An outright ban on NHS consultants increasing their income through private work was proposed yesterday by the Commons health select committee as the long-term answer to unfairness in the health service. The report, pushed through by Labour MPs against opposition from the Conservatives, raised suspicions that some consultants "are driven by perverse incentives into maintaining long NHS waiting lists in order to stimulate lucrative private practice". The MPs said they could not prove this charge, but concluded: "What is indisputable is that NHS patients wait longer than private patients, and that private earnings are highest in those specialties where NHS waiting times are longest."
The tone of the report was a lot more hostile to the private sector than ministers had been over recent weeks. Alan Milburn, the health secretary, has said he wants to use private hospitals to reduce NHS waiting lists. He also suggested it was not possible to force consultants to abandon private practice, although merit bonuses might in future be directed to those who worked only for the NHS.
In contrast, the MPs said it was indefensible the system allowed patients of equal clinical need to go ahead of others because of their ability to pay.
"Therefore we believe the government should make it a long-term objective that consultants in the NHS do not undertake private practice...The NHS was founded on the principle of equity: it should put that principle into practice."
The MPs noted an argument from the British Medical Association that a ban on private work might make some consultants leave the NHS. But other consultants might decide it was in their best interests to work solely in the NHS. The government should research the consequences and work out incentives to keep the best consultants in the NHS, the MPs said.
Their report was published after a three-week inquiry into the contracts of the 25,000 NHS consultants. It found that their average NHS salary was £68,000, but about two-thirds also undertook private practice.
Last year their average private earnings were £10,790, but there was a huge variation in the income potential of specialities, ranging from £75,413 for plastic surgeons to £5,000 for pathologists.
Since the NHS began in 1948, full-time consultants have been entitled to increase their earnings by up to 10% by taking on private practice.
Those on "maximum part-time" contracts gave up one eleventh of their salaries in return for the freedom to earn as much as they like privately, as long as they fulfilled their NHS commitments. About 70% work on whole-time contracts, the remainder as maximum part timers.
The report said hospital trusts did not enforce the 10% rule for whole-timers and did not collect enough information to keep track of the hours worked within the NHS by maximum part-timers.
David Hinchliffe, the committee's Labour chairman, said: "There would be problems in stopping consultants from working in the NHS and in private sectors, but I think there are generational differences. Medical students and junior doctors I have talked to agree that it is an unfair situation. I think the government has to take a long-term view. What we need to do is write into junior doctors' contracts that they can only work for the NHS, and give them incentives to sign those contracts."
Peter Hawker, chairman of the British Medical Association's consultants committee, said: "Given the shortage of consultants and the long-term investment required to increase their numbers, we think it is unrealistic, even as a long-term objective, to oblige consultants to choose between a wholly NHS or wholly private sector career.
"We believe it is right for patients to have choice, and that it is entirely possible to have the two sectors working alongside each other."
