Trusts must offer choice of consultant led team from April

NHS director general for informatics Christine Connelly told HSJ: “Our intention is to publish not polish information on services.”

We believe transparency will drive behaviour so we want to put information out as quickly as possible without being reckless or silly about it

The data will be published in response to the government’s commitment to offer patients choice of “a named consultant led team, as long as the referral is clinically appropriate”.

But in its consultation document published on Monday the Department of Health confirmed hospitals have just six months to implement the requirement and to list their services on the choose and book IT system “in a way that allows users to book appointments with named consultant-led teams as well as general clinics”.

The move will be complemented by a so-called “information revolution” which will see the publication of datasets previously used for internal consumption only, or which are incomplete and otherwise imperfect.

Ms Connelly admitted the change, affecting millions of elective referrals a year, was “a challenging thing logistically”.

She said it meant trusts would have to plan staffing schedules earlier and stick to them. At the moment they specify when clinics will be run but not who will run them.

Ms Connelly said trusts would “have to work out their schedule rather than simply saying, ‘we have this clinic in this time’.

“The challenge is to make the link into all the things that happen in different trusts.”

Ms Connelly confirmed the move would mean the publication of more data on an individual clinician and team level. However she said providing genuinely comparable data on the quality of different teams would be difficult.

At present data on individual teams is only available in very limited specialties, for example cardiac surgeons’ death rates.

But Ms Connelly said other data was already collected by the NHS Information Centre which is fed back to teams for their own internal review purposes.

That data is now likely to be put in the public domain, even though it is in places incomplete and often not immediately comparable between teams and organisations. For example, it may not be adjusted to reflect different case mixes, ages or co-morbidities of patients.

“We expect progressively to put more and more data into the public domain, not necessarily to wait until we have everything,” Ms Connelly said.

“We will be publishing things before every piece of comparability has been done and every check, so things will get published with caveats, and we will have to go back to them.

“We believe transparency will drive behaviour so we want to put information out as quickly as possible without being reckless or silly about it.”

However, medics questioned the sense and feasibility of the move.

British Medical Association consultants committee chairman Mark Porter said the plans failed to take account of the interdependency of consultant led teams, which shared nursing staff, support workers and resources.

Trying to assign outcomes data to a particular consultant led team was “chasing a dream”, he said, adding: “It’s a further attempt to reduce healthcare to a series of billable entities.”

The information many elective patients wanted was around long term survival rates, but this was harder to obtain for specialists with less experience, he said.

NHS Confederation medical director Hugo Mascie-Taylor said: “The issue is going to be what exactly is a consultant led team?”

Defining the team would be particularly difficult where staff frequently rotated under a number of different consultants, for example.

NHS East of England medical director Robert Winter, a consultant respiratory physician, said the move to offer patients more choice was the right “direction of travel”, but he queried how that could work where there was only one consultant team in a particular sub-specialty. If a patient with those needs wanted choice it would have to be between teams at different hospitals, Dr Winter said.

The choice consultation also confirmed the government wants people to be able to choose their GP regardless of location, but acknowledges there are “issues to be worked through” to do that, including how the proposal relates to GP commissioning. It pledged to “publish a policy framework by early next year” to resolve these issues.