NHS Consultant Contract / Private Practice.

[Manximus Aururaneus]

I have posted in other threads that I believe that there should  be open debate regarding our Health Service and that, given the seriousness of the issue and that we will all at sometime or another depend on that service, then such debate should, where possible, be based on fact not myths or falsehoods.

I have read many opinions here and elsewhere relating to Hospital Consultant working contracts and in particular their relationship with Private Practice work. I am going to try to provide a simple explanation of the basic principles of the contract, keep my own opinions to myself, and hope that at least some others will find the information helpful. 

There will be those who will wish to have a go at me for doing so, but my life has already been saved by the NHS (The Public side of the service) and I want nothing more than informed debate on how to provide the best service to us all.

It's complicated but I will try to keep it brief (ish). I will use the term 'NHS' as the contract over here is based on the NHS contract albeit with variations.

In 1997 the Tony Blair / Gordon Brown government was elected. In 2001 negotiations commenced between 'New Labour' and the BMA representing doctors with the Governments aim being to reduce costs and increase the productivity of doctors (Consultants in particular). John Prescott (Deputy Prime Minister) famously stated that 'We are no longer going to foot the bill for hospital consultants to play rounds of golf - if clocking in and out is good enough for my union members - it's good enough for Hospital Consultants as well' (words to that effect).

Prescott had decided to reduce the consultant wage bill by paying doctors for what they did (hours worked) rather than their position (salary). Brown, as Chancellor,  was happy to accept the cash saving, Blair liked the political overtones.

In the first ballot, the Consultants rejected the new deal (about 60/40 iirc?) - The BMA said that the Government had misunderstood how doctors actually worked.

Government tweaked the deal slightly, and put it back to a new vote with two (pretty serious) new conditions attached;

1. The 'New' contract would be mandatory for all hospitals, no variation permitted and therefore no 'bartering' between hospitals to get the best Consultants, and

2. Any Consultant who refused to sign the new deal would stay on the old contract (as they could by right) - but no Consultant on the 'old' contact would ever receive a further annual pay-rise. The old contract would therefore be left to 'wither on the vine'.

And so, in 2003, with a small majority (52/48?) the '2003 New NHS Consultant Contract' was born. Doctors would now have to account for their working hours, and hence NHS spending on senior doctors would reduce.

Except it didn't! Senior doctors started 'clocking in' as instructed, they billed the NHS for hours actually worked (sessions) and the wage bills rocketed. Hospital budgets started to suffer, Blair, Brown and Prescott went V. quiet about it all. BMA shrugged shoulders and said 'Told you so'. Turns out the doctors had been telling the truth all along, 55-60 hours being typically worked but only 40-45 being previously charged for (big generalisation and lots of variation I accept, but overall situation broadly along those lines).

How does the contract work?

In short, a 'Job plan' is agreed between each individual consultant and (usually) his/her Clinical Lead / Clinical Director - it then gets passed up to the Medical Director & CEO for approval. Annual reviews take place, changes by mutual agreement only, dispute system in place. Looks very similar to a School Timetable  (who/where/what etc.) There are national example job plans available for every specialisation with input from NHS, Government, Royal Colleges, BMA etc. Not much dispute about job plans these days - they've being going since 2001.

 A 'Standard' job plan consists of 10 sessions of 4 hours each = 40 hours during the hours 0700-1900. Extra 'sessions' by mutual agreement to recognise extra work such as admin for 'Clinical leads' Clinical Directors etc.

Stay with this now, this is the bit that matters to the NHS (and particularly to small jurisdictions such as the Island).

1. If you have a very specialist Consultant, for whom say there is not enough NHS work at that location to justify a full 10 session (40 hour) contract - the hospital can offset its costs by offering (say) only a 20 hour 5 session contract and mutually agreeing that the individual may then work in private practice outside of those 20 hours. That is mutually beneficial! It allows the hospital to acquire the services of a specialist that they could not otherwise afford or justify.

2. On the other hand, if the Hospital has more than enough work in a specialisation than it has staff - Then the individual Consultant MUST (as part of the 2003 contract) offer at least one further session (11 sessions / 44 hour week) to the NHS before they can then engage in any Private Practice.  The Hospital is not contractually bound to offer this 11th session - but the individual Consultant is contractually bound to accept if requested by the hospital. The NHS / Hospital is contractually entitled to the first 44 hours of any full time Consultants services if they choose to take it.

