End of independence?

By Robin Stride

Results of the Paterson Report will spark a widespread drift away from self-employment to a salaried service for doctors in private practice.

This is the view of the chairman of the Federation of Independent Practitioner Organisations (FIPO) following last month’s release of findings from the long-running former Bishop of Norwich’s inquiry into rogue surgeon Ian Paterson.

Mr Richard Packard

Mr Richard Packard told Indep­endent Practitioner Today: ‘The changes proposed in the report should lead to greater uniformity in governance processes across hospital providers in both the independent sector and the NHS. This may lead to a greater acceptance of privately-funded care in the UK healthcare landscape. 

‘It is also likely that employment status in the private sector will become polarised, with more senior consultants continuing to work independently and retaining their professional autonomy, while newer consultant providers are employed.’

He added: ‘I believe that both these shifts are likely to become marked within the next five years.’

Far-reaching changes

Consultants now await the outcome of the Government’s verdict on the report’s wide-ranging recommendations, which herald some far-reaching changes for independent practitioners.

Private doctors already face a huge defence cover shake-up under Government proposals published in 2018. These argued the merits of insurance over the discretionary cover provided by traditional medical defence organisations.

This has been backed by private hospitals who say they have long wanted fully comprehensive insurance indemnity cover to replace the ‘simply not tenable’ discretionary system.

Paterson’s defence body did not cover his malpractice, as his cover was discretionary, and it refused to settle claims, as his actions were considered criminal rather than negligent. 

Now the inquiry wants an urgent review of medical indemnity to prevent discretionary withdrawal of cover. 

Some other of its recommendations would mean upheaval for doctors and the surmounting of difficult barriers, according to a FIPO analysis, starting today on page 15. These include:

Consent: The inquiry recommends a standard ‘cooling-off period’ to allow reflection on treatment choices. But this could mean routine extra consent clinic appointments before NHS/private hospital admission, which has funding implications.

Procedure coding: This differs between the private and NHS sectors. FIPO favours the latter as
universal currency to allow for accurate data capture of complex procedures.

Multidisciplinary team meetings: Moves to make them routine for appropriate private patients raise the issue of who pays.

Complaints: It is likely all private hospital providers will be mandated to subscribe to the Independent Sector Complaints Adjudication Service, FIPO believes.

Transparency: The private sector will have to disclose more information such as what practising privileges are held, defence arrangements and provisions for sick patient transfers.

Investigating poor practice: The report does not say what immediate measures are needed if a perceived safety risk arises from institutional systematic failures. FIPO says the patient safety issue needs clear guidance: ‘A contextual understanding is necessary before any precipitate actions are taken against individuals.’

Medical advisory committees: Significant reform is likely.

Corporate accountability: FIPO expects private hospitals and their groups will be wholly or partially liable for individual doctor’s actions working in them. 

Patient recall: A co-ordinated protocol across sectors for a comprehensive recall of patients, if necessary.

Information on consultants

The Paterson Report also called for a single repository of whole-practice consultant information, available to managers and healthcare professionals.

Under a pre-existing initiative from NHS Digital and the Private Healthcare Information Network (PHIN), there is now a consultation – closing on 31 March – on the next part of a programme to align private healthcare data with NHS recorded activity.

It is hosted on the NHS Digital Consultation Hub and wants doctors’ views, among others, ‘to help shape the future changes’.

Known as the Acute Data Align­ment Programme (ADAPt), PHIN will share the national dataset of private admitted patient care in England with NHS Digital, ‘creating a single source of healthcare data in England’.

Its ability to become the ‘repository’ called for remains to be seen. PHIN provides access for patients to search information on around 2,500 consultants so far, covering both their NHS and private practice.

But another possibility could involve IT specialist Healthcode’s Private Practice Register (PPR), which has been signed up to so far by over 16,000 health professionals.