Time to take shelter. . . and become an employee?

The current private healthcare system may not be sustainable, warns Keith Hague. It could be time for consultants to think about the benefits of a huge change – being employed by a private hospital.

rain umbrellaAfter a lifetime in healthcare, both in the public and private sectors, I never really thought the time was coming when I would see that fundamental change is needed in the way  the private sector handles the application of private consultant practice.

Since the Harold Shipman debacle, consultants in the UK have been subject to a wave of change, at times bordering on significant criticism of the way they practise, both in the NHS and in the private sector.

It’s hard to think of another group of healthcare professionals who have endured the onslaught from government, the regulators, their NHS masters and indeed anyone that feels criticism would be appropriate.

And yet some of those critics have little understanding of what consultant practice really entails and the pressure and responsibility that goes with the job.

In the UK, private sector things are becoming complex for the consultant. His or her practice costs are spiralling and practice revenues are falling.

Medical defence costs have spiralled out of all proportion over the last three years.

A consultant in spinal surgery, for instance, will more than likely have seen defence costs triple to well over six figures in the last few years.

Those who specialise in complex surgery will have seen the same happen. And, right now, some consultants are being refused defence cover, as their practice is judged to be risky. Or in other words, costly.

This, combined with the rising costs of practice facilities, the costs of administration of a practice and the fact that the Compet­ition and Markets Authority (CMA) has removed the support opportunities available from private operators, makes the lot of the consultant pretty miserable at present.

Added to this cost pressure, there is a decided trend from the health insurers towards lowering re-imbursement. The top-line revenue for any consultant practice is under significant pressure and the relationship between some of the major UK insurers and consultants could be argued to be at an all-time low.

Unattractive proposition

I was speaking to a group of young surgeons recently who were close to moving into the consultant grade. When asked if they were considering developing private practice alongside their NHS work, the response was a definite ‘no’.

Simply, they said they could not afford the cost of private practice and the re-imbursement for new consultants from one UK insurer was deemed to be too low to make this an attractive proposition.

So it looks at least from my straw poll of young doctors that the new feedstock of consultants into the private sector will diminish. Not a good sign, really, for those of us who wish to have ourselves and our families cared for in the independent sector.

Some fundamental questions need to be asked:

  • Is there an alternative for the application of private practice?
  • Is there an opportunity for a consultant to still practise privately but without the cost pressures and the trend towards diminishing revenues?
  • Is this the time for a consultant to consider ‘employment’ in the private sector?

As little as five years ago, had I mentioned to any consultant group that they should consider being employed by a private hospital organisation, I would most likely have been turfed out of the room.

Not fit for purpose

But things are different now and time has moved on and one may wish to consider that the long-honoured practice in existence for over 50 years, whereby consultants bill a fee for service alongside the hospital facility fee, is more than likely ‘not fit for purpose’.

Private patient episodes can generate multiple bills for the insurer to settle.

But under a system whereby the consultant is employed by the hospital, the insurer gets one bill.

Good for the insurers, that’s true.

But those rising practice costs currently borne by the consultant, especially defence costs, disappear and become a cost to be borne by the hospital.

In a similar vein, the hospital will assume responsibility for the application of medical governance concerning the practice of the consultant.

And surely any consultant in single-handed practice – and even those working in groups – will welcome the support of such a change.

So is it time for the consultant to move under the protective umbrella of the private hospital organisation by obtaining employment?

Some will argue otherwise and some may be right. But I think the time has come for the specialist to consider his or her practice under a different organisational structure.

Employment within the private sector may well be worthy of consideration.

Keith Hague (right) is chairman of Worldwide Healthcare Associates

What do you think?

Should consultants be employed by private hospitals? Would that suit you? Or would you say ‘Never!’

Let Independent Practitioner Today know your views by emailing robin@ip-today.co.uk