Letter: Harmful surgical cuts

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Sir: We congratulate Nicholas Timmins on his balanced review of the report of the Monopolies and Mergers Commission ('Top specialists can earn in excess of pounds 400,000 a year', 12 February).

He correctly acknowledges that while the average gross private earnings of a consultant may range from pounds 18,000 in Northern Ireland to pounds 49,000 in the South-east, most consultants do more work for the NHS than they are actually paid for. Thus maximum part-time consultants worked on average 51 hours for the NHS while contracted for 35, and between six to 10 hours in private practice. The few very high-earning consultants, who are always referred to, usually have a significant number of patients from overseas, which is irrelevant to British insurance premiums. Indeed, 13 per cent of general surgeons earn less than pounds 10,000.

Much of this data was given to the Monopolies and Mergers Commission and followed a recent survey of general surgeons. We found that whereas 92 per cent referred to the Bupa scales, so patients would not have to pay more than the insurance company provided, only 4 per cent used the BMA scales (as their sole guide) which the commission has condemned.

Adherence to the Bupa scales has had a major effect in keeping fees down over the last five years because they have not risen in line with inflation. So abolishing the BMA scales will probably have little effect.

We as an association have been campaigning for several years for an increase in the number of consultant general surgeons, but the temptation to reduce private costs by employing less experienced surgeons (either from Britain or abroad) could end in a far worse deal for patients.

Yours faithfully,




Honorary Secretary

Association of Surgeons of

Great Britain and Ireland

London, WC2