The Ministry of Health and physician representatives advocate for the government’s proposed major change in the employment relationship of NHS physicians. The possibility of private practice outside the hospital for NHS doctors on terms that the Department of Health will attempt to provide, with a provision in a bill expected to be presented next week to Parliament, has sparked a backlash, as well as division within the country’s medical world. The ministry’s attempt to make the NHS more attractive to doctors while still allowing citizens to choose their public health doctor is being opposed by hospital and private doctor unions demanding the controversial provision be withdrawn.

Some express fear that many patients will be forced to turn to the private sector given the shortcomings of the NHS, while others speak of creating unfair competition. On the other hand, there are hospital doctors who believe that injustice is being restored, since university and military doctors already have the possibility of private work and that it will be possible to increase their income.

In particular, a provision in the Secondary Care and Medical Education Bill, which was recently submitted for public comment, provides that NHS physicians may engage in private work outside the hospital once or twice a week. In other words, they will be able to run a private practice or provide medical services with any relationship, be it a consultant, whether it is performing surgery in a private clinic or working in a private diagnostic laboratory. As stated in the relevant explanatory opinion, “the soil is ripe and the conditions are ripe for the limited opening of access for doctors of the state system to the private sector”. The main condition for an NHS doctor to work privately is the doctor’s consistent performance of all his duties in the hospital during normal work, his work on call, as well as participation in the operation throughout the day. , i.e. day clinics or evening receptions (when they come into operation).

The bill is expected to be presented to Parliament – unexpectedly – next week, and the MoH will assure that a specific provision will be included, taking into account the comments made in the context of the consultation. “The possibility of private work for NHS doctors remains in the bill,” Deputy Health Minister Mina Gaga said last Thursday.

The bill would allow NHS doctors to do private work outside of the hospital once or twice a week.

In general, the bill regulates many issues related to medical education and the specialization of NHS hospitals, such as the creation of groups of hospitals – training centers for specialties, the expansion of autonomous emergency departments to more hospitals, financial incentives for TEC doctors. and part-time private doctors in the NHS. But the private work provision for hospital doctors is likely to monopolize the discussion of the bill in the House Social Affairs Committee before the bill gets to a vote in plenary session. Ten days ago, Health Minister Thanos Plyuris and Deputy Health Minister Mina Gaga recorded New Democracy’s health sector objections at their respective meeting. Tomorrow, a group of the Federation of Greek Hospital Physicians’ Associations will travel to Parliament, where they will hold successive meetings with representatives of political parties in Parliament on the bill in general and this provision in particular.

If the regulation is finally adopted, ministerial decisions will follow that will set out the type, scope, terms and conditions of employment of NHS doctors in the private sector, as well as how conditions will be verified. It is planned to introduce it gradually, starting with a pilot project in some hospitals. The leadership of the Ministry of Health stressed that the emphasis will be on the introduction of insurance barriers to prevent any “transfer” of patients from the state system to the private sector. In this regard, an electronic system for monitoring the regular work of the hospital will operate. For example, if there is an unreasonable cancellation of morning doctor’s appointments, he will be deprived of the opportunity to engage in private work.

It is noted that it is estimated that about 20,000 doctors, including adjuncts, currently work in the National Health Service. In total, about 66,000 doctors (private and public sector) are registered in medical associations throughout the country. According to the doctors themselves, not all doctors will take advantage of the possibility of private practice. In practice, this mainly concerns surgical doctors, possibly also radiologists, and on the other hand, specialties such as surgery, for example. cytology does not provide many opportunities for providing a private project.

Accordingly, there are regions of the country where doctors will not have such an opportunity. “For example, there is no private clinic in Amfissa or Syros. How can a surgeon have a private practice in such areas? Kostas Livadas, 2nd Vice-President of the Federation of Associations of Hospital Physicians of Greece, told K about this. Some believe that most of those who start a private project will either end up choosing to stay out of the Social Security Administration or decide to stop their private project.“In 6-9 months, there are very few who will work in the NHS and do private work,” the president notes “K”. Panhellenic Medical Association Athanasios Heksadaktylos.

