The scandal of moonlighting doctors

The scandal of moonlighting doctors came to light in early March 2019 when managers at Basildon University Hospital discovered that Dr Moboladale Ojutiku, one of its most senior obstetricians, had failed to appear for a critical inspection by the Care Quality Commission. Instead, Ojutiku was reportedly at Chartwell Private Hospital, treating patients under a separate arrangement. This incident sparked broader concerns about the prevalence of moonlighting among medical professionals in the United Kingdom, particularly within the National Health Service (NHS). Between April 2017 and May 2019, Ojutiku conducted 44 private clinic sessions for Ramsay Health Care, earning £24,000 in the process. During the same period, he also received £5,000 from the local NHS trust for “Supporting Professional Activities” (SPAs). These SPAs are designated blocks of time intended for tasks such as teaching, audit, research, and administrative duties, activities that do not directly involve patient care. However, Ojutiku's actions raised ethical and financial concerns, as his private work occurred during hours that were officially allocated to NHS responsibilities. In June 2019, the Medical Practitioners Tribunal ruled that Ojutiku’s conduct was dishonest and imposed a 12-month suspension from the NHS. Notably, Ojutiku had already retired from the NHS before the tribunal’s decision. His case highlights a growing issue within the healthcare system, where some senior doctors take on additional private work while maintaining NHS roles. According to a 2022 health department report, approximately 90% of UK private practice specialists continue to serve as NHS consultants. While engaging in some private work alongside NHS commitments is legally permissible and common, the ethical implications remain contentious. The core issue lies in the misallocation of resources and the potential impact on patient care. Each hour a consultant spends on private work instead of fulfilling NHS obligations represents a loss of taxpayer-funded services. Patients whose care is compromised due to divided attention may unknowingly bear the consequences of these dual roles. Moreover, the financial incentives for moonlighting can create conflicts of interest, particularly when private earnings come at the expense of NHS duties. A key factor complicating the situation is the lack of systematic oversight regarding SPAs. Unlike direct patient care, which is typically monitored, SPAs are rarely scrutinized. Some consultants view these periods as informal opportunities for extra income, treating them as unregulated time slots. Ojutiku’s defense centered on the claim that his SPA obligations were fulfilled elsewhere, yet the NHS trust had explicitly warned in writing as early as 2016 that private work was prohibited during SPA or on-call hours. The tribunal rejected this argument, underscoring the need for stricter adherence to existing guidelines. Despite clear contractual agreements and codes of conduct, enforcement remains inconsistent. The Department of Health’s code of conduct on private practice, established in 2004, mandates that private work must be declared and integrated into a consultant’s job plan, ensuring it does not negatively affect NHS patients or NHS time. However, compliance appears to rely heavily on individual accountability rather than institutional checks. Personal experiences suggest that challenges to moonlighting often result in dismissive responses, with colleagues frequently failing to recognize the severity of the issue. The broader implications of this phenomenon extend beyond individual cases. They reflect deeper structural issues within the NHS, including financial pressures and the difficulty of retaining skilled professionals. While some argue that moonlighting helps retain talent, others contend that it undermines the integrity of public healthcare. As the debate continues, the focus remains on balancing professional autonomy with the responsibility to uphold public service standards.