Consultants and others will have noted a series of articles in the Financial Times, the Times and other newspapers which have suggested that the advent of ISTCs and foreign contractors will lead to a collapse of private practice. There seems no doubt that independent practice in the UK may face a downturn as a consequence of these Government sponsored changes. On the other hand, there may be opportunities for NHS work to be contracted out as noted in recent Government statements. Many consultants, including the FIPO Board, are concerned about the destabilising effects of these transactions on NHS Trusts and the implications for training.

At the present time there is still confusion and doubt about which new ISTC providers have actually signed off their contracts with the DoH and whether or not it is going to be possible to obtain and sustain the services of the foreign teams of doctors and nurses that these centres will require. It may be that there will have to be a breach of the DoH “Additionality” clause (which essentially bans UK consultants with an NHS commitment to have any dealings with an ISTC). If so this would certainly irritate those UK providers who made unsuccessful bids for ISTCs based on a UK consultant workforce.

Some have predicted that self-pay patients in the independent sector (which in some areas reached as high as 30%) will entirely disappear and that the private (and to a lesser extent the corporate) insured market could reduce by as much as 50%. However reliable or accurate predictions at the moment are virtually impossible to make and as yet (July 2004) very few patients have been treated in ISTCs.

Consultants’ reactions around the country have depended to a large extent on their speciality and their local opportunities for independent practice. Some areas such as central London may be buffered to some extent from these winds of change.