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Private Practice ActivityIntroduction The old consultant contract arrangements for NHS consultants allowed us to carry out private practice activity in addition to NHS activity by taking what is called a ‘maximum part time contract.’ By relinquishing 10% of my NHS salary I was allowed to carry out private practice. This has continued under the new contract. 9% of admissions under my care are private. These are cases that are either admitted to Frenchay or to the Nuffield St Mary's Hospital in Bristol. (I used to operate at the BMI Bath Clinic, but had my practicising rights removed when my activities with SWIS were deemed to be a commercial conflict of interest with BMI! - See section on SWIS). There are advantages and disadvantages of both institutions. Frenchay hospital has fully equipped theatres for both intracranial and spinal surgery. It has resident anaesthetists, who are on hand to carry out emergency intubation if postoperative complications occur and it has the facility to ventilate patients on ITU if required. The disadvantage of Frenchay is the lack of beds and the associated inability to plan ahead, the lack of HDU facilities and the poor quality of the buildings in which we work. (Temporary Nissen huts erected in the second world war that are still in service !) St Mary's on the other hand has more capacity. It can guarantee both general and HDU bed availability and the hospital is fully equipped to manage elective spinal neurosurgery Although staffed with excellent staff, there are no resident anaesthetists on site and only the facility to ventilate a patient temporarily. I therefore have to balance convenience and bed availability against patient safety when deciding where I carry out my private operating. Private surgery The following is a list of the procedures with their codes that I perform privately in order of frequency. The cases in red are only operated on at Frenchay. 1. Spinal cord stimulator insertion - A4830 2. Lumbar microdiscectomy – V3370,V3470 3. Posterior lumbar decompression – V2530, V3410 4. Anterior cervical discectomy – V2940, V2950, V3040, V3050 5. Craniotomy for Intrinsic brain tumour – AO200, AO300, AO400 6. Laminectomy for Intradural tumour – A4500, A5110, V4980 7. Craniotomy for extrinsic brain tumour e.g. meningioma – A3810, L7510, A3680 8. Posterior cervical decompression – V2200, V2300, V2280, V2380 9. Upper cervical decompression / fusion – V2980, V3730, V0390 10. Burr hole procedure – AO300, A2210, A1250 11. Skull surgery – V0110, VO510, 12. Carpal tunnel decompression – A6510, A6580 13. Trigeminal neuralgia surgery – A3200, A5160 14. Insertion of motor cortex stimulator – AO900, AO300 15. Craniotomy + lobectomy for epilepsy – AO110, AO300 16. Thoracic laminectomy – V2400, V2430, V2410, V2431 17. Insertion of peripheral nerve stimulator – A7010
Medico – legal practice In addition to assessing private patients for surgery, I also assess patients for medical legal purposes. I believe it is important that practicing clinicians should be involved in this process. I aim to give as balanced a review of a case as possible. The Woolf reforms have made this so much more straightforward in ensuring that an individual expert’s responsibility is to the court and not primarily to the appointing solicitor. My recent activity (2001 / 2002) has consisted of: Plaintive Defendant Both
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