Why ‘Private’ Shouldn’t Be a Dirty Word in Healthcare

The uncomfortable reality of private healthcare and why we can’t ignore it

Walk into any hospital mess in the UK and you’ll hear it whispered, often with a mix of suspicion and disdain: private. Private medicine. Private practice. Private hospitals. It carries the sting of betrayal, as if to step into that world is to step out of solidarity with your NHS colleagues.

But here’s the uncomfortable truth: private healthcare is already woven into the fabric of our system. Patients are using it, consultants are working across both sectors, and doctors at every stage of training are quietly wondering what it might mean for them. Yet we don’t talk about it. Not honestly, anyway. So let’s.

The Taboo

From day one as junior doctors, we’re fed a story: your path is fixed. Training rotations, specialty exams, a consultant post at the end if you’re lucky. Along that path, private healthcare is painted as something “other” - something you might cross into only after decades of NHS service. A reward, perhaps, for survival.

But that’s not the reality. Increasingly, doctors are finding themselves exposed to private systems earlier in their careers. Maybe it’s through locums. Maybe it’s through rotations in independent hospitals. Maybe it’s simply through the patients who move between the NHS and private care. And yet, we rarely reflect on what this means for us as professionals.

The Workforce Crisis is Not Theoretical

The NHS is haemorrhaging staff. That’s not news to anyone reading this. What’s striking to me, though, is how few conversations we have about where those doctors actually go. Some leave medicine altogether. Others leave the UK. And many, though they’re less likely to admit it openly, shift their practice towards the private sector.

Is that a problem? Or is it actually part of the solution?

The Uncomfortable Benefits

Here’s where it gets tricky. Private healthcare offers things the NHS increasingly struggles to time with patients, functioning IT, sometimes even safer staffing levels. For doctors, that can mean professional satisfaction instead of burnout. It can mean exposure to innovation-centric platforms, new models of care, even different ways of thinking about patient flow. It can mean agility with adaptation in ways of working from functional feedback loops, something rarely seen across NHS Trusts and PCNs.

Is it perfect? Of course not. Inequalities are real. Access isn’t equal. But ignoring its role doesn’t make those problems disappear.

Reframing the Question

Instead of asking whether private healthcare is “good” or “bad”, maybe we need to ask: how do the two systems learn from each other? What can the NHS borrow from the operational flexibility of the private sector? How can private providers ensure their innovations aren’t siloed, but shared more broadly?

And perhaps most importantly for us as doctors: how do we stop treating private medicine as a betrayal, and start seeing it as part of a bigger ecosystem we already work in?

Why this Matters to You

If you’re a junior doctor right now, private healthcare may feel distant. But it isn’t. The choices you make over the next decade, where you train, where you work, what you value in your career will bring you face to face with it, whether you like it or not.

So ask yourself: what do you want that relationship to look like?

Because pretending private healthcare doesn’t exist, or doesn’t matter, is no longer an option.

Hacking’s Classification Effect: How a Diagnostic Label Changes You

When a patient receives a diagnosis, it subtly reshapes how they perceive their own body. At least, this was the view of the philosopher and social theorist, Ian Hacking, who termed this the ‘Classification Effect’.

He believed that a label instructs patients on which signs and symptoms to notice. Thus, in actively searching for typical markers of the disorder, patients often register bodily changes they might previously have dismissed.

One has to be careful when making such arguments. It may be true that labels influence patient perception, but we must ensure that socially constructed phenomena are separated from biological ones. Labels may change perception and behaviour, but they do not necessarily manufacture underlying disorders.

Take the example of Hypermobile Ehlers-Danlos Syndrome (hEDS), which was only formally recognised in the 1990s. Unlike the other subtypes of Ehlers-Danlos Syndrome, which have established genetic markers, hEDS is fraught with diagnostic ambiguity and shares considerable overlap with conditions like fibromyalgia and chronic fatigue syndrome.

The number of patients presenting with hEDS and its typical symptom combination has grown dramatically. Consultant neurologist Susan O’Sullivan remarks that she cannot recall encountering a single patient with the classic hEDS presentation until around fifteen years ago.

So, Hacking believed that labels influence both perception and behaviour, shaping the way patients experience and report their symptoms—sometimes creating patterns of illness that might not have fully manifested without the diagnostic framework.

Is the State of the Economy Really a Doctor’s Concern?

Why indifference to the UK’s economic woes isn’t the right argument…

Fiscal Indifference

In the midst of the resident doctors’ strikes and the ongoing tension between medics and the government we wanted to discuss a common argument that you can find circulating on many Reddit threads. It goes a little like this:

The responsibility for the country’s economic failures lies with the government and not with doctors. Doctors’ duty is to their patients, not to the Treasury.

Parts of this argument may seem compelling, but we would argue that a country in which everyone thought like this and hyper-individualism was the goal, would not be a country most of us would actually want to live in

To absolve oneself entirely of the political and economic consequences of one’s own actions is to believe that the idea of collective responsibility to an institution (like the NHS) or even to one’s own nation is nonsense.

