New independent providers framework on clinical governance for medical practitioners

It is hard to believe that it was back in December 2013 that Professor Sir Ian Kennedy published his report, Review of the Response of Heart of England NHS Foundation Trust to Concerns about Mr Ian Paterson’s Surgical Practice; Lessons to be Learned; and Recommendations. 

This was then followed in April 2014 by Verita’s report, Independent review of the governance arrangements at Spire Parkway and Little Aston hospitals in light of concerns raised about the surgical practice of Mr Ian Paterson.

Now, in 2019, the Independent Healthcare Providers Network of NHS Confederation has published the Medical Practitioners Assurance Framework.

The framework is focussed on the “battle” as the King’s Fund put it against serious quality failures in healthcare.

The framework focuses on:

• being clear about the individual respective responsibilities of medical practitioners; and
• the boards and senior leaders of providers reinforcing that it is the patients who are the priority for care delivered in the independent sector.

It also covers the governance responsibilities of commissioners and NHS organisations whose medical practitioners also work in the sector.

The foreword emphasises that oversight of medical practitioners is an area where the independent sector and the NHS should work together to improve clinical governance through transparent, evidential assurance on the quality of an individual medical practitioner’s practice.

Sir Bruce Keogh, Chair of the Expert Advisory Group, lists 11 key expectations that the MPAF places on providers:

• Ward to board clinical governance with clear lines of accountability
• Developing an IHPN practising privileges template
• Standardise key aspects of practising privileges
• Define the role of the Medical Advisory Committee
• Data to be submitted to national registries and to PHIN (Private Healthcare Information Network)
• Seek assurance that medical practitioners are participating in quality improvement activities
• Formalise arrangements for Multidisciplinary team review
• Share relevant governance information about performance of medical practitioners in a timely and straightforward manner
• Require medical practitioners to share as a minimum summary appraisal outcomes and personal development plan to inform the practising privileges review
• Transparent clinical governance framework that is explicit about responsibility for medical performance and how performance issues are identified, managed, escalated and communicated
• Have effective processes in place that support speaking up

The framework is divided into four sections:

1. Creating and effective clinical governance structure for medical practitioners
2. Monitoring patient safety, clinical quality and encouraging continuous improvement
3. Supporting whole practice appraisal
4. Raising and responding to concerns

It is recognised that one size will not fit all but chief executives and boards are asked to allocate appropriate staffing, facility and system resources for the activities that support effective clinical governance for medical practitioners.

Points to note

• IHPN and its members are overseeing the development of a secure information sharing platform for independent providers that can be used initially to ensure there is full visibility by all relevant organisations of a mandatory dataset about medical practitioners, visibility of all locations where a medical practitioner is employed and holds practising privileges and scope of practice.
• Lessons should be learnt from analysing adverse incidents, near misses, complaints and legal claims. Lessons learnt should be used to continually improve performance and feed back into the clinical governance systems for medical practitioners and more widely.
• Processes should be in place to support medical practitioners in their professional duty of candour and require medical practitioners to support providers in complying with their statutory duty of candour.
• If it is necessary to restrict, suspend or remove practising privileges due to concerns about a medical practitioner’s performance or where they withdraw from practising privileges during the course of an investigation, this information should be communicated to all other organisations where a medical practitioner practices (including the NHS). NHS commissioners should be informed where restrictive measures are taken. IHPN and private medical insurers are developing a voluntary code on sharing information.
• There should be no barriers to concerns about patient safety being raised.

Chief executive, David Hare of IHPN comments that this is the starting point for the sector and that this framework can play a critical role in raising the bar in medical leadership, driving up overall standards of assurance around medical practitioners across the independent sector and NHS.