Doctors eschew private practice


By Mr Richard Packard, chairman, Federation of Indepen­dent Practitioner Organisations (FIPO). 

Mr Richard Packard

The demand for treatment in the private sector has rebounded. 

This has been led largely by the self-pay market – up by around a third on 2019 figures – as patients, frustrated with very long NHS waiting lists, opt to pay for their treatment themselves. 

This contrasts with an approximate 16% reduction in the volume of patients using insurance to pay. In terms of regional variations, the biggest increases in self-pay patients have been in Wales and Scotland, 90% and 83% respectively. 

London has seen the smallest increase at 20%. This probably reflects the capital’s higher percentage of insured patients. 

What is more surprising from figures released by the Private Healthcare Information  Network (PHIN) has been the significant reduction in consultants working in the private sector, down by about 12%. 

FIPO believes that this is due to a combination of retirements and the failure of young consultants to opt to enter private practice but preferring instead to do NHS waiting list initiative lists. 

These do not require the start-up costs in the independent sector and can be carried out on an ad hoc basis.

Cancelled lists 

In particular, a reduction in the number of anaesthetists wishing to carry out private practice is beginning to impact accessibility for patients willing to pay for their treatment. 

FIPO has heard of cancelled lists in certain areas of the country due to lack of anaesthetic cover. 

Anaesthetist colleagues find NHS Choose and Book lists a more appealing option, as their administrative and regulatory responsibilities are covered and the re-imbursement is a more realistic compensation for their expert professional services

FIPO remains very concerned that the multiple pressures on private practice, such as indemnification costs, reporting requirements, loss of professional autonomy and decreasing re-imbursements from private medical insurers, will indeed result in a reduction of both choice and accessibility.

Distortions in competition

This was foretold by the Compet­i­tion and Markets Authority (CMA) who said a report: ‘If extensively and rigidly applied, fee-capping consultants could lead to distortions in competition between consultants and to reduced consumer choice. 

‘Fee-capping – and derecognition of consultants who do not agree to abide by the insurer’s fee schedule – has the potential to increase the disincentives on consultants from setting fees to reflect their costs, experience, expertise and the local market conditions. 

‘This distortion may potentially be increased, the greater the number of insured patients on policies that require open referrals from GPs, as policyholders are channelled to lower-cost consultants.’

This is an excerpt from the 2014 CMA Report and we all know that, unfortunately, this is the current situation.

Further evidence

However, I believe that by providing further evidence of private medical insurers’ behaviour, we may get a more sympathetic hearing. Please keep telling FIPO about your members’ experiences in this regard.

The effect of private medical insurers’ behaviour as above is a further attempt to deprofessionalise and commoditise medical practitioners and their expertise. 

Thus, expertise and experience and personal attention – which is what patients are looking for when they opt for private medicine – are no longer recognised as being as important as the cost of a claims episode. Choice for patients is the casualty. 

As we have seen already, consultant numbers in the independent sector are falling. This, combined with the increasing difficulty in guaranteeing anaesthetic cover, do not augur well for the future of the independent sector. 

It is currently being propped up by the surge in self-pay patients engendered by the long waiting lists in the NHS. One must assume this will not last forever.