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Alternatives to sole NHS employment for consultants

Health Policy and Economic Research Unit
December 2006

With today’s plurality of access to medical care there are several potential avenues for consultants to provide care for patients, both alongside NHS practice, and potentially as an alternative. Consultants will need to assess how they may act together to bid for extra/alternative NHS work or provision of health care outside the NHS. "Alternatives to sole NHS employment for consultants" aims to help you identify the best route, and avoid some of the pitfalls. It addresses some of the practical considerations and highlights the legal and pension implications.

The document can only highlight some of the numerous issues involved and consultants considering any of the arrangements referred to in the paper are strongly advised to seek appropriate professional advice before taking any action. Your attention is drawn in particular to the section on the Competition Act on page 12 of the pdf file.

Breaking new ground
Currently, there is an increase in the use of a diverse range of healthcare providers. More patients are seeking to pay for operations themselves, and the government is encouraging trusts to commission private providers to supply care for NHS patients. The Department of Health now has a ‘concordat’ with representatives of private healthcare providers. The concordat outlines the department’s commitment towards planning the use of private healthcare providers, not only at times of pressure but also on a more proactive longer term basis. It enables NHS commissioning bodies and/or providers to enter into arrangements with private providers to supply services to NHS patients at no cost to those patients. It also provides a framework within which a new contractual relationship may operate.

Consultants may wish to devise a way to work privately, and negotiate with a range of providers, to develop a portfolio of income generating work, rather than relying on full or part-time salaried practice for providing their services to the NHS.

In order to maximise efficiency, it may be beneficial to cooperate with other consultants, and negotiate jointly. Consultants may be able to work with greater flexibility, to deliver NHS services in a radically different way, one which offers advantages to both patients and doctors. In certain circumstances they may find that private work becomes an alternative to employment in the NHS. Much of the experience to date has been around the provision of private clinical services, some examples of which are used throughout this document. This publication is based on an earlier policy document produced by the BMA’s Health Policy and Economic Research Unit which can be read here.