Ian Paterson’s betrayal of the basic principles of medicine have had a devastating impact not only on the patients whose lives he ruined but also on the medical profession as a whole.

FIPO welcomes this long-awaited response by the government to the remaining recommendations of the Bishop of Norwich’s inquiry into his reprehensible behaviour. It is gratifying that the majority of these sensible recommendations have been accepted. FIPO hopes that their implementation will allow a restoration of confidence in the professional integrity of doctors throughout the sector.

The integration of practice data should allow for earlier identification of concerns, but this will need to be viewed within an independent professional governance framework. A peripheral benefit will be to ease the data capture burden for consultants who work at multiple sites.

The matter of consent for surgery is less likely to be an issue in the private sector where the consultant will be giving the informed consent and performing the surgery, normally with a time gap for the patient to consider what they have been told. However, in the NHS where many procedures are placed on pooled lists and the surgeon performing the surgery may not meet the patient before the operating list, consent can be an issue and the implementation of this will need to be practical.

Multidisciplinary team meetings are in clinical practice considered in many instances to be best practice. The routine adoption of these meetings compliant with national standards throughout the sector will need to be professionally monitored to ensure that, as was the case with Paterson, this does not degenerate into a tick box exercise. However, these meetings are very resource and time intensive in terms of assembling the necessary skill sets to perform them. There is also the issue that currently neither the hospital providers nor the private medical insurers (PMIs) reimburse the doctors and other professionals involved for their time. Although some of the PMIs have done so in the past, they now refuse to do this.

For some years some private providers have supported ISCAS to allow for independent assessment of complaints when in house procedures have failed to satisfy the complainant. FIPO whole heartedly supports universal adoption of ISCAS and its principles by providers but also believes that there should be better independent processes for complaints made by doctors about remote clinical decision making by insurers about individual patients. Currently the insurers are regulated by the Financial Conduct Authority and since clinical decisions may be made on financial grounds FIPO believes that there should be independent professional medical monitoring of such complaints.

Recent cases have highlighted the need for a clear understanding of the responsibility and liability of both hospital providers and consultants. Hospitals will need to accept responsibility for the quality of care in their establishments. This may also require a change in the law in relation to indemnity insurance and the government intends to report on this in 2022.

Overall FIPO endorse the government’s measured response to the Inquiry’s recommendations. We hope that their implementation will improve patient safety and restore professional respect and trust for patients choosing to use the private sector.

See also Renewing Faith in Doctors – independent-practitioner-today.co.uk

Richard Packard personal comment

Richard Packard, Chairman of the Federation of Independent Practitioner Organisations that through its membership organisations is representative of around 15,000 consultants working in private practice, says:

‘I believe that the majority of private consultants are pleased with the government’s endorsement of most of the Patterson recommendations and think this will restore public confidence and the general perception of private healthcare which provides such a helpful adjunct to the NHS in these challenging times.
The consultants will need support from their providers in order to make sure these recommendations are implemented. In particular funders will need to take responsibility for financially supporting their expert input to ensure effective MDTs where indicated.
It is important that professional integrity is maintained and whilst independent oversight is necessary we are keen to ensure that ‘box ticking’ mechanisms are not adopted at the expense of medical professionalism
As the original architect of guidelines for MACs in the private sector, a member of the MPAF advisory group and a provider of appraisals FIPO is keen to start working with Providers to develop independent professional oversight by doctors for doctors and their patients and I believe that this should start immediately’

January 2022