Should GPs be allowed to offer private services to their patients?

At the start of 2024, a GP practice in Northern Ireland began offering private appointments during the evening to people who weren’t on its NHS list. The decision was forced on the GP partners at Abbey Medical, in Derry (Londonderry), because the practice was in financial crisis.

“We were knee deep in debt,” says Tom Black, one of the partners. “It was obvious that we were about six months from bankruptcy and that was because of underfunding.

“Over the previous 12 months we’d tried to maximise our income by working harder, and we’d tried to minimise our costs by making cuts, but it wasn’t working, it was just getting worse and worse.”

“Political incompetence was going to close down a practice which had been running for 100 years,” says Black who has been a GP for more than 35 years.

“It made me angry and frustrated, and I decided to embarrass myself by contravening all my Bevanite principles—universal, free at the point of delivery, funded by taxation—and open a parallel practice offering private appointments at a fee of £75 to those who aren’t NHS patients,” says Black, who was chair of BMA Northern Ireland Council at the time.

The five doctors at the practice do not get paid or receive time in lieu for seeing private patients. All the money from the private clinic goes towards clearing the practice’s overdraft.

Patients requesting private appointments are also triaged. “We try only to see people who are sick and need to be seen,” Black says.