Poll says BMA failed to support private practice

BMA private practice conference.

A BMA private practice survey of 1,113 responders has uncovered a widespread view that the union is a left-wing organisation and hostile to independent practice.

BMA private practice committee co-chairman Dr Jeremy Lawrance revealed that comments had included:

 ‘BMA do not appear to offer any support to members working in private practice’;

 ‘As an independent consultant, I am self-employed and therefore the BMA provides no help what­sovever’; 

 ‘The (private practice) committee has done nothing in the last year’.

Dr Jeremy Lawrance

But he told the meeting that the private practice committee was now getting a lot of support from the association’s leadership and hoped to see ‘big changes in the next year’ to improve BMA  support in future.

Dr Lawrance disclosed that a former chairman had said there were no meetings with insurers for ten years, but recently the committee had conducted meetings with the large insurers. These were ‘frosty’ at first, but he reported ‘a little bit of progress’.

No doubt it will be tackling a ‘disturbing’ report at the conference that a consultant failed to get recognised by an insurer because it already had enough doctors in the doctor’s specialty.

Dr Lawrance said many insurer negotiations had been challenging, but were generally amicable and he pointed out there was no obligation on the insurers’ part to meet the BMA because it was not a trade union for private practice.

The committee’s primary demands were:

1. Fee uplifts;

2. Annual inflationary rises;

3. Allowing top-up fees;

4. Abandoning ‘low-pay managed care and preferred providers’.

He said : ‘I’m paid more than a colleague younger than me and it is ridiculous.’


Dr Lawrance advised delegates they had a choice and could consider which insurers they were willing to work with. However, waiting list initiative (WLI) work might be more lucrative and less demanding.

But he warned against getting a foot in the door for low remuneration – which was self-defeating.

‘As long as doctors do the work, insurers see no reason to raise fees – and we feel that doctors need to decide on their lifestyles, what their take-home pay should be and decide on where they do private practice.’

Some fees were dropping and he pointed attendees to a BMA fee calculator which could help them assess how much their time was worth.

There had also been meetings with private providers HCA, Spire, Ramsay, Circle, the Cleveland Clinic and other bodies such as the Competition and Markets Auth­ority, the Private Healthcare Information Network and the Federation of Independent Pract­itioner Organisations, he said.

More options

Patients were increasingly seeking private care due to waiting times and more options in the independent sector, according to a market development specialist.

Mr Ali Bahram, senior associate at Mansfield Advisors, giving an upbeat talk on the changing landscape and future of private practice, said more options were opening for GPs. 

One insurer’s private online consultation number had risen from 2,000 to 42,000 a month and private GP appointments had significantly increased.

Asked by Civica Medical Billing and Collection’s Simon Brignall about the potential for the consultant employee model outside London he replied: ‘I wouldn’t hold my breath.’ 

He doubted private operators would offer consultant employee status away from the capital, although if independent hospitals were to report how well these contracts worked, then it might have some traction.

Starting up a private clinic could be ‘a real headache’ around compliance issues and indemnity costs and many younger consultant­s were considering their options. 

Employment might seem attractive when 10-15% of self-emp­loyed income would go to back-end operations of the business. But he did foresee the One Welbeck model of consultant partnership picking up outside of London.