What could be more professionally satisfying then being able to offer your patient effective and fast clinical care from diagnosis to treatment? While this is often only an aspiration for clinicians working within the pressurised NHS, it can be the reality for those in the private sector.
Providing the highest level of care to your patients in a system that works is a dream scenario, but practising within this sector is not without its medicolegal risk.
This article discusses three key considerations for minimising that risk: organisational familiarity, indemnity arrangements, and careful consideration of conflict of interest.
1. Do I really understand the organisation, systems and policies?
When I advise doctors who have had concerns raised regarding their practice by a private provider, one of the first things I ask for is a copy of their contract or practising privileges. Sometimes a doctor is not aware of what their obligations are to their private provider, and they may be very different to the expectations of the NHS.
Take the time to ensure that you are clear on what the organisation expects of you and clear on their policies and processes.
If you are new to the organisation, get to know it and its key players: take time to understand who is responsible for what. You are unlikely to have had the luxury of time to do this in the NHS. You can, however, make time in the private sector. If you are serious about committing to the organisation in the longer term, then any investment you make at the outset will pay dividends.
For some private practitioners, this may not come naturally and, as an outsider to the organisation, the tendency is to keep a low profile until you are more established. But think about it the other way – people can be more open and understanding of you as a new joiner who is showing proactivity in understanding how things work. You may feel it is much harder to ask basic questions about systems/policies six months down the line. Embarrassment or not knowing who to ask will lead to those questions being left unanswered. That could expose you to medicolegal risk and criticism.
Be proactive and be practical. Introduce yourself to complaints, governance, IT, finance, HR and administrative colleagues. Developing relationships early can lead to additional support when you need it. Understand the IT systems and get sufficient training to so you can provide safe care to your patients. Consider observing colleagues or think about having a mentor in that organisation. Are you clear on the data protection requirements? Do you know who to go to if you have invoicing issues, or if you must take unexpected leave? Systems and processes can be very different to those in the NHS, so ensure your induction and training covers what you need.
2. Is my indemnity sufficient?
Before you start private work, liaise with your indemnity provider to ensure that you are correctly indemnified and review arrangements regularly. Your Medical Defence Organisation (MDO) or insurer may be your only friend, if your professional practice is called into question by a private provider.
Your indemnity is usually tailored to your professional role/s, and the MDO or insurer will want to be reassured that you have been paying the correct fees that reflect the full scope of your practice, before they can assist you with a medicolegal matter. This is why it is so important to update your indemnity provider with any change in your professional circumstance. It is also a mandatory professional obligation as set out in Good Medical Practice 2024, to ensure that you have appropriate private practice indemnity/insurance.
3. Am I at risk of criticism for having a conflict of interest?
There is an inherent conflict of interest risk in private work. You are there to give safe, effective clinical care as your only professional concern. However, you are also there to support your own income, and if you are allied to a private organisation, they will also be expecting you to generate profit for them.
It is acceptable to work within this context and you can get this balance right. The key is that whatever the financial or other pressures that may exist on your private practice, the only factor that should guide your clinical decision-making in the private sector is to act in line with what is best and necessary for safe clinical care. The GMC provides helpful advice on this in their guidance Identifying and managing conflicts of interest.
A private practitioner must also exercise their own discretion and decline any request by employers or insurers which may conflict with their professional obligations. The key points to remember are:
- Patients come before profit.
- Your clinical actions must be dictated by your clinical judgment.
- Really think about conflict of interest. If you cannot justify the clinical need, then do not recommend it as a course of action for the patient.
- Do not be influenced by other factors such as financial benefit, employer/ insurer demands, or organisational profits.
- If you are being put under pressure to act in a way that puts other considerations over clinically justified need, then you should raise your concerns in line with GMC guidance.
This approach may not be as profitable as others, but it will reduce your medicolegal risk in the long term and your professional reputation will be held in high esteem because of your focus on clinical excellence above all other considerations. It will also avoid any concerns about your probity, which the GMC takes seriously.
4. What if it goes wrong?
If a patient makes a complaint about a doctor in the private sector, that complaint may be dealt with directly by the doctor or coordinated by the organisation’s complaints team (if there is one). Any complaint should be responded to in line with the organisational complaints policy and these can vary between private provider, so take time to familiarise yourself with what the organisation expects of you if a complaint is made by a patient.
A detailed and carefully drafted complaints response is time intensive to prepare, but worth it. If done well, it can minimise the risk of other medicolegal processes, such as a claim for negligence, or a referral to the GMC.
A private organisation may also undertake its own review of a concern about a doctor. This would usually be undertaken as a disciplinary process. The organisation should provide a doctor with the relevant policy that they are to follow as part of that investigation. It is also helpful to familiarise yourself with the role of the Independent Sector Complaints Adjudication Service ISCAS and find out if your employer is a member.
If a doctor has concerns raised about their work in the NHS, there is a national framework for managing concerns, and that usually has provisions for continuing of the doctor’s salary whilst those concerns are being investigated. Not always so in the private sector. It is more usual for a private organisation investigating concerns about a doctor to temporarily remove the doctor’s practising privileges whilst the concern is being investigated, and that means a temporary pause in your private work (and therefore, income).
After many years of supporting doctors in responding to clinical concerns, my experience is that there is significant variation in how private organisations investigate concerns about a doctor. Some undertake a fair process that affords the practitioner an opportunity to reflect on the concern, provide their factual account, and learn, and the matter is concluded swiftly and informally. In other cases, the process does not offer an opportunity for the clinician to comment on the concerns made, or the organisation is intolerant of allowing a doctor to have time to prepare carefully for any discussion about the concerns: the process can feel one-sided, adversarial, and extremely unfair.
If you have concerns raised by either a patient or the organisation about your private work, contact your MDO or insurer at soon as possible so that they can support and advise you.
You must also fulfil your professional obligation under Good Medical Practice, which requires that, if you have any suspension or restriction placed on your practice you must, without delay, notify any organisation for which you carry out medical work, and any patients you see independently.
Summary
Private practice can be extremely rewarding and you can minimise your medicolegal risk as follows:
- Familarise yourself with the private organisational requirements, policies, and systems.
- Ensure you are correctly indemnified.
- Put patients before profit, in order to manage any conflict of interest.
- Engage with complaints early.
- Contact your MDO for advice and support if concerns arise.
Dr. Sabira Hughes is a medicolegal consultant at Medical Protection.