3. If a Consultant is on contract to the NHS - only after 10 sessions (or 11 sessions if requested by Hospital) of NHS work may he/she then undertake private practice (PPS). The contract states;

'Subject to provision of schedule 9 of the T&C's, you may not carry out PPS during your Programmed Activities.

In other words, it is perfectly possible for a Consultant to be undertaking PPS (of which the Hospital will be taking their cut!) during 'The Working week'  IF that individual has already completed either 10 or 11 sessions of NHS work. It is not the 'Normal working hours' that matters - it is that individual doctors' completion of either 40 or 44 hours of NHS programmed activities before commencing any PPS that matters.

Enough for now.

 

 

[paswt]

I was advised by my GP that the waiting time with the NHS for an endoscopy was excessive and it would be quicker to go private (on Island).

Given the discomfort I was experiencing I chose to go private , still a few months wait but at least the money was spent on island and Nobles got a fee.

The procedure was not unreasonable but surprised by the fee for 2 biopsies ( examination)  at £850, if the same guy is used by the NHS he must be 'minted'

Just saying 

[hissingsid]

This is not right when you have paid contributions,mandatory, all your working life, and your employer has also paid in for your health care.   It is totally unacceptable and should be sorted asap.   When the dentist shortage was at its peak a lot of people went private, this has saved the government mega bucks.   I know a lot of people who have had hips and knees done privately because they could not put up with the pain, sold stuff to pay for the treatment.   Also, if checks and investigational procedures are delayed serious illnesses can develop and the subsequent treatments will cost much more apart from the suffering to the patient.   If ordinary members of the public can see this why can't the decision makers.    A persons health is the most important thing in the world be it physical or mental it should be prioritised when decisions about funding are decided.   Instead of pissing around with vanity projects this is one sure thing that needs sorted.

[P.K.]

2 hours ago, Manximus Aururaneus said:

That is mutually beneficial! It allows the hospital to acquire the services of a specialist that they could not otherwise afford or justify.

Am I right in assuming that the above is underlined because the OP has an agenda...?

[paswt]

1 hour ago, hissingsid said:

This is not right when you have paid contributions,mandatory, all your working life, and your employer has also paid in for your health care.   It is totally unacceptable and should be sorted asap.   When the dentist shortage was at its peak a lot of people went private, this has saved the government mega bucks.   I know a lot of people who have had hips and knees done privately because they could not put up with the pain, sold stuff to pay for the treatment.   Also, if checks and investigational procedures are delayed serious illnesses can develop and the subsequent treatments will cost much more apart from the suffering to the patient.   If ordinary members of the public can see this why can't the decision makers.    A persons health is the most important thing in the world be it physical or mental it should be prioritised when decisions about funding are decided.   Instead of pissing around with vanity projects this is one sure thing that needs sorted.

I agree entirely despite the fact that I have paid for treatment  I disagree with and would not buy "health insurance", but when one has been advised to expect a considerable wait for a medical procedure and one has little faith in Gov to improve matters it's not surprising that folk put monies aside to pay for private treatment as they do for their 'old age'.

Given that if one paid for private medical treatment it is interesting to note that the Gov will not consider giving one  a tax incentive as they do to the 'shyster god squad brigade', funny old world.

 

[Max Power]

The problem is that NI contributions are a drop in the ocean compared to the costs of our healthcare, the rest comes from tax revenues of all sorts. If we were made to pay more towards NI, we would expect higher pensions and better healthcare and wages would have to rise, making the place less desirable to potential employers.

It's a sick world we live in! 

[dilligaf]

50 minutes ago, MrPB said:

I’ve been dealing with a family friend at the moment who has had to go private to get treatment. No health insurance so he’s paying cash to get sorted. Then ended up in a massive bunfight as NHS staff have refused to provide certain things to the private consultant. Seems they prefer to play politics rather than try to help a sick person out who just wants to secure treatment in the fastest possible way to reduce the likelihood of them dying. Those paper pushers up at the hospital should hold their heads in shame. They aren’t there to provide a service just play political games with peoples’ lives under the pretense of saving money for the taxpayer. They really seem to hate some of the consultants doing private work and like to put up blockers even if that interferes with people’s treatment. Probably typical Manx envy for people earning more than they are. 

Not many are Manx these days in positions that matter. Loads of local knowledge and experience has been lost

[Uhtred]

42 minutes ago, dilligaf said:

Not many are Manx these days in positions that matter. Loads of local knowledge and experience has been lost

Do you mean medics/nurses Dilli?

