Private medical practitioners and healthcare providers must have greater transparency around conflict of interest declarations and give more prominence to expectations around patient consent.
The tighter guidelines are part of the Independent Healthcare Providers Network’s (IHPN) updated Medical Practitioners Assurance Framework (MPAF) for its members.
The representative body for independent sector healthcare providers initially launched the framework in October 2019.
The framework is led by former national NHS medical director Sir Bruce Keogh and contains key principles to strengthen and build upon the medical governance systems already in place in the sector and sets out expected practice in a number of key areas.
The overhaul includes taking into account recommendations from the Bishop of Norwich’s inquiry into Ian Paterson, as well as Baroness Cumberlege’s Independent Medicines and Medical Devices Safety Review (IMMDS).
And under the section on medical practitioner responsibilities, the framework says they must ensure their awareness of, and compliance with, their legal and other responsibilities for their patients, including under the Competition and Markets Authority’s Private Healthcare Order, and NHS and GMC Conflicts of Interest guidance.
For independent providers of healthcare, the framework recommends that they should have robust processes for assessing novel therapies/procedures in place that protect patients, medical practitioners and the organisation without stifling innovation.
This framework adds this recommendation also applies to amended therapies/procedures and common procedures new to a particular organisation. Provider policies need to clearly set out independent provider and medical practitioner responsibilities, clear standards for reviewing the evidence, staff training, conflict of interest declarations, incident reporting and monitoring of outcomes for any new or innovative procedures.
When it comes to patient consent, the framework calls on independent providers to have clear policies on patient consent outlining which professionals should be involved in the decision-making process with the patient.
Their policies should include the need to provide full information (referencing independent sources where available) on risks, potential benefits and alternatives to the treatment.
Policies also need to provide for patients to be given specific time to reflect and make decisions and detail how consent is documented and recorded and take account of specific guidance around defined procedures.
New initiatives such as the Learn from Patient Safety Events (LFPSE) service are also reflected in the refreshed framework, as well as an IHPN Development Plan which sets how the network will support providers to continue to implement the MPAF.
In developing the framework, IHPN was supported by a reference group consisting of representatives from the Department of Health and Social Care, CQC, the General Medical Council (GMC), NHS Resolution, medical Royal Colleges, Federation of Independent Practitioner Organisations, and the Patients Association.
The Care Quality Commission (CQC) now uses the framework’s principles in assessing how well-led an independent service is, with the framework a requirement of the NHS’ 2022/23 Standard Contract which all independent sector providers of NHS-funded care must adhere to.
David Hare, chief executive of the Independent Healthcare Providers Network (IHPN), (pictured) said: “Since the MPAF was launched in 2019, independent healthcare providers – with the support of CQC and NHS England – have really embraced the framework, using it to review and update their practices to further raise the bar in medical leadership in the sector.
“With a continued focus among the entire healthcare system around improving patient safety and quality, this framework ensures providers adhere to the latest medical governance practices.
“This will not only ensure greater consistency around how clinicians work across the independent sector and NHS, but also give confidence to patients that independent healthcare providers are committed to delivering the safest possible care”.
CQC chief inspector of hospitals Dr Sean O’Kelly said: “Robust medical governance is central to patient safety and high quality care.
“CQC very much welcomes the updates that IHPN has made to strengthen the Medical Practitioners Assurance Framework and we are pleased to have been part of the expert advisory group that helped shape its development.
“Where providers can demonstrate effective implementation of its principles, this is considered as evidence of good governance and informs the judgement we make about how well led services being provided by that organisation are.”
Una Lane, director of registration and revalidation at the General Medical Council, said: “Since its launch the framework has played an invaluable role helping ensure patients receive safe and good quality care, in both the NHS and the independent sector. This refresh takes account of recent high-profile cases and will strengthen that protection.
“The importance of good local clinical governance cannot be overstated. This updated framework will help medical practitioners, as well as responsible officers and designated bodies, to develop and maintain effective local systems, enabling them to provide the best possible care to patients.”
Professor Neil Mortensen, president of the Royal College of Surgeons of England, said: “The Royal College of Surgeons of England welcomes the updated Medical Practitioners Assurance Framework. There is growing demand for private services, including elective surgery. This makes it all the more urgent to ensure that high standards of care and good governance processes are in place, supporting the specific challenges faced by the sector.
“We have recently published guidance for surgeons working in the independent sector, which aims to provide advice on good practice for individual practitioners. So, we hope this will be used in conjunction with the IHPN framework.
“The framework addresses a number of key areas, including data sharing and whole practice appraisal across the NHS and the independent sector. Also, quality improvement, and an emphasis on the need for sufficient peer review systems that will reduce the risk of professional isolation and lone practice. We would like to see all independent hospitals, even the small number not in IHPN membership, commit to implementing the framework.”
Rachel Power, chief executive of the Patient’s Association, said: “We expect patients to receive safe and effective care no matter where they are treated. The refresh of the Medical Practitioners Assurance Framework, and the number of providers who have signed up to it, gives patients confidence that the independent sector collects and shares information about the performance of their services, and the practitioners working within them.
“We believe concerns raised by patients or staff offer vital intelligence on how to improve services for patients and can serve as warnings, helping to prevent errors.”
Vicky Voller, director of advice and appeals at NHS Resolution, said: “NHS Resolution welcome the launch of the refreshed Medical Practitioners Assurance Framework. As a member of IHPN’s reference group, we were able to contribute our expertise in resolving concerns and disputes to the development of the Framework and are confident that it meets current best practice in the health system and, most importantly, provides greater consistency across the NHS and the independent sector, thereby embedding a systems-wide approach to patient safety and quality.”