The new rules of private practice

HCSA Independent Healthcare representative Chris Khoo explains the new procedures regime that all doctors carrying out private work need to be aware of

Independent practitioners have faced new challenges in the past year as they feel the outcome of The Competition and Markets Authority’s investigation into the private healthcare market.

Its conclusion, that patients considering private healthcare were not being given enough information to understand and compare their options, led to recommendations that have created a complex new reporting landscape for doctors practising in the sector.

HCSA is part of FIPO, the Federation of Independent Practitioner Organisations, which has been working actively with this agenda. FIPO’s Charter upholds the highest standards of private care, but there have been concerns across the profession about the practicality of the CMA’s remedies.

A central plank of the CMA’s 2014 Order required all UK Consultants undertaking private activity to submit information to the Private Healthcare Information Network, which will publish hospital and Consultant data with the aim of “empowering patients to make better informed choices.”

The competition watchdog intended that patients should be aware of the cost and quality of private activity, and proposed specific “remedies” that would enforce its view.

The CMA’s fee remedy aimed to see all Consultants publish charges from April 2019, although close to the deadline only 5,100 had provided consultation fees and 3,500 a procedure fee.

Meanwhile the Order outlined 11 outcome measures that must be reported by hospitals and individual Consultants as part of the CMA’s information remedy:

  • Volumes of procedures undertaken
  • Average lengths of stay
  • Infection rates
  • Readmission rates
  • Revision surgery rates
  • Mortality rates
  • Unplanned patient transfers, including to the NHS
  • Patient satisfaction
  • Information from registries and audits
  • Procedure-specific measures of improvement in health outcomes
  • Frequency of adverse events.

PHIN has enabled individual Consultants to sign off their data as accurate online via its Consultant Portal (, to which all Private Practice Consultants have been invited. The portal also allows Consultants to upload profile information, including special interests.

The nature of the quality “outcomes” prescribed by the CMA means that those performing surgical procedures have been the initial target. As the April deadline approached, around 2,150 Consultants had approved their data, raising questions over the planned publication date.

All private practitioners must now also comply with two further requirements of the CMA Order by sending out pre-consultation letters, and following up with a “Treatment/Tests” letter if any additional investigations or treatment have been advised.

The information required is tightly defined, although private hospital operators are required by the order to provide consultants with a pro-forma letter which can be personalised.

In June 2016, FIPO appealed against the CMA’s initial Order and lost – but it has continued to work closely with PHIN to try to ensure that patient choice does not suffer from an oversimplification of the complexities of medical care.

As one FIPO director noted, “Choosing your Consultant isn’t the same as choosing to buy tomatoes from Waitrose, Sainsbury’s or Lidl based only on price.”

All private practitioners must now...

1. Submit fee and outcomes data to the Private Health Information Network (PHIN)

2. Sign off on the data as published on the PHIN Consultants Portal ((

3. Send a pre-consultation letter to all patients informing them:

  • The initial consultation fee
  • The follow-up consultation fee
  • Whether the Consultant has any financial interests in the hospital or clinic, or any equipment
  • The Consultant must list all private medical insurers who recognise them
  • The letter should remind insured patients to check the terms of their policies, especially regarding the type and level of outpatient cover
  • The patient should be directed to the PHIN website for quality information.

4. If any additional investigations or treatment have been advised, the patient must be provided with a further letter informing them:

  • The reason for the further tests or treatment
  • An estimate of the cumulative charges of the recommended treatment
  • Any Consultant fees additional to a quoted package price
  • Contact details for any other Consultants whose fees have not been quoted
  • Or, for self-pay patients, the total package price
  • A statement of what is not included in the estimate, for example: i. Anaesthetic fees; ii. Fees which cannot initially be quantified (for example the cost of managing complications)
  • The costs of possible alternative treatment, which might only be decided during surgery
  • Where they can find quality information on the PHIN website