Government commits to public repository of consultant details “in principle”
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3115 (Published 17 December 2021) Cite this as: BMJ 2021;375:n3115
The government has committed “in principle” to creating a public repository of consultants’ practice details that sets out their practising privileges and key performance data, including how many times they have performed a particular procedure and how recently.1
The commitment was part of the response to an independent national inquiry, launched in 2017, following the malpractice of rogue surgeon Ian Paterson. Now serving a 20 year prison sentence, Paterson had undertaken numerous unnecessary breast operations in both private and NHS practice, causing harm to hundreds of patients.2
The inquiry, published February 2020, found that Paterson was able to harm patients over more than decade because of the “dysfunctional” healthcare system.3 It outlined 17 recommendations for the government to respond to, mainly focusing on improving oversight and governance, as well as ensuring greater scrutiny of private providers.
At the time, some saw the report as a missed opportunity to tackle the systemic patient safety risks of the private hospital business model, such as financial incentives which can lead to overtreatment.4
The government has now fully accepted nine of the recommendations, accepted five more “in principle,” rejected two (one will be kept under review), and one recommendation is still pending a decision.
In response to the first recommendation for a public and easily accessible “single repository of the whole practice of consultants across England” to be created, the government pointed to NHS Digital’s acute data alignment programme (ADAPt).5 It said this project has already started developing a set of standards for data collection, performance measure methodologies, and reporting systems across the NHS and the independent sector. The government said that ADAPt has the “potential” to be fully implemented by 2023. It will decide in the next year “what information can be published” and “whether further action will be needed” to achieve this recommendation.
Neil Mortensen, president of the Royal College of Surgeons of England, welcomed the decision and said, “The independent inquiry exposed how patients were let down at every level by the system. The inquiry’s recommendations are designed to improve patient safety and prevent such criminal actions from happening again.”
GMC role
The recommendation is similar to one made last year by Julia Cumberlege in her review of Primodos, sodium valproate, and pelvic mesh, which recommended that the General Medical Council register should be expanded to include a list of doctors’ financial and non-pecuniary interests, as well as their clinical interests and recognised specialisms.6
Cyril Chantler, vice chair of that safety review panel that conducted that review and a non-executive director of the Private Healthcare Information Network (PHIN), told The BMJ that the government’s response is a “step in the right direction” but that he would like to see commercial and other interests also reported.
Although the GMC is not mentioned in the Paterson inquiry recommendation, Chantler believes it should oversee the interests register, which could easily be added to the appraisal process, making it easy for doctors to update.
“All the bricks are there—the appraisal system, the revalidation, the collection of data,” he said. “But we don’t want to make it so burdensome that it becomes an absolute pain for doctors.
“You’ve got a lot of bricks, now somebody needs to build the house and somebody needs to make sure the house is built to specifications, and that is the GMC. We’re not asking the GMC to do it, we are asking them to validate the process and to guarantee the outcomes, in the sense that patients have a right to be able to access information and to make sure the information is accurate.”
Chantler added that the system could start with consultants and then be extended to other doctors, and later other healthcare workers and clinicians.
When asked by The BMJ whether the GMC would be involved in the repository, a spokesperson suggested this would not be the case. “The collection of consultant clinical performance data is being taken forward through the ADAPt programme, which is jointly run by NHS Digital and PHIN. We welcome initiatives to better track clinical outcomes data across both the NHS and independent healthcare sector,” they said.
The GMC has previously rejected calls for it to set up a central register of doctors’ declared interests, arguing that it lacked the legal power.7
Other recommendations
Recommendations accepted or accepted in principle included:
Making it standard practice for consultants to write to patients outlining their condition and treatment in simple language and to copy this letter to the patient’s GP
Ensuring that differences in the way care is organised in the NHS and private sector are clearly explained to patients
Ensuring that all patients with breast cancer have their case discussed at a multidisciplinary meeting, in line with national guidance
Ensuring that information about how to escalate a complaint is communicated more effectively
Checking that all Paterson’s NHS and private patients have been reviewed
Recommendations not accepted were:
When a hospital investigates a healthcare professional’s behaviour, any perceived risk to patient safety should result in the suspension of that healthcare professional
The government should make arrangements to ensure that all accepted recommendations are to be applicable across the whole of the independent sector’s workload (meaning private, insured, and NHS funded) if independent sector providers are to be able to qualify for NHS contracted work. (Being kept under review)
The recommendation still under consultation is that the government should reform urgently the regulation of indemnity products for healthcare professionals and introduce a nationwide safety net to ensure patients are not disadvantaged.