Cost of the middlemen

Our local commissioning group (aka GP fundholders) have agreed on an contract for our local NHS X-ray department to do MRI scans at £330 each. In fact its quite an achievement to get them to agree to anything but that's another matter. What is interesting is that uk-radiology do private MRI scans for £200 and both the radiologists and the Trust can turn a modest profit at this price using the very same machine, radiographers, clerical staff and radiologists. It is not however at all clear that the Trust will make a profit at £330. How can this be? The difference is that we have cut the middlemen out of the equation for private patients: that vast army of people who shuffle paper, collect statistics, analyze waiting times, go to meetings and attend courses on staff motivation and capacity and demand management. This is one of the clearest illustrations I have seen of the cost of all this dead wood; not just cost in terms of money, it is the reason front line staff posts are frozen and vital pieces of equipment are not purchased to the ultimate detriment of the service we can provide.