The strange world of private medicine

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:355
  1. Peter Kandela, general practitioner (
  1. Ashford, Middlesex

To build a flourishing private practice is the dream of most hospital consultants, but to achieve this they are almost totally reliant on the goodwill of general practitioner colleagues. There is nothing new in this, except that increasingly I hear GPs complaining about being the poor relation in this lucrative business. To put it bluntly, Mrs Smith may be worth several hundred or even several thousand pounds as she trots up to a private consulting suite underwritten by her health insurance company, but to her GP she can never be worth more than £20.05 per year. GPs know that this is the way of the world, although many are not happy about it. What price ethical purity in an increasingly market driven health service? However, if GPs cannot reap financial benefit from private referrals, they do at least have the ability to decide which of their consultant colleagues will benefit, and some are enjoying the power that this gives them.

It used to be much simpler. When I joined general practice nearly 30 years …

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