Private practice practising privileges – What to do when problems arise
First published in Independent Practitioner Today in May 2020
Most doctors who have a private practice will have an arrangement agreed with a private service provider, commonly a large organisation which operates a number of private health facilities. That service provider allows the individual doctor to have practising privileges at a particular venue, generally a private hospital where healthcare services can be provided to the public. In general, doctors in private practice apply for privileges to be granted at a particular facility, subject to suitability checks, history and appropriate indemnity cover.
These arrangements are of course extremely important to many practitioners, not least because of the income which can be generated. It is also important for the service provider, which invests large sums of money in establishing facilities; and without doctors providing the individual service, those facilities would of course not be operational. It is therefore an arrangement of mutual benefit. However, the dynamics of the arrangement are such that it is rather different to the employer/employee relationship most hospital doctors will experience, when working with NHS Trusts.
In the Trust context, there are clear government and employment principles, as well as clearly-defined regulations applicable in the event of any dispute, and safeguards in place to ensure fair procedures are applied. Similarly, private practice is subject to regulatory oversight by bodies such as the Care Quality Commission and the General Medical Council. However, where a professional conduct issue arises in the context of private work, it is very much a matter between the service provider and the individual practitioner to resolve. The framework for resolving disputes largely depends on the contractual documentation between the service provider and the individual practitioner, and the terms of those contractual arrangements are very much a matter for the individual service provider.
Generally, practising privilege arrangements are overseen by an internal committee or body, who make the key decisions in regard to the appointment of practitioners, or in terms of ongoing review and problem/dispute resolution. The framework within which disputes are managed, can vary widely from organisation to organisation, and often the safeguards and rights afforded to NHS practitioners working under the umbrella of a Trust, are notably absent from the internal management processes of private service providers.
From the individual practitioner’s point of view, it is vital that early advice and assistance is obtained when any professional conduct issue arises in private practice, as it would be in any other context. The lessons of the Paterson case are likely to be very much in mind for any managers investigating private practice conduct issues, and therefore it is in the interests of private practitioners to have the benefit of support and guidance from someone experienced in dealing with private practice providers in this context.
Perhaps the most vital aspect of engagement with a service provider, when any suggestion of misconduct arises, is to ensure fairness of any investigation and procedure, in the hope that the matter can be resolved to mutual satisfaction without long-lasting impact on the practitioner’s right to practise, and privileges at the particular service provider. ‘Fairness’ is a difficult concept to define, and the frequent absence of safeguards within providers’ disciplinary procedures can make it difficult to protect the practitioner’s best interests. In the present climate, service providers, following on the experience of Paterson, are likely to treat any potential conduct issue seriously, and indeed with a perception of the need to protect the public, they are likely err on the side of caution in making any decisions. The individual practitioner may therefore be in an extremely difficult position, necessitating objective advice and support during an extremely stressful period.
The key message in this context is therefore to engage and seek support at the earliest opportunity, and if possible, liaise with the service provider to try and resolve matters by dialogue if at all possible, as it can be difficult to resolve the situation after disciplinary action is taken – sanctions imposed can be draconian, with rights of appeal often limited and difficult to take advantage of.
It is not uncommon for practising privileges to be suspended during the course of an investigation, and therefore efficient investigation and early engagement are likely to be in the interests of both service provider and practitioner, in achieving the earliest possible resolution with full information obtained as required. Practitioners should also bear in mind the potential for any issue arising in the private context to be referred to the regulator (GMC, NMC etc), which itself is a good reason to ensure that proper advice is taken at the earliest opportunity, given the potential implications both in regard to the private arrangements, and fitness to practise entitlement generally.
Overall, private practitioners should not be fearful of the arrangements they have with private service providers, but as the reality of the world after Paterson becomes clearer, it is advisable to keep in mind the potential for inquiry and investigation should issues arise, be prepared to take early advice and engage as necessary.