What are practising privileges?
A practising privilege is the ‘licence’ agreed between individual medical professionals and a private healthcare provider. In effect, they set out the clinician’s offer, such as the range of surgery they are competent to perform.
It is clear that governance of practising privileges is a major risk.
As self-employed contractors, the onus falls on individual clinicians to mark their own homework. They set the scope of their activity, often much broader than their NHS work, where increased specialisation is the norm.
Individuals are responsible for raising any relevant concerns or reviews of their work – which is a clear conflict of interest. Checks with their regular employer, usually the NHS, are rare.
Too often, complaints are managed with a feather-light touch. The default is for the individual clinician under question to provide the response. Professional or corporate challenge is limited as unlike in the NHS, there is often no clear clinical hierarchy or procedures in place. Many also lack staff trained and experienced in carrying out investigations. This obviously prevents independent scrutiny. As important, it stops identification of longer-term patterns of poor medical practice – see Verita’s work on weak signals here.
Private healthcare providers are under increased scrutiny. The independent inquiry into the malpractice of convicted surgeon Ian Paterson is underway. The CQC are sharpening their teeth. Tighter regulations are sat on Whitehall desks.
Private hire giant Uber had its licence to operate turned down by Transport for London (TfL) last year on public safety grounds. Uber’s drivers are self-employed and expected to alert Uber to any relevant safety or criminal concerns. Uber is in turn expected to alert relevant authorities. TfL felt this wasn’t happening and Uber was not acting in a ‘fit and proper’ manner — including a failure to report “serious criminal offences”. Uber, after admitting in court that TfL were correct to take action, and tightening up their policies and procedures, have now been granted a short-term licence rather than the usual five-years, and scrutiny continues.
If I was a journalist covering the inquiry, practising privileges would write their own headlines. If I was a private patient, the lack of proactive checks would worry me. If I was a private healthcare provider, I would tighten my governance now or face accusations of offering ‘hail-a-doc’ healthcare.
Check out the Key Principles relevant to Practising Privileges produced by the AIHO (Association of Independent Healthcare Organisations).
If you would like further information on how we can help your organisation please contact Verita’s managing director Ed Marsden on 020 7494 5670 or [email protected].