Independent Practice Committee (IPC) update

The (IPC) has spent the last year consulting, meeting, and responding to members and external organisations. The following update looks at some of the issues we've been working on that affect those within the independent sector.

WSM session
The IPC chaired a session at the 2018 Winter Scientific Meeting. We heard from Aaron Swinton, Chartered Accountant and Partner at Sandison Easson Ltd, and Dr VJ Joshi, Clinical Informatics Officer at PHIN. After the presentations a Q+A addressed many issues affecting members. We plan to hold a session at WSM 2019 so please do join us.

IPC guideline
The current Independent Practice Guideline was written in 2008 and much has changed since then. We are now in the final stages of updating the guideline, which will be published later this year.

IPC survey
We conducted a survey of members with independent practice at the end of 2017. 157 members took part, helping us form a picture of anaesthetic practice within the independent sector as well as identifying some of the issues affecting members. We plan to summarise the survey for publication, and to repeat the exercise at regular intervals to help identify trends over the coming years.

BUPA consultation
We've been made aware that BUPA have undertaken a pilot trial of a new model of remuneration for anaesthetists in one London hospital. The AAGBI and the IPC have not been involved in this trial, but we are trying to find out more information from BUPA. If any members can provide more information for the IPC then please contact us.

PHIN (Private Hospital Information Network)
We are aware of confusion amongs anaesthetists about the role of PHIN and individual responsibilities around the Competition Market Authority (CMA) order. We have written a summary of the CMA process and subsequent arrival of PHIN within the Independent Practice guideline (soon to be published).

In summary: The Competition Market Authority (CMA) investigation into private healthcare in 2014 identified a lack of transparency and quality of information within the sector.

CMA created legally enforceable remedies to:

  • Improve data collection
  • Publish safety and quality measures – see below
  • Publish clinician fees (note the legally enforceable bit is the clinician, not hospital, fee) – known as Article 22

PHIN was appointed as the information organisation with a duty to:

  • Collect data from all providers of privately funded care
  • Publish performance measures to help patients make informed decisions
  • Publish by hospital site and for individual consultants

PHIN is:

  • Independent, not-for-profit, with patients as core focus
  • Funded by mandatory subscriptions
  • Represented by a Board of Directors – clinical, hospital, insurer, academic, and CMA representation

PHIN has two main products with the following stated aims:
1. Online portal for consultants and hospitals

  • Displays data submitted by hospitals (and NHS data)
  • Displays consultant performance measures as they'll appear online BEFORE publication
  • Allows consultants to check the accuracy and completeness of data prior to publication online
  • Performance measures adjusted for complexity and benchmarked

2. Public website for patients

  • Shows only performance measures for hospitals and individual consultants
  • Adjusted for complexity
  • Contextual information to help patients interpret information
  • Performance measures driven by data in portal

What will be published?

  • All care in independent hospitals = about 15% of healthcare
  • Performance measures published by hospital and individual consultants
  • Activity volume/Length of stay/Infection rates/Readmission rates/Revision rates/Mortality rates/Unplanned transfers/Patient feedback+satisfaction/Clinical registries and audits/Improvement in health (PROMs)/Adverse events

Where are PHIN now?
PHIN are focusing on performance outcomes, letters of engagement with clear initial consultation and procedure fees (focusing on self pay clinician fees in the first instance).

Article 22 – consultant fees
The CMA found a lack of transparency on consultant fees, which were often separate from hospital fees. FIPO launched an appeal against this remedy, which was rejected by the Court of Appeal in July 2016.

Consultant letters to patients

  • By 31 December consultants must send written information outlining initial consultations
  • By 28 February consultants must send written information outlining treatment and intervention fees
  • Hospital must maintain an audit
  • Publication of fees on PHIN's website
  • By 31 December 2018 fees for privately funded care submitted to PHIN
  • 30 April 2019 PHIN will publish consultant fees

AAGBI involvement
We have met with PHIN on several occasions highlighting the AAGBI as the largest membership organisation for anaesthetists with activity in the independent sector. FIPO (Federation of Independent Practitioner Organisations) were appointed to PHIN as the only clinical representation and we have been clear that anaesthetists need separate representation.

The CMA remedies only ordered the publication of clinician fees (probably no more than 25% of total fees), not hospital fees. PHIN are working with independent hospitals on how to include an indication of hospital fees. It's difficult to see how publishing clinician fees without the hospital fees truly helps patients but CMA set out the legal ruling and this is what PHIN have to do.

The AAGBI has made representation to PHIN as to how to publish anaesthetic fees. Initially plans were in place to include surgical fees, a proposal that anaesthetists would oppose. The AAGBI are aware that the publication of fees is extremely complicated and may vary depending on local and national variables. Our aim is to help PHIN find the best way of doing this legally enforceable and unavoidable process.

What do you need to do?
Currently PHIN are focusing on self pay surgical consultant and hospital fees; anaesthetic consultant fees are deemed too complicated to address in the first wave, mainly due to the fact that patients rarely have the opportunity to choose their anaesthetist. This is still under significant discussion and the solution is not clear. PHIN will have to address anaesthetic fees as well as fees for patients with private medical insurance in order to comply with the CMA order.

You should engage with PHIN and your independent hospitals and provide any information requested of you. The AAGBI will continue to lobby PHIN to defend the interests of anaesthetists and has further meetings with them to find a workable solution to this legally enforceable order.

Member enquiries
We are happy to consult with members about any matter affecting their independent practice. We aim to provide advice and identify trends. Some recent issues include:

1. Appraisal
A number of independent hospitals are reportedly requesting disclosure and sharing of the full annual appraisal. Previously most doctors shared a summary and confirmation of appraisal. There's no national requirement to share the full appraisal, but it may form part of local requirements for continued practicing privileges. Do be mindful of patient confidentiality if sharing your full appraisal.

2. Pre-operative anaesthetic consultations
We are aware of significant variations in practice nationally for the remuneration of pre-operative consultations and management between private medical insurers (PMIs). Practises around pre-operative management have changed significantly over recent years both within the NHS and independent sectors. The AAGBI are supportive of members seeking appropriate remuneration for pre-operative management within the independent sector and are aware of difficulties faced by some when seeking appropriate remuneration. We are looking to draft guidance on this subject to help explain the importance of this aspect of patient care to PMIs.

3. Threat of de-recognition by PMIs and threat of withdrawal of practicing privileges by independent hospitals
We are aware of members being threatened with withdrawal of PMI recognition or withdrawal of hospital practicing privileges. The circumstances are varied for the threat to be issued but the advice remains the same. Ensure you are familiar with the terms and conditions of engagement – both PMI and local hospital. Use national guidance to negotiate with the PMI and/or local hospital. Let the IPC know of your difficulties so that trends can be identified, and advice given where possible. If a member of the BMA then also inform the BMA Private Practice committee.