Intended for healthcare professionals


Capping earnings from private patients in NHS foundation trusts

BMJ 2009; 339 doi: (Published 11 November 2009) Cite this as: BMJ 2009;339:b4698
  1. John Appleby, chief economist
  1. 1King’s Fund, London W1G 0AN
  1. j.appleby{at}

    Higher earnings must not compromise patient care and use of public money

    The boundaries between public and private care in the NHS have never been clearly demarcated—not even in theory, let alone in practice. Recently the Department of Health announced that it will review the cap on foundation trusts’ earnings from private patients.1 As with the recent review of top-up payments,2 the review is the latest example of re-emerging tensions arising from historic fudging of a messy and complicated subject.

    The department wants an alternative way of regulating private income that protects the interests of NHS patients and prevents taxpayers subsidising private care, but that also deals with anomalies in the current capping system, which have led to perceived unfairness between NHS hospitals and a potential restriction on innovation and trade.

    The private …

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