Although the recent Laing and Buisson survey shows that private medical insurance subscriptions are being maintained this year this is not reflected by the experience of many consultants as many around the UK have noted a decline in their private practice.  Mr Derek Machin (FIPO Board member and Chairman of the Private Practice Committee of the BMA) confirmed this when he spoke at the Laing and Buisson conference in October.  The results of this years BMA review of consultant fees and expenses has revealed that average income fell and expenses rose.  Mostly the rise in expenses was due to medical indemnity and so the UK experience is following that in the USA where medical insurance and Medicare reimbursements are falling and medical indemnification costs are rising.  This has forced many specialists in high-risk areas of surgery to abandon practice all together.