Managing timetable conflicts

When carrying out NHS and private practice work, it’s important to ensure that the needs of both your private patients and your NHS patients are met. Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection, looks at one potential scenario and offers some guidance.

Imagine you are a consultant general surgeon with both an NHS contract and practising privileges at the local private hospital. You are contacted by the private hospital to inform you that a patient you operated on yesterday has become very unwell. The Resident Medical Officer has reviewed the patient and considers that an emergency return to theatre may be needed. They are asking that you attend urgently.

You are, however, contracted for NHS duties today and are just about to start your ward round. You are aware you have several complex patients who require consultant review.

It is important to be aware of your obligations in a timetable clash like this.

The GMC’s Good Medical Practice states that you must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must promptly provide or arrange suitable advice, investigations, or treatment where necessary, and refer a patient to another practitioner when this serves the patient’s needs[1].

In managing this scenario, you must ensure that the needs of both your private patient and your NHS patients are met. The document Terms and Conditions – Consultants (England) 2003 states that the consultant is responsible for ensuring that the provision of private professional services or fee-paying services for other organisations does not result in detriment of NHS patients or services, or diminish the public resources that are available for the NHS.[2]

This should be read in conjunction with A Code of Conduct for Private Practice, which sets out that the provision of services for private patients should not prejudice the interest of NHS patients or disrupt NHS services. Previously agreed NHS commitments should take precedence over private work, except for when emergency care is required.[3]

In this situation, you have been requested to attend to your private patient urgently, but you should also ensure that your NHS patients are reviewed.

The options available to you may include:

• Discussing the matter with your clinical lead to request that you are granted time to review your private patient and to seek cover for your NHS ward round.
• Request that a colleague with practising privileges in the private hospital reviews your patient while you conduct your NHS ward round.

It would, however, be prudent to consider, before committing to both private and NHS work, how to prevent or mitigate this scenario by pre-emptively arranging for cover if and when such a situation was to arise.

This could, for example, include reaching an agreement with another colleague who holds privileges in the same private hospital, so that you cover each other’s private patients should an emergency arise. You could also arrange for your NHS colleagues to cover your NHS duties were you to be urgently called away to the private hospital. You should ensure that your NHS lead approves any cross-cover arrangement and that you keep proof of the agreement.

It would also be prudent to ensure your contract or terms of engagement with your private patients makes clear that in the event of an urgent problem or emergency, another clinician would need to be involved if you are not available.

Further, you may to wish to consider whether it would be appropriate to request changes to your NHS job plan, or to your scheduled times at the private hospital, to minimise any disruption that may be caused to your NHS work should there be a complication arising from a procedure you have performed privately. This might, for example, mean adjusting your timetable so that you do not have NHS clinical commitments at a time when it may be more likely that complications would occur in your private patients.

Failure to ensure that all your patients, both NHS and private, receive the appropriate care may result in an adverse outcome for the patient, which may lead to a complaint or claim against you, or disciplinary and/or regulatory action. It is worthwhile giving consideration in advance as to how you would tackle the above dilemma if it arose.

[1]Good Medical Practice. General Medical Council. April 2019

[2]Terms and Conditions - Consultants (England) 2003 (Version 11, April 2018). NHS Employers. April 2018

[3]A Code of Conduct for Private Practice: Recommended Standards of Practice for NHS Consultants. DoH. January 2004