David HareThe Chief Executive of the Independent Healthcare Providers Network, David Hare, talks about the launch of a new framework aimed at improving consistency in standards of governance across the independent sector.

Healthcare provision is constantly evolving, and with expectations from patients, regulators and other bodies growing, continuous improvement must be the priority for all healthcare providers. The independent healthcare sector is no different.

The forthcoming report of the Paterson Inquiry is also likely to raise a number of issues around how doctors’ work with independent healthcare providers, and how performance and scope of practice can be better monitored. Indeed, with 1.9 million acute patient journeys across the independent sector every year and rising, it is vital that we as a sector reflect on how to ensure that the safest, highest quality care can be delivered, and what can be done to drive this improvement.

As part of a major package of work on improving safety and medical governance in the sector, we asked Sir Bruce Keogh, the former NHS England National Medical Director, to work with us and our members to explore improvement and consistency in the oversight of doctors in the independent sector. This has culminated in us launching the Medical Practitioners Assurance Framework, which identifies expected practice across a number of key areas including:

  • clinical governance structures
  • patient safety
  • clinical quality and continuous improvement
  • supporting annual whole practice appraisal
  • raising and responding to concerns from staff and patients.

Critically, the framework sets out a clear view of how providers and doctors can work together to improve  assurance around clinicians working in both sectors.

Building on good practice

Given the vast majority of providers already have robust clinical governance structures in place, we’re clear that the framework isn’t about re-inventing the wheel, but simply about strengthening and building on existing systems. Indeed, as in the NHS, doctors working in the independent sector are already required to act in accordance with the guidance issued by the General Medical Council (GMC) on clinical, medical and ethical issues, and follow accepted best clinical practice. The framework therefore takes a principles-based approach to medical governance, whilst avoiding creating any new bureaucracy or making the system more complicated.

Of course, independent healthcare providers do not work in a vacuum but rather as part of a larger healthcare system. We were therefore delighted that in producing the framework, we were supported by a range of partners including the Academy of Royal Colleges, the Care Quality Commission (CQC), the Department of Health and Social Care, the Federation of Independent Practitioner Organisations, the GMC, NHS England and NHS Improvement and the Patients Association.  This helped us develop a contemporary consensus view of expected practice, which is aligned with existing legal and regulatory frameworks. Critically, the framework also articulates the need for healthcare providers across the NHS and independent sector to work much more collaboratively – improving communication channels and ensuring that patient safety pathways reflect the pathways that patients themselves increasingly flow through, as they live with increasingly complex conditions. We highlight the GMC’s information sharing principles as an essential reference here to ensure that all the relevant information around fitness to practice and scope of practice is shared.

Ensuring effective implementation together

Our organisation is, of course, not a regulator. While adherence to the framework isn’t mandatory, we’re pleased that all our acute hospital members and a range of other service providers have signed up to implement its principles. As part of our work to ensure its effective implementation, we are working closely with the CQC. It has committed to considering the effective and robust implementation of the framework’s principles as evidence of good governance, which will inform the judgement they make about how well-led a service is.

There have been significant changes in the healthcare system and regulation in recent times. The framework is designed to be iterative with an inbuilt review process and should be viewed as a starting point for the sector to build upon. In the last year alone, the proportion of independent acute hospitals rated good or outstanding has risen from 70% to 77%. However, there is always more to do, and we believe that the framework can play a critical role in raising the bar in medical leadership – which the GMC rightly states is vital for patient safety. We want to help drive up overall standards of assurance of doctors across the independent sector and the NHS, so that all patients can be confident of receiving the safe, high quality care they deserve.