A happy and prosperous 2016 to all our readers
Hit your website jackpot
The secrets of converting visitors to your aesthetics clinic website into clients P16
All you need is ... news
You really don’t need PR. What you need to promote your practice is news generation P20
staff from predators
How private practice staff can cut the risk of sexual harassment allegations arising P40
By Robin Stride
Independent practitioners experiencing falling incomes are being alerted they could be due a New Year defence subscription rebate if they have not told their defence organisation about their lower earnings.
Equally, those with higher than anticipated incomes from private practice may need to pay extra if their changing situation has not already been accounted for.
James Gransby, a partner at accountants MacIntyre Hudson, said doctors looking to decrease sessions or do more pre-indemnified work like NHS Choose and Book should ensure subscriptions are paid in the right tier as it could help get money back.
‘Costs are increasing and profits for some may be lower than expected. This could especially affect doctors who are close to a tier. A lot of people are finding expenses rising for rooms and secretaries as a result of the Compet ition and Markets Authority (CMA) inquiry.
‘But a lot of doctors have earned more, so should check they are paying the right amount, as it is harder to make corrections after the event.’
The MDU said the GMC recently highlighted that doctors were required to hold adequate indemnity and failure to do so could mean sanctions.
Doctors’ indemnity could be affected if they did more work than they had told their defence body about or worked in a different field or location.
An MDU spokeswoman said it was therefore important for doctors to keep their defence body updated about their current working circumstances to ensure they were adequately indemnified.
ship year’s income and expenses details without the need for a written application form, so long as they can declare no incidents have arisen from this work.’
Equally, a doctor might find they were doing less or cutting out some types of work. Unless they reported this, they could find they paid more than they needed.
She added: ‘Even if gross income is not falling, a consultant may be able to save on their MDU subscription, as we allow private practitioners to deduct allowable expenses of up to 50% from their gross practice income to determine their net income – one of the factors on which indemnity subscriptions are based.
‘The MDU recognises it can be tricky for private practitioners to estimate their income and expenses in advance and that it may take some time for this information to be confirmed by their accountant.
‘As a result, we allow members to make adjustments to their current and immediate past member-
She said the MDU could consider a written request for a retrospective change if a member realised they had substantially underdeclared their working activity for many years.
The MDDUS said subscriptions were based partly on work done and partly on fees earned. Renewal notices showed the earnings level the subscription was based on and it was doctors’ responsibility to ensure this covered expected earnings for the year ahead, it said.
Change should be notified immediately to enable a revised subscription to be calculated. Doctors could adjust things at the end of the year if their estimate proved to be too high or too low.
A spokesman said: ‘We would like to be clear that the figure used should be your gross private earnings from the practice of medicine, however delivered. In the event that you have formed a company for accounting or other purposes, the relevant figure is the gross income to that company in relation to your practice of medicine.’
The MDDUS said a few doctors were declaring their company salary as opposed to the gross fees. Here it had discretion to make retrospective adjustments. If it found members had paid too little, it would examine individual circumstances to establish why.
‘In the very infrequent cases where members have either deliberately or recklessly avoided proper declaration of their income, we may limit or withhold the benefits of MDDUS membership, or bring membership to an end.’
MPS said it would refund up to one year’s subscription overpayment if a member made contact about a grade change and this resulted in a lower subscription. The refund could be credited to any outstanding subscription for the current year or refunded where their subscription was fully paid.
A spokesman added: ‘Our subscriptions reflect members’ risk profiles and income earned from private practice is used as an indicator of their practice and their risk profile. Members are able to deduct legitimate practice expenses from their gross income up to a limit of 25%.
‘Other medical defence bodies and insurers may allow different percentages to be deducted, but the key figure for private practitioners to consider is the actual subscription charged for their area of practice.’
n See page 4
December 2015-January 2016
The competition watchdog explains how it’s vital to know the rules on cartels P14
Get on the ball in sports expertise
What you need to know before you take to the field as a sports team medic P24
Tricks of website design are simple
An expert outlines what your website needs to have to attact patients P32
Vision of a bright future in Africa
How your skills can be put to good use volunteering for a medical charity P36
Diplomatic missions
Seeing embassy patients? Check out Gary Nials’s great tips on charging affairs P44
Should I pass down before passing on?
New freedoms allow you to pass on your pension, but it may be better not to P46
PLUS OUR REGULAR COLUMNS
Doctor on the Road: Volvo XC90 P48
Starting a private practice: Bespoke account systems P50 Profits Focus: Ophthalmologists P52
EDITORIAL COMMENT
Self-assessment for tax is a big topic on the agenda for independent practitioners and their accountants this month – but now there is another self-assessment to be aware of.
