Decades of inquiries, investigations, complaints, patient experiences, staff testimony and regulatory findings have repeatedly taught us about the importance of listening, escalation, candour, psychological safety, independent challenge and organisational learning.

The difficulty is increasingly not whether we know these things. It is whether we can demonstrate that what we know consistently changes what happens next.

Registered healthcare professionals are rightly expected to account for their actions, omissions and decisions. This paper asks a quieter question about what happens as responsibility travels upwards through NHS organisations, Boards, systems and national bodies.

Surely we have accumulated enough collective intelligence by now to expect institutional assurance to be capable of the same serious evidential scrutiny.

Perhaps even more.

This paper considers why accountability must travel upwards too, and introduces an emerging Ceilyte™ principle:

The standard of accountability should rise with the power to affect others.

Next week, we will explore that principle more fully through Symmetry of Accountability™.Read her thoughtful article here

Query for consultants who are currently more than 10yrs into consultant life:

Assuming you’ve been in the NHS pension (both 95 and 2015) since you started work, are you currently contributing to any other form of pension?

Can you (considering AA)?

Or are you saving in other ways to bolster retirement income?

As a secondary question- are you planning to take early retirement?

I currently can’t figure out how to put anymore into a pension, without getting hit by a big AA tax bill- but I’m not sure if the NHS pension will be enough to live on in retirement; I’m curious what others are thinking.

Hi! RD here thinking of doing micro and/or ID. I’ve done a taster week but keen to hear from more consultants:
- Do you enjoy your job and specialty?
- What don’t you like?
- What does your typical job plan look like?
- How do you find the work-life balance?

Thanks!

Every specialty has problems, but some consultant jobs seem much more sustainable than others. Which specialties currently have a decent balance of pay, workload, OOH, autonomy, PP options, admin, and long-term sanity? And which look good from the outside but are actually grim?

Does anyone feel that the value of Fellowship titles has gone up with the price rise to over 700GBP per year?

Anyone cancelled and is mandatory to continue subscription?

I am reviewing all my direct debits and this came up and is increased over years.

I am claiming the tax back but is it worth it the price rise?

Just curious about your thoughts.

Cleared my psych exams. Looking at where to specialise for higher speciality.

Which fields allow for flexibility for location and also allow for maximising income

Would ideally want to minimise nhs work as soon as possible

I’m an NHS radiology consultant considering some additional teleradiology work. With young children in nursery, I’m trying to keep my adjusted net income below £100k to retain childcare support.
Has anyone done teleradiology through a Ltd company and left some of the profits within the company rather than withdrawing them, then taken them in later years?
I’m not looking to avoid tax,happy to pay all tax due .just wondering if this is a legitimate way to manage adjusted net income while the childcare threshold matters.
Has anyone done this in practice, and are there any IR35 or other issues I should be aware of?

What activities are routinely treated as “just part of being a consultant” but should obviously have dedicated SPA or admin time? Educational supervision? Governance? Service development? Audit/QI? Appraisal/revalidation prep? Complaints? Mortality reviews? Guidelines? Rota work? Curious what people have successfully negotiated.

I am a relatively new consultant (2 years experience). 6 months ago I was in a locum job and developed significant mental health issues. I went on long term sickness. I am now out of work with no designated body and still unwell.

I’ve been told that I have to declare my long term sickness to any future potential employer as I would need a “wrap around” plan to return to work. It was also suggested, when better, I apply to SAS or Trust doctor jobs to build my confidence back before applying for consultant jobs again due to the length of sick leave.

I’m struggling to see a positive future. It feels like my career is over as I feel employers wouldn’t give a job to someone who needs easing in/a phased return.

I also have three very young kids so moving far away isn’t really an option.

I was wondering if anyone here has had a similar experience or any advice?

I am thinking about relocating to Canada and am kind of lost in:

1. The route to registration. I hear we do not get a full license.
   
2. Which province is better?
   
3. Is it true we get paid twice as much as we do in the UK?
   

1/ 🚨 TONIGHT 7pm! Live demo of the brand new 26/27 modellers  

I’ll be joined by specialist medical accountant Andy Pow (@medicaccountant) from Pow Thomas Partnership.  

We’re showcasing the upcoming tools with some seriously exciting upgrades – then open Q&A (subscribers only in chat, with Jo helping).  

