Health boards need to strengthen their arrangements for managing the impact of private practice on the NHS

11 Feb 2016 - 12:10am

Local systems are not robust enough to provide assurance that private patients who subsequently transfer to the NHS for treatment are not unfairly advantaged

In a report published today, the Auditor General for Wales has concluded that while private practice represents a very small level of activity when compared to the total NHS activity that takes place in Wales, health boards lack controls to ensure that private practice work is not impacting on the provision of NHS services. He also concluded that weaknesses in local systems mean that health boards cannot provide firm assurance that private patients are not ‘queue jumping’ NHS waiting lists and accessing NHS care quicker by paying for an initial private consultation and then subsequently joining an NHS waiting list.   

Health boards are not currently required to identify private patients that are entering the NHS for treatment, which makes it difficult to differentiate these patients from NHS patients referred by their GP, and for NHS bodies to ensure that their waiting times are fair and equitable. An analysis of the waiting times of a small sample of private patients who subsequently joined an NHS list was not able to provide a definitive answer on whether queue jumping was occurring. Some private patients who transferred to the NHS list were treated more quickly than average, although a large proportion of these were identified as requiring urgent treatment. The review however, also found that a number of patients experienced much longer waits despite some of them also being classified as urgent.

Auditor General for Wales, Huw Vaughan Thomas said Private practice must be effectively managed to ensure it does not place a strain on NHS resources. Firmer guidance needs be put in place to help NHS staff to better understand how private patients should be treated when entering the NHS for treatment. The process for data collection must be reviewed and improved by health boards, so that the information collected is robust and timely. These improvements should help to ensure NHS resources are used correctly, and that the total costs for private practice are being appropriately recovered.

Guidance on how to treat private patients being transferred to the NHS for treatment needs to be improved.
The information provided by the Welsh Government conflicts with UK-wide guidance, leading to inconsistencies in the way NHS staff interpret and use the information. The main waiting times guidance used by staff in NHS Wales does not refer to how to manage private practice at all, and many NHS Wales staff are unaware of Welsh or even UK-wide guidance.

The basic principle underpinning guidance on private practice is that it should not impact on NHS provision. However the guidance that exists lacks clarity as to when and how much private practice can take place in the NHS. Currently there are no monitoring mechanisms in place to ensure guidance is being complied with and many NHS managers were unaware of private practice activity taking place in their clinical areas. Data collected as part of the audit found that 98 per cent of private practice in NHS facilities takes place during the week, and although some of this is managed before and after NHS commitments, and in dedicated private sessions, a small number of cases were found to be taking place during periods when NHS work was scheduled.

The ability of a consultant to undertake private practice work can be an important factor in attracting high calibre individuals to NHS consultant posts. Moreover, NHS organisations can generate income from private practice work undertaken in their facilities which can then be invested in NHS services. Whilst most health boards are recouping the costs of private practice undertaken on NHS premises, it often takes more than 3 months for payments to be made, and in some cases costs are not recovered at all. In general terms, the processes for recouping costs are cumbersome and can sometimes be based on incorrect or incomplete information.