Harley Street. Even the name creates a picture. Executive medicine for the elite, cosmetic surgery for the glitterati, healthcare excellence and no expense spared. It’s more than just a street—it’s a brand with international recognition that would be the envy of any marketing campaign. A worldwide reputation that attracts patients from across the globe. As it’s not far from the BMJ offices I sometimes pass by and the street sign always startles with its familiarity. I see luxury cars parked outside—they could be doctors or patients. And, peering in at the plush waiting rooms, I imagine backgrounds for the patients—princes of royalty or industry—and what might have brought them here.  

Private medicine is synonymous with Harley Street. And, in the past, it seemed almost exclusively confined to the street itself. But, just as Harley Street itself expands, wrapping itself around the corners of the neighbouring streets, private medicine has spread beyond central London, to every corner of the land.

At first, it seemed an unnecessary luxury for those who simply didn’t want to mix with the rest of us. Specialists boosted their income with a few extra sessions after hours in their rooms in the leafy suburbs. Harmless enough. The medicine wasn’t any better—just a leapfrog up the list and a bit of pampering. Sometimes patients had private rooms in public hospitals, but usually just the privilege of a side ward or a curtain round the bed if times were busy. Private hospitals offered a few restricted procedures and doctors quietly muttered that overnight care might be better in the NHS if you were really sick. Now there are huge private hospitals, purpose built and equipped to the highest standards with excellent 24 hour care. They have few restrictions on procedures and private healthcare has become a major industry.

Even in my own city, almost as far away as you can get from the heart of London, private healthcare has expanded beyond what I could possibly have imagined. No longer is there a single luxury clinic, but it seems there are private facilities at almost every cross roads. I pass workmen renovating yet another as I drive to the surgery.

Private medicine creeps closer and closer to the working class heartland where I practise.

Domhnall MacAuley is primary care editor, BMJ.