Update from the Care Quality Commission on practising privilages

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The independent regulator of health
 and social care in England

Fast-tracking of processes for granting interim practising privileges to NHS consultants

NHS England have recently published a partnership agreement between the NHS and the Independent Sector (IS) which is intended to make available hospital facilities and staff within the sector for the admission and treatment of NHS patients. This will include provision of a range of services in a large number of providers locations and in the majority of cases the IS provider will remain legally accountable for the quality and safety of care. The movement of patients from the NHS has already started and is expected to rapidly pick up pace. IS providers are mindful that they need to comply with Regulation 19 and Schedule 3 of the Regulated Activities regulations 2014, in respect of individuals who work for them. The particular pressure this week is the process for granting practicing privileges to consultants who do not already hold them with the hospital, or with another IS provider, which is normally a lengthy one.

We have agreed with the sector a fast-track process for granting interim practicing privileges so that consultants can start work immediately in these hospitals, which recognises the unique situation we are in. The interim process provides for balance between ensuring patients are protected through agreed safeguards continuing to be in place while recognising that a reasonable and pragmatic solution is needed quickly.  CQC recognises that providers will be using their best endeavours to rise to the challenge and will not be penalising providers who are adopting these fast-tracked solutions.

 

Guidance

This guidance applies only to providers that are included within the NHS COVID 19 collaboration contract. Any other IS provider must follow the usual process for granting practising privileges.

Any consultant who will be providing services to NHS patients in an IS provider hospital under the contract, but who does not already have practising privileges at the location, will be required to provide the Registered Manager at the IS provider hospital a declaration confirming that their NHS employer (the trust within which they work), or another IS provider with whom they already have practising privileges, has available in relation to them the following information -  

  • DBS (relevant to practice – likely to be enhanced for doctors),
  • reference,
  • appraisal,
  • CV,
  • certificates of qualification (and a check on the GMC register that they hold relevant professional qualifications on the register), and
  • confirmation of health status (Hep B, C and HIV status). 

The consultant will need to provide the IS Registered Manager with this signed declaration before starting to treat patients at the IH hospital. The doctor does not have to provide evidence of each piece of information, as would be the case in normal circumstances, as the declaration will be considered sufficient evidence for the purposes of granting interim practising privileges and complying with Regulation 19 and schedule 3.

Before starting work at the hospital, the IS provider must see evidence of proof of identity (must include a recent photo) and must verify the consultants GMC number and that they are included on the specialist register using the GMC’s checking service.  

 

Further guidance to be published

This interim process guidance is the first stage, to rapidly get doctors into the IS provider hospitals from this week with as much assurance as is reasonable in these unique times. We are checking the position of medical indemnity cover requirements for consultants working under practicing privileges in these circumstances  and will confirm early next week if this is added to the guidance.

CQC will consider whether further stages later down the line might be needed to strengthen this, such as arrangements to ratify individual doctors’ assurance with their RO. It may also be that a third stage is needed where the consultant provides services in the IS hospital for a long time period (to be defined), which would include getting access to the information available from their HR department at their NHS employing Trust / other private provider and the possibility of conversion into a full application for permanent PPs.

We also recognise that staff of all clinical disciplines will be transferring across both NHS and independent healthcare sectors for the foreseeable future. We will be issuing guidance early next week about the approach that will be needed to ensure safeguards are in place but also is fastest and most pragmatic solution.

We also know that IS providers are receiving many requests from NHS trusts that are different to the services set out in the partnership contract. These are causing confusion about who is accountable for the service, and concern that services are out of the scope of the hospital. We are discussing those with NHSE and will advise you of the outcome as soon as possible.

Finally, we will be issuing guidance to our own staff about this immense change to provision of services in the independent sector.