Nhs consultants who shun private practice
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Executive summary
A minority of NHS consultants deliberately avoid private practice for professional, ethical or practical reasons, even though most consultants do some private work and private practice remains an entrenched and contested part of the consultant employment landscape [1] [2]. The choice to shun private work is shaped by personal values, contractual rules and institutional pressures, and it sits at the heart of ongoing debates about conflicts of interest and the integrity of universal NHS care [3] [4].
1. Why some consultants turn their back on private practice
Some consultants reject private work on principle: they see it as inconsistent with the NHS’s equity goals or fear divided loyalties between paying and NHS patients, a theme highlighted in professional debates and academic research that questions whether fee-for-service incentives distort clinical priorities [2] [4]. Others feel personal unease about the optics of private income early in a consultant career or value the professional rhythms of NHS practice over the administrative and business demands of private clinics, a cultural factor noted in guidance for new consultants [5] [2].
2. Practical and contractual reasons for avoiding private work
Practical constraints also deter some consultants: national consultant contracts set limits and reporting requirements for private practice, job plans and the offer of extra programmed activity to the NHS, while codes of conduct demand disclosure and avoidance of conflicts, making private work administratively onerous for those who prefer to focus on NHS duties [6] [7] [8]. In some trusts local policies further restrict which NHS facilities can be used for private work and require formal approvals, adding procedural friction that nudges clinicians away from private practice [9].
3. Financial incentives, geography and career calculus
The pull of private income varies by specialty, city and individual circumstances: while most consultants earn modest sums privately, a small subset does substantial private work, and lucrative urban markets can draw consultants into more fee-paying activity — a dynamic that prompts concerns about shifting loyalties and workforce distribution [7] [10]. Conversely, some newly appointed consultants avoid early private referrals to preserve local referral networks and reputations, an approach advised by private-practice guides that notes turning down referrals can harm long-term private opportunities [5].
4. Ethical scrutiny and political pressure
Public and parliamentary scrutiny has repeatedly targeted consultant private work: a House of Commons committee once recommended that the long‑term aim should be consultants not practising privately, reflecting political anxieties about a two‑tier system and observable overlaps between NHS and private activity [1] [11]. Journalists and campaigners have amplified those suspicions during crises such as the pandemic, when senior managers asked consultants to pause non‑urgent private work to prioritise NHS cases — an episode used to argue that private work can siphon capacity from the public system [10] [12].
5. The middle ground: controls, norms and professional ambivalence
Most regulatory and professional materials accept private practice as lawful but insist on strict boundaries and transparency: the BMA and NHS guidance say consultants must not discuss private treatment during NHS consultations and must disclose commitments, reflecting a compromise that allows private work but tries to contain conflicts [6] [8]. Many consultants occupy that middle ground — doing limited private hours while claiming their NHS loyalty — and commentators inside medicine express continuing ambivalence about whether that arrangement erodes public service ethos [4] [3].
6. What reporting leaves unclear
Available sources document motives, rules and controversies, but they do not provide a definitive national count of consultants who completely shun private practice or granular, up‑to‑date data on how motives vary by specialty and region; academic studies and professional surveys indicate norms but stop short of mapping every individual’s choices [2] [7]. Without a current national dataset publicly cited in these sources, the exact scale and distribution of consultants who avoid private work cannot be precisely stated from the reporting provided.