Letter from Mr William Jory to the Chairman
of the Committee (PS 63)
I heard you speak on the Today programme
this morning. I have practiced both in this country (in the private
sector and the NHS) and in Canada, where I was Chairman of Physician
Manpower studies in British Columbia and also National studies
for ophthalmology and other eye care professionals.
We felt very strongly in Canada that there should
only be one tier of medical service. Indeed, federal legislation
laid down at the inception of Medicare in 1967 made it illegal
to offer private medical insurance in Canada. Of course the situation
in this country is different and there will always be a public
and a private sector.
However, I feel very strongly that a consultant
should either work in the public or the private sector alone.
We used to liken the system in Britain to a British Airways pilot
who flew from Chicago to London and then to pay private school
fees for his children, did a quick charter to Majorca and back.
Of course, this is rightly outlawed in the interests of safety.
I believe that consultants should work either
in the NHS or privately, but not both. Of course, there will be
great cries of outrage from the medical establishment, since they
can much more than double their earnings by doing private work
as well. However, this must compromise patient safety, just as
my example of the pilot shows. There would not be a great exodus
from the NHS into private practice, since it is mainly by gaining
a reputation amongst local referring GPs, that a consultant makes
his name. He is therefore dependent on his place in the NHS. Of
course some of the older consultants would leave, but many of
them retire at 60 from the NHS anyway.
In the long term, not only would there be, as
your report suggested, the equivalent of 2,000 extra consultants
in the NHS, but they would be able to contribute much more to
the NHS, devoting all their energies to it. Their wives and children
would also be grateful, since many of the consultants hardly see
their families while they are growing up and retire early from
None of this is to suggest that the ethical
standards of consultants in the United Kingdom are any less than
in other countries.
I think at the same time, if it is within your
committee's remit you should look at the excessively long training
periods in this country. On average European countries have a
four year specialist training course before they become consultants.
This is also the case in North America and generally this training
period is well structured. By contrast, in this country, training
may go on for seven or eight years at least and there is now a
mandatory one year research period. I cannot see what use this
is to the NHS unless the doctor is going to proceed to academic
You might also look at the requirements of the
specialist training authority. A specialist list was introduced
three to four years ago and many specialists who are perfectly
fit and indeed do consultant locums and thereby prove their expertise
are denied a chance to become consultants.
With these three measures in place the shortage
of consultants in this country would be solved very quickly. Of
course we would have to make sure that we are offering enough
places in our medical schools for future growth.
9 January 2002