It should be recalled that the first opportunity for legal private work with doctors of the National Health Service was provided in 2001 during the ministry of Alekos Papadopoulos, when evening clinics were established that worked in hospital premises, and part of the income went directly to the hospital. ESY day clinics received 430,871 visits last year. An afternoon operations operation is also expected, the institutionalization of which was updated last spring.

Mina Gaga
Deputy Minister of Health

“ESY was a very important achievement for Greek society 40 years ago when it was founded. However, in these 40 years the world around us has changed. Medical technologies are different, needs are different, and a more patient-centered approach to healthcare services prevails. Patients now have a greater say in their care,” Deputy Health Minister Mina Gaga told K.

As he points out, the bill regulates very important issues regarding the training and specialization of young doctors in accordance with the needs of the country’s health care system, the organization of emergency departments, and also provides financial and institutional benefits to its EAC doctors. Specifically for the challenged Article 10 – according to the numbering of the bill that has been tabled – Ms Gaga emphasizes that “what we are trying to do is to strengthen the public health system. We want more flexibility in the health care system, making it more attractive so that we can keep our doctors and attract new ones, make better use of hospital infrastructure and night operations, and give patients more choice. We stick to the dichotomy: more satisfied patients and a more attractive system for doctors.”

One of the arguments in favor of this particular provision, cited by the Ministry of Health, is that in most European countries there is the possibility of private work for doctors in public hospitals. “This is how the systems work in almost all countries, and this is one of the reasons why our doctors go abroad,” emphasizes Ms. Gaga.

Thassos Callicis
Ophthalmologist, Director of SSY at Evangelismos Hospital

The patient’s right to choose their NHS doctor, as well as the possibility for hospital doctors to legally increase their income, are being put forward as arguments by doctors advocating private employment for NHS doctors.

As noted by ophthalmologist, NHS Director at Evangelismos Hospital Thassos Kallitsis – one of the group of directors of the ophthalmological clinics of public hospitals in Athens, who submitted a proposal to the Ministry of Health a few months ago – “with this provision, the chronic weakness of the NHS associated with the exceptional employment of doctors, which from some point became a brake on both the doctors themselves and patients who want to choose their own doctor.

This gives the citizen the ability to access the particular public health doctor of their choice, which they usually cannot do today.

But it also gives a way out to a doctor who can increase his income by going the legal way. At the same time, nothing changes in the morning work of the hospital.

A citizen is not obliged to visit a doctor in private. This is the choice he has been given. For a patient who doesn’t want a particular doctor or can’t go private, nothing will change. The implementation of the provision will not worsen the waiting list.

Secondly, the doctor must see the patient in the morning at a regular clinic in the hospital and refer him to a private hospital for surgery. For these cases, there should be control mechanisms, and responding is also a matter for a citizen.”

Konstantinos Livadas
2nd Vice President OENGE

Athanasios Hexadactylos
PIS President

Representatives of hospital doctors are in favor of a complete change in the philosophy of the NHS in terms of universal coverage and equal access of citizens to health services, and private doctors believe that unfair competition is being created, since NHS doctors will perform private work from an advantageous position.

As Konstantinos Livadas, Second Vice President of the Federation of Greek Hospital Physician Associations, points out in K, “instead of supporting the NHS, there is a situation that takes us back 40 years before the founding of the NHS, due to the inability to allocate funds. This completely changes the philosophy of the system, from universal coverage and equal access of patients to health services, to the different speed of doctors and patients, while leading to a limitation of regular work of services and an increase in private work in health care. In a nutshell, this is about moving NHS patients to the private sector at a time of unmet citizen needs and shortages in the NHS.”

“Even individuals don’t want another elite team in their area. The ESY doctor will enjoy the trust of the hospital and will compete with the doctor who has a doctor’s office with ongoing costs,” Athanasios Heksadaktylos, president of the Panhellenic Medical Association, notes to K. And he emphasizes: “But even we, who believe that the system should be open, do not believe that this is the proposed agreement. I believe the NHS private part-time provision should be changed to allow NHS doctors, if they want to work in the private sector, to convert their current contract to part-time. employment. And automatically announce your position to fill.”