Get ready for ‘D’-day

Letter to consultants working in private healthcare from Matt James (below) Re: Competition and Markets Authority Private Healthcare Market Investigation Order 2014.


Matt James 4 web

Matt James

We are writing to make you aware of progress with implementing the Competition and Markets Auth­ority (CMA) Order, which creates new legal obligations affecting all consultants in private practice.

The Order requires the publication of specified performance measures about consultants and private hospitals from April 2017, with the aim of helping patients make informed choices of private care providers.

This letter is only for information, but these changes will have an impact on your practice and you will need to take action before publication.

The Private Healthcare Inform­ation Network (PHIN) is the information organisation approved by the CMA to implement this part of the Order. PHIN is working closely with the GMC, Care Quality Commission and other public and professional bodies across the UK.

Publishing information for patients in the private sector

The CMA’s investigation reported a number of concerns with the way private healthcare works for patients.

You will remember that, last year, part of the Order came into force which prohibits private hospitals from offering incentives to consultants to direct patients to them.

The CMA also expressed a serious concern over the ‘lack of independent, publicly available performance and fee information’ to inform patients’ choice of private care provider.

Its remedy was to require all private hospitals to supply data to PHIN to support publication of 11 performance measures at hospital and consultant level.

These include procedure numbers, re-admission rates, unplanned transfers and measures of health improvement (PROMS) for private patients. As far as possible, these measures and the data collections to support them are aligned with the NHS to aid comparison.

The Order applies to all providers of privately-funded care across the UK, including NHS hospitals offering any private treatment, and providers in Scotland, Wales and Northern Ireland.

Clinics that undertake only outpatient consultations and diagnostic tests do not need to participate. PHIN is an independent, not-for-profit organisation, the role of which is to facilitate this process. We would like to see this become a real opportunity for consultants and hospitals to demonstrate to patients the quality of their services.

Where will the data come from?

The legal duty to supply data falls on hospitals, and consultants should not need to undertake any new data collection. However, the hospitals at which you practise may need your support in providing adequately detailed records, and you will want to check all data held about you thoroughly.

Hospitals must supply records of care using NHS coding standards for every admission (day case or inpatient). In some cases, data may come from central sources such as the HES data held by NHS Digital (HSCIC) in England, in lieu of direct submission.

We will republish existing performance measures from national clinical audits and registries wherever possible. Finally, some measures such as PROMs, adverse events and patient satisfaction (the Friends and Family Test), which should mostly be familiar from NHS practice, are being extended to cover private patients.

We will approach each measure with due caution and appropriate professional engagement, aiming for fairness and accuracy in all circumstances. It may not be possible to have all performance measures available for publication by April 2017, but it is essential that all consultants and hospitals are engaged and working towards publication on as broad a basis as possible.

The CMA and other regulators have enforcement powers available where required, but PHIN’s aim is to support all participants with compliance so that those enforcement powers are rarely needed.

Checking the data

This is the first attempt at collecting comprehensive data about private healthcare, and it will take time and effort to get right. We anticipate finding significant data errors and omissions that will need to be addressed. PHIN will invite you to check the data supplied about you prior to publication.

For most consultants, you will be invited to access our secure online portal toward the end of 2016, allowing time for checking and correction of data prior to planned publication in April 2017. Most issues with the data will be fixed at source, by the hospitals that supplied it.

Hospitals should have been collecting data to our specifications since the start of 2016, and are required to begin submitting compliant data no later than 1 September this year. Your activity will not be fairly and fully reflected unless all hospitals at which you practise are compliant and submitting data, and you may want to check now that they are progressing toward submission.

PHIN aims to provide a whole-practice view for each consultant, including records of activity conducted in the NHS. The intention is to give a fair and complete picture of a consultant’s practice, even where only a minority is privately funded.

Data covering episodes of care funded by the NHS and conducted in NHS hospitals will be taken from central sources including HES data supplied by NHS Digital (England). We are aware of significant concerns over both the quality of that data and the limited potential to correct errors; we will need to evaluate the extent of those concerns in use and your feedback will be vital to that.

Portal pilot: Testing the data collection and reporting process

Prior to the general roll-out of our online portal later this year, around 200 consultants at participating hospitals across the UK have volunteered to test the portal during May and June.

Their input will help PHIN and the hospitals to assess data quality, data presentation and communication, and refine the whole process to ensure it is as intuitive and straightforward as possible. The pilot will be the beginning of a substantial effort to ensure that treatment delivered privately to patients is accurately recorded.

Professional engagement to ensure fairness and accuracy

PHIN is engaging with a wide range of professional representatives and stakeholder organisations to ensure that the information that we collect and publish, and the way that we do it, is accurate and fair to all

Professional advice and input is being co-ordinated by The Federation of Independent Practitioner Organisations (FIPO), the members of which includes a large number of specialty associations and representative consultant groups.

FIPO has convened a Clinical Outcomes Advisory Group (FIPO-COAG) which is supported by, among other groups, the Federation of Surgical Specialty Associations (FSSA), which makes recommendations to PHIN on the use of information from registries and clinical audits and also advises on PROMs and adverse events.

We are working closely with the GMC to try to ensure that we are reaching all 14,000 or so consultants subject to the Order and that they understand these new obligations. The GMC is interested in the clear potential for consultants to use the data that PHIN makes available through its portal for revalidation and appraisal.

We recently met with the chairman of the BMA Private Practice Committee and will keep them informed. We also have significant professional representation on our board of directors.

Publication of private treatment fees

Article 22 of the CMA’s Order concerns the publication of consultants’ fees. As you may know, that article remains subject to a legal appeal brought by FIPO, and is not yet in force. We understand that the CMA will provide an update in due course.

Next steps

If you have not been asked to participate in PHIN’s pilot, then you will receive your invitation to the portal later this year. Your portal credentials will be sent to your ‘GMC Online’ email address, so we recommend you check that it is up to date.

You may also wish to speak with the hospitals at which you practise privately to ensure that they are engaging with PHIN and preparing data appropriately. During the year, you may receive further information from PHIN, your hospitals, the GMC or your specialist and membership organisations. For more information, visit

Yours sincerely,

Matt James

Chief executive, Private Healthcare Information Network