Speech from the Chairman of the Private Practice Committee
Mr Derek Machin
Thursday 1 July 2004
Mr Chairman, RB
This has been another very busy year for the committee and secretariat.
The profession continues to have many problems with the National Care Standards regulations, which are now controlled by the Healthcare Commission.
We have had constructive discussions with Mark Avery, the director for Voluntary and Independent Healthcare and we have been invited to assist him in a review of the regulations and fees.
I am confident that we will achieve more proportionate and sensible regulation.
There are two issues on which I wish to concentrate - Appraisal and Revalidation, and the future of private practice.
Appraisal and revalidation are creating great anxiety and I am pleased that we are making good progress in achieving solutions.
For doctors with an NHS contract we have agreed a system of whole practice appraisal with the DH in England, the GMC and the Independent Healthcare Forum, which is the new trade body for private hospitals. We are awaiting final approval from CCSC and the devolved health departments.
Whole practice appraisal will allow a practitioner to bring an agreed common dataset from each private hospital in which he/she works for use in the NHS appraisal, which will in turn enable the doctor to renew his/her practising privileges in the private hospitals.
The situation with wholly private practitioners was made very difficult when the GMC in April 03 said that appraisal was only the appropriate vehicle for revalidation if the practitioner worked in a managed system. We have negotiated on this and it is now accepted that appraisal can be used, provided that the appraiser comes from a quality assured system, eg. NHS, Colleges, or IDE. We are currently working with the Academy of Medical Royal Colleges to identify appraisers for all colleges and we will be issuing guidance.
Jim Johnson told us in his address on Monday that the unprecedented changes in the NHS are going to have an enormous effect on private practice and I entirely agree with him and have been putting out warnings to the profession. I think we are going to see more change in private practice in the next two years than in the previous 200.
Recognising the threats, we commissioned a survey of Consultant Income from HPERU to ensure that we had base line information so that we can monitor trends with annual surveys.
The reduction in waiting times for NHS patients is reducing the incentives for both corporate and individual subscribers to take out medical insurance and, indeed, for patients to self pay.
The effect will vary with specialty and geography but we have already seen some cardiac surgeons lose all their practice and I suspect that opthalmologists adjacent to treatment centres will be next.
Contrary to popular belief most consultants do not make a fortune from private practice - 60% make between zero and £20,000 gross, which after expenses and tax does not amount to much.
This makes it essential that UK doctors have access to work being done in treatment centres, but currently they are excluded. The government has put a clause into the contracts with treatment centres, preventing them directly contracting with current NHS staff or staff who have worked in the NHS in the post 6/12 (even as a locum).
We have challenged the Department of Health and are pressing for a response. In the meanwhile we are in the process of obtaining counsel's opinion regarding possible legal remedies. We will pursue this issue vigorously.
I think that the future will see very different patterns of private practice with less income being derived from self pay or insured patients in the tradiitonal fashion but with new income streams coming from contract work in treatment centres, which will guarantee volumes of work but at rather less than full private practice rates.
The private practice committee will be monitoring development so we can advise members.
In closing I should like to thank HPERU and the legal department for all their invaluable help, the PPC secretariat together with Chris Hartley, Head of division, and especially the ever efficient Sheridan Hammond, secretary to the Committee and its eyes and ears.
Mr Chairman, I move the report of PPC.