Collectively Responsible

A doctor who says, “I don’t care about the wider impact, I just want what I think I deserve,” is effectively claiming independence and neutrality in a system that only survives through mutual interdependence. You may not have created the fiscal constraints, but your actions, as part of a collective workforce, directly determine how those constraints evolve.

Doctors do not work in a vacuum sealed off from the state; every decision they make affects the NHS and the wider economy. To claim indifference to that dynamic, to say that “it’s not my problem,” is moral short-sightedness. If one claims to care deeply about the future of the NHS, then one must also care about the sustainability of the state that funds it. These two concerns are inseparable.

Of course, not every doctor subscribes to the ideal of a publicly funded service free at the point of use, and for those who do not, appeals to collective responsibility may land differently. But for the majority who still see the NHS as a virtuous project as much as a workplace, acknowledging financial constraints is realistic, not defeatist.

At some point, the question becomes larger than pay; it becomes about belonging. Ask yourself this: Do we, as doctors, see ourselves as participants in a national project? Do you wish for the country and its healthcare system to look a certain way for your children and grandchildren? Do we still believe in a shared stake in the public realm, or have we decided that the health of the system, the nation, and its future generations is simply someone else’s problem? If the latter is true, then the tragedy is not just political; it is societal.

And this is the ironic thing: you can answer yes to both of those questions and still maintain that strike action is the best solution, whether through the maintenance of a healthy workforce or through another argument. What you cannot do, however, is invoke indifference to the wider fiscal context as the basis for that stance.

“Just Say You Are Anti-Strike On-Call”

Some of our community may be thinking what this subheading proclaims. (We encourage you not only to think of rebuttals but also to send them to us.)

This is not On-Call suggesting that industrial action is unwarranted; there are good arguments for why doctors may wish to withdraw their labour, and indeed, we have covered many of them in this newsletter. But this argument, the one we will call the ‘indifference argument,’ is not one of them.

This is not how we should want the wider public to view our profession. On-Call News was created in recognition of the fact that, as doctors, we often want to delve deeper into the current affairs, ethics, economics, politics, and philosophy of medicine. So even when it’s uncomfortable or when it would be easier to do so, indifference to the consequences of our actions isn’t an option.

“I have never seen more conflicting advice than that on which question bank to use for the MSRA. I swear there are five major question banks, and roughly 20% of people advocate for each.”

“We are still missing many opportunities for HIV testing, especially when we often see two common indicator conditions, CAP and unexplained chronic diarrhoea, on the acute take. Early detection in this HIV cohort is crucial.”

“Ah, yes, ‘Pyrexia of unknown origin’ aka ‘patient has a fever and I have no clue why’. Petersdorf and Beeson didn’t create the PUO classification in 1961 for the phrase to be thrown around like this! PUO has a very specific meaning and is classified by: Fever >38.3°C on several occasions, Duration of at least 3 weeks and no diagnosis after one week of inpatient investigation.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

One of the truths about modern medicine is that the more successful healthcare becomes, the more we will encounter frailty. Our patients are living longer than ever before. Here is a fantastic review on how to approach ‘the frail patient’ by Dr. Tilakkumar

Healthcare is a complex business, and one area where the NHS needs improvement is its administrative side. This article from The Kings Fund explores many ways the NHS can make admin-related gains from solutions to patients unsuccessfully trying to book appointments to relatives ringing the ward for updates, and finding themselves unable to get through.

Weekly Poll

Last week’s poll:

Would you have accepted Wes Streeting’s latest offer to the BMA?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

Childcare Cut-offs: The UK’s Anti-Work Taxation System Is Stinging Doctors

The days of treating workers earning £100,000 as the second coming of Richard Branson are long gone. For many ambitious middle-class professionals, including our consultants, that figure is starting to mark the point where work costs more than it pays.

We know how necessary taxes are to fund the vital services that keep our country running, but we also know that any rational system must avoid discouraging work; otherwise, it risks becoming self-defeating. Most of the noise surrounds the personal allowance losses that occur when you hit £100,000, but it’s the vital childcare support we want to focus on today.

When one parent crosses £100,000, families lose up to 30 hours a week of funded childcare for under three-year-olds, as well as tax-free childcare worth up to £2,000 per child. The Institute for Fiscal Studies estimates that a London family with two children would need £144,500 just to recoup what they have lost.

This bizarre aspect of our taxation system means that if just one doctor in a household earns £101,000, they lose everything, while two partners earning £99,000 each keep the full childcare benefits. It should now be obvious why many NHS consultants and senior registrars are cutting down their hours or frantically sacrificing their salaries into private pensions to fall below the £100,000 mark.

The UK has created a system in which some of its most skilled workers are turning down work, at a cost to the economy and the NHS. Given that Rachel Reeves is frantically searching for solutions to plug holes in the country’s public finances, we can’t see this trap being addressed in her upcoming budget at the end of the month.