Laurence Gerlis: Is private medical practice that bad?
12 Oct, 16 | by BMJ
During my 30 years as a private GP I have become used to being insulted by other doctors. Some see us as mercenary quacks, with little genuine interest in patients’ needs, who overprescribe and bombard NHS GPs with useless health screening reports.
NHS doctors are not volunteers, they are paid. All patients pay for NHS treatment, even the poorest who pay via taxes including VAT. The money just takes a more circuitous route than it does in our clinic. So there is no moral discrepancy. My patients pay again, mainly because they cannot get an NHS appointment soon enough and they work in Central London where I am based. My average patient is not a rich oligarch, but a 30-something working person on a slightly above average salary. I don’t see this as vicious queue jumping, just being practical. I have never had any income apart from what I can earn in fees from individual patients, whereas NHS doctors have a guaranteed patient flow and income plus pension. One NHS GP confided to me, “I wish I had the nerve to take a chance as you did, but I need to know that I have regular income.”
In our clinic we strive to work to high standards and we were the first group of doctors to be inspected by the forerunner to the CQC (the National Care Standards Commission began solely by inspecting private doctors in 2003). As a Responsible Officer for my Designated Body I am appraised by the NHS since revalidation is run by NHS England. This week we had our regular annual meeting with our GMC Employment Liaison Adviser.
Our samedaydoctor protocols forbid the prescription of controlled drugs and we do not prescribe benzodiazepines except in rare situations. We swab throats for strep and we check CRP levels to confirm bacterial infections. We find that approximately 20% of our patients with sore throats have streptococcal infections. I can still remember the effects of rheumatic fever from untreated strep infections.
We work seven days a week and deal with enquiries, emails, and results every day from 6 am to 10 pm. I do this because I wish to offer a first rate service to patients, and if in doing so we make a living, so be it. I am still guided by Hippocrates not Mammon. We see many emergencies, and take a large workload off the NHS and often pick up the pieces.
I have personally subsumed my life and that of my family into my work—we do not have holidays for more than one week and I always take a laptop with me so that I can deal with enquiries from my colleagues and regular patients, all day every day. We never talk of work/life balance. There is none. Margaret McCartney questioned the safety of some types of private medicine and also suggested that it draws resources from the NHS. She feels that the independent contractor status of GPs and private services will cause “NHS fragmentation and destruction.” In my (slightly detached) view the only problem with the NHS is that it tries to do too much for too many people, and that the demands on the NHS need to be controlled. Although I am a private doctor, I do not support the idea of charging fees to NHS patients (too complicated, too many exemptions), but I do support early triage: for example, the A+E specialist near the entrance to the hospital and similar systems in general practice to allocate resources better, and maybe sometimes even turn people away—to the pharmacy for example.
When the private Medicentres (walk in clinics in stations) first opened, a spokesperson for the NHS was clearly determined to find a criticism, and eventually came up with “The doctors have no access to NHS GP records,” but neither do NHS A+E departments. Reflex tribal reactions to private practice should be replaced by mutual respect and, dare I say it, working together.
Laurence Gerlis is a private GP with samedaydoctor in London and Medical Adviser to the National Theatre and the charity the Independent Diabetes Trust.
Conflicts of interest: no further interests declared.