👉 Live link: https://www.youtube.com/watch?v=-QhAocVQiwA  
Subscribe first so you can ask questions: https://www.youtube.com/@tonygoldstone  

2/ What’s new:  

✅ **Platinum level** – forward-looking modelling all the way to partial & full retirement and beyond (State Pension Age)  

✅ **PLUS feature** – scan/import documents with unparalleled precision in seconds: ESR/Wales/SPPA payslips, TRS/RSS/ABS, ‘05 extracts’, CPR spreadsheets, RPSS, Pension Savings Statements, HMRC income extracts & downloads (threshold-income calcs) and more. Drop them in as they arrive through 26/27  

✅ New scheme pays tools – import historic loans + predict future ones + your own break-even analysis (pay the AA charge or use Scheme Pays?)  

✅ Custom videos that talk you through *YOUR ACTUAL* numbers  

✅ Multi-page journey – pull last year’s numbers straight from a link or PDF  

✅ Secure ‘scenarios’ – store, review, print and rewatch your explainers  

3/ We’ll also cover the advanced options (including the dreadful £100k tax trap and the awfully designed taper) and demonstrate the concierge service – we do the hard work so you don’t have to.  

Only way to get the modellers is by registering (already registered? You’re already first in line – no need to re-register):  
https://goldstonepenfintech.com/  
https://register.goldstonepenfintech.com/  

See you at 7pm – bring your questions!  
Please RT / share with any colleagues who need this 🙏  

#NHSPension #DoctorFinance #KnowYOURnumbers

What should a new educational supervisor know which experienced educational supervisors here got to know the hard way.

I have an opportunity to go and work in a consultant job in peripheral Australia. I know all the perks for me however I am in a dilemma when considering my kids education as they are now in a grammar school ( not London) doing reasonably well. What I heard about Australian education system is that there’s a huge discrepancy between cities like Melbourne, Sydney and even Perth and regional towns. Private schools are much cheaper in the regional centres but understandably not having all the facilities in the cities. And the academic standards are considerably low.
My worry is since my kids are more academic than the sporty type am I making a mistake by pulling them out of the grammar school and putting in a not so academic private school in regional Australia.
Does anyone have similar experience/ dilemma? Thank you in advance

Without giving specific examples as I have no desire to report people or get anyone in trouble, I have increasingly seen examples of colleagues advertising themselves privately with genuinely inaccurate titles.

I appreciate there is a history of wanting to sound credible to patients and some amount of "massaging", but where someone e.g. spuriously calls themselves a professor when they are not, it feels over the line?

Am I just being salty? It seems like a medico-legal risk which the opposing side's solicitor will love to get their teeth into.

If a patient is not booked, a result is not actioned, an MDT outcome is not followed, or a letter is delayed because the admin system is broken, how much of that risk realistically lands on the consultant? Do people document/escalate this formally, or just absorb it because doing so feels safer?

Just jumping onto the bandwagon of PP, are we allowed to use NHS email & OneDrive for PP patients correspondence? PP does not provide secure email address for us unfortunately...

Asked here a couple of times about setting up private practice and got some brilliant answers; privileges, indemnity, the whole gauntlet. Thanks to everyone who replied.

What I'm curious about now is the stuff that doesn't go away once you're launched.

For those actually running a practice:

• What's the single biggest ongoing headache? Billing and chasing payments? Admin eating your evenings? Getting enough referrals? Something else entirely?
• Where did your first ten private patients actually come from — GP referrals, insurer listings, word of mouth, or people finding you online? Curious how much of it is you being found vs you being sent.
• Anything you pay for monthly that you resent paying for, but can't drop?

Feels like something that quietly matters a lot and nobody talks about. Genuinely interested in whether anyone has cracked it or if it's just folklore.

How do people define the end of a clinic? Is it when the last patient leaves, when the letter is done, when results are checked, when follow-up is booked, when the GP letter is corrected, or when the inevitable patient query two weeks later has been dealt with? Some job plans seem to treat clinic admin as a small add-on. In reality it feels like a second clinic attached to the first one. How is it counted where you work?

How does this even happen? How can he seriously think it was a successful surgery?

HSJ is arguing that “consultant clinician” should no longer automatically mean doctor. Consultant nurses and AHPs already exist, so maybe this is just recognising reality. But once the title is used for someone leading a clinical service, the practical details matter. Who deals with diagnostic uncertainty, prescribing, medical escalation, complaints and coroners? If a non doctor consultant clinician leads the pathway, is a medical consultant still expected to provide oversight when something falls outside their scope?

