02.10.17
No one can serve two masters
Source: NHE Sep/Oct 17
The time has come for the NHS to fix the unethical situation of consultants taking up part-time work in competing private hospitals, argues Angus Wallace, emeritus professor of orthopaedic & accident surgery at the University of Nottingham and consultant orthopaedic surgeon at Nottingham University Hospitals NHS Trust.
It has become increasingly common for whole-time NHS consultants to take up work in private healthcare organisations on a part-time basis. In many cases they are predominantly treating NHS patients in the private hospitals. Initially they often continue to work full-time for the NHS – properly filling their NHS contracts and carrying out extra sessions in the private hospital – but later, many reduce their NHS commitment to a part-time contract and extend their work even further in the private organisations.
If we analyse what happens in the business world, it is extremely rare for an employee to work for a competing organisation on a part-time basis at the same time. If that happened their employer would likely terminate their employment because of a conflict of interest.
Is working for an NHS hospital and in a private sector organisation actually a conflict of interest? Yes, it is a direct conflict of interest because the private healthcare organisation is often competing for contracts with the NHS hospital through the CCGs. Not only is this happening, but the private organisations are often cherry-picking the easier cases that will progress more quickly through their hospital pathways. In some cases, NHS consultants working for an NHS hospital are doing outreach GP clinics organised by the hospital and are then referring the NHS patients they see through the private hospital route – and in some cases actually operating on them themselves in the private hospital, which is clearly inappropriate.
Surely the time has come for the NHS to tidy up this controversial and unethical situation. NHS-employed consultants should not be operating on NHS patients in competing private healthcare facilities – this would never happen in normal businesses in the UK.
Why has this happened?
This is the responsibility of Jeremy Hunt, who has been aware of this situation since taking up his appointment as health secretary in 2012. Because Hunt has wished to encourage the private sector and has pushed for competitive tendering, he was always aware that the bottleneck was the number of staff, particularly surgical staff, available to do this work in the private sector. This system is unfair because NHS consultants usually retain many of their NHS benefits – superannuation, indemnity protection and annual appraisals.
How should the NHS manage this iniquitous situation?
The time has come for NHS England to make it clear that this practice must disappear by 2019. NHS consultants should no longer operate on patients in both NHS hospitals and in their competitor private hospitals. Consultants should work for one or the other – they should not be working at the same time for competing organisations.
However, consultants and private hospitals will need a year to prepare for this, hence the need to delay an absolute requirement for a year. We do need the private sector to do some NHS work, but this should be carefully controlled through capitated/block contracts. That way, the primary employer can commission and control their consultants to use the private space to do work.
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