Employment checks and training in the independent sector

Published: 11 September 2020

These statements set out our position on:

• employment checks of doctors prior to working for an independent provider as part of a postgraduate trainee programme
• updated guidance on fast-track practising privileges for consultants

1. There is a contract between NHS England and Improvement (NHSE/I) and the independent sector for the provision of elective and diagnostic services for NHS-funded patients. As part of this, Local Education and Training Boards and Health Education England (HEE) may make requests for the planning and provision of education and training for (NHS) healthcare workers. Independent providers should cooperate with these requests. Currently the contractual provision covers doctors. In future this might be extended.

2. HEE and NHSE/I say that doctors' education and training should take place wherever NHS services are being provided. Where this takes place in the independent sector, it is there to ensure the future pipeline of workforce supply and service delivery. Not using training opportunities in the independent healthcare (IH) sector may increase the risk of the need for training extensions. This could lead to financial burdens on the NHS, including:

• increased locum costs
• delays to service delivery
• impact on patient and healthcare outcomes.

3. CQC does not prevent any provision of training in an independent hospital. We expect the provider to have the governance, employment checks, clinical supervision and infrastructure to support the training. CQC would expect registered providers to be able to evidence that the following is in place:

• That the medical practitioner is an approved trainee; confirmed by the Medical College Dean or HEE. The provider must also be aware of HEE's Quality Framework.
• The level of skill and competence of the trainee.
• The level of supervision that should be in place for the trainee medical practitioner and the name of the consultant that will be providing the supervision.
• That a mechanism is in place to ensure that information required by Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 is available and has been checked prior to commencement of the rotation.
• The start date and finish date of the rotation.
• That an identity check has taken place when reporting on duty at the independent hospital for the first time. The IH provider must ensure that the trainee wears appropriate approved photo identity.
• An appropriate, effective and documented induction takes place on the first day or as soon as possible. The induction must include essential information. This may include, but is not limited to:
  • hospital layout
  • health and safety
  • fire safety
  • resuscitation arrangements and key policies and procedures.

4. CQC recognises there are various mechanisms or systems that an IH registered manager (RM) may have in place to make sure that Schedule 3 information is available and has been checked. Whatever system or process is used, it must be robust and effective.

5. RMs are accountable for assuring that:

• doctors are always supervised by a consultant who is a recognised clinical or educational supervisor in the NHS and who is currently employed by the host trust
• the consultant supervisor understands that they remain the clinician with overall responsibility for the care of the patient being treated
• that systems are in place for making the Post Graduate Dean (PGD) aware of any issues that may give rise to any fitness to practice concerns for doctors in training

6. The PGD is responsible for ensuring the training environment meets requirements. The RM is responsible for providing and maintaining the training environment.

Update on CQC position on practising privileges for consultants

1. CQC expects all independent healthcare (IH) providers who grant practising privileges to medical practitioners to ensure that they have robust processes in place for ensuring that full pre-employment checks are undertaken. These checks must meet Schedule 3 of the regulations.
2. CQC acknowledges that during the pandemic there may be a variety of temporary mechanisms being used to ensure pre-employment checks for medical practitioners are undertaken. It is not necessary for an IH provider to undertake these checks themselves or to hold the evidence of such checks having been completed at the location; but irrespective of how they have been undertaken the IH provider must be satisfied that all necessary checks have been successfully completed and be able to provide evidence to this effect.
3. CQC expects to see that IH providers have action plans in place to withdraw any temporary assurance measures that might have been initiated when undertaking pre-employment checks for medical practitioners being granted practising privileges during critical phases of the Covid pandemic. These plans should include withdrawing practising privileges from medical practitioners who are no longer providing medical services at the location.
4. Healthcare Providers are required to undertake robust pre-employment checks and procedures for all medical staff, to be assured that safe care and treatment is provided to patients at all times.