FOI Request - Private Practice Oversight

Summary

The requester sought details on Manx Care's governance and authorization processes for radiology consultants engaging in private practice. Manx Care disclosed the relevant committees, the governing 'Heads of Agreement' document, and specific criteria regarding NHS workload and application requirements.

Key Facts

• The Private Patients Administration Team and Private Practice Medical Advisory Committee (PP MAC) oversee private practice arrangements.
• Governance terms are contained within the 'Private Practice Heads of Agreement Document, Version 8 dated Dec 07' rather than a separate document.
• Consultants must demonstrate 11 PA NHS work and are prohibited from conducting private practice during Job Planned NHS hours.
• Breach of private practice rules results in a disciplinary review, though patient safety concerns may override restrictions in urgent situations.
• Consultants must submit a 'Private Patient Unit Application for Practicing Privileges' to the Private Patients Administration Team to practice at Nobles Hospital.

Data Disclosed

• Version 8
• Dec 07
• 11 PA NHS work
• January 1, 2020
• 21 August 2025
• 12 September 2025

Original Request

Dear FOI Officer, I am writing to request information under the Freedom of Information Act regarding the authorization of private practice for radiology consultants within Manx Care. Specifically, I would like to request the following: 1. Governance and Oversight: 1a. Details of any committees, boards, or internal bodies within Manx Care responsible for reviewing, approving, or overseeing private practice arrangements for consultants, particularly in radiology. 1b. Terms of reference or governance documents for these committees. 2. Authorization Process: 2a. Copies of policies, procedures, or guidance documents outlining the process by which radiology consultants may apply for and be granted permission to engage in private practice. 2b. Criteria used to assess such applications, including any conflict-of-interest considerations or workload assessments. 3. Records and Documentation 3a. A list of all documents (including internal memos, meeting minutes, approval letters, or agreements) relating to the authorization of private practice for radiology consultants from January 1, 2020, to the present. 3b. Dates of issuance or approval for each document listed. 4. Monitoring and Compliance 4a. Information on how Manx Care monitors compliance with private practice authorizations, including any audits, reviews, or reporting requirements. If any of the requested information is exempt from disclosure, please provide the reasons for the exemption and confirm whether any redacted versions can be shared. I would prefer to receive the information electronically, if possible. Thank you for your time and assistance. I look forward to your response within the statutory timeframe.

Data Tables (11)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4890389 12 September 2025

Dear

We write further to your request, received 21 August 2025, which states:

"Dear FOI Officer,

I am writing to request information under the Freedom of Information Act regarding the authorization of private practice for radiology consultants within Manx Care.

Specifically, I would like to request the following:

1. Governance and Oversight:

1a. Details of any committees, boards, or internal bodies within Manx Care responsible for reviewing, approving, or overseeing private practice arrangements for consultants, particularly in radiology.

1b. Terms of reference or governance documents for these committees.

1. Authorization Process:

2a. Copies of policies, procedures, or guidance documents outlining the process by which radiology consultants may apply for and be granted permission to engage in private practice.

2b. Criteria used to assess such applications, including any conflict-of-interest considerations or workload assessments.

1. Records and Documentation

3a. A list of all documents (including internal memos, meeting minutes, approval letters, or agreements) relating to the authorization of private practice for radiology consultants from January 1, 2020, to the present.

3b. Dates of issuance or approval for each document listed.

1. Monitoring and Compliance

4a. Information on how Manx Care monitors compliance with private practice authorizations, including any audits, reviews, or reporting requirements.

If any of the requested information is exempt from disclosure, please provide the reasons for the exemption and confirm whether any redacted versions can be shared.

I would prefer to receive the information electronically, if possible.

Thank you for your time and assistance.

I look forward to your response within the statutory timeframe."

Response

1. Governance and Oversight:

1a. Details of any committees, boards, or internal bodies within Manx Care responsible for reviewing, approving, or overseeing private practice arrangements for consultants, particularly in radiology. 1a. Private Patients Administration Team and Private Practice Medical Advisory Committee (PP MAC).

1b. Terms of reference or governance documents for these committees. 1b. - No terms of reference exists on its own for the Private Practice MAC but it is in the Private Practice Heads of Agreement Document, Version 8 dated Dec 07.

