Doctors upset by jibe over private work

OPEN HOSTILITIES have broken out between doctors' leaders and the Government over allegations by the Health minister, Alan Milburn, that hospital consultants are spending too much time doing private work.

The British Medical Association reacted angrily to criticism of consultants contained in a letter from Mr Milburn to the Doctors and Dentists Pay Review Body (DDRB).

In the letter, Mr Milburn re-iterated his plan, announced last summer, to reform the pay of consultants to reward those who spend more time on NHS patients.

However, the language that he used infuriated doctors. Mr Milburn wrote: "Taxpayers have a right to expect value for money from this highly paid group of professionals. There are a minority of consultants who do not properly co-operate in working productively for the NHS and put their private practice before their NHS work."

The BMA fired off its own protest letter to Brandon Gough, chairman of the DDRB, defending the consultants. "The fact is that consultants across the board are already working some 51 hours per week, well in excess of the legal maximum," said Ian Bogle, chairman of the BMA council.

The row signals deteriorating relations between the BMA and the Government. Senior doctors have become weary of reports of incompetent or misbehaving doctors being used to tar the whole profession and believe that Mr Milburn is fanning the flames against them.

The association was also angered by Mr Milburn's earlier proposal to change the law underpinning the General Medical Council to make it easier for the Government to intervene in its running.

Although the proposal was rebuffed, doctors saw that episode as evidence that he was more interested in controlling the profession than working with it.

The latest row has its origins in an Audit Commission investigation three years ago which found that consultants with large private practices were neglecting their NHS duties, leaving junior doctors to run outpatient clinics and carry out operations unsupervised.

The Audit Commission found that although most doctors worked long hours and showed great dedication to the NHS there was wide variation in the amount of work done by consultant surgeons.

Some were doing five times as much as others, even after allowing for differences in the nature of the operations and the complexity of the cases. The report also found that the 25 per cent of consultants who did most private work, did least for the NHS.

The BMA said then that the commission had failed to take account of the time doctors spent on call and had made false comparisons between them.

In the latest dispute about pay, the association complained on Thursday that it had been misled. Health department officials who attended a meeting with the BMA about the consultants "did not even raise the question of pay, let alone give an indication that there was any question of a major restructuring of NHS pay," said Dr Bogle.

Mr Milburn said the current pay system was holding back the modernisation of the NHS. "Too many NHS staff work under outdated, narrow job labels and depend on a range of arcane allowances of varying value to enhance basic pay," he said. "This fragmented approach to pay and conditions distorts working patterns and inhibits the development of the 24-hour flexible services we want for patients."

In a separate letter to the nurses' pay review body, Mr Milburn said that a new national pay system for the NHS was needed. "The scale of the problem calls for radical solutions," he said.