How can we boost audits?
The Independent Healthcare Providers Network is working to ensure doctors in private practice can fully contribute to national clinical audits. David Hare reports.
Independent practitioners and providers are rightly proud of the quality of care they deliver and the sector is constantly looking for ways to make continuous improvements across all areas.
As part of this, the sector has long recognised the importance of internal and external audit to understand and benchmark performance.
In some areas such as orthopaedics, independent providers have a long history of high levels of participation. More procedures have been submitted to the National Joint Registry (NJR) by independent providers than by their NHS counterparts since 2020.
However, in other clinical areas, there exist significant hurdles and barriers that prevent similar levels of participation.
To tackle some of these issues, the Independent Healthcare Providers Network (IHPN) has been working closely alongside the Healthcare Quality Improvement Partnership (HQIP) and NHS England in the last few years to ensure our members can take part in appropriate national clinical audits.
Below I list some of the key take-aways Independent Practitioner Today readers should be aware of.
Working with HQIP, which commissions the National Clinical Audit and Patient Outcomes Programme (NCAPOP), IHPN identified two key initial areas to focus on that would capture the range of challenges posed by quite different types of work carried out by the sector.
These were cataract activity as part of the National Ophthalmic Database (NOD), run by the Royal College of Ophthalmologists, and the National Vascular Registry, which is run by the Royal College of Surgeons of England.
Unexpected dynamics
Running these programmes across the pandemic, unsurprisingly, led to some unexpected dynamics.
For example, some larger independent providers with high ophthalmology volumes began to participate fully in the NOD. This allowed us to focus on understanding barriers facing organisations yet to deploy specialist ophthalmology electronic medical records (EMRs).
We also experienced challenges testing data flows into the NVR, which were largely down to changes in activity as independent providers flexed away from their usual case-mix to respond to changing local clinical demands in response to the pandemic.
Participation in audits – as many readers will be aware – is not something that is done lightly.
Providers need to commit suitable resourcing, which often means embedding new working practices and infrastructure.
Having a clear framework within which to make and implement those plans is therefore essential, and below are just some of our key reflections on how to make them work at a system level.
Defining in-scope activity
While the NCAPOP run by HQIP comprises around 40 audits, registries and reviews, many are currently out of scope for the independent sector.
For some audits, this is quite reasonably due to their focus on clinical areas that are rarely delivered by independent providers.
But in many cases, a clear specification of in-scope activity, readily available and defined by procedure or diagnostic code, would be hugely beneficial to identify relevancy and encourage participation.
Designing audits that welcome participation
Requirements that inadvertently exclude independent providers should be pro-actively avoided.
For example, high-volume minimum thresholds effectively rule out participation by independent sector hospitals, which tend to be smaller than their NHS counterparts.
Explicitly involving the full range of providers that deliver relevant care in the design process of audits from the outset would ensure future iterations are inclusive by design and do not inadvertently rule out independent sector providers.
Mechanisms to support data collection
Many independent providers – and likewise in the NHS – are currently scaling up their digital capability, investing significant resources to procure EMRs and build their informatics and clinical support teams.
Given the clear opportunity to embed the collection of data for clinical audit into the fabric of the infrastructure that we are building as a nation, audit providers should present a clear technical specification that is consistent with current and future standards.
This presents a huge opportunity to improve the quality of data, to reduce avoidable administrative burdens and to increase audit participation across both NHS and independent sector.
Streamline information governance hurdles
The public is becoming ever more sensitive to privacy concerns and independent providers rightly comply with wide ranging legal requirements to protect patient information.
There is significant scope to reduce the range of administrative pre-requisites, that determine how information can be safely and legally shared, by agreeing common templates and approaches applicable across the range of audits and registries.
Funding
It is, of course, recognised audit activity needs to be funded. But it is also vital for funding mechanisms to be appropriate for all organisational structures.
For example, some independent providers operate from a single site, while others will have many hospitals and community-based locations within their group structure.
Fee structures should therefore reflect this and adhere to principles of fairness, proportionality and transparency.
With a move towards much greater transparency across UK healthcare, ensuring independent providers and practitioners can fully contribute to audits, registries and reviews has never been more important.
Clearly, making this work in practice is a complex job, requiring full engagement by providers and practitioners, audit providers, commissioners, regulators, and of course, the IHPN.
But the benefits in showcasing the high quality care delivered in the sector and ultimately further improving the care provided to patients will be immense.
The IHPN will continue to advance this agenda alongside its members and we look forward to taking you on this journey.
David Hare (right) is chief executive of the IHPN
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