Private MRI scanning. Best year ever.

Now that we are coming to the end of Patsy Hewitt's "best year ever" for the NHS it is interesting to ask why, in my region of the W.Midlands and Wales, record numbers of patients are paying for their own CT and MRI scans and other radiology at UK-radiology and at our local Nuffield private hospital.

Many private patients are covered by medical insurance provided by their employers and I am sure in areas such as London, where the economy is booming, many people will "go private" because of this but in my area, which has missed out on the economic boom, patients are mostly paying out of their own pockets and doing so in increasing numbers.

We are also seeing a number of private companies risking their own money setting up private scanning services, even though Nulabour has already negotiated and paid for a vast increase in scanning provision from their friends in the independent sector.

To me, this doesn't indicate improving satisfaction with the NHS. Why is this?

I haven't done a scientific survey or brought in management consultants to look into this but I can think of a number of reasons.

The "improvements" in the NHS have been targeted at the sexier aspects of healthcare and for someone with, say, M.S., sciatica or dementia, access to scanning has not really improved. In fact, because of the pressure to do cancer patients urgently, these patients often wait longer now. Waiting times figures for facet injections, which I do for back pain, are not even collected by the DOH and these patients can still wait indefinitely without breaching any target.

I don't think the process of "NHS dumbing down" is driving radiology patients to the private sector yet. Most patients don't even realise that a Radiologist is a medical consultant and have been blissfully unaware that their ultrasound scans or barium enemas have been done by advanced practitioners for the last few years (if a nurse practitioner is called a "Numpy" should I call a radiology practitioner a "Rumpy"?). Now scans are being reported abroad and the UK medical establishment has lost control over standards but the general public is still unaware of this.

I think the real reason is unmet rising public expectations. When my medical colleagues or their families suffer say, back or neck pain, we tend to give them priority and scan them within a few days. However, like other departments, we also issue "evidence based" recommendations to our GPs regarding who should and shouldn't be scanned and therefore ration access to scanning for the general public. Wanting the reassurance of a normal scan is not considered adequate reason for a scan but it is the reason my doctor friends and, indeed myself, would want a scan. I suppose the distinction is between need and want and, as Dr Crippen points out on his blog, the government has quietly been changing the provision of NHS care from "free and the point of use" to "free at the point of need". So far they haven't specified who will define "need" but I predict this will be a moveable hurdle imposed by a system of incentives like the GP QoF points system.

Nulabour wanted to abolish private practice and private schools and, after 10 years, they are both flourishing. "Vote Nulabour - things can only get better"

Overpaid doctors

Dr Rant and Dr Grumble both pick up on an article in the Telegraph today quoting a GP comparing the annual cost of providing GP care and insuring a hamster (£50 vs £65).
Vets are skilled, dedicated professionals, who have been selected for university degrees from among the brightest of our school leavers and undergone rigorous and demanding training. In a free market, they deserve whatever they are paid. So would doctors in a free market. Looking at the USA, it would probably be more than they are currently paid. The truth is that having the same monopoly acting as employer, provider of facilities, regulator of trainee and job numbers and regulator of income has actually held back doctors wages. Perhaps the USA is not typical one might argue. After all UK doctors are the best paid in Europe. They may well be but there is also government interference in healthcare in Europe and perhaps a more valid comparison would be with those other bright and hardworking individuals working at the pinnacle of free markets - the City, where a fund manager with say 15-20 years experience, if he still needed to be at work, would consider a GPs or Consultants annual wage no more than lunch money.
I was made aware of how much we stood to benefit from free markets when I started contacting osteopaths about our MRI service. I really knew nothing about osteopaths until recently but the ones I have spoken to have been gracious, well mannered and personable. Then again they are all self employed and these same qualities are their stock in trade. And what a trade it seems to be. Having phoned up many dozens of practices it seems many work from about 8am until 8pm and some even do OOH home visits. They book patients back-to-back at 20 minute intervals and the going rate around here seems to be about £35. I have never managed to phone and find an osteopath free between patients. Some employ a receptionist but some just have an answering machine and a few even work out of their own homes so expenses are low. When I did call in to one practice to deliver leaflets I noticed a patient paying in cash so even paperwork is minimal.
Well, by my calculations that is around £100/hour, lets say 10 hours/day, 5days/week, for 40 weeks a year (they all seem to take a long holiday between Xmas and the skiing season). That makes £200,000 pa before expenses.
Recently I have had 6th form students, interested in a career in Medicine, spending part of the day with me at work and I have mentioned that they could be earning this sort of money after only a three year course and should reconsider their options.
My other conclusion from my observations is that patients are willing to pay hard-earned cash to someone who is nice to them and devotes 20 minutes personal attention. The same message in the magazine from the Medical Protection Society today - patients rarely sue doctors who are nice to them. Whether the treatment is correct, safe, evidence-based or effective doesn't even register on the scale. Doctors ought to remember this.