Wednesday, 4 January 2012

Private practice

The Earl Howe amendment to the Health & Social Care Bill was announced, with perfect timing, just before the Christmas break. This is the amendment to allow English NHS Trusts to raise half their income from private practice. At present only 2% of their funds may be derived privately.

This raises a number of questions. Firstly many doctors choose not to engage in private work, for a variety of reasons, including moral objection. Are these doctors going to be forced, not only to treat, but to prioritise private patients? As an illustration, is a breast surgeon dedicated to cancer work going to find himself expected to do cosmetic work by his employer?

And what of the financial arrangements? If you look in your contract there is a clause forbidding consultants from doing private work in NHS committed sessions. This could be used to insist that you do this work as part of your NHS contract, for your basic NHS pay, while the Trust charges the patient or insurer premium rates for your work, and makes a profit on you.

The alternative is even worse. They could allow consultants to charge these private patients in the traditional manner. This would be hugely divisive. The almost complete unity of the profession in opposition to the bill would evaporate, as a considerable proportion would suddenly see great potential financial benefit, and switch sides. And we all know how much bitterness, backstabbing and conflict is caused by consultants competing for as big a slice of private pie as they can get their grasping paws on.

It is in the government’s interests to keep the consultants divided amongst themselves, and thereby weakened. Up until now they have achieved this by use of the clinical excellence award system, but the writing is on the wall for CEAs. Perhaps this amendment is deliberately intended to replace CEAs as the main dividing force among hospital consultants. Just like Bevan they intend to stuff (some of) our mouths with gold.