• Clinical autonomy in the NHS should be compared to international systems
  • Royal College of Surgeons says changes should not stifle innovation
  • Report into general surgery described as “blueprint for better care”

The clinical autonomy enjoyed by NHS surgeons should be reviewed and clinicians monitored more closely to ensure consistent care, a national report recommends.

The Getting It Right First Time report into general surgery has been endorsed by the Royal College of Surgeons.

Colorectal surgeon John Abercrombie, who wrote the report, described his recommendations as “a blueprint for better care”. The study highlighted systems in American and German hospitals where the chief surgeon or department chair sets standards and governs ways of working.

“Given the wide variation in patient outcomes evidenced in this report, and the expectation that similar findings will be made in other specialties, it is time for the NHS to consider a similar approach,” the report stated.

Although surgeons complete rigorous training and repeat assessments before qualification, the report highlighted “few robust mechanisms” in place to assess performance, with little or no oversight of professional development.

“Surgeons are granted considerable autonomy, both in the decisions they make about patient care and about their own learning,” it said.

“This means that, conceivably, a busy surgeon could remain unaware of new surgical techniques, developments in infection control and alternative care pathways.

“It is possible that this in turn contributes to the variation already identified in the way the same conditions are treated in different hospitals.”

The report said the NHS’s approach to continuing professional development was “not of the rigour expected in other professions”, with surgeons free to choose which conferences to attend with no monitoring of effect on performance.

Mr Abercrombie said recommending a review of clinical autonomy in the NHS was not about stifling innovation but sharing best practice to improve patient care.

He said: “In a lot of areas, those [trusts] doing things consistently are the ones leading the way.

“But we are not saying you must do this or not do that. It is not about restricting practice.

“Show patients are getting good results and we will be happy.”

The RCS said: “Given the wide variation in patient outcomes evidenced by this report, it is clear there’s a need to assess the NHS model of clinical autonomy.

“If there is evidence from international comparators that more defined care pathways reduce unwarranted variation, the NHS should reflect on this.

“At the same time, we should be careful to avoid stifling the innovation that comes with a degree of autonomy that surgeons in the NHS will be used to.”

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