In January 2025, a colorectal surgeon at Nuffield Health Brighton, Marc Lamah, was found to have complication rates six times higher than expected. The private hospital acted swiftly, withdrawing his practicing privileges following an independent investigation. Yet, the same surgeon currently treats NHS patients at Royal Sussex County Hospital, where a separate audit concluded his outcomes were, “within expected national ranges.”
These apparently contrasting decisions highlight worrying potential gaps in oversight between private healthcare vs public healthcare that could impact patient safety. While private hospitals are able to act quickly when withdrawing practising privileges, NHS trusts operate under different frameworks, timescales, and standards.
For patients who have already been through treatment and feel let down by the standard of care, these differences raise an urgent question. How can the same surgeon be seen as unsafe in one setting but acceptable in another? Understanding how private vs NHS oversight actually works could be essential for making sense of your experience, and for deciding what steps to take next.
How the NHS Oversees Doctors
The NHS operates a multi-layered approach to doctor oversight that combines routine monitoring, formal appraisals, and clinical governance systems. Revalidation is based on local evaluation of surgical practice through appraisal, with each doctor relating to a responsible officer who makes recommendations about their fitness to practise to the General Medical Council (GMC).
- Clinical Audits and Performance Monitoring: Clinical auditing is a way to find out if the healthcare being provided is in line with wider standards. It lets care providers and patients know where a service is doing well, and where there could be improvement. These audits include the ward environment, patient experience, quality improvement, infection prevention/control, and more, with matrons providing real-time feedback and sharing learnings from past incidents.
- Annual Appraisal System: Doctors are able to monitor their practice through performance information, clinical indicators about patient outcomes, and feedback from patients and colleagues. This includes reporting on clinical results, such as mortality data, case review, or discussion (including peer analysis, and significant event reviews).
- Organisational Governance The NHS oversight framework appears designed to identify issues through systematic reviews, though the timeframes and processes may differ significantly from the private sector. Should the appraisal process indicate that a doctor is “in difficulty,” set procedures are triggered, though the specifics of these may vary between trusts.
This structure suggests the NHS does have comprehensive oversight mechanisms, though questions remain about how quickly they can respond to new concerns when compared to private healthcare settings.
How Private Hospitals Oversee Doctors
Private hospitals operate through “practising privileges” that may allow for more direct oversight than NHS structures. This represents a well-established system of checks and agreements that enable doctors to operate in hospitals without being directly employed by them.
- Practising Privileges Reviews: Hospitals are required to review practising privileges every two years, though they can act sooner if concerns arise.
- Direct Oversight Authority: When a professional conduct issue arises in private work, it is considered to be a matter between the service provider and the individual. This suggests that private hospitals have more autonomy in making important decisions.
- Independent Investigations: The Marc Lamah case demonstrates that decisions can be made more quickly in private settings. Nuffield Health conducted an independent investigation and withdrew privileges relatively quickly. While still subject to CQC and GMC oversight, the consultant/hospital relationship may enable faster decision-making in comparison to the NHS.
The Role of the GMC
The GMC serves as the overarching regulator for all UK doctors, regardless of whether they work in NHS or private settings. The GMC is the independent regulator of doctors, physician associates (PAs) and anaesthesia associates (AAs) in the UK.
- Investigation Process: The GMC investigates any and all allegations made about individual doctors where they have allegedly fallen below the requisite standards. However, if an allegation is more than five years old the GMC will generally not investigate unless it is in the public interest.
- Potential Timing Issues: While the GMC provides overarching regulation, there may be gaps in how quickly different sectors report concerns or share information.
- Cross-Sector Challenges: The Marc Lamah case suggests potential inconsistencies in how GMC oversight translates into practice across different healthcare settings, particularly regarding the speed and transparency of information sharing between private hospitals and NHS trusts.
Where Standards Diverge
This case illustrates how private healthcare vs public healthcare systems can reach different conclusions about the same practitioner. While the GMC provides overarching regulation for all doctors, the practical implementation may vary between sectors.
The GMC investigates allegations made about individual doctors where they have allegedly fallen below the requisite standards. However, the timescales and processes may not align with the faster-moving decisions in private healthcare vs public healthcare environments.
One potential issue is the speed of information sharing. Private hospitals can act on internal investigations and withdraw privileges while GMC processes are ongoing. However, NHS trusts might need to wait for formal regulatory conclusions before acting.
This divergence in private healthcare vs public healthcare creates questions about whether patients receive consistent protection regardless of where they’re treated.
Implications for Patient Safety
The disconnect between private healthcare vs public healthcare oversight could leave gaps in information that risk patient safety. When the concerns in one sector aren’t visible in another, some patients may be unaware of the full picture, which makes informed consent an issue.
In cases similar to Marc Lamah, NHS patients might not be aware of private hospital concerns about complication rates. Where a professional conduct issue arises in private work, it is very much a matter between the service provider and the individual. However, this privacy may limit transparency across sectors.
For families dealing with medical concerns, these knowledge gaps add unnecessary uncertainty about oversight.
What Worried Patients Can Do
Patients who are concerned about private healthcare vs public healthcare oversight can take several steps to protect themselves. These include:
- Check GMC Registration: You can search GMC registers to find a doctor and view their registration status and other useful information. Warnings are visible on the online register for two years, along with a summary of why the GMC issued them, though this may not capture all concerns in private vs NHS settings.
- Ask About Experience and Outcomes: Some patients are understandably uncomfortable when it comes to asking about their surgeon’s competence. However you can reframe the situation by tactfully enquiring about their experience with your specific procedure and discussing typical success rates. Ultimately, you’re not doubting the clinician’s ability, you’re just looking to put your mind at rest.
- Seek Second Opinions: For complex procedures, consider getting opinions from practitioners in different healthcare settings to get a broader perspective.
Given potential information gaps between private healthcare vs public healthcare systems, patients shouldn’t hesitate to be their own advocates.
Building a Robust Framework for Patient Safety
The contrast between how the NHS and private healthcare oversee doctors reveals more than just procedural differences; it exposes potentially damaging flaws in how patient-safety information is shared. When the same clinician can face restriction in one setting yet continue practising in another, the system could be seen as failing to offer patients the consistent protection they deserve.
Both sectors operate under the umbrella of the GMC, but oversight is only as effective as the speed and transparency with which data moves between them. Private hospitals often act quickly through internal governance, whereas NHS trusts are bound by longer, multi-layered processes. This imbalance can delay decisive action when concerns arise.
A joined-up national framework for data-sharing and performance monitoring is needed. Patients should not have to investigate where they are about to receive care to understand how well-protected they are. True accountability means private and NHS oversight systems working in step, with real-time communication and a shared duty to safeguard patients.
If you or a loved one has been affected by surgical errors, or have concerns about how a hospital investigated your care, CL Medilaw can help you explore what went wrong.
Speak to our medical negligence solicitors for free initial guidance on your next steps.
