Select Committee on Health Appendices to the Minutes of Evidence


Letter from Mr William Jory to the Chairman of the Committee (PS 63)


  I heard you speak on the Today programme this morning. I have practiced both in this country (in the private sector and the NHS) and in Canada, where I was Chairman of Physician Manpower studies in British Columbia and also National studies for ophthalmology and other eye care professionals.

  We felt very strongly in Canada that there should only be one tier of medical service. Indeed, federal legislation laid down at the inception of Medicare in 1967 made it illegal to offer private medical insurance in Canada. Of course the situation in this country is different and there will always be a public and a private sector.

  However, I feel very strongly that a consultant should either work in the public or the private sector alone. We used to liken the system in Britain to a British Airways pilot who flew from Chicago to London and then to pay private school fees for his children, did a quick charter to Majorca and back. Of course, this is rightly outlawed in the interests of safety.

  I believe that consultants should work either in the NHS or privately, but not both. Of course, there will be great cries of outrage from the medical establishment, since they can much more than double their earnings by doing private work as well. However, this must compromise patient safety, just as my example of the pilot shows. There would not be a great exodus from the NHS into private practice, since it is mainly by gaining a reputation amongst local referring GPs, that a consultant makes his name. He is therefore dependent on his place in the NHS. Of course some of the older consultants would leave, but many of them retire at 60 from the NHS anyway.

  In the long term, not only would there be, as your report suggested, the equivalent of 2,000 extra consultants in the NHS, but they would be able to contribute much more to the NHS, devoting all their energies to it. Their wives and children would also be grateful, since many of the consultants hardly see their families while they are growing up and retire early from exhaustion.

  None of this is to suggest that the ethical standards of consultants in the United Kingdom are any less than in other countries.

  I think at the same time, if it is within your committee's remit you should look at the excessively long training periods in this country. On average European countries have a four year specialist training course before they become consultants. This is also the case in North America and generally this training period is well structured. By contrast, in this country, training may go on for seven or eight years at least and there is now a mandatory one year research period. I cannot see what use this is to the NHS unless the doctor is going to proceed to academic medicine.

  You might also look at the requirements of the specialist training authority. A specialist list was introduced three to four years ago and many specialists who are perfectly fit and indeed do consultant locums and thereby prove their expertise are denied a chance to become consultants.

  With these three measures in place the shortage of consultants in this country would be solved very quickly. Of course we would have to make sure that we are offering enough places in our medical schools for future growth.

9 January 2002

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002