The College and the independent sector

Sugarman & Nimmagadda (Psychiatric Bulletin, November 2007, 31, 404–406) argue persuasively for equivalent access to Continuing Professional Development, revalidation and appraisal requirements for both private sector and National Health Service (NHS) consultants. But it is disappointing that they attempt to drive a wedge between private and NHS (‘government service’) psychiatrists, arguing without evidence that the latter are more mired in administration and are less focused on clinical work. They also take a swipe at nationally agreed terms and conditions with their outdated criticism of the NHS pension scheme and Clinical Excellence Awards, implying their support for a more casualised medical workforce governed by market forces.

The article highlights the need for the College to take a more critical stance than the one afforded by Hollins (2007) on the involvement of the private sector within publicly funded services. Of all detained patients in March 2006 17.1% were located at private hospitals (Department of Health, 2007) and it is surprising that increasing private sector development at the expense of local NHS development has not led to the same level of debate as the Independent Sector Treatment Centres within surgical specialties. The authors are correct to challenge myths about the competencies of clinicians working in the private sector but legitimate concerns regarding the relative costs of care, increased geographical isolation of private units, and poaching of NHS-trained staff on often inferior terms and conditions should not be dismissed lightly or ignored as the elephant in the room.