Monitoring doctors wherever they work

Independent Practitioner Today readers will know the Independent Healthcare Providers Network (IHPN) is committed to playing its role in supporting all our members and the people that work with them, says David Hare.

How we reported on the impact of the Medical Practitioners Assurance Framework in November 2019

As the trade association representing healthcare providers across the independent sector, we also want to deliver the best possible care to patients and drive continuous improvement of safety and quality in the sector.

A key part of this is around improving consistency in safety and medical governance, something the Care Quality Commis­sion has highlighted as an area for improvement in recent years. The subject is a key issue raised by the Paterson case.  

In 2018, the IHPN therefore began the development of a Medical Practitioners Assurance Framework (MPAF) led by former NHS England national medical director Sir Bruce Keogh. 

The framework’s aim is to support improvement and consistency in the oversight of medical practitioners in the independent acute sector.

It seeks to identify expected practice and set out clearly where responsibility lies for ensuring the best available care possible for patients across the following areas: 

  • Creating an effective clinical governance structure for medical practitioners;
  • Monitoring patient safety, clinical quality and encouraging continuous improvement; 
  • Supporting whole-practice appraisal and raising and responding to concerns. 

Critically, the framework was designed to be a ‘live’ document and provide a contemporary consensus view of expected practice, giving confidence to patients and regulators over ‘what good looks like’. 

Over one year on from its launch, IHPN is pleased to have finished an independent assessment of how the framework is being used by independent providers and practitioners and how it can be further improved on.

Tangible changes

Despite the impact of Covid-19 on the independent sector and wider healthcare system, the framework has been wholeheartedly embraced.  

There are high levels of awareness and support for the principles contained in it among independent sector medical directors, registered managers and medical advisory committee chairmen. 

And critically, it has led to some tangible changes and improvements in providers’ governance processes and frameworks. 

We were pleased to hear from independent practitioners about the benefits they felt the MPAF had brought to their organisations.

These included ‘much clearer understanding of roles and responsibilities for individual practitioners and awareness of proper engagement with governance and assurance processes’ and greater importance given to ‘peer-to-peer working, with emphasis on multidisciplinary team (MDT) approach to practice and management of complex cases’.

Our review did, however, highlight the importance of ongoing engagement with practitioners about the MPAF. 

Making relevance clear

In particular,targeted communications for those working in the sector were suggested, including how the MPAF relates to other safety and governance frameworks so that its relevance and impact on the practitioner’s practice is clear. 

Further communication about the MPAF from independent providers to all medical practitioners with practising privileges, including potentially incorporating knowledge of the MPAF principles into the annual or biannual review of practising privileges, was also suggested. IHPN will look into supporting both of these suggestions. 

Our review also found that those working in the sector are keen to build on the MPAF. In some key areas there is appetite to develop the framework’s principles even further.

This includes more clarity around standards and best practice for MDTs; obtaining data on a  practitioner’s whole scope of practice; and clarity about how medical appraisal outputs are used to support medical governance. 

IHPN is also looking into how it can further embed the framework in the medical practitioner community and particularly with smaller independent providers. 

Greater collaboration

Responding to the coronavirus pandemic has undoubtedly been the focus for the whole of the healthcare system in the year following the MPAF’s launch. 

But with much greater collaboration between independent and NHS providers as part of the Covid response, it is even more crucial to ensure the full implementation of the MPAF and a genuine ‘whole-systems’ approach to safety and governance, particularly evaluating scope of practice.

We thank all practitioners working in the sector for their engagement with this issue and we look forward to working with them over the coming months and years to further embed the MPAF.

This will help continually improve the safety and quality of care delivered by independent sector providers to both NHS and private patients. 

David Hare (right) is chief executive of the IHPN