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Bringing doctors onboard

by ​VJ Joshi

28/04/2016
It’s been a tough transitional year, with many doctors in private practice feeling a bit bruised by the impact so far of the Competition and Markets Authority’s Private Healthcare Investigation Order. So it can be hard to persuade people that there is a positive side to the changes that are coming through, with some big benefits, not just for patients, but for doctors as well.

By next year, PHIN will have begun publishing information about quality and performance for all hospitals and consultants in the UK. Hospitals will share their data with us, which we will use to develop a number of performance measures. These will be available to the public on our website to help people make informed decisions about private healthcare.

I spent years working as a doctor in emergency medicine, so I know from my own personal experience how cumbersome data collection can be, especially if it is implemented at odds with spending time on patient care. Then again, I also know how powerful data can be when it is correct and used in the right way. That’s why in order to make sure that everyone benefits from this process, it’s vital that doctors engage with the information we’re going to be publishing.

Here’s why it’s so important:
 
1. The data will be a powerful tool for doctors as well as patients

There are many benefits to patients of being able to review objective information about their options when considering what care provider is right for them. But consultants will be the first to hugely benefit from this process.

For most doctors this will be the first time they will see the whole of their practice played back to them within a single report, covering all their NHS and private activity. In effect this will aggregate the data that’s required for appraisal and revalidation into one place, but with the added benefit of being able to deep dive into individual episodes of care. They’ll have at their fingertips an independently evidenced report that demonstrates the wealth and breadth of their experience. More than that, we’ll then be publishing performance information, derived from that data, on our website in a format that patients can understand. Pretty powerful stuff.
 
2. We have to do this in partnership, or the data won’t be right

One of my previous roles at a large NHS trust combined working as an A&E doctor, with a managerial job in Information & Performance. I spent some of my week providing care, and the rest of it analysing data about that care. This gave me an in-depth understanding, not only of how powerful the data could be to help me improve the quality of my work, but also that data had real limitations. I could see what those numbers didn’t tell you. Being able to fill in the gaps meant that I was best placed to identify issues with data capture, making sure we were asking the right people for the right things at the right time.

Long before anything gets published for public consumption, we’ll be sharing with consultants what data we have about them. This will be an opportunity for them to tell us if the data is a complete and accurate record, is fit for purpose, and work with us in deriving information from this. We expect there to be issues that need to be ironed out. And I know from experience that doctors are probably the only people who can help us identify these issues, as ultimately it is a description of our work.

3. We want what we publish to be a fair and helpful reflection

What we’re doing is really complicated. Collecting data is hard enough, but to turn it into information that will be both representative and meaningful for patients is going to be even harder. Only consultants themselves can help us understand that complexity and ensure we’re presenting it in a summarised way that is accurate and fair.

Let me give you a simplistic example. Just looking at the outcomes from knee operations under different surgeons doesn’t take into account the different mix of cases those surgeons might be taking on. A good outcome might look different depending on whether your patient is a 90-year-old with arthritis or an otherwise healthy 20-year-old skier. It’s very important that we take those pre-existing characteristics into account. As the specialists in their own areas of care, consultants will need to help us identify and understand these nuanced complexities, and present the online information accordingly.

Case mix adjustment is also important for ensuring excellence is recognised and celebrated and that those who take on the more specialised cases aren’t penalised. Think about a specialist heart hospital, patients are likely to have rare and complicated conditions with many factors working against the chances of a good outcome, and yet the surgeons there are probably the best in their field. Our representation of hospitals and consultants must accurately reflect this.

So we have a big job ahead to encourage doctors to engage with the work we’re doing. But quite simply, we can’t do it without them. Change can be tough, but it can also be exciting. I feel confident that we'll come out of this process so much stronger as a profession, more transparent, and with more knowledge about ourselves.

To find out more about how we’re working with consultants and professional bodies and how we’re currently piloting the work with the Federation of Independent Practitioner Organisations (FIPO), read our recent article in Independent Practitioner Today.