Information overlord

Consultants in private practice will be legally obliged to publish performance measures from April 2017. Matt James reports on what is being done to prepare for this

Information overlordLast month, I exp­lained that the Private Healthcare Inform­ation Network (PHIN) is likely to be the organisation charged with the task of helping the sector to respond to the information ‘remedies’ arising from the Compet­ition and Markets Authority’s (CMA) recently-concluded investigation of the private healthcare market.

Those remedies include requirements for both hospitals and doctors to publish a range of performance indicators by April 2017.

There is a separate requirement for publication of consultant fees but, as this is still the subject of a legal challenge, I will concentrate on the performance measures for now.

The only sensible place to start is with the CMA’s Private Health­care Market Investigation Order, and the list of mandatory performance measures it sets out at Article 21.1 (see box on the right).

Valid concerns

Right at the outset, let me acknowledge that you are likely to have a number of concerns about the validity and deliverability of these indicators, particularly as they apply to individual specialists. Fair enough; as do we.

Some of these indicators are relatively straightforward; some will need a lot of work; some will, at best, not be applicable to many specialties or procedures.

Don’t worry; there is time to get this right, and we will involve consultants throughout.

As you can see, data doesn’t need to reach the information organisation until September 2016 – nearly two years away.

In practice, that date has little bearing on most consultants, since you are not expected to produce the data, which will come from hospitals, registries and existing collections – for example, adverse events via the Care Quality Commission and infections data via Public Health England.

We will work with the professional specialist societies, consultant representatives and the hospital operators to consider what data can and should be published, moving on to how it should be presented to make it meaningful for patients, and a fair representation of both hospitals and consultants.

In parallel, we will take the available data, assemble it into a view of your practice, and ask you to check it.

First things first – let’s try to get the data right. I expect that work to begin in earnest in 2015, and to continue right through to the point at which publication is required, in April 2017.

We expect that you’ll find the data useful. We’ll assemble records from both private practice and the NHS to give a whole-practice view, mapped into NHS coding so that you can compare apples with apples, with relevant benchmarks where that is valid and helpful.

The data will be certainly be useful for appraisal and reval­idation and for managing your practice, with good information on referral patterns, patient demographics and so on, in addition to the clinical indicators.

This will all be presented via a secure website, and only you, or people you explicitly authorise, will be able to see details of your whole practice.

Case mix adjustments

Perhaps more importantly, once the hospitals start to apply ICD10 diagnostic coding to records – also mandated by the CMA – we will, for the first time, be able to undertake comprehensive case-mix assessment and adjustment to our indicators.

As has been often observed, it is vital that analysis reflects complexity so as not to deter doctors from treating difficult cases.

Even so, we’ll want to agree an approach, possibly varying by specialty, for how to deal with cases assigned to responsible consultants in the NHS, where they were not the surgeon who performed the procedure.

And we’ll need approaches to handling low numbers, new consultants, part-time consultants and so on.

At this stage, let’s assume that these problems are capable of being solved.

I believe that, in the end, this will work and, moreover, will work to your benefit, while being genuinely useful to patients.

If it helps patients to understand and trust private healthcare and gives them confidence to make decisions, then it will encourage them to buy private healthcare. And that’s good for you.

In a future edition of Independent Practitioner Today, we will start to look at the individual measures, and how they will be constructed and presented.

It’s an interactive process, so do get in touch if you would like to be involved. Email me at


Article 21.1 of the CMA’s Private Healthcare Market Investigation Order 2014

Every operator of a private healthcare facility shall… supply the Information Organisation, quarterly from a date no later than 1 September 2016, with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the Information Organisation to publish the following types of performance measures by procedure at both hospital and consultant level:

  • a) Volumes of procedures undertaken
  • b) Average lengths of stay for each procedure
  • c) Infection rates, with separate figures for surgically-acquired and facility-acquired infection rates
  • d) Re-admission rates
  • e) Revision surgery rates
  • f) Mortality rates
  • g) Unplanned patient transfers – from either the private healthcare facility or private patient unit to a facility of one of the national health services
  • h) A measure, as agreed by the Information Organisation and its members, of patient feedback and/or satisfaction
  • i) Relevant information, as agreed by the Information Organisation and its members and, where available, from the clinical registries and audits
  • j) Procedure-specific measures of improvement in health outcomes (PROMs), as agreed by the Information Organisation and its members to be appropriate
  • k) Frequency of adverse events, as agreed by the Information Organisation and its members to be appropriate

Matt James (right) is chief executive of the Private Healthcare Information Network