New patient - What process

Just found this - so long as you are moving back to settle here, it seems you’ll be fully entitled to NHS services, but you need to fill out a form GMS1 and provide evidence you’re settling here.

https://www.gov.uk/guidance/using-the-nhs-when-you-return-to-live-in-the-uk

Ulsterman

My NHS treatment has been excellent and I’m not worried about its ability to cope in the future.  Of course, it could be better, but I have been well looked after 

My NHS treatment has been superb - no complaints. The frills around the side have all worked nicely too - Macmillan nurses, holistic needs analysis (HNA), ED clinics, etc. My GP is also superb. Both my GP and my consultant have allowed me to take control of my treatment, but that's because I put in the effort to become an expert patient, something of which they fully supported (although not all consultants/GPs do).

I am worried for the future though.

I counsel men with PCa, and I'm aware not everyone gets such good treatment. Learning about your disease does seem to help considerably, but postcode lottery comes in to it too. Some people never even get to see their consultant other than whilst anesthetised.

I've counseled a few men who've gone privately, and that can go very wrong. My GP stopped me going privately when he first referred me - I didn't understand why at the time, but I do now. There are two main problems - there's often no MDT (multi-disciplinary team) involved, and that means there's an important level of checks and oversight missing from the consultant's decisions (MDT working is mandatory in the NHS), and secondly, there's often no supplementary services such as access to a CNS/Macmillan nurse, ED clinic, counseling, etc. This is certainly not always the case with private practice - I know a CNS who works in private practice, and NHS hospitals with private wings do sometimes process private patients through their MDT. The cases I've seen which have gone wrong have all been those who went to a urologist, and ended up with them doing a prostatectomy (RP), which quickly failed. When I look back at their diagnosis, I think why the hell did you go for a RP, which was so unlikely to work? Then on further probing, I find it was done privately with no MDT. Then, when it goes wrong, they've got no CNS or team to go back to for what to do next.

Of course, I'm sure much private treatment goes fine - I am unlikely to see those patients. As an NHS patient, you can (now) go and have any private diagnostic tests and treatments you like, without losing the NHS connection. (10+ years ago, that wasn't the case - the NHS would usually drop you once you had any private procedures, but it's now required to cooperate with any private procedures the patient undertakes, sharing test results, etc.)

Andy62

It's very interesting. my treatment has been private as I have Medical Aid insurance here.

My process was annual psa tests and when starting to climb the GP referred me to the Urologist. I had the good fortune to interrogate both the Urologist and Oncologist on the route to follow. I had done a lot of research into PC and the decision was left to me. I went for the radical prostatectomy and after about 18 months the Radio Therapy.

Once my psa doubled to 8 in 6 months I was advised by both my GP and Urologist (independently with differing reasons) to chat to the Oncologist who gave me the option to take Hormone Therapy Injections. I have now had two, 12 weeks apart.

My oncologist was advised of my planned move to the UK and she was happy that the therapy could continue in the UK.

Not true in my case. I started HT at The Royal Marsden Sutton in 2007 as a NHS patient as a preliminary to Having RT there. However, I decided to have my IMRT with Carbon Ion boost as a private patient within a study in Germany and first run this by an expert on radiation treatment Worldwide. The Royal Marsden were miffed about this because they were offering me cutting edge RT in the UK but said they would be prepared to monitor me as a NHS patient thereafter. They did so and in due course referred me to UCLH in London for HIFU as a small tumour had again grown within my Prostate. I continue to be monitored by UCLH as a NHS patient.

I would only go outside the NHS for treatment not available within the NHS or where this was not offered to me. I did pay privately for a 68 Gallium PSMA scan for example when it was very difficult to get one on the NHS. (it's still not widely offered even now).

Taking a long term view, because you never know whether PCa will again require treatment, I would recommend a highly rated hospital as found largely in major towns. These not only have a lot of experience but often participate or even instigate trials so you get more individual monitoring and a chance to be involved in latest advances with more back up.