Difficulties can arise when a clinician works both in the NHS and privately. Dr Heidi Mounsey looks at a potential scenario and offers some guidance.
Imagine you are a consultant general surgeon with both an NHS contract and practising privileges at the local private hospital.
The private hospital contacts you to say that a patient you operated on yesterday has become very unwell. The resident medical officer has reviewed the patient and considers an emergency return to theatre may be needed. You are asked to attend urgently.
However, you are contracted for NHS duties today and are just about to start your ward round. You have several complex patients who require consultant review.
It is important to be aware of your obligations in a timetable clash like this.
The GMC’s Good Medical Practice states you must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must promptly provide or arrange suitable advice, investigations or treatment where necessary and refer a patient to another practitioner when this serves the patient’s needs .
In managing this scenario, you must ensure the needs of both your private patient and your NHS patients are met. The document Terms and Conditions – Consultants (England) 2003 states that the consultant is responsible for ensuring that the provision of private professional services or fee-paying services for other organisations does not result in detriment of NHS patients or services or diminish the public resources that are available for the NHS.
This should be read in conjunction with A Code of Conduct for Private Practice which sets out that the provision of services for private patients should not prejudice the interest of NHS patients or disrupt NHS services. Except for the need to provide emergency care, agreed NHS commitments should take precedence over private work.
In this circumstance, you have been requested to attend to your private patient urgently, but you should also ensure your NHS patients are reviewed.
The options available to you may include:
Discussing the matter with your clinical lead to request that you are granted time to review your private patient and to seek cover for your NHS ward round;
Request that a colleague with practising privileges in the private hospital reviews your patient while you conduct your NHS ward round.
But it would be prudent to consider, prior to committing to both private and NHS work, how to prevent or mitigate this scenario by pre-emptively arranging for cover if this situation happened.
This could, for example, include reaching an agreement with another colleague who holds privileges in the same private hospital so that you cover each other’s private patients if an emergency arises; or arranging with NHS colleagues to cover your NHS duties were you to be urgently called away to the private hospital.
You should ensure your NHS lead approves any such cross-cover arrangement and that you keep proof of the agreement.
It would also be prudent to ensure your contract or terms of engagement with your private patients makes clear that in the event of an urgent problem or emergency, another clinician would need to be involved if you are not available.
You may wish to consider whether it would be appropriate to request changes to your NHS job plan or to your scheduled times at the private hospital to minimise any disruption that may be caused to your NHS work if a complication arose from a private procedure.
This might, for example, mean adjusting your timetable so you do not have NHS clinical commitments when it may be more likely that complications would occur in your private patients.
Failure to ensure all your patients, both NHS and private, receive the appropriate care may result in an adverse outcome for the patient, which may lead to a complaint or claim against you, or disciplinary and/or regulatory action.
Dr Heidi Mounsey (right) is a medico-legal consultant at Medical Protection