Supporting the participation of independent healthcare providers in the NCAPOP: A feasibility pilot project


HQIP, funded by the Independent Healthcare Providers Network (IHPN), led on a feasibility study exploring Independent Sector (IS) participation in the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The project included surveys and workshops to engage with IS providers and to understand the specific challenges to participation. HQIP aimed to identify solutions and opportunities via piloting data flow with two HQIP commissioned audits, which has led to a comprehensive set of recommendations and next steps to move forward to include the Independent Sector in national audits.


The aim of the project was to explore and define the practical, technical, information governance and financial challenges of supporting the participation of independent sector providers in the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

We know that comparative, reliable information about the performance of clinical services gives healthcare providers a tool to support quality assurance and quality improvement.

Independently funded care is not included within the scope of the NCAPOP, funded by NHS England, commissioned and managed by HQIP. It is worth noting however that NHS funded activity is in scope, and independent sector providers do varying combinations of both.

Involving independent providers of healthcare services in national clinical audits provides an excellent opportunity to gather high quality information on quality of care and to support the regulatory framework within which the independent sector works.

In order to achieve this HQIP has been working with the Independent Healthcare Providers Network (IHPN) and its members to understand the barriers that prevent independent sector providers from contributing to relevant audits and programmes.


HQIP has been involved in discussions around involving independent sector providers in the NCAPOP since late 2017. These discussions culminated in a joint workshop in late 2018 and the formation of a Steering Group (SG) composed of key stakeholders in 2019 (the SG included representatives from the independent sector, regulators and NCAPOP audit providers).

The project’s key focus has been to understand the barriers that prevent independent sector providers from participating in audits, to propose solutions for increasing engagement.

The key steps that HQIP worked through include:

  • Phase 1 (gap analysis), November 2019 – February 2020:
    – Developing a gap analysis survey to capture current barriers to participation across the four key areas above noted
    – Assessing the results of the surveys to inform the next stage data flow testing phase
    – Engagement with relevant key national stakeholders and professional societies to help inform the testing phase
    – Communicating with and encouraging the IS to sign up to the second phase of data flow testing through outreach workshops

[NB: the COVID-19 pandemic interrupted the project at this point and delayed the phase 2 work by over a year. Activity recommenced in April 2021]

  • Phase 2 (testing), April 2021-March 2022:
    – Confirming pilot participants in the two data flow areas and pre-testing briefing
    – Developing of information governance documents required, including any Data Sharing Agreements and the data collection template
    – Data flow testing from surgeons working across provider sites on a sample number of operations over a six-month period
    – The two audits for the pilot project reported back on the ability of IS providers to flow data against the data requirements of the audits. Barriers and technical issues were noted and recommendations provided
    – Final workshops with project participants to review the findings and agree the recommendations.

Key Findings

The project surfaced a number of key findings around the following four broad categories:

  1. Understanding the barriers to participation
  2. Independent sector engagement in the project
  3. Supporting infrastructure for participation
  4. Limitations to pilot testing.

While the findings identified specific barriers in the four areas noted earlier (practical, technical, information governance and financial), it was also noted that there are some areas where the independent sector is currently participating fully, such as in the National Joint Registry, and that the barriers can be overcome with all key interested stakeholders acting on the proposed recommendations.


The recommendations were developed in consultation with the project Steering Group and in summary recommended actions for:

  • NCAPOP audit providers to consider that would support IS participation through the provision of more easily accessible information around technical data requirements, information governance and the costs of participation
  • HQIP and IHPN around providing coordinated communications and provision of information and resources to the IS to support the onboarding process
  • The independent sector to work through as they identify relevant audits for participation
  • Policy makers and regulators to support greater future engagement by the IS in the NCAPOP.

Next steps

HQIP will continue to support this area of activity as Independent Sector providers identify relevant audits they can participate in. If you are interested in understanding more about this, please contact us.

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