October 2021 update on FIPO and PHIN

Updating members of BOA discussions relevant to the Independent Sector (IS), Public Healthcare Information Network (PHIN) and the Federation of Independent Practitioner Organisations (FIPO).

Andrew Manktelow
21st October 2021

The BOA is represented in discussions relating to the Independent Sector (IS), with the Private Healthcare Information Network (PHIN) and within the Council of the Federation of Independent Practitioner Organisations (FIPO), by a member of BOA Council, Mr Andrew Manktelow (Nottingham) at present. The BOA does not have a formal Private Practice committee. At present a report on IS relevant, FIPO and PHIN discussions is made to BOA council after each meeting. Recently, we have discussed how the content of those discussions and the relevant issues can best be communicated to interested BOA Members.

While many BOA Members do not practice in the IS, many are active in private practice. It should also be recognised that many patients now have their orthopaedic surgery performed within the IS, either privately funded or as part of NHS initiatives. This situation is likely to increase as a consequence of the delays caused by Covid. Thus, there are a number of issues that will be relevant to BOA Members and as importantly to their patients.

This new addition to the BOA Newsletter is designed to inform members of the matters that have been discussed, to provide a brief summary of those discussions and when relevant, to provide a link to other material providing additional detail when felt helpful. It could also provide a potential mechanism through which BOA Members can raise specific concerns and/or contribute to discussions.

Recent communication with PHIN has surrounded their efforts to increase Consultant engagement as they work to fulfil the requirements of the CMA (Competition and Markets Authority) order. Their fundamental aim is to provide better information for patients as they embark upon clinical care in the IS. PHIN are clear in their role and in their requirement to ensure compliance with the CMA ruling. More recently, PHIN have been in renewed contact with surgeons encouraging them to validate data and to provide information on fee structures and clinical activities within the independent sector. It is likely that the CMA will contribute further to that drive. In discussions with PHIN, the BOA has raised surgeons' concerns regarding data accuracy and validity.

The BOA has been asked to comment on developments to the website and also to contribute to patient information leaflets on hip and knee surgery. More recently there has been a conversation regarding how hospital level data on never events could best be represented on the website.

PHIN have made a very specific effort to improve their website and additional information is now being made available by PHIN to patients (the new website was recently launched and can be viewed here.) This now includes information not only on procedure numbers and length of stay (which have been present for several years) but the newly added metrics on patient satisfaction and experience, at Consultant level. Additional discussions are ongoing regarding a possible link from the PHIN website to the NJR Surgeon and Hospital Profile site. The stated over-arching aim of all the above is to contribute useful information, to inform and to help patients as they seek information regarding how best to proceed with orthopaedic surgery within the IS.

More specific detail in all these areas can be found on the PHIN website

With regard to FIPO, discussions at the recent AGM on 4th October 2021, demonstrated a clear desire to improve communication with Orthopaedic surgeons active in the IS. FIPO is keen to optimise the quality of patient care in the IS while representing clinicians in their interactions with healthcare providers and insurers. The BOA is one of a number of medical associations and specialist societies that make a financial contribution to the running costs of FIPO. As such a BOA representative is invited to contribute to relevant FIPO Council meetings. Previous concerns that the organisation was seen to be rather 'London centric' and more relevant to those in more 'full time' private practice have been expressed. Recent meetings and the discussions have demonstrated a very much more general interest. FIPO produces regular newsletters and frequent communications. They are keen for a more widespread distribution of this material. FIPO's initial expectation was that their communications would be distributed to all BOA members. As FIPO communications are not prepared or reviewed by the BOA, it is not felt that a blanket distribution of their material is acceptable. The plan at this stage is to introduce and inform with regular contributions to the BOA newsletter. Then inviting interested BOA members to follow a link provided to the FIPO website, to gain more detailed information.

Several issues have been discussed with FIPO over the last 18 months. While initially centralised on the issues that surrounded the initial involvement of the IS with the NHS response to Covid, more recent discussions have looked at how that relationship has developed as the IS desire to provide optimum care for independently funded patients has been balanced with the requirement to support elective services in a time of national need. The implications of both the Patterson and Cumberlege reports on the IS have been explored and the need for an MDT approach to care in the IS, to be supported by private medical insurers and providers has been discussed. Concerns regarding how PMIs have influenced patient choice, defining patient referral pathways and limiting Consultant 'recognition' have been discussed. The decision to describe specific billing arrangements by certain providers, adding costs, has been discussed as well as concerns that surround how data collected within that process could be used. In addition to all the above, conversations at this month's AGM (4th October 2021) surrounded recent PHIN activities. FIPO is keep to understand how patients can be best be supported as they seek information to help make important clinical decisions. The changing face of how clinicians might be employed within the IS was discussed. Finally considerable time was spent exploring how FIPO can best communicate and disseminate information with relevant clinicians.

Additional details were presented in a formal report to BOA Council in October 2021. This will be minuted within that meeting.

For those interested and keen to hear more of FIPO's activities, visit the website here.

In addition, if there are specific areas of concern please don't hesitate to contact me via the BOA. I will be happy to provide additional detail as I continue my role to represent BOA Members as best as I can in this complex and changing area of clinical practice.

Andrew Manktelow
21st October 2021