[Uhtred]

1 hour ago, MrPB said:

I’ve been dealing with a family friend at the moment who has had to go private to get treatment. No health insurance so he’s paying cash to get sorted. Then ended up in a massive bunfight as NHS staff have refused to provide certain things to the private consultant. Seems they prefer to play politics rather than try to help a sick person out who just wants to secure treatment in the fastest possible way to reduce the likelihood of them dying. Those paper pushers up at the hospital should hold their heads in shame. They aren’t there to provide a service just play political games with peoples’ lives under the pretense of saving money for the taxpayer. They really seem to hate some of the consultants doing private work and like to put up blockers even if that interferes with people’s treatment. Probably typical Manx envy for people earning more than they are. 

About 2 to 3 months ago there was a very strange page on the IOMN website  - under the headline “New management team at hospital” there was absolutely no narrative on the page whatsoever, just a photo of an Asian lady and a grey-haired white male. According to the reception staff at my GP practice the lady has left already and there is a belief that the gentleman may have done too. I presume both these staff members were recruited when the hospital manager (Mike Wotsit) left. There certainly seems to be a lack of continuity among the upper echelons at Nobles.

[craggy_steve]

1 hour ago, MrPB said:

I’ve been dealing with a family friend at the moment who has had to go private to get treatment. No health insurance so he’s paying cash to get sorted. Then ended up in a massive bunfight as NHS staff have refused to provide certain things to the private consultant. Seems they prefer to play politics rather than try to help a sick person out who just wants to secure treatment in the fastest possible way to reduce the likelihood of them dying. Those paper pushers up at the hospital should hold their heads in shame. They aren’t there to provide a service just play political games with peoples’ lives under the pretense of saving money for the taxpayer. They really seem to hate some of the consultants doing private work and like to put up blockers even if that interferes with people’s treatment. Probably typical Manx envy for people earning more than they are. 

I'm currently dealing with issues for an elderly relative. Needs both cataracts doing in order to avoid going into a care home. IoM NHS Opthalmology wait list is (according to Opthalmology Dept) 30 months to see the consultant, followed by 14 months wait for treatment = 44 months total.

She'll probably be dead before then.

Private would be fine, she can afford it - but the Nobles Private Patient Unit is closed.

Currently looking at getting it done across, probably within the next 2 months, but means 5 or 6 trips to the UK for a nonagenarian. 

The only reason that Private treatment is even necessary for many cases is that the NHS is so effing inefficient - if we didn't have these stupid waiting lists, which are largely the consequence of poor NHS management and obviously unnecessary because private treatment is usually available pretty promptly, the majority of private treatment would evaporate.

 

[finlo]

Do you not think such long waiting lists are deliberately so? I think there are two things at play here, 1 if you croak before treatment = saving for the hospital 2 forcing more people into the consultants lucrative private practices.

[finlo]

41 minutes ago, Uhtred said:

About 2 to 3 months ago there was a very strange page on the IOMN website  - under the headline “New management team at hospital” there was absolutely no narrative on the page whatsoever, just a photo of an Asian lady and a grey-haired white male. According to the reception staff at my GP practice the lady has left already and there is a belief that the gentleman may have done too. I presume both these staff members were recruited when the hospital manager (Mike Wotsit) left. There certainly seems to be a lack of continuity among the upper echelons at Nobles.

Wasn't the lady responsible for the Wigan cut and paste fiasco?

[dilligaf]

40 minutes ago, finlo said:

Wasn't the lady responsible for the Wigan cut and paste fiasco?

She was not Asian.

[Uhtred]

45 minutes ago, finlo said:

Wasn't the lady responsible for the Wigan cut and paste fiasco?

No; different person - “Cut and Paste” works with Couch at DHSC HQ. The Asian lady was an HR person at Nobles. 

[The Lurker]

The biggest problem faced by the Manx NHS is recruitment; a problem caused (as I’ve bleated on about before on this forum) by IOMG’s insistence on moving away from the UK NHS pension to the Manx GUS about 10 years ago.

This results in a shortage of qualified staff and very expensive locum contracts that siphons funds away from treatment. 

Nobles cannot work miracles; if we want them to end waiting lists we have to pay. 

One of the problems with private surgery is that the cost rarely covers aftercare. Therefore a person pays to jump the waiting list for their surgery but is then referred to their GP to follow up thus increasing the time NHS patients have to wait for appointments. 

Personally I would ban private medicine; the fact that wealthy individuals can nip off to Harley Street disincentives wealthy politicians from truly reforming the NHS. I’d happily make the same argument for education too.