Since March 2020 it was sensible medical practice to consider making all possible beds in the NHS available to potentially admit ill patients with COVID-19. The expected admission rate was supposed to risk overwhelming the NHS, so independent sector facilities apparently volunteered and were then contracted to the NHS as priority, with full remuneration for their losses, and all private practitioners were effectively frozen out from seeing, admitting and operating on their own self pay patients. In addition, all patients with private medical insurance were unable to be seen or operated on in the private hospitals, yet the insurance companies continue to take extortionate premiums. All of the doomsday scenarios predicted by epidemiologists have fallen flat and there has been a catastrophic effect on the economy and workers outside of the state sector. The ‘essential workers’ included NHS surgeons, the majority of which have sat idle for the majority of the week on full pay throughout, and have recently been awarded a nice pay rise to boot.   

There are strong arguments that lessons from multiple coronavirus outbreaks over the past 10 years have neither been learned nor understood. A huge amount of taxpayers’ money has been wasted on poor media management, inappropriate purchases of PPE and testing equipment and these have simply created a blind panic and scare that now affects the entire economy. I feel that my considerable taxes have been wasted by underqualified politicians in good faith, but advised by inexperienced epidemiologists and pseudo-scientific advisors with no greater knowledge than the rest of us. I could have spent my taxes more efficiently for the community than that lot.

From previous outbreaks we saw that caseload numbers would peak, then soon trough and it would be very unlikely that a major second spike would occur, although aftershocks would be likely in clusters. All that was required initially was appropriate control of our borders, selective isolation, full testing facility, improved personal hygiene, antiseptic handwashing, an educated use of face masks and individuals separating by a distance that avoids droplet or aerosol spread. The economy could have been spared and we would all be better off.  

Despite PHE stating the effectiveness of face masks was debatable for weeks on end, they have finally been forced to drop their dogmatic approach even though there has been data published years before that coronavirus is spread by contact, droplet and aerosol and masks can only limit the viral load delivered, not avoid infection. The actual viral load appears proportional to severity of illness. So masks can reduce the viral load exposure.

In a pandemic, the hospitals themselves and not society should have been isolated, with no movement of staff or release from hospital accommodation until repeated swabs in a step down unit were tested negative. This isolates the virus in one area. The stupid thing to do was allow staff that are very likely contaminated within the NHS hospital environment going home in their same uniform and mixing with the public in petrol stations and supermarkets. It was also clearly stupid to allow NHS medical and nursing staff to work in both NHS and private hospitals, operating on NHS patients and to moonlight in care homes as second jobbers.

It was identified by Semmelweis in the 19th century that doctors are a major cause of nosocomial infection when they don’t wash their hands, and by the RCN that nurses at the end of a working shift in hospital have up to an 80% chance of being contaminated with a pathogenic organism. We know that at least 20% of hospital staff have had COVID-19 from March 2020 and the actual numbers are likely to be considerably higher. A large percentage of COVID deaths occurred in managed care facilities, including hospitals and care homes, being probably cross-infected from contaminated asymptomatic staff. It is also infuriating to hear that patients were discharged from NHS hospital care homes without swab testing with apparent stupid ignorance that there was no risk of transmission. Why, oh why have low paid carers been allowed to move freely to do working sessions at multiple facilities, probably using that day’s contaminated uniform between each facility?

To me, as a plastic surgeon exclusively working in private practice, the effect of this absurd NHS contracting system is to deny me any source of income. I was of the opinion in March that my patients should be a low priority and I should stop working, because the potential needs of the many was important, but I am now disillusioned with the motives and the activities of management behind the process. The private hospitals have had all of their expenses and potential losses, including those that I would have generated through my practice for them, paid in full, yet I have had no income and am unlikely to start working again until next year. In March I volunteered my services, as a leading UK surgeon, to help with the expected deluge of urgent NHS waiting list patients. The NHS, having contracted 100% of the private facility did not require my services and I have been frozen out of my practice of over 30 years. I have discovered that the 57 or so local NHS plastic surgeons and many other doctors were not included in the direct care of COVID-19 patients and have been idle, yet received full NHS salaries and have managed to clear their own waiting lists for day surgery using the private sector facilities. In the independent hospital that I have supported for the past 30 years, NHS management want the waiting list surgery contracts extended, especially to do orthopaedic hip and knee replacements, making the NHS orthopaedic surgeons very wealthy individuals with a lucrative double income. Not only are they doing very small numbers of operations in their NHS sessions in NHS facilities, they are also paid extra per patient in the private sector. Little wonder the private hospitals are more efficient! Why not just reopen their unused facilities in the NHS to urgent and soon cases with green pathways? In orthopaedics the joint replacement lists are so inefficient in the NHS that they have apparently built up enormous waiting lists that need to be shifted into private hospitals under newly agreed contracts. With no expenses and all insurance and consulting room charges paid by the NHS to do daytime, mid-week sessions, why would they want to go back into the NHS hospitals? Surely this is a serious conflict of interest and a clear reason why they objected to the publication of data on NHS doctors’ incomes from private practice. There appears to be an NHS working week directive loophole that allows secondary contracting for the full-time NHS consultants to operate on NHS patients in private hospitals. Those on part-time contracts have the very best of both worlds, with NHS job security plus a most generous pension and unfettered access to the private hospital. 

As a taxpayer I find this use of public money a disgrace and am especially concerned that the NHS has just extended its contracts to run to the end of the year and my income will be zero for at least nine months. No consideration by the private hospital nor the NHS has been made for the total loss of my income and that of other independent practitioners.

With so much money having been wasted on these NHS contracts, I suggest that it is now urgently redirected to improve NHS capacity for the longer term. If NHS surgeons want to do private practice, including doing NHS patients on premium weekday daytime operating lists, they should leave the NHS or be made redundant. It is time that independent practitioners are reimbursed for their serious loss of income, because few can survive on no income with all the associated expenses in maintaining a practice.



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James D Frame (Prof)

Springfield Hospital, Chelmsford, Essex, UK.

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