‘What private general practice taught me – and why I’m glad they sacked me’

Following a short spell working as a GP in the private sector, Dr Jonny Currie warns of the commercial pressures threatening general practice that could tip the NHS toward a profit-driven system

Something amusing happened towards the end of last year. Well, I say amusing, but being made redundant (even if it was from a private medical side-job) is not really in the least bit funny.

Let me start at the beginning. My main job is working as a GP in east Newport, where three in four of our patients live in the poorest part of what is already a poorer nation than across the border in England. A few months ago, I decided to pursue a part-time job in the private healthcare sector, alongside my NHS GP role. Yes – I can already detect your raised eyebrows, because yes, I have had them all before. To be honest, I count it as a good thing because it shows the measure of the people I hang out with.

But I have never been able to let go of the idea that we all ought to walk in each other’s shoes more. Having seen the perils of private healthcare overseas – the profit ethos, the inefficiencies of a two-tiered system, the rampant inequalities it can drive – as well as at home (I temped as a Harley Street clinic secretary during a gap year years ago), I had already formed a firm view of the sector. But an older, wiser me knew I could explore it further. And so, I adopted the role of remote private clinician, braving the new and mercantile world of corporate health.

Despite my concerns about private medicine, I did find it taught me a thing or two. I noticed different approaches to safeguarding, mandatory training (I can’t be the only one to admit that we can be a bit lax on that in the NHS), incident reporting, patient feedback, and audit. I must admit that I felt uncomfortable with the level of scrutiny on me; not so much by patients whose feedback was collated and sent to us regularly, but by the idea that my notes would be frequently audited. And this is coming from someone who feels scrutiny and transparency can only be positive.

But it was here that the deeper problem became clear to me. Commercial healthcare wants our NHS. It wants our staff. And it obviously wants our patients. To do this, it is pricing and innovating (a lot more than we in the NHS are) to secure an increasing market share, driven by the idea that many are dissatisfied with the status quo of the NHS.

The difficulty is that this growth is not built around continuity or integration. As a remote private GP, I had no access to your NHS universal healthcare record. I can’t speak freely to local clinicians in the community or hospital about your care. I can’t book you bloods or investigations the same day. I only know what medication you need or are asking for if I can see what you had last time or are on now.

I can’t get advice from an expert in your condition digitally and continue to lead your care. I can’t see you. I can only pass you on to someone who can, which invariably in commercial healthcare is not another GP, but a specialist. And to me, this undermines the core strength of the NHS: GP-led continuity of care, carried out by community medicine experts, coordinating the cacophonous orchestra that is fragmented care, fragmented across conditions, specialties and agencies.

In the world of commercial healthcare, GPs are cannon fodder. It is our expert colleagues in surgery, specialist medicine, technology and others who will drive up profits, not us. And so, I am fortunate, unlike my patients whose job loss too often wounds or scars, to be there no longer, as I have learned enough. Corporate and mercantile healthcare is here to stay.

But for GPs, participation should come with open eyes. In this world, general practice is not the prize: it is simply the conduit. Profits are driven by specialist activity and throughput. Continuity, coordination and community knowledge – the very things that once made the NHS work – are being gradually eroded.

As I said at the beginning, I was made redundant from the private job (which rather proved the point I was in the process of learning!) And, acknowledging that I will differ from colleagues whose redundancies will hurt, I was somewhat glad it came to an end. I really don’t know how much longer I could have kept up the role: moonlighting as a quasi-anthropologist of commercial healthcare or not.

We obviously do need more innovation, goods production, and marketing (less of the pharmaceutical kind, thank you very much) in the NHS. But private healthcare does not grow alongside a universal, comprehensive and fair health system. Rather, it grows in its absence, filling gaps created by delay, fragmentation and dissatisfaction – and in doing so, risks widening them.

Before deciding whether you agree with this sentiment, don’t just think about America as the obvious example. Think instead about the UK before Wales donated England and the rest of the country (yes, we did, you’re welcome) the NHS in 1948. Care was fragmented and transactional – and it really isn’t that long ago in our history.

I learned these lessons and, redundancy aside, I had the luxury of stepping away with my eyes open. Many of our patients will not be so fortunate, nor clinicians. If we are not careful, private healthcare will not merely sit alongside the NHS; it will hollow it out. We GPs need to summon our inner Nye Bevan and ask what kind of world and health system we want our grandchildren to inherit. Raise an eyebrow at that, please.

Dr Jonny Currie is a GP partner, public health consultant and clinical research fellow at Cardiff University. He is also the co-director at 19 Hills CIC, a social enterprise promoting integrated and holistic community health and wellbeing activities.