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Professional self respect

Editor—The provenance of a wine often determines its worth, and so must it be for authors. Hence the BMJ asks for “each author’s current appointment and full address.” It remains intriguing why in October Richards chose to describe himself in his article as president of Hughes Hall, Cambridge,1 a post he had recently started in, when for three years until September 1998 he had been employed as medical director to Northwick Park and St Mark’s Hospitals in Harrow. To limit his location to Cambridge is perhaps not a high crime or misdemeanour, but he knew that he would be back in November 1998 as part time medical director of Northwick Park and St Mark’s Hospitals for another five months. No conflict of interest? Or simply an interest in conflict from afar? 
 
Richards asserts that a local strategy developed that allowed time for non-NHS commitments in exchange for a “real and regular commitment to NHS emergency services at nights and weekends” and partly by “giving up one paid session.”1 He floated this idea at Northwick Park and St Mark’s NHS Trust, but it foundered quickly. As chairman of the BMA local negotiating committee I responded to his strategy document with an open letter attempting to clarify contractual issues as they existed nationally; it could not as he hoped be manoeuvred unilaterally. Alas, he quoted only a small part of this letter (sent to all members of the medical staff committee of the trust) in his article. 
 
Richards contends that the contract benefits only the “minority of consultants who earn substantial amounts outside the NHS.” In a report on private medical services the Monopolies and Mergers Commission stated that 17 100 (74%) of the 23 100 consultants in the health service in 1992 were engaged in private practice2—hardly a minority. The median net private earnings were £17 000 a year—not substantial but certainly helpful. 
 
Richards’s discussion of consultants’ contracts exposes his antipathy to private practice. He ignores problems in the NHS of low staff morale and motivation and poor retention and recruitment of staff. Surgeons cannot operate because beds and nurses are unavailable, not because they are moonlighting in the private sector. He suggests a pay for work contract but does not appreciate the enormous difficulty there is in trying to equate workload and productivity with health care. Any system built on differentials of basic pay between similar professionals will lead to fragmentation of the NHS. Richards recommends altruism. He should show this and avoid unwarranted criticism of his colleagues’ acknowledged professionalism.