‘Unfeesable’

By Robin Stride

Consultants have hit out at NHS England proposals to try and force them to reveal their private practice earnings, warning the idea is pointless, unworkable and ludicrous.

Doctors’ bodies, including the Independent Doctors Federation (IDF), the Hospital Consultants and Specialists Association (HCSA) and the Federation of Independent Practitioner Organisations (FIPO), all expressed strong criticism.

Accountants also joined the protest against the plan which would require declaration of gross incomes within three suggested bands: under £50,000, £50,000-£100,000 and over £100,000.

Ray Stanbridge

Ray Stanbridge

Independent Practitioner Today columnist Ray Stanbridge (right), of Stan­bridge Associates, called the bands illogical. He said gross earnings were irrelevant since tax was paid on net profit. And it would be ‘impossible’ to file figures from the ‘previous 12 months’, as proposed.

He added: ‘The main problems from an accounting viewpoint is that the proposals have not identified what is “private practice”. Until a uniform definition is agreed, any figure will be subject to major error.’

Parties have until 31 October to respond to the NHS England’s report Managing Conflicts of Interest in the NHS: A Consultation.

It claimed the proposals aimed to ensure the existence of private duties is well known ‘in keeping with wider moves towards transparency, and so that conflicts can be either managed or avoided’.

Doctors would also be asked where they practise, when, in which specialty and what major procedures they perform.

Specialists’ organisations say they support transparency, openness and honesty, but the IDF said it ‘shared the views of most of our medical colleagues’ that there was nothing to be achieved by requiring doctors to publish private practice earnings.

Dr Brian O'Connor

Dr Brian O’Connor

Its specialists committee chairman Dr Brian O’Connor said: ‘The vast majority of NHS consultants work well beyond their contractual obligations.

‘Despite this, they are subjected to rigorous annual appraisal, close scrutiny of their NHS commitments at annual appraisal and, of course, as laid down by managers within the NHS implementing specific job plans.

‘It is now a requirement that all doctors declare their time spent in private practice and, indeed provide additional details as to location, scope of practice and procedures undertaken.

‘The publication of gross income accrued from private practice, which is done outside of NHS contracted hours and in the doctor’s own time is not of any specific interest to anybody and is unworkable.’

If mandatory for doctors, then all individuals with influence on NHS patient care, such as trust board members and managers, should be obliged to declare all their income too.

He added that full disclosure of all private and public sector income by those involved in key NHS decision-making would allay any public anxieties about conflicts of interest.

‘It would seem ludicrous to single out consultants, a small minority of the NHS workforce, for such transparency,’ Dr O’Connor said.

The Federation of Independent Practitioners Organisations (FIPO) said provided consultants worked appropriately within NHS contracts and job descriptions, then private practice arrangements outside and within their own time should not be subject to this type of analysis.

Chairman Mr Geoffrey Glazer said it was difficult to see exactly what benefit there would be be in asking consultants to declare fee income.

BMA consultants’ leader Dr Keith Brent said the vast majority of consultants already gave beyond their contracted hours. If wishing to do private work, they first had to offer extra NHS time. They made an annual declaration of substantial conflicts of interest in accordance with legislation.