It’s simple—the NHS is free at the point of delivery. Or is it? Prescriptions, eye tests, and dental treatments have long been removed from the guarantee of NHS funding, but it is now becoming apparent that other areas of healthcare are being added with the advent of the “self funding” NHS patient.

A recent investigation found that several trusts are offering patients the choice of paying for treatment or services themselves if these are either not approved for NHS funding by primary care trusts (PCTs) or have long waiting times.1

In vitro fertilisation (IVF), bone scans, cancer surgery, and screening for hereditary diseases are all areas where patients may be given the opportunity to self fund. How patients are classified varies between trusts, with some describing them as NHS patients merely taking the opportunity to pay for something themselves and others as private patients being seen on NHS premises.

The main concern is what effect this has on the founding principle of the NHS. Shadow health minister Jamie Reed wrote in a recent letter to health minister Simon Burns: “The Health and Social Care Act established an unprecedented change within NHS hospitals, with an increased private patient cap now allowing hospitals to devote 49% of their beds, procedures and services to private patients.

“The government’s PPI [private patient income] cap and successive NHS budget cuts have simultaneously given hospitals the freedom and incentive to open up a private market within the NHS.”

The BMJ spoke to some of the trusts identified in the investigation and found a range of attitudes and approaches to this practice, but all believe …