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Thursday, 13 June, 2002, 09:37 GMT 10:37 UK
Six Forum: Hospital Consultants
The BBC's health correspondent Karen Allen answered your questions in a live forum for the BBC's Six O'clock news, presented by Manisha Tank.

  Click here to watch the forum.  

The government has backtracked on plans to ban newly qualified hospital consultants from working privately for seven years.

Under a new NHS contract agreed between the government and the British Medical Association, all consultants will be able to run private clinics.

However, the health service will have first call on consultants' free time before they are allowed to undertake private work.

NHS Trusts will be able to ask existing consultants to work an extra session or four hours each week before allowing them to do private work.

The contract, due to come into effect in April 2003, will also increase consultants' pay by 20% and significantly cut the length of their working week.

Shadow Health Secretary Dr Liam Fox described the government's decision to scrap its proposed ban on newly qualified consultants carrying out private work as a "complete and humiliating climb down".

What does this mean for patient care in the NHS? How does this decision affect you?


Manisha Tank:

In a major turnaround, the BMA and the NHS have agreed to major changes in the way that consultants work. Now the Government would tell you it's been done all in the name of the patient - they're getting a better deal. But you've all had something to say about it and here to address some of those e-mails and text messages that have been sent in is Karen Allen, our Health Correspondent.

Our first e-mail is from Alyssa Berry, Rochdale, UK asks: It seems to me that doctors have made themselves better off with this deal. They retain the right to work privately, their hours are cut and they get a pay rise. What's in this for the patient?

Karen Allen:

She's right on some of the fronts. Certainly they have seen an increase - or under this deal they will see an increase in their pay. The starting salary for a consultant will rise by about 20% to 63,000 per annum - a lot of money. Doctors won't actually have their hours cut - if anything they've had their hours clarified. Basically what this deal will say is that a doctor has to devote the first 48 hours of their week exclusively to the NHS. Over and above that, they can work for the private sector.

You might remember that when these negotiations first started about 18 months ago, the Government was absolutely adamant that it didn't want newly qualified consultants working in the private sector. It has had to back down on that. It would argue that it's not a concession because it has clarified exactly what a doctor's working week should be.

What do patients get out of it? Well, the long-term plan is that because the basic salary for a consultant working in the NHS is a lot better than it would have been up until now, that more doctors will be encouraged to stay - we desperately need more consultants and it will be an incentive to them to remain in the NHS and not drift over and do more work in the private sector.

Manisha Tank:

Already we're having prospective patients writing in to us quite concerned about the impact of working hours in particular. A text message has come in saying: "I'm shocked that consultants are allowed to work more than 48 hours - surely that raises safety concerns?

Karen Allen:

This is a technical issue - we've been talking about it in the newsroom. When you hear about the sorts of hours that doctors are having to work - a 48 hour working week is the maximum a doctor can work under the working time directive, which gets introduced for consultants next year. But because of a technicality, if they've got a different employer - if they're working for the private sector - they can work over and above that. So there is an issue about health and safety. Don't forget the document is just a framework document and we'd expect to hear a little more detail limiting the amount of private work that a doctor can do to reflect those health and safety issues. But yes, it is a very good point.

Manisha Tank:

Karen, would you know who might monitor the quality of the 48 hours and the minimum rest period in work?

Karen Allen:

In terms of the quality and how it's spent that would be a Trust issue and it would also be an issue that the British Medical Association, which is the doctors' union, would be very, very keen to negotiate the detail on. Clearly it's in no one's interest to have tired consultants working in hospital wards and operating theatres if it's going to put patients' lives at risk. The reality here is we have a chronic shortage of doctors and everyone is doing whatever they can to try and provide an incentive for them to stay.

Manisha Tank:

On the issue of incentives, let go back to money and this 20% increase in the basics - that starting salary for consultants. Richard Gritas has sent in an e-mail - he is from the Chartered Society of Physiotherapy. He asks: This increase will undoubtedly raise expectations of other NHS professionals.

Karen Allen:

It will raise expectations and the Secretary of State for Health earlier this year in the budget announced a huge bumper 40 billion for the NHS in the next five years and all different professionals within that have been jostling for a slice of the cake.

There is an argument that it will raise expectations - there have been pay rises - not of this magnitude - but there have been pay rises for nurses, there have been pay rises for physiotherapists and other ancillary staff. The big challenge for the Government will be how does it keep people on side to be able to get its NHS reforms through, yet make them feel that they're getting decent pay in return.