The Competition and Markets Authority (CMA) is advising that if you are currently working with your competitors, you should carry out a self-assessment to ensure your conduct complies with competition law.
This self-assessment does not apply to work carried out under employment with the NHS in relation to NHS funded services, however.
The advice forms part of a
‘60-second summary’ on the CMA website giving private doctors useful information on competition law (see story opposite and feature on p14).
It is part of a new campaign to help everyone steer clear of costly infringements and we urge you to take time to read all the material now available under this welcome initiative.
We recommend you also read the CMA’s open letter and take time to study other data on fee compliance and fee setting produced by the Federation of Independent Practitioner Organisations following a series of discussions with the CMA.
TELL US YOUR NEWS Editorial director Robin Stride at robin@ip-today.co.uk
Phone: 07909 997340 @robinstride
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By Leslie Berry
Independent practitioners with buy-to-let properties or second homes will be hardest hit by Government policy changes.
A 3% surcharge on stamp duty will apply to all bands from April 2016 to some buy-to-let properties and is expected to raise a total of £1bn for the Treasury by 2021. Properties with a purchase price of £40,000 to £125,000 will be subject to a 3% stamp duty tax where none applied before. Those from £125,000 to £250,000 will attract a 5% stamp duty rate, while 8% will apply to those costing between £250,000 and £925,000.
Landlords purchasing a property worth £250,000 would, for example, see the applicable stamp duty rise from £2,500 to £8,800.
George Osborne’s Autumn Statement also announced that second home owners will be targeted by a change to capital gains tax rules from 2019. Any CGT due from selling a property must be paid within 30 days of completion rather than at the end of the tax year.
This comes on top of last year’s stamp duty reforms which already affect higher-end properties, as well as the news in the summer Budget that landlords will receive only the basic rate of tax relief on their mortgage payments from 2017.
Simon Bruce, managing director of specialist financial planners Cavendish Medical, said: ‘Many senior doctors with small buy-to-let businesses will be frustrated that they are once again in the Treasury’s firing line, while commercial property investors –those with more than 15 properties – are exempt from the new changes.
‘These Government moves highlight the point that senior doctors must carefully consider whether buy-to-let remains an attractive investment, particularly in what is termed as the “decumulation” stage of their financial plan.
‘Now is the time to thoroughly review all assets to ensure they are still offering the best opportunities for growth and income.’ See page 7
London Medical has signalled its intention to build on strong growth by appointing David McLaren, a former chief executive of Leaders in Oncology Care (LOC) as a non-executive director.
Chairman Neville Abraham said: ‘This is a significant appointment for us. Our clinic is attracting new consultants and growing numbers of patients, and is developing ambitious plans for future development.
‘David brings an unusual combination of extensive management,
marketing and communication skills plus very successful leadership of one of the UK’s most innovative specialist clinics. This experience is very relevant to our own plans to build on the recent strong growth which London Medical has seen this year.’
General manager David Briggs said: ‘This year we have aimed to widen and deepen our consultant bench-strength. We have brought in 17 outstanding new consultants and seen a double digit increase in our patient numbers.’
By Robin Stride
The Competition and Markets Authority (CMA) has followed up Independent Practitioner Today ’s ‘Are you fixing prices?’ report in November with more information to help private doctors stay within the law.
Together with a helpful feature in this issue (page 14) from the CMA’s senior director of anti-trust enforcement Ann Pope, consultants can also see how to steer clear of trouble by accessing an open letter to them on our website www.independent-practitionertoday.co.uk.
In addition, the Federation of Independent Practitioner Organisations (FIPO) has published its own in-depth fees and charging guidance at www.fipo.org/index.
htm and the CMA has issued a ‘60-second summary’ to raise doctor awareness.
The campaign follows the £382,500 fine imposed on the Consultant Eye Surgeons Partnership (CESP) Ltd in August 2015 after it admitted infringing competition law between September 2008 and May 2015.
CMA warning letters have been sent to a number of individual CESP-member limited liability partnerships.
Mrs Pope said: ‘The eye surgeons case, coupled with the results of recent research, suggests that there is a worrying lack of knowledge about competition law, and the penalties that can be imposed for breaking it, among businesses, including medical practitioners.
‘In cases where practitioners are acting anti-competitively in their private work, patients can ultimately suffer, as they can end up paying more to receive treatment, either directly or via higher insurance costs.’
She said most practitioners wanted to comply with the law.
CESP Limited admitted competition law infringements including:
Recommending members refuse to accept lower fees offered by an insurer, and that they charge insured patients higher self-pay fees.
