Boob Jobs and One Night Stands

The PIP breast implant scandal rumbles on with a seeming stand-off between the Minister of Health and the principal users of these implants, Transform and The Harley Medical Group. The Department of Health has published its interim report listing in appendix D some but not all of the organisations that used these suspect PIP implants. It is not clear why Durham and Darlington Foundation NHS Trust has used so many, and most of the 3000 NHS PIP implants are unaccounted for.

It may be that demanding the information over the Christmas holidays from all units that had used the Implants meant that the information was inevitably going to be incomplete. As the MRHA issued a warning over these implants in 2010 and the CE kite mark was withdrawn at that time, this does seem to have a whiff of panic about it at the Department of Health. This seems to be a case of  poor supplies procurement, which in the NHS is particularly price driven. One wonders whether the same supplies departments procure other items such as hip joints, vascular stents etc. Cheapest supplies may work out expensive in the long run, in both terms of finance and of suffering.

The British Association of Aesthetic and Plastic Surgeons is housed within the Royal College of Surgeons, and lists its members here. Most BAAPS Surgeons practice in one or more of the three main UK private hospital chains (Nuffield, BMI and Spire), who all together implanted 1600 of these implants. All of these organisations have promised to replace these Implants if desired by the patient, at no cost. As 3000 patients were implanted in the NHS it seems that these three major private providers have put in about half as many PIP implants as the NHS, despite this being a procedure mostly carried out privately. BAAPS advises that these patients should be reviewed and explanted if desired. Nearly 85% were implanted elsewhere in the Private Sector, and an unknown number in British medical tourists, in Eastern Europe and elsewhere.

Transform has nothing on its website (that I could find) to inform patients about the PIP implant issue. The Harley Medical Group does so here, but feels that this is a problem that it wishes to lay on the MRHA for licensing the PIP implants. Both are interesting organisations, with peripheral clinics where early consultations with Nurse specialists are followed by surgery at a few central hospitals. The Transform group lists its Surgical staff here. I could not find similar information on the Harley Group website, though they do state that their surgeons are on the UK Specialist Register as Plastic Surgeons, this may well be because of recognition in another EU state. Several on the Transform website seem to have only Specialist Training as General Surgeons.  The Transform Surgeons have mostly trained overseas and are not rooted in the UK medical culture in the same way as most BAAPS members, most of whom have past or present substantive NHS Consultant posts.

The main implanters of these PIP implants are these newer providers with their Nurse Counsellor / itinerant Surgeon model. It will impact on the profits of Nuffield, Spire and BMI to revise these surgeries, and there may be a down turn in the overall demand for breast implants for some time, before the rise  in cosmetic surgery resumes. These three will however gain a lot of work in the longer term if Transform and Harley Medical go bust. It is an ill wind that blows no good!

Transform and Harley Medical have some resemblance to the ISTC model of care. ISTCS are not popular with British Doctors (either in NHS or Private Practice) being another unwelcome entrant into the health care sector, but a model favoured by both New Labour and Coalition policy. Now some may see this as defence of private practice, but it may represent an intrinsic dislike of the loss of continuity of care, the cornerstone of good medical practice. These ISTCs often have similarly poor continuity of care, a major role for Nurse practitioners, and their own scandals such as this one in Shepton Mallet. GPs dislike the Darzi polyclinic model for much the same reasons.

Continuity of care improves the satisfaction of patients, the job satisfaction of doctors, and reduces medical errors. It also means that a practitioner has to face up to their own results in a continuous informal quality improvement scheme. Those who deal with their own complications learn from them, those who dump them on others learn nothing. Traditional medical practice relies on a carefully cultivated local reputation, and this is vulnerable to damage. Most NHS Consultants with Private practice are fully aware of this and know that abusing the system is not in their long term interests. GPs are attentive to their patients and listen to their feedback, with this affecting future referrals. Developing a traditional medical practice requires a long term interest comparable to courting, both these new entrants in the private market and ISTCs are modelled more on a one night stand, and “one night stands” are often followed by regrets…

So will Transform and Harley Medical attempt to rectify their mistake in using these implants? Will they go bust? Will they be bailed out by the NHS, rather like our banks? One can only get away with bad practice for so long before it catches up, whether sub-prime loans or sub-prime care. One can have only so many one night stands before catching something nasty…

Dr Phil