APPENDIX 6
Letter from the Chief Executive, General
Healthcare Group, to the Clerk of the Committee (CC13)
INQUIRY—CONSULTANTS'
CONTRACTS
I write on behalf of General Healthcare Group
Limited, the largest provider of independent healthcare within
the UK. We have 43 acute care hospitals within which we serve
some 200,000 in-patients and day cases each year. We also have
13 psychiatric hospitals which provide specialised psychiatric
services for a range of difficult to place patients for Health
Authorities from across the whole of the UK.
Our purpose in writing is to add balance to
some of the more sensationalist media reporting that the Committee
will have seen relating to the private practice activities of
NHS Consultants. Across our acute care hospitals we have some
6,500 Consultants with admitting privileges, therefore probably
amounting to over 35 per cent[1]
of all NHS Consultants who undertake some form of private practice.
Within our psychiatric units we employ some 22 Consultant Psychiatrists.
We therefore have direct experience of Consultants and their contractual
terms.
We would make five substantive points to the
Committee:
1. It is wrong to infer from a very small
number of individual highly publicised cases that NHS Consultants
have little sense of responsibility as to their NHS commitments.
On the contrary, our experience is that those Consultants who
are busiest in private practice are generally also the individuals
who have the busiest NHS clinical practices, and typically the
larger NHS caseload throughputs.
2. A critical difference beween Consultants
practice in the NHS and that in the private sector is the proportion
of time devoted to "clinical" as opposed to management
matters. In relation to a Consultant's private practice, almost
the whole of the time devoted to private practice will be patient
facing, spent either in consulting or operating. The position
in the NHS is, we understand, very different.[2]
3. For NHS Consultants, the ability to generate
private fees is a critical career factor given the relative level
of NHS Consultant earnings when compared to comparative professions,
such as law or accountancy. Whilst the initial motivation on entering
medical school is unquestionably a wish to provide public service,
over time the NHS Consultants' salary level will incline a Consultant
towards some form of private practice.
4. We believe that the present NHS Consultant
contract—with its highly imprecise wording as to the specific
time commitments of a Consultant—requires an overhaul to
clearly define when Consultants are required to be within their
NHS bases.
5. Although we have a vested interest in
this particular issue, we would observe that one factor which
does inhibit Consultants' NHS patient throughput is the unsatisfactory
practice of "tacking on" private patients to NHS operating
and consulting lists. In our view NHS facilities should only be
used for private work where the local NHS waiting list has been
eradicated and clear clinical need can be evinced.
We would be happy to expand on any of the above
if that would be helpful to the Committee.
12 June 2000
1 Figure based on MMC estimate of number of Consultants
in the UK engaged in private practice. Source-Monopolies
and Mergers Commission Report, Private Medical Services, 1994,
para 3.31. General Healthcare Group believes that the estimates
in that Report are still generally applicable. Back
2
A recent survey by Birmingham University Health Services Management
Centre indicated that for a sample of 182 NHS orthopaedic consultants,
(all being either full time or maximum part time) the average
time per week spent in the operating theatre was seven hours-in
effect only some 18 per cent of the committed NHS time was spent
in theatre. Source-Health Service Journal, "Consultant
Work Patterns", 27 April 2000. Back
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