A doctors' leader has been questioned about the right of consultants to see private patients, "having been trained by the NHS" and amid spiraling waiting lists.

BMA Scotland GP chair Dr Andrew Buist was asked if the reason why NHS consultants work in the private sector was "simply down to money."

Interviewed on BBC Radio Scotland's Mornings show today he said it was probably best to ask a consultant that question but added: “Some of it is giving up their free time, evening work, Saturdays to work in a different environment possibly – a lower stress rate…to bring in extra income for the family."

Host Stephen Jardine questioned if this was right given that their training “has been provided by our NHS.”

Sounding slightly flustered Dr Buist replied: “That’s true.”

Asked if their time wasn’t better spent in the NHS he paused and said: “Yes, I suppose so. 

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"By and large private healthcare surgery in Scotland is quite small,  although saying that I would recognise that it has grown during the pandemic.

“Yes, their time would be better spent in the NHS if that were possible.”

The BMA says the ability of NHS consultants to carry out private practice in their non-NHS time is "an essential part of the flexibility and freedom built into national contracts" but conditions apply.

Doctors must ensure that private practice or fee-paying services "does not have a detrimental effect on NHS patients or services" and are obliged to disclose any private practice commitments to their employer.

Dr Buist said many of his patients had dipped into their savings to pay for procedures such as hip replacements.

“My preference would be that that surgery is performed on the NHS but at the moment our system is overloaded," he said.

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He said the BMA agreed with Paul Gray, the former head of NHS Scotland, who said the health service is "unsustainable" in its current form, with pressure on staff growing and service to patients deteriorating.

He has called for a debate about whether the private sector should have a greater involvement in healthcare.

"The current trajectory of the NHS is unsustainable and we need reform," said Dr Buist.

"The BMA has been calling for this since 2021 with a call for a national conversation.

"We just can’t continue to carry on as we are doing and hope for the best."

He said Scotland could follow the example of other countries such as France, Germany and Scandinavia where patients pay a co-payment or some form of insurance or the NHS remains free at the point of delivery with a rise in taxation, “which no government wants to do”.

He said another alternative was to reduce the health service “up front” which he said was already happening unofficially with long waiting times and complex eligibility criteria for certain services such as weight management or mental health services.

“This is where we see the growth in private care”, he said. “And we start to see, slowly, the emergence of a two-tier system.”

He said the BMA had met with a delegation from Norway earlier this week for an information-sharing discussion.

“They are dealing with the same problems of an ageing population,” said Dr Buist.

“Norway is in a different financial situation to what we are but we do need to look at other countries. It doesn’t have to be the American system which from what I’ve heard is a terrible, terrible system where 30% of the population in the richest country in the world cannot get access to good healthcare."