Don’t fear the drive for more openness

The principal aim of the Competition and Markets Authority Order is to improve patient safety – and no consultant should be against that, says consultant plastic surgeon Mr Nigel Mercer. 

He shares his views with Independent Practitioner Today as a member of the Private Healthcare Information Network (PHIN) board.  

Mr Nigel Mercer

Your previous national roles included being immediate past president of the Federation of Surgical Specialty Associations (FSSA). Why did you join the PHIN board? 

I have worked with PHIN pretty much since the start when I was president of the British Assoc-iation of Aesthetic Plastic Surgeons (BAAPS). 

Even from the early conversations, I felt PHIN’s work was clearly very important, particularly at that stage for cosmetic plastic surgeons like myself. Historically, we haven’t been great at recording our activity – particularly our private work. 

I’ve continued to be part of the conversation in my presidential terms with the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the FSSA. 

It became clear to me that there was an enormous misconception among a lot of surgeons with what PHIN was about and they felt alienated from the process. 

I have good working relationships with the specialty associations and Royal Colleges of Surgery and feel that I can play a role in bridging the gap with the consultant community. 

What role do you think PHIN can play in supporting patients? 

Twenty odd years ago, the local GPs would know consultants in their area and, in particular, who was ‘good’ for any particular procedure. Unfortunately, the breaking of the link between primary and secondary care has been
an enormous detriment to the public. 

People no longer have an easy way of knowing which consultants are ‘good’, in particular in the private sector. That’s why I think PHIN has a really important role in providing information for patients. 

From personal experience, I have had family members who needed pretty rapid private care in a part of the country where I don’t have many contacts, and the amount of information which I could get about the surgeons in the area was a problem. 

Private healthcare is very expensive and patients really do deserve to have better information. After all, they are buying a bespoke, luxury service.

Providing information for patients is what the Competition and Markets Authority (CMA) Order is about. PHIN was set up by the CMA to make sure that the CMA Order is fulfilled; it is a legal requirement, after all. This whole project is about making sure information is transparent and easily available to patients.

Earlier this year, the CMA wrote to all hospitals encouraging better engagement with PHIN and the CMA Order. Is the CMA ‘upping the ante’?

I think this is more about the CMA putting a marker in the sand. The Order is secondary legislation, so it has to be done and, to be honest, it’s probably about time they did put pressure on to get it finished. At this stage, the Order can’t be changed and so we do need to get it done. 

I would also say that, in the last few months, there’s been a real sea change in terms of the relationship between PHIN and the providers, the private medical insurers and consultants. It’s definitely much more collaborative now than it was previously. There is also a genuine understanding now that we do need to change things. 

Why should consultants engage, and what would you say to consultants that are wary?

The main reason consultants should engage is that it’s a legal requirement and you can’t choose not to engage with a legal requirement. 

However, there are other good reasons for consultants to engage. To me it is a bit of a no-brainer. I know of consultants who have complained for many years that they aren’t getting the referrals. This is a chance to put information about the quality of care you provide in front of patients. 

No surgeon should be worried about having their practice data published. We would all want to know the data about the surgeon that we see for our own care and the same applies to the public. 

The information that PHIN is gathering is also gold-dust for our appraisal and revalidation. You can push a button every year and out comes your private activity, which you can submit to your appraiser and, if need be, to your Responsible Officer. It will make the consultant’s life so much easier. 

What do consultants need to do?

We have to remember that we’re still coping with the pandemic and there’s been another big increase in hospital admissions and infections with Covid. 

We also have to be mindful that most consultant surgeons have been working their tails off to try to catch up with the backlog and are very tired.

What I would say to surgeons is what we’re asking you to do – and what you’re mandated to do – is actually extremely quick and straightforward to do. It would take you or your secretary probably an hour to submit your fees. 

Having done it myself for my own private practice some time ago, I know that it used to be a little laborious, but the way that the portal is set up now it cross-references everything and it’s quick to do. 

Everything else that PHIN publishes about consultants is collected and submitted via the private hospitals in which you work. 

Of course, we encourage you to look at your activity and other data. If your hospital has you down as having operated on a toenail when, in fact, you are a hip specialist, then that will give patients a very odd view of your work. It will also ensure you are paid correctly for what you do. 

It doesn’t have to be you who looks through the data – most consultants working privately have very good medical secretaries, who probably know what we do better than ourselves.

Essentially, this is about making sure what is recorded in your billing correlates with what your hospital has recorded and submitted to PHIN. If the information submitted about your practice is not correct, you can correct it.

What should consultants do if they have any questions? 

Anne Coyne

PHIN has an excellent consultant relationship team, led by Anne Coyne, whom many people will know. They can be contacted at 

And if people want to talk to me directly, I’m very happy with that. I view that as part of my role on the PHIN board. That can be set up through Anne and her team at PHIN. 

The final thing I would say to anyone concerned about this is that no one is the ‘enemy’ in getting the CMA Order completed. We have a law to comply with and PHIN is the co-ordinator of the industry’s response. The principal aim is to improve patient safety, and no consultant should be against that. 

Mr Mercer chairs the MHRA’s Plastic Reconstructive and Aesthetic Surgery Expert Advisory Group