefit limits, and underwriting terms, can be overwhelming. This is why thousands of people turn to an independent broker.
Here’s how an expert PMI broker like WeCovr helps:
- Whole-of-Market Comparison: We are not tied to any single insurer. We compare policies from all the leading providers to find the one that best suits your budget and needs.
- Expert, Unbiased Advice: Our team are specialists in the nuances of PMI. We can explain the difference between moratorium and full medical underwriting, help you choose the right hospital list, and ensure you understand exactly what is and isn't covered. We have a track record of high customer satisfaction because we put our clients first.
- It Costs You Nothing: Our service is completely free to you. We are paid a commission by the insurer you choose, but this does not affect the price you pay. You get expert advice and support at no extra cost.
- Support at Claim Time: While the claim process is between you and the insurer, having a good broker in your corner means you have someone to turn to for guidance if you hit any bumps in the road.
Can I use my PMI if I'm already on an NHS waiting list?
Do I have to tell my NHS GP that I have private medical insurance?
What happens if my acute condition becomes a long-term chronic condition?
Does using private care affect my right to use the NHS later?
Ready to explore how private medical insurance can offer you faster treatment and greater choice?
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
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