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Research: Stephen Morris, Bob Elliott, Ada Ma, Alex McConnachie, Nigel Rice, Diane Skåtun, and Matt Sutton Analysis of consultants' NHS and private incomes in England in 2003/4 J R Soc Med 2008; 101: 372-380 [Abstract] [Full text] [PDF]

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Private Practice - Bevan's Bogey

J Mark AITKEN   (1 August 2008)

Private Practice - Bevan's Bogey 1 August 2008
J Mark AITKEN, consultant physician Colchester Hospital University NHS Foundation Trust Send letter to journal: Re: Private Practice - Bevan's Bogey mark.aitken{at}colchesterhospital.nhs.uk J Mark AITKEN	Aneurin Bevan’s unswerving determination to see a National Health Service (NHS) established by parliamentary law and Lord Moran’s desire to be re-elected as president of the Royal College of Physicians (PRCP) played a significant part in the evaluation of consultants’ remuneration. Previously, consultants had been paid a pittance for their work in the public sector but could make small fortunes from private patients. Who would turn down an offer which greatly enhanced their earnings from the public sector (justified by a probable increase in patient demand) whilst being allowed to continue to make a killing from private practice? Consequently, the NHS was born and Lord Moran was duly re-elected PRCP. Furthermore, consultants were given an internally regulated mechanism with which they could negotiate even greater rewards from the public sector by what were described as merit awards. This was intended to compensate teaching hospital consultants and associated university appointees for their diminished exposure to private practice, but quickly became another bonus open to all consultants and unrelated to clinical input. Once this gravy train had been set in motion there was little that could stop it short of a government that would both appeal to the conscience of the medical profession and match that with salaries commensurate with those earned by, for example, lawyers. After working for over 40 years in general medicine I was recently paid at a rate of £52/hour for an eight hour shift in our emergency department. A solicitor in the town charges £195/hour but is unlikely to be exposed to mental or physical abuse or risk of contagion! Do aspiring doctors today see the medical profession as a humanitarian vocation or a means to a potentially substantial income? Inspecting the tables produced by Morris et al1 might encourage prospective medics wishing to engage in a lucrative career to see Essex as the county of choice and, for those with surgical inclinations, to choose orthopaedics, whereas those with a non-surgical leaning and no wish to engage in emergency work, to select dermatology. Their paper suggested that working in both the public and private sectors “might” cause a conflict of interest. Let’s not pussyfoot about. It does cause a conflict of interest. Doctors must choose between God and mammon as recommended by the 2000 parliamentary select committee2, but a fulltime NHS commitment would require a level of remuneration which made private practice financially unattractive and illegal. References 1 Morris S, Elliott B, Ma A, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med 2008;101:372-80 2 Parliamentary Select Committee on Health. Third report: consultants’ contracts (HC586). London: MHSO;2000