With the NHS being the largest employer in Great Britain it makes sense that we’ve covered it in Civvy Street from many and various angles. However, for people seeking a career in the medical sector or for Service-leavers with medical qualifications, it isn’t the only show in town. The private medical sector has a variety of opportunities to work within a hospital or other clinical environment outside of NHS control.
Although the National Health Service was founded in 1948 for use by the general public there has always remained the alternative of private medicine. This provides patients with the choice to select different practitioners or therapies and in some cases can ensure a swifter treatment schedule to that found in the publicly funded NHS.
A private patient is simply defined in the NHS Act 1977 as “a patient who gives (or for whom is given) an undertaking to pay charges for accommodation and services.”
The broad reputation of the private sector is that the inherent quality of service will be above that of the NHS, perhaps not necessarily in expertise of the healthcare professionals but almost certainly in terms of the peripheral issues such as being seen quicker (avoiding waiting lists) by the consultant of their choice as well as a private room during treatment and recovery which is unlikely to be available to NHS patients. The fact that the consultant may have an ongoing relationship with the specific patient is also something that private patients seem willing and able to pay for and gives them a feeling of assurance that key elements of their medical history and diagnosis won’t be missed or forgotten about.
In private healthcare, patients have a direct professional and contractual arrangement with their doctor (or team of doctors) and the terms of engagement require an informed financial consent of the patient from the outset.
Whilst this might not immediately concern a healthcare professional considering their next career move, it should. In NHS practice, patients are sometimes asked (when admitted to hospital) to sign a compliance ‘contract’. In other words, they must allow the medical professionals to provide the services/treatments they see fit. If they (patients) are not compliant, they are invited to leave (discharge themselves or be discharged). Of course, in private healthcare the word ‘patient’ might be substituted for ‘customer’ and the level of consultation is likely to be more specific, demanding therefore, a greater ability to discuss and negotiate on the part of the concerned healthcare professional. Although it would be foolhardy in private medicine to suggest that ‘the customer is always right’, they do need to be thoroughly consulted.
Just as any other business is at the mercy of supply and demand, so is a private healthcare practice. Private patients may fund their treatment individually, or through claiming on their private medical insurance. (The doctor’s contract is always with the patient, and it is therefore the patient’s responsibility to ensure that the doctor’s terms and fees are met.)
Any doctor fully registered with the General Medical Council (GMC) in accordance with the provisions of the Medical Act 1983, is entitled to set up in private medical practice. This rule presents any old quack from hanging a doctor’s sign above the door and so even doctors with provisional or limited registration cannot practise in their own right without supervision. Doctors registered with the GMC do not need to inform them that they will be undertaking private work, but are required to ensure that they fully observe the GMC guidance on ‘Duties of a doctor’ which sets out the responsibilities and constraints of doctors working in private practice.
According to the Royal College of Surgeons, private hospitals have very strict criteria for awarding practicing privileges to doctors using their facilities. These help to assure patients that they are being seen by experienced and fully-trained registered specialists.
There are several essentials that a doctor in private practice must have. (Here are the main items among others.)
According to the British Medical Association (BMA) indemnity “is essential:, and a General Medical Council (GMC) requirement exists for all private practitioners to have an adequate level of indemnity cover from one of the medical defence bodies”. (The NHS indemnity schemes do not cover private work.)
Cover can be obtained from:
Medical Defence Union: www.themdu.com
Medical and Dental Defence Union of Scotland: www.mddus.com
Medical Protection Society: www.medicalprotection.org
Recognition with private medical insurers
Since many private patients fund their treatment through medical insurance claims it’s useful for private practices to have recognised status with the companies supplying private health insurance schemes.
Sometimes known as PMIs, private medical insurers such as BUPA, AXA PPP, WPA and Aviva will only reimburse customers that use a recognised consultant. This helps the insurance company to maintain the quality expected from their customers (patients).
Again, according to the BMA: “The requirements to obtain specialist recognition vary between the insurers, but most grant recognition to individuals who are on the specialist register and hold, or have held, a substantive NHS consultant appointment. The recognition arrangements of the insurers do differ, however, and some may not require a formal recognition procedure.” The best starting point for practitioners is to contact health insurers to discuss the recognition criteria (which may include other terms as well).
Registration with the Care Quality Commission (CQC)
Regulating matters concerning the private (or independent) healthcare system in England is the Care Quality Commission (CQC). Any service provider who carries out a regulated activity must register with the CQC, however, there are certain exemptions that apply to independent medical practitioners which means that some of them do not have to register. To be exempt, an individual medical practitioner (or all those in a group of medical practitioners), must be a service provider (or employed by a service provider) that is registered with CQC for carrying out a regulated activity. The exemption for a group of doctors only applies to a practice of doctors not a body that employs a range of staff including doctors.
Many doctors do not hold an NHS contract, and work purely in the independent sector, either with practising privileges at one or more independent hospitals, on a self-employed basis with no practising privileges. Even so, these doctors are still required to participate in appraisal in order to revalidate with the GMC. In addition, independent providers have responsibility through the National Minimum Standards from the Care Standards Act 2000 to ensure clinicians are appropriately appraised.
Doctors in this category can participate in an appraisal process via: the independent sector organisation in which they work, the relevant Royal College, the Independent Doctors Federation, or an independent appraiser. The Doctors Responsible Officer (RO) is required to ensure that they are satisfied that the appraiser and appraisal process meet the standards required for revalidation.
Consultants are free to set their own charges for private medical procedures.
When consultants treat patients who have private medical insurance they are not obliged to set their fee based on the level of benefit that the provider offers their customer (the patient). Two exceptions to this are the healthcare insurers AXA PPP and BUPA. Both have specific terms of recognition for approved specialists.
It can be difficult to give an average indicator as to the relative wages available to private professionals next to their public sector counterparts and this is no different when viewing the NHS and private healthcare settings since many NHS healthcare professionals will also have part time private roles and lower skilled jobs in the NHS can be outsourced to private suppliers.
Specialist roles undertaken in private medicine attract higher fees according to the National Careers Service.
In common with all other employment sectors, specialist agencies operate in the private healthcare sphere.
The advantage of using agency contacts is that they provide a bridge between candidate and potential employer which is especially useful if you are approaching the marketplace ‘cold’ or haven’t approached an employer for an extended period of time. Medical agencies will already have an established relationship with private medical employers who will trust that their ‘screening’ interviews of new candidates ensure that only good quality candidates make it through to interview stage proper.
Agencies also know enough about the state of the overall marketplace that they will know where the ‘gaps’ are and therefore be able to place you in the correct position but also for the best possible terms (as per the needs of the market).