Manisha Tank:

An e-mail from John in the UK who asks: Consultants get paid enough already, what about the grossly underpaid ancillary staff? Hospitals would not be able to do anything without all the non-medical staff that never actually get a mention. The porters, the cleaners, kitchen staff and all the clerical workers - they are the forgotten army that keep the whole thing going and get paid a pittance.

Karen Allen:

He's absolutely right. The real difficulty here is - we focus on a consultant's contract and in a sense it opens a whole can of worms about everything that's wrong with the NHS - all the huge deficiencies that need to be turned around. The issue about ancillary staff and people who have tasks and don't have the glory that some of the consultants have of course will feel quite hard done by, by this. But it is a long-term programme of change that is being introduced.

The Government was in a difficult position - it had to keep consultants on side. There hasn't been a contract that's been negotiated since the 1970s. It needs to redefine what a consultant's job actually entails and this, they would argue, is a starting point. There are lots of other areas within the NHS that have to be addressed. But yes, if I was hospital cleaner or an ancillary worker, I would not be feeling too sorry for hospital consultants today.

Manisha Tank:

An e-mail now from Brian Malcolm in Scotland who asks: Why on earth does a doctor earning 68,000 need to top up his salary with private work?

Karen Allen:

It's a question of value judgment. What this is about - it's not about sums, it's not about amounts of money - it's about freedom. What doctors will argue is that they will put in a certain number of hours within the NHS. One doctor that I've been speaking to earlier on today is a cardiologist and works an in excess of 50 - 60 hours a week on the NHS and does about 10 hours a week in addition to that in private work. The argument would be whether you take on that private work or not - what you do in your own free time is your business and is it unfair of the Government to start imposing limits on that? Now that is nothing about the amounts of money - although there are huge incentives to work in the private sector - one operation, for example, a cardiac operation, a very simple procedure, angioplasty, you could earn about 1,100 from one procedure like that in the private sector and that's a huge incentive. But this is about the freedom to be able to do what you want in your spare time and not so much about the actual money.

Manisha Tank:

A text message asks: Why shouldn't doctors be able to do what they want with their free time? Do they tell you what to do with yours?

Karen Allen:

That's a difficult question because the taxpayer foots the bill for training a consultant - it take 10 years to train a consultant up to that level. They have enormous amounts of responsibility and duly there is a feeling that we should be getting something back. It's about trying to moderate the needs of the NHS but also allowing doctors the freedom to go and work in the private sector. Let's not forget the separation private sector and the NHS is becoming more and more obscured. There will be many patients who get treated in private hospitals by private doctors who are actually NHS patients who are being looked after to try and get through the waiting list.

Manisha Tank:

Sean Duffy, England asks: As a personnel manager in the NHS I don't think we will see any significant improvement in healthcare for patients. Private practice income will still be a huge attraction for consultants given the amount of money they're paid for doing it.

Karen Allen:

There is a huge incentive to do private work - we can't get away from that. Not all specialities will actually have that incentive, for example, if you're a physician rather than a surgeon, the options to go and do private work may be slightly less. There certainly is that incentive and it's very difficult to see what you could do other than an outright ban to prevent doctors from leaping at that.

The difficulty is that what this is about is compromise, it's about perceptions and it's about planning. There is a perception that every consultant is out there doing additional hours in the private sector and the reality is that there are large numbers who are earning money in the private sector but there are also large numbers who are not - they simply don't have the time. It's drawing a balance between those and the actual need to try and keep doctors on side and to continue to work in the NHS without them leaving in their droves in which case we'd be in an even bigger mess than we are at the moment.

Manisha Tank:

Janet in Oxford asks: I think this is great. Staff in the NHS are demoralised and these changes will show them that they are valued. I think this could lead to better patient care and a bigger intake of medical students.

Majorie, in the UK asks: The Government has not addressed the issue of increasing the number of consultant posts simultaneously and quickly and that is a serious matter. I know the Liberal Democrats were saying a great deal about this in response to what we've heard from the NHS and the BMA. What have you heard in response to that?

Karen Allen:

The Government have got a commitment to try and increase the number of consultants by 10,000 by 2004 - the difficulty is the time. It takes time to be able to fill these posts and it takes time to be able to train the doctors up to the standard. What we're finding is that we're having to rely increasingly on doctors being shipped in from overseas from countries like Spain and Germany where they have too many, to get them to come in and to fill these posts.

It's a really difficult argument - you can see from the breadth of e-mails and text messages that we've received today - there really is no one clear cut answer. We have a chronic shortage of doctors, if we're going to turn the NHS around and the Government is going to honour its pledges and still have a service that provides healthcare from the cradle to the grave, it needs to have the doctors to do that and it's doing all it can to try and retain it. If you upset the doctors too much, we are going to be in a worse position.

See also:

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