Medicine And The Media

Embarrassing greed?

BMJ 1995; 310 doi: (Published 21 January 1995) Cite this as: BMJ 1995;310:198
  1. Christopher Bulstrode

    Dispatches this week featured a programme based on Serving Two Masters, the report by Dr John Yates, a former government adviser and authority on NHS management. The report was funded by the Joseph Rowntree Trust after John Yates's well publicised bust up with the government over the issue of whether private practice was interfering with work done by consultants for the NHS.

    Interviews with GPs and patients produced the usual depressing catalogue of cases waiting for up to a year to be seen by a specialist, but offered almost immediate treatment if they were prepared to pay. The documentary argued that waiting times in the NHS are increasing because consultants are spending more time doing private practice than they should.

    John Yates produced a letter from the Department of Health stating that consultants on maximum part time contracts should not do more than one half day a week of private work during normal working hours.

    He then set out to prove that many consultants do more than this and that neither managers nor the government are prepared to do anything about it. His staff phoned consultants' rooms, ostensibly to find out about obtaining an appointment but actually to find out how often consultants saw patients privately. The film of consultant surgeons being tailed through London traffic from one private hospital to the next by private detectives in radio cars with supporting motorcycles made gripping television. In juxtaposition to film of John Yates in church with the very people who had been given the choice of long waits or the loss of life savings, the message was clear.

    If Dr Yates is right in his report, and judging from his previous quality of work I have no doubt that he is, then I was left deeply embarrassed that I belong to a profession which has shown itself both unwilling and unable to set standards that would make this documentary unnecessary. Of course the issue is complicated; many consultants are workaholics who may be doing more than their contracted NHS work and large amounts of private work at the same time, but the programme tried to present both sides of the argument fairly.

    Some statements made in the film will inevitably be taken out of context and used to belabour John Yates and the makers of the programme. Unfortunately too, all consultants however honest and hard working will now be tarred with the same brush as those whose aim is the sordid pursuit of money. The real message from this documentary is that there is a danger that some doctors might be allowing their greed to distort health care in Britain. Either we as a profession accept this (as in the United States) or we put a stop to it from within the profession. If we do not, then I think that the public after seeing this programme will rightly demand that it is done for us.—CHRISTOPHER BULSTRODE, clinical reader in trauma, John Radcliffe Hospital, Oxford

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