Private practice 'adds to NHS waiting lists'

Consultants can earn large sums doing private work

Doctors' private practice can add to the length of NHS waiting lists, say health service bosses.

Consultants' contracts should be radically overhauled to address this potential conflict of interest, according to a survey of trust chief executives by the Consumers' Association.

Current arrangements for NHS consultants, including contracts, need a radical overhaul

Clara Mackay, Consumers' Association

The case of disgraced consultant Rodney Ledward has highlighted the problems which can arise from doctors working in both sectors.

The Ritchie Report published last week said Mr Ledward had pressured women in to paying for private operations they could have had on the NHS, and accused him of performing unnecessary procedures in order to earn more money.

The Consumers' Association survey of 88 NHS chief executives in England and Wales found that 77% of them believed there could be a potential conflict of interest.

In 20% of cases, chief executives were worried that private practice could have a negative impact on the quality of care for NHS patients, while 40% said NHS waiting lists for operations suffered when consultants were performing private work as well.

The Government is already looking at ways to modernise consultants' contracts, including giving financial incentives to work solely for the NHS.

At the moment, many consultants are on "maximum part-time" contracts which enable them to earn ten-elevenths of an NHS salary while carrying out as much private work as they want.

All the chief executives questioned said working more than two half-days a week in private practice was unreasonable.

But a 1998 survey found that the average consultant sets aside more than this amount of time each week for private work.

'Not effective'

Half of the chief executives described current contracts for consultants as "not very" or "not at all" effective.

Clara Mackay, senior health policy adviser for the Consumers' Association, said: "This new research strengthens our view that the current arrangements for NHS consultants, including contracts, need a radical overhaul.

"This research shows that the current contract is flexible for consultants but does not hold them to account to the NHS.

"A modern 21st century NHS requires a modern relationship with consultants and that means a new contract that puts their accountability to the NHS and the quality of patient care at the top of its priorities."

The research has been submitted to the House of Commons Health Select Committee inquiry into consultants' contracts.

Dr Peter Hawker, chairman of the British Medical Association's consultants' committee, said: "I am disappointed that trust chief executives are raising this issue when they should be well aware of the very long hours worked by NHS consultants.

"Surgeons find it demoralising to be accused of causing long waiting lists because they are conducting as many theatre sessions as their Trusts can give them."

He said he backed plans to appraise consultants, currently being planned by the General Medical Council, to ensure doctors are giving the NHS the service they should be.