Friday, 2 July 2010

Private Practice

Sometimes, it has to be said, I am disappointed and disillusioned by my Consultant colleagues. Like the time I heard a colleague approaching retirement holding forth on the sheer inadequacy of his pension. Knowing him to have paid for his house, and having no longer any dependant children, I reflected that his pension was going to be equivalent to twice the average national wage, and I remember thinking what a pompous greedy little f****r he was.

The area where I am most often disappointed is in the way some of our colleagues conduct their private practice. Don’t get me wrong, I have no objection to the principle of private practice. What a Consultant does in his own time is entirely his own business. But that is where the problem lies. Some (a minority) seem to have rather strange ideas about what constitutes their own time.

For clarification I checked my own contract, which I imagine is similar to everyone else's. It states quite clearly “You may not carry out private professional services during your programmed activities” That seems pretty unequivocal to me.

And yet relatively recently I have seen three examples of practices which blatantly flout this contactual obligation.

The first and most common is the practice of leaving a trainee to finish a clinic or a theatre session leaving the Consultant free to nip down the road to St Graspers. I fully accept that towards the end of their training senior trainees need their cord stretched a little before it is cut and that managing patients on their own is a necessary part of this process. But if a Consultant delegates such work to a trainee he should at least remain in the Hospital and making himself unavailable is thoroughly reprehensible.

The second and more brazen abuse arises when a Consultant takes sick leave from his NHS post, usually for a perfectly legitimate reason, but still seems to find the resilience to attend his patients in the private hospital.

But to my mind the worst abuse is the following scenario.

A trainee, on duty in the evening encounters a clinical situation where he feels out of his depth and phones his Consultant requesting assistance. His Consultant tells him that he can’t come as he is busy (in the private hospital as it happens) and that the trainee will simply have to manage. There is no excuse for this. On call rotas are arranged well in advance and making arrangements to do private work on your night on call is a disgusting practice. It is not fair to the trainee and is certainly not fulfilling your responsibilities to your patients, It is a blatant and deliberate breach of contract motivated by greed. In my view there is only one appropriate way to deal with this type of practice. Instant and summary dismissal.


  1. I don't think private psychiatry can work as well as NHS psychiatry. Experience with colleagues who do both supports this.

    But too, I'm not at all sold on private medicine as a whole, having had less than glorious exposure to this.

  2. I could not agree more. And I haven't finished commenting on private practice yet.

  3. The only problem I note with summary dismissal is that, can we afford to (as a nation of taxpayers and thus stakeholders in the NHS) throw away a person with a large amount of experience who cost the public purse a lot to train?. Would not some punitive ban banning further private practise for a certain length of time be far better? I realise this post is deeply dehumanising.

  4. Unfortunately employers do not have the authority to dictate what a consultant does outside NHS time. The GMC assure us that sanctions are not punitive, and can supposedly only be imposed in the interests of patient safety. A consultant can not be safe in one location and not in another. There is at present no way of enforcing the ban you suggest.