1. Authorization Process:

2a. Copies of policies, procedures, or guidance documents outlining the process by which radiology consultants may apply for and be granted permission to engage in private practice. 2a. Private Practice Heads of Agreement Document, Version 8 dated Dec 07.

2b. Criteria used to assess such applications, including any conflict-of-interest considerations or workload assessments. 2b. Every consultants PP privileges, were, are and should be vetted under current agreed heads of agreement and all consultants are to demonstrate 11 PA NHS work and not carry out PP in Job Planned NHS hours. Any breach would result in a disciplinary review. There is however acceptance that in certain urgent situations patient safety overrides any such concerns.

There is an acceptance for pay back of time too as an added layer of governance to the current heads of agreement any consultant wanting to undertake Private Practice within Nobles Hospital must now complete a Private Patient Unit Application for Practicing Privileges and submit the form to the Private Patients Administration Team.

This form requires the consultant to provide information to support their application such as but not limited to: GMC Licence, GMC registration Number, GMC Specialist Type, Insurance Information, ICO Information, Primary Interests and proposed procedures, Secondary Interests and proposed procedure, Consultant requirements from Private

Patients Admin Team to facilitate private practice, any information on GMC/DMC investigations, declarations, convictions or previous suspensions.

Once the application is received, reviewed and information provided verified, the Commercial Development Manager will forward the application to the PP MAC with their comment either supporting or not supporting the application. The PP MAC under the current Heads of Agreement will provide the final approval or not and will notify the Consultant and the Private Patients Administration Team of the final decision.

1. Records and Documentation

3a. A list of all documents (including internal memos, meeting minutes, approval letters, or agreements) relating to the authorization of private practice for radiology consultants from January 1, 2020, to the present.

While our aim is to provide information whenever possible, in this instance Manx Care is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested.

3b. Dates of issuance or approval for each document listed.

While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested because exemption s30(2)(b) has been applied because: Disclosure of the information would be likely to prejudice the commercial interest of Manx Care. As section 30 is a qualified exemption it is subject to a public interest test. The public interest must be something that is of serious concern and benefit to the public at large.

Factors Supporting Disclosure 1. Transparency over how costings are agreed. 2. Transparency on how Private Practice works alongside Manx Care to prevent impact on Manx Care patients. 3. Transparency on how income is utilised for Manx Care services.

Factors Supporting Non-Disclosure 1. Commercially sensitive – negotiations between Manx Care and those providing private practice services to obtain best pricing for the public may be affected leading to alteration of costs to the public, (including Insurance cost agreements). 2. Impact on maintaining current and future relationships with Private Practice Service providers.

In this instance, we have concluded that the public interest in maintaining the exemption outweighs the public interest in disclosure. Releasing the information namely FP and C Committee Paper 01022024 Private Services – Retrospective Approval could prejudice commercial negotiations and reduce confidence in our ability to protect sensitive business information, which may ultimately not be in the public interest.

3a. & 3b - 'FP and C Committee Paper 01022024 - Private Services - Retrospective Approval'. Created as required by the DHSC approval mechanism via the mandate assurance framework which was followed for all 'Legacy' private service that were already occurring within Nobles Hospital when Manx Care was formed. Included in this paper was Private Radiology Services. Retrospective DHSC approval was granted April 2024. - Private Practice Heads of Agreement Document, Version 8 dated Dec 07.

1. Monitoring and Compliance 4a. Information on how Manx Care monitors compliance with private practice authorizations, including any audits, reviews, or reporting requirements.

4a * The governance framework mirrors the current ManxCare public healthcare governance protocols as well as under PP MAC as they did with the DHSC governance framework before inception of ManxCare.

Please quote the reference number 4890389 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me.

Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

HEADS OF AGREEMENT Page 1 of 6 VERSION 8.0 Dec 07

NOBLE’S HOSPITAL, BRADDAN

HEADS OF AGREEMENT:- PRIVATE PRACTICE

ACCESS TO PRIVATE PRACTICE FACILITIES WITHIN NOBLE’S HOSPITAL

1. INTRODUCTION

1.1 The Hospital aims to provide a high quality, evidence-based, value for money healthcare, delivered in a healthy and safe environment by well-trained and well-motivated staff

1.2 Central to this is the advice support and co-operation offered by the Consultant Medical Staff who work within the Hospital.

