• The Royal College of Surgeons warns high volume of operations done in private sector is impacting on training opportunities and trainees’ morale
  • Knee and hip operations often taken on by private sector as they are “low-risk”
  • College calls for private sector to be supported to train surgical workforce where qualified to do so

The transfer of a “substantial volume” of NHS work to the independent sector has “negatively impacted” surgical trainees, the Royal College of Surgeons has warned.

The royal college has said it is concerned the increased amount of work being done in the private sector has resulted in a loss of training opportunities in the NHS and a “subsequent decrease in morale”.

“The RCS has heard from members that private providers often choose patients who are the lowest clinical risk for them to treat,” the Royal College said in a report shared with HSJ.

“This means patients who require relatively low-risk operations, such as hip and knee replacements. As these are ideal training cases, surgical trainees have less opportunity to develop the technical and operative skills required for their Annual Review of Competence Progression.”

According to Department of Health and Social Care statistics, private providers carried out 31 per cent of knee replacement operations in 2017-18, an increase from 29 per cent two years before.

The private sector has also steadily increased its share of hip operations done over the past three years. In 2015-16, it did 26 per cent of operations, but this rose to 30 per cent in 2017-18.

RCS added it is aware obstetrics and gynaecology trainees are also experiencing similar issues with losing training opportunities, such as treatment for fibroids and endometriosis being done in the private sector.

To mitigate the loss of training hours, the royal college said the private sector should be supported to “educate and train the future surgical workforce where it is appropriately qualified to do so”.

It called for “reciprocal arrangements” between private providers and NHS hospitals, to ensure hospital rotas are viable when trainees are undergoing training in the private sector.

“This will help to ensure that training takes place within NHS contracted hours and trainees are covered by NHS indemnity,” it said.

Derek Alderson, president of the RCS, said: “Given the substantial increase in NHS funded hip and knee replacements taking place in the independent sector, Health Education England must now give serious thought to how surgical trainees access training in private hospitals.”

Professor Alderson said trainees are missing out on “valuable training opportunities” as surgical trainee contracts do not permit them to work in the independent sector.

“Where [reciprocal] arrangements do exist, standards of training are variable,” he added.

“The RCS would like to see the establishment of a national framework for the independent sector to provide training that ensures consistent standards of training and compliant hospital rotas, while streamlining funding and indemnity arrangements,” Professor Alderson said.

David Hare, chief executive of the Independent Healthcare Providers Network, said independent sector hospitals can provide “an excellent training ground for medical, nursing and allied health professional trainees”.

However, Mr Hare stressed that independent providers are “not currently funded to provide training”.

“We have therefore sought conversations with HEE on how a more structured approach to training placements can be developed where funding follows the trainee, rather than as a lump sum payment to providers, enabling trainees to experience working in both NHS and independent sector organisations with both providers being appropriately reimbursed,” he said.

The RCS warned earlier this year that winter pressures on trusts and elective surgery cancellations have also affected training opportunities for surgical trainees. 

Update: This story was amended on 16 November to correct the figures regarding the proportion of knee replacement operations taking place within the private sector. NHS Digital explained DHSC had misinterpreted its data in answer to a parliamentary question.