Sir, The unfortunate Dr Ubani’s prescribing error (report, May 5) is yet another illustration of the result of privatising sections of the NHS with no concern for the quality of the service provided. The Government offered GPs the option of giving up their out-of-hours service in return for the surrender of a derisory amount of money. Not surprisingly, many of them took up that offer. Equally unsurprisingly, the Department of Health then discovered that the service actually cost a lot more to provide than it had thought (because the GPs had been doing it for next to nothing). The result is that it now has to contract the service out to commercial providers who cut corners, with the inevitable outcome.

Dr Bob Bury

Leeds

Sir, Mark Roberts’s observations on consultants misusing the NHS by practising privately (letter, May 5) are outdated and inaccurate. Before the 2003 Consultant Contract there was no clear delineation of the amount of time consultants could devote to private practice, although if their private income exceeded 10 per cent of their NHS income for three consecutive years, they took a reduction in salary.

Since the adoption of the 2003 contract consultants are not permitted to perform private practice within the time that they are being paid by the NHS, except in cases of emergency. Their commitment to private practice must be disclosed annually.

If Mr Roberts has seen consultants walk from one hospital to another, then what he witnessed was personnel finishing an episode of work for one employer, and moving to another episode of work for a different employer. Just because he cannot see the arrangements in place that allow this to happen without detriment to the NHS, doesn’t mean that they are not there.

Lawrence Roberts

Consultant obstetrician and gynaecologist, Winterton, Lincs

Sir, Senior NHS consultants are not paid an average of £119,000 to reflect the number of hours that they spend in hospital or the number of patients that they see. That they are paid a salary at all is in order to access their clinical acumen.

This is the ability to correctly manage patients, acquired through repeatedly applying medical knowledge to produce experience that can be drawn on in the future. The crux of the issue is that junior doctors have just enough to function, while consultants eligible to earn £119,000 per year have it in spades.

This means that deciding how much senior doctors should be paid is a bit of a charade, because the value of clinical acumen cannot be measured in pounds. To those who have use of it, it is beyond value.

C. M. Pearce

Bristol

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