Health secretary Alan Milburn this week announced further links with private companies to help modernise pathology services and GP premises in the NHS, but failed to find a way of keeping doctors working for the health service rather than migrating to private practice.
In a heated debate in front of the House of Commons health select committee, Mr Milburn defended the government's commitment to increase partnerships with the private sector, arguing that they spelled improvements for patients.
"What we need is a bigger relationship with the private sector. This should be a long term relationship and not a one night stand," said Milburn. "Where we can use private sector capacity to improve care for NHS patients, that is what we will do. We are doing that through the private finance initiative, to give NHS patients the biggest hospital building programme the country has ever seen. And we are doing it through the concordat with the private sector that is giving more NHS patients NHS treatment in private hospitals."
In one of the new schemes nearly £8m (€13m; $11.6) of NHS money is being used to set up joint ventures with private companies to upgrade pathology services in Teesside, Lincolnshire, Leeds, Bradford, and London, he announced. Another 12 areas have been earmarked for inclusion in the NHS LIFT (local improvement finance trust) scheme, whereby public-private partnerships are used to help build and refurbish primary care premises across the country and then leased back to GPs. This is in addition to the first six areas proposed last February, he said.
But David Hinchliffe, Labour chairman of the committee, argued that private practice was hindering expansion of NHS services because the reduction of waiting lists through the concordat was having an impact on doctors' private lists, which many doctors did not like. He suggested that banning private practice among NHS doctors would create more time for NHS work among consultants.
Mr Milburn admitted that "staff is the biggest constraint in increasing services for patients" and that he had not yet found a way to get consultants to commit more of their time to the NHS. He said that banning private practice would force many doctors to leave the NHS altogether, as they could earn much more in private practice.
The most promising option was to get all new consultants to agree to work exclusively for the NHS for seven years. "The proposal is controversial, but there is a deal on offer [with the BMA]," said Milburn. "We are prepared to pay doctors more to treat more NHS patients more quickly."
An alternative would be to compensate doctors for their loss of private earnings, which can reach £50 000 to £100 000 a year. But Milburn admitted that it would be "unfair and illogical" to offer some doctors extra money for doing less NHS work, while others who could not earn a private income, such as doctors in emergency medicine and geriatrics, got nothing. And to compensate all doctors would cost £1bn—"not a sensible use of NHS resources," he said.