Circulating among its members detailed price lists for ophthalmic procedures such as cataract surgery to be used with insurers.
These collectively-set prices did not pass on lower local costs –such as cheaper hospital fees –and made it harder for insurers and patients to obtain competitive prices.
Facilitating the sharing of consultants’ future pricing and business intentions, such as whether to sign up to a private hospital group’s package price, which enabled members to align their responses.
CMA resources offer advice on what business practices may not be acceptable and suggest practitioners take independent legal advice if they are unclear.
In the most serious cases, businesses found in breach of competition law risk fines of up to 10% of turnover. Individuals could face up to five years in prison and disqualification from acting as a director.
Further information, go to www. gov.uk/government/news/private-medics-warned-of-pitfalls-ofbreaking-competition-law.
Surgeons and hospitals are being urged by the Royal College of Surgeons (RCS) to gear up for changes to radically improve cosmetic surgery standards of care.
Eligible surgeons are being urged from this Spring to apply for certification to demonstrate their skills and expertise.
Private doctors will be able to demonstrate they have the appropriate training standards and experience to perform cosmetic surgical procedures.
Cosmetic surgery is not currently a defined surgical specialty and there are no common standards available to surgeons who perform it. The law allows any doctor to perform cosmetic surgery.
But the RCS said the new certification system will address this and
allow highly-qualified, experienced surgeons to be distinguished from those working without adequate defence cover or the necessary specialist training.
Mr Steve Cannon, chairman of the RCS Cosmetic Surgery Interspecialty Committee (CSIC), said:
‘We are calling on all surgeons who perform cosmetic surgery to prepare for these very important changes. This new system of certification will raise standards of care for patients and enhance the reputation of the profession as a whole.’
Surgeons will be able to obtain certification in one or more groups of closely-related procedures as long as they are on the GMC specialist register in a specialty that demonstrates training and experience in the chosen area of prac -
tice, and they can demonstrate they meet certification requirements.
This will include providing evidence they have:
Performed a minimum number of surgical procedures in the area of certification and of their outcomes;
Indemnity covering practice in the UK;
Undergone successful revalidation including at least one appraisal taking into account their cosmetic practice;
Attended an accredited masterclass on professional skills in cosmetic surgery;
Confirmation of knowledge and adherence to relevant GMC and RCS guidance.
The changes follow the PIP breast implant scandal, which
prompted the Government to ask Prof Sir Bruce Keogh to review the regulation of cosmetic interventions.
Individuals will be able to apply by submitting evidence of their work through a secure website. Evaluators will review the application and decide whether to award certification.
Dr Andrew Vallance-Owen, who sat on the RCS committee, said: ‘Unfortunately, this certification will be voluntary for the time being, as there is no sign of Government interest in taking forward relevant legislation.’
But certification would be relevant for appraisal and revalidation and it was hoped indemnity insurers would also want evidence of certification before being prepared to cover cosmetic work.
By Robin Stride
Worrying increases in medical indemnity costs spurred Independent Doctors Federation (IDF) members to come out in force for a ‘Question Time’ event where they were able to grill providers.
Over 120 consultants and GPs attended the evening to hear the established defence organisations and a new generation of insurers answer queries on issues affecting subscriptions and premiums.
Doctors were given responses to preagreed questions from members, including risk profiles, claims history and if cover is valid for the period when an incident occurred or when a claim is made.
Other burning topics included whether ongoing cover is provided when a doctor retires or dies, when a claim might be refused and arrangements for policy excesses.
The meeting, chaired by ENT surgeon Prof Antony Narula, also took questions from the floor for a panel of speakers representing brokers, the MDU, MDDUS, MPS, Premium Medical Protection and Specialist Professional Indemnity Services.
Their policies may differ on many topics, but all stressed doctors should alert them early on if they thought they had a problem.
IDF president and council chairman Dr Peter KingLewis said all
private doctors needed to know what was going on in the indemnity world and ‘find out about it before you have to find out about it’.
He told Independent Practitioner Today: ‘I think a lot was learned about what we didn’t know. There has been a bit of an ostrich mentality. We pay our defence subs every year and moan about it, but we don’t know what questions to ask.
‘Now we have got the concept of IDF “question time” rolling, we want members to give us feedback on what we can put the headlights onto next.’
Email suggestions to info@idf. uk.net
Traffic to Bupa’s free online directory of consultants, therapists and facilities (www.finder.bupa.co.uk) has nearly doubled over the last year.
Bupa UK medical director Dr Steve Iley said it now contained a record 16,000 consultants and therapists with personalised profiles and received more than 200,000 visits a month.
