Inconvenient truths

Ian Forgacs (December 2006 JRSM ¹ ) confessed to being trapped by the conflict of interest generated by his moral allegiance towards the principles of the NHS and his ethical concerns regarding best practice for a particular patient. This was solved in that case by seeing the patient privately. We must assume that the personal financial gain did not enter into the equation. However, this solution can only be seen as a positive gain for the NHS if the patient can afford to pay.

Dr Forgacs’ ability to facilitate rapid resolution for a private patient's medical problem was because he was in control of the management process. The NHS situation could be improved if doctors were given the opportunity to exploit similar management pathways.

My approach was to develop my own outpatient IT system, so that from the receipt of the general practitioner communication the patient could be seen on any of the four weekdays on which I had a clinic. Clearly, I decided the degree of urgency but, when appropriate, I could see the patient on the next day. Any complex imaging process that might be necessary unfortunately fell into the NHS resource-driven black hole, because management refuses to run a theatre or scanner outside of ‘normal working hours’ unless the patient can stump up the associated fee.

My system met with managerial obstruction and resentment: patients loved it. Letters were only dictated on new referrals. The remaining correspondence was IT generated. The reduction in secretarial time was rewarded by reducing my access to secretarial help to 2½ days per week without the budget savings being returned to my speciality. (The penalty I paid for rocking the boat.) It is the numerous conflicts of interest within healthcare provision which fuels the demand for and the acceptance of private practice.