The focal point for the collection of this advice should be a small Medical Advisory Committee (Private Practice). In conjunction with the Hospital Manager, the Medical Advisory Committee will ensure that patients needs are met and the private patient service is successful in terms of business, quality of care and reputation in the Island’s community.

1.3 In order to achieve such success, patients in the Hospital must receive medical care of the highest quality from Consultants and other clinical professionals who are appropriately trained, qualified and experienced.

1.4 The purpose of this paper is to describe the criteria and conditions under which a Consultant may be granted authorisation to undertake the care and treatment of a private patient within the Hospital. If granted, this authorisation is on the basis of a licence to utilise the facilities of the Hospital on a private patient basis and throughout this policy this licence is referred to as ‘practice privileges’.

1.5 This paper describes:

• The role of the Medical Advisory Committee • The role of the Hospital Manager • The responsibility of the practitioner • The eligibility criteria for the grant of private practice arrangements • The duration and renewal of private practice arrangements • The responsibility of the Hospital • The application procedure and the granting of access to private practice

1. THE CONSTITUTION OF THE MEDICAL ADVISORY COMMITTEE

2.1 MEMBERS

2.1.1 The Medical Advisory Committee (MAC) will comprise up to 3 individuals elected from amongst the Medical Staff Committee. HEADS OF AGREEMENT Page 2 of 6 VERSION 8.0 Dec 07 2.1.2 The Chairman will be elected by members of the MAC. 2.1.3 So far as is possible, membership will equitably reflect clinical teams working across the services within the Hospital. The MAC has the power to co-opt additional representation as and when required to discuss specific matters. 2.1.4 Management will be represented by:

• Hospital Manager • Clinical Manager • Medical Director 2.1.5 Other members may be co opted as required

2.2 ROLE

2.2.1 The MAC has no executive power, its role is advisory. Nonetheless, the Hospital Manager will consult the MAC before recommending any major policy changes affecting the clinical provision of private patient care. 2.2.2 The MAC will provide advice to the Hospital Manager on matters relating to safe, efficient and ethical use of the private facilities within the Hospital. 2.2.3 The MAC will provide advice on the applications for the granting of practice privileges in the light of the eligibility criteria attached as Appendix A. 2.2.4 The MAC will provide advice to the Hospital Manager when the variation to, or withdrawal of, a practitioner’s access to private practice is being considered. 2.2.5 The MAC will ensure that there is a regular review of data from clinical audit, clinical governance, the review of practice and untoward incidents and make recommendations where appropriate. 2.2.6 The MAC will provide advice and assistance in the matters of clinical ethics. 2.2.7 The MAC will act as a formal channel of communication between clinicians active in private practice within the Hospital management. 2.2.8 The MAC will regularly review the utilisation of physical and human resource in the provision of private patient care, paying particular emphasis on theatre time and the availability of beds. 2.2.9 The MAC will monitor the private work undertaken in NHS time and will assess ‘pay back’ on an individual basis in relation to the individuals workload and commitments.

2.3 TERM OF OFFICE

2.3.1 All Consultant members of the MAC have a three-year term of office, which may be extended by one year if agreed by the MAC. At the end of the term of office, an election must be held. 2.3.2 The term of office of any co-opted member will be made on a meeting- by-meeting basis 2.3.3 Management representatives remain on the MAC until they relinquish the relevant post or responsibilities.

3 RESPONSIBILITY OF THE HOSPITAL MANAGEMENT

The Hospital Manager has specific responsibilities for –

HEADS OF AGREEMENT Page 3 of 6 VERSION 8.0 Dec 07 3.1 The procedure by which private practice privileges are sought, considered, granted and withdrawn 3.2 Monitoring compliance with the arrangements governing the quality and quantity of private practice 3.3 Ensuring that private practice is not to the detriment of NHS patient services.

4 RESPONSIBILITY OF THE PRACTITIONER

The Consultant will –

4.1 Hold or have held a Consultant NHS contract to work at Noble’s Hospital with full current registration 4.2 Apply for access to private patient practice and receive approval before undertaking any private patient activity and immediate

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