Finder enables customers, GPs and the general public to find a Buparecognised doctor or therapist, see where and when they practise and how to reach them.
Dr Iley said the insurer had worked to enable profiles to show off specialists’ skills and expertise.
Having as much information as possible was important when people were choosing who to treat them and it was good to see so many providers enjoying the benefits of exposure on the site.
‘Profiles with a photo and extra information such as main areas of interest and languages spoken all help, as we’ve seen that updated
profiles on average receive 67% more page views. Our customers also value being able to see a consultant’s outcome data, which can also be added.’
Dr Iley believes Finder is the most comprehensive online directory of private practice consultants and facilities in the UK and expects further growth in tandem with increased online research.
Dr Iley said advisers use Finder to
help customers look at different treatment options so data such as any awards won, research or papers published, being a recognised expert, or holding certain NHS posts, all helped patients make an informed choice.
Bupa asks recognised doctors wanting to know more about making the most of their profile to visit www.bupa.co.uk/healthcareprofessionals/finder.
Highlights of a Bupa seminar for consultants, looking at the informed consent legal implications of the Montgomery v Lanarkshire Health Board (Scotland 2015) case – see Independent Practitioner Today, June 2015, page 28 – are now available for YouTube viewing.
Speakers cover clinical issues and consequences, what a collaborative approach is, the shared decision-making model as a possible solution, actions to demonstrate change and the consequences if no changes are made.
www.youtube.com/playlist?list=PLHvo6VCYsyo5ka4GMjaBSEsPzpUSehfrP
The head of the Association of Medical Insurers and Intermediaries (AMII) has branded the recent rise in insurance premium tax ‘as ill conceived and ill thought through’.
Stuart Scullion told the body’s Health and Wellbeing Summit the 58% increase from 6% to 9.5% would put both further financial and operational pressure on the NHS.
The hike is estimated to raise an additional £177m a year revenue. But the insurance salesforce says cost is the single biggest reason for health policy cancellations in the 60+ age category.
Mr Scullion warned: ‘Propensity to claim and the cost of those claims is at an increasing level. The net impact will be to drive people back into an already overstretched NHS.
‘While they do not necessarily wish to be treated in the NHS, if they are unable to maintain their private PMI through cost, many will have no option but to fall back on the state system.
‘I would predict that the financial cost of treating those people through the NHS will equate to more than three times that of the revenue gained.’
He backed views of Medicash chief executive Sue Weir who told a CBI dinner: ‘Businesses should be encouraged to offer healthcare insurance to their employees, not put off from doing so by adding a tax uplift.
‘Business productivity across the UK will be affected as absenteeism increases due to health issues having a negative impact on the longterm economic wellbeing of the nation.’
She added: ‘Life insurance, permanent health insurance – income protection – and all other “longterm” insurance are exempt from insurance premium tax and healthcare insurance products must be included in that category.’
By Leslie Berry
HCA’s innovative techniques to help cancer sufferers and improve quality of life were recognised in a double win at the LaingBuisson 10th annual awards.
The Christie Clinic – a collaboration between HCA and The Christie NHS Foundation Trust in Manchester – was recognised for its work to personalise cancer care and redesign the patient pathway to better support patients receiving radiotherapy.
An award also went to London’s The Harley Street Clinic for the development of a study to spare hair follicles of patients undergoing radiotherapy to the brain to reduce hair loss and improve speed of regrowth following treatment.
This ground breaking study is hoped to bring significant benefits to future patients, reducing the worry of hair loss, improving quality of life and potentially becoming best practice.
HCA chief executive Mike Neeb said he was proud of HCA employees’ work and delighted to see teams recognised for their dedication to improve patients’ lives.
Judges were asked to look at the core values and aims of the organisations, project outcomes, longevity of projects, opportunities given to both staff and customers and the importance of the provider within the context of the independent sector.
RADIANT EXAMPLE: The radiotherapy treatment team at Parkside Hospital’s Cancer Centre
London scooped the innovation of technology category for their pioneering work ‘heart-sparing radiotherapy for left-sided breast cancer using ABC and response’.
From left: Dr Anna Kirby, consultant clinical oncologist, Keisha Robinson, radiotherapy services manager, with awards presenter Michael Portillo
CLINICAL SERVICES
Healthcare Outcomes: The ExtraCare Charitable Trust, Healthy Lifestyles Team
Medical Practice: Spire Cardiff Hospital, Direct Anterior Approach Hip Replacement Surgery and Enhanced Recovery at Spire Cardiff Hospital
Mental Health: Surehaven Glasgow Hospital, Shaw Healthcare
Nