. . . . In my work as an NHS GP the corrupting effect of private practice is less immediately obvious, but through my correspondence with specialists I know it still goes on: scans, arthroscopies and follow-up appointments are all more lavishly recommended when the patient is paying, which makes one wonder about the criteria used to recommend them. Recently an angry father insisted I refer his son for consideration of a tonsillectomy after a couple of episodes of tonsillitis. If I want to refer someone to have their tonsils out on the NHS, my local surgeons won’t countenance seeing them unless they meet certain criteria: seven episodes of tonsillitis in the last year, or 10 over the last two years, or three a year for the last three consecutive years. There are good reasons for this: tonsillectomy risks haemorrhage, infection and leaving you more prone to throat problems in the future. Though we all pay for NHS care through taxation, no doctor in the NHS will now remove your tonsils just because you’ve asked them to – that would be considered a grave abandonment of professional standards, and a flouting of evidence-based practice. But the private healthcare market specialises in treatment on demand, and the rules are different over there. When the father repeated his demand at a private clinic the surgeon’s professional reservations melted away and the operation was scheduled within days. The surgeon’s later correspondence contained a tortured justification for tabling the surgery that was painful to read. It must have been painful too for the patient who went on to need NHS hospital admission to address subsequent complications (bleeding and infection). Several of my own clinic appointments were used to deal with the aftermath. There is as yet no reliable mechanism for the NHS to bill private health companies for the expenses incurred when private procedures go wrong.
Private providers sell an image of excellence and efficiency, but that glossy sheen, in the UK at least, is built on the assurance that whenever a patient becomes unprofitable, or presents too much of a risk, the NHS will step in. This is what some of the private companies taking over aspects of NHS care are beginning to discover: profitability is high if you can pick and choose which patients and procedures you deal with, but drops off when you are confronted with providing a comprehensive service for everyone based on need rather than privilege.