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Doctors should not do both private and NHS work

Private and public medicine are incompatible and doctors should not be allowed to work in both sectors, a cardiologist argues.

Dr John Dean, a consultant cardiologist at Royal Devon and Exeter NHS Foundation Trust Hospital, describes how he quit private practice after realising “it has direct adverse effects on the NHS”.

To begin with, he writes in The BMJ, he felt that he needed the money “to renovate the house, educate the children, and so on”. And he was sure that he could keep the private work separate from the NHS work.

But, he says, “it became increasingly difficult to keep the lid on the private jar as the contents expanded, and spillage was inevitable.”

The fact is that the business of medicine and the practice of medicine are at odds, he argues. Private medicine encourages doctors to make decisions based on profit rather than on need.

“No matter how high I set my own moral and ethical standards, I could not escape the fact that I was involved in a business for which the conduct of some involved was so venal it bordered on the criminal – the greedy preying on the needy,” he says.

He believes that private work has direct adverse effects on the NHS. A consultant cannot be in two places at once, he writes, and time spent in the private sector deprives the NHS of this valuable resource.

And he points out that, although patients think they are paying for higher quality medicine, the main advantage is simply to jump the NHS queue. “Private hospitals are five star hotels but for the most part no place to be if you are really sick.”

But the most pernicious aspect of private medical work, he says, is the indirect effect it has on a consultant’s NHS practice.

“It is difficult to justify subjecting private patients to unnecessary tests and treatments if you avoid doing them to NHS patients. So you have to operate the same system in both wings of your practice to ease the stress of this cognitive dissonance.”

Private practice also creates a perverse incentive to increase your NHS waiting times, he adds.

The inescapable fact is that money is at the root of it all, he says, which is why he left private practice and why he believes the rulers of healthcare “should draw an uncrossable line between private and public medicine and tell doctors to choose: you cannot work on both sides of the divide”.

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2 Responses to “Doctors should not do both private and NHS work”

  1. Malcolm Morrison says:

    Dr Dean is, of course, entitlted to his opinion; but there is an alternative view!

    When I was working in both the NHS and private practice (I am a retired orthopod), I was able to keep them separate. I did not do emergencies in the private hospital. The actual clinical treatment I gave was the same for both PPs and NHS patients; but I was able to give the PPs more TIME.

    I found the private practice ‘relaxing’ in that it was conducted at a more leisurely pace; and it reminded me of the ‘standard’ I should be striving to provide in the NHS – but was unable to do so because of the insatiable demand that enforced a ‘production line’ style of care

  2. Mark Cowling says:

    I would make two points on this. The NHS has been highly dependent on those consultants who do private practice to manage waiting times – our local private hospital now caters mainly for NHS patients (we are not in a wealthy part of the country) and without this activity waits for a number of procedures such as joint replacements would routinely be greater than 18 weeks.
    The other point is that we work for a monopoly employer and that position has been abused as a matter of course for many years by successive governments, particularly over the course of this parliament. Whilst I acknowledge the ethical argument put forward we should not at this stage put ourselves in a position of complete powerlessness when ministers are prepared to consistently mislead the public about levels of consultant engagement in the running of the NHS for political gain, attempt renege on contracts, decimate our pensions and ignore the DDRB.

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