• Sir Bruce Keogh says new approach will make it harder for people to do the wrong things
  • IHPN developing new information platform for doctors working in independent hospitals
  • Framework comes ahead of the publication of an inquiry into rogue surgeon Ian Paterson

A new database to track doctors working in the independent sector is being developed as part of wider reforms to improve the clinical governance of those providers.

The secure system will allow information to be shared between hospitals including a mandatory dataset about where doctors work and their scope of practice. If any concerns are raised this should be shared with everywhere they work, including in the NHS, under the scheme.

The framework – developed by former NHS England medical director Sir Bruce Keogh with the Independent Healthcare Providers Network, is designed to head-off concerns over governance and the ability for clinicians to operate without providers being fully aware of their activities.

It comes after the conviction of breast surgeon Ian Paterson, who was jailed in 2017 for carrying out unnecessary surgery on patients. Mr Paterson worked under so-called “practising privileges” and concerns about him were not shared between the NHS and Spire Healthcare.

The new framework recommends independent providers reform the practising privileges model of employing doctors who are able to use a hospital and its staff but are not technically its employees.

This model has been widely criticised for allowing the providers to avoid liability for negligence and not acting soon enough over concerns about doctors.

Sir Bruce told HSJ the new Medical Practitioners Assurance Framework, published today, “would reduce the chances” of a similar scandal to that of Ian Paterson. “We are trying to put in some clinical governance measures that make it less likely that it will happen and that it will be picked up sooner if it is happening,” he said. “It will make it harder for someone to get into that position and make it easier for them to be detected.”

Sir Bruce said the framework was not “trying to solve every problem. I have seen too many reviews that try to boil the ocean. This is very focused on trying to get some of the governance systems in place and I think it gives people permission to have a conversation about how we improve.”

Sir Bruce said scrapping practising privileges altogether, and moving to an employment model, would be too “disruptive” for the sector. He argued: “One thing I have learned from doing reviews is that if you recommend massive changes sometimes they don’t happen. We are trying to get to a pragmatic place, this is not about creating a massive melee of change it’s about making it easy for people to do the right thing and more difficult to do the wrong thing.”

An independent inquiry into the Ian Paterson scandal is currently being carried out by the Right Reverend Graham James, Lord Bishop of Norwich, and is expected to report later this year.

IHPN chief executive David Hare told HSJ: “A number of reports have shown while there is world class care in the UK independent sector there is an inconsistency around quality… 

“Fundamentally the sector collectively needs to be offering the high-quality services we see in parts… routinely and consistently across the country and this is an attempt to define that consensus view and embed that in all independent sector organisations.”

He added: “This is supported by the sector but we acknowledge that it does need to have clear teeth and we are fully expecting the CQC to embed this in their ‘well-led’ domain.

“Any organisation that is either not doing what we say or has not got credible policies in place to deal with the issues we flag will consequentially have an effect in terms of the judgement of the CQC which for those organisations which do insured work means less work being referred into them. There will be a practical commercial consequence for organisations not doing it.”

Among the key recommendation include:

  • Clinical governance leads should be appointed at executive and non-executive level;
  • There should be a standard approach to practising privileges applications and subsequent reviews of them;
  • A standard system of oversight/monitoring and assurance – including supporting whole practice appraisal and quality improvement activities;
  • A standard system for identifying and acting on concerns about any medical practitioner;
  • A clear understanding of the responsibilities of individual medical practitioners;
  • A standard approach to the introduction of new procedures and innovative techniques;
  • Clarity on how a hospital’s medical advisory committee links into clinical governance.


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