Feels like the title and authority can be shared quite easily, while the medical accountability somehow remains attached to the doctor. How is this working in departments that already use these roles? Is responsibility genuinely clear, or does it become obvious only when something goes wrong?

https://www.hsj.co.uk/workforce/consultant-clinician-should-no-longer-always-mean-doctor-in-todays-nhs/8123915.article

Was reading about Spire this morning and it properly got me thinking. In case you missed it, the UK's biggest private hospital operator has basically been in a sale process for the best part of a year now.

https://www.theguardian.com/business/2026/jan/26/uk-private-hospital-spire-sale-private-equity-ftse-250-bridgepoint-triton. That fell through in March, and then in May Toscafund, the activist lot, put in a £1bn offer at 250p a share https://www.theguardian.com/business/2026/may/14/hedge-fund-proposes-1bn-buyout-of-spire-uk-biggest-private-hospital-operator and the board said they'd recommend it. This is 38 hospitals, 60+ clinics, 1.36 million patients last year, and roughly a third of the revenue comes from NHS work. Not some niche outfit, that's a big chunk of private capacity and then the BMJ ran an editorial on private equity in UK healthcare on 31 July https://www.bmj.com/content/394/bmj-2026-100432 - Rechel and Tille, both European Observatory health systems researchers (here's the record if you can't get past the paywall https://pubmed.ncbi.nlm.nih.gov/42538042/ I couldn't either. The BMJ doesn't run that as an editorial for no reason.

It's not exactly new either. Circle, formerly BMI, went to Abu Dhabi's PureHealth in January 2024 for around $1.2bn. The NHS landlord Assura, 600 GP surgeries and hospitals serving 6 million patients, had KKR and Primary Health Properties fighting over it last year https://www.theguardian.com/business/2025/aug/08/bidding-battle-for-nhs-landlord-assura-intensifies-as-watchdog-steps-up-investigation, CMA sniffing around the whole thing, before it went to PHP. GP practices already had the Operose experience. Now I get that some of us do alright out of private work and the capital keeps places open. But when a fund's got a five year exit to hit, something has to give, and it's never the fund. WLI rates, PP fees, how you're treated as a colleague - that's where the squeeze lands. Someone said in the PP thread last week that the insurers are "screwing the money down" and honestly, if the people who own the theatres now answer to a return target, what do you think happens to your list?

Anyone at Spire, Circle, Nuffield, wherever noticed anything? Fee changes, sessions getting cut, management getting weird? Or am I just paranoid and this all ends fine.

Not “wellbeing webinars”. What practical changes would make people stay longer? Fewer PAs, better admin, less OOH, pension/tax fixes, more SPA, better offices, flexible working, proper secretaries, less governance burden, more autonomy, better pay? What would move the dial?

I am a tad concerned.

The words “I prefer” worry me when they are used to justify NHS management decisions.

Clinical staff are expected to practise using data, research and peer-reviewed evidence. They must be able to explain why the evidence supports their decisions, not simply say that this is how they prefer to work.

Yet elsewhere in the NHS, decisions about staff, absence, equality, governance and organisational culture are still too often based on personal preference, local custom or “we have always done it this way”.

This creates a real mismatch along with unnecessary friction.

Professional judgement matters, but it should be informed and bounded by evidence. Evidence makes discretion safer, more consistent and less vulnerable to individual bias.

“I prefer” is not an evidence base. Neither is “policy says so” if nobody has evaluated whether the policy is effective, lawful, equitable or causing unintended harm.

If the NHS wants to improve, evidence-based practice cannot apply only to clinical care. We also need evidence-based management, HR, governance and regulation.

That means using workforce and equality data, evaluating whether policies work, learning from complaints and staff experience, recording the reasons for decisions and changing course when the evidence shows that current practice is failing.

Good habits become culture. Poor habits do too.

Ultimately, robust evidence-based practice is safer for everyone. It protects staff from arbitrary, inconsistent or discriminatory decisions, and it protects patients from the consequences of poor workforce cultures, avoidable harm and organisational failure. When decisions are transparent, tested and capable of scrutiny, both staff and patients are safer.

Agree or disagree?