Introducing a new technique into private practice

Introduction

Any novel therapy should always have patient benefits at its core. The evidence for this could come from the National Institute for Health and Care Excellence (NICE) guidance¹ or research studies where the technique has been adopted at an earlier phase.

In the case of an interventional technique not yet the subject of published NICE guidance, the Royal College of Surgeons advise within Good Surgical Practice (section 1.2.4)² that you should contact the Interventional Procedures Programme at NICE to learn the status of the procedure. You may also wish to liaise with your specialty association, who may have further information available on the technique, its use, and whether it is recommended by them to be used in the circumstance you propose.

Onboarding the new technique

Where the proposal is novel, but licenced and used elsewhere, its introduction through an agreed service evaluation process may be appropriate. If unlicenced, then this would need to follow a research proposal route and have the necessary approvals.

Any new technique will require approval by the relevant committee at the institution you propose to introduce it at. Private providers will almost certainly have existing policies that govern the process of introducing new techniques or treatments into their institution. It’s important to ask for a copy of this policy at the outset and follow it. Failure to do so may result in your introduction being unsuccessful and may put you at risk of criticism.

Your own evidence of how it will benefit patients will be helpful in reassuring a private provider and your team that they should support your change in practice. All doctors have an obligation to regularly audit their own standard of care as described in Good Medical Practice (paragraph 22)³:

"You must take part in systems of quality assurance and quality improvement to promote patient safety. This includes:

1. taking part in regular reviews and audits of your own work and that of your team, responding constructively to the outcomes, taking steps to address any problems, and carrying out further training where necessary
2. regularly reflecting on your standards of practice and the care you provide…"

This is never more important than when you are introducing a technique not previously established in an institution.

Training your colleagues

It’s essential when introducing a technique to demonstrate that you, and those involved in supporting the performance of the technique or care of the patient, have received appropriate training.

It would be unwise to begin practising a new procedure or using new equipment without clear evidence of your training, experience, and competence in that technique. You will most likely be asked for this evidence when seeking agreement with the private provider.

“You must recognise and work within the limits of your competence.” GMC’s Good Medical Practice (Paragraph 14)

You will also be required to develop and maintain your skills in the technique by attending regular educational activities specific to this aspect of your practice.

There may well be other healthcare professionals you work with that will not have been exposed to this new treatment or technique. Training the whole team will be vital to its safety and success, as they may assist in its delivery, or the care provided to the patient. The private provider, if they agree to its introduction, may ask you to be involved in training others and monitoring their competence.

Training may incur a financial cost. It would be important to agree in advance who is going to be responsible for delivering, funding, and monitoring this training. It’s a good idea to include professionals who may not be directly involved but have a role in caring for the patients, for example, ward staff, outpatient staff, pharmacists, and GPs who will be caring for the patients in the community. These professionals should be aware of any impact it may have on their management of these patients and be fully informed of any variance there may be to their usual care. The GMC sets out your obligations when delegating tasks to other professionals in paragraph 44 of Good Medical Practice⁴:

“When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.”

Consent for new medical techniques

The consenting process for any patient undergoing a newer technique will be required to be in line with GMC guidance on decision making and consent⁵. Patients and their carers should be informed of the benefits and risks in comparison with previously used and alternative techniques. The Royal College of Surgeons also emphasises that you should tell patients if the technique is relatively new and be open about your experience and training, as well as your outcomes to date.²

There may be no published patient information leaflets available at the institution you plan to introduce the technique to, so you should be involved in drafting these and ensure that any information given is clear and in line with any established national guidance.

The Royal College of Surgeons recommends that you discuss your proposal with your colleagues locally.² You may find that the introduction is more easily accepted when your colleagues understand what you are doing and are on board with the decision.

Doctors should be mindful of the possibility of a conflict of interest and appreciate their professional obligations, particularly where there is a commercial organisation involved in the introduction of a new technique.

The Association of the British Pharmaceutical Industry’s Code of Practice⁶ sets out the ethical framework for organisations that promote medicines. Medical technology companies have an equivalent association – the Association of British HealthTech Industries – which has published its Code of Business Practice⁷ for its members.

You should ensure that you are open with the private providers and patients, and follow any local policy on commercial interests of doctors working within that organisation. The GMC has its own guidance for registrants within Good Medical Practice (paragraph 77-79) as well as further guidance on financial and commercial arrangements and conflicts of interest⁸.

“77. You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.

79. If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision making.”

Gaining expertise and practising using a relatively new technique or treatment can bring many benefits to your patients, as well as being personally rewarding. However, it is not without its risks and can be time consuming and expensive. An understanding of the potential pitfalls and your professional obligations in this area are essential components of a successful new addition to your private practice. I hope this article has provided a useful overview and pointed out some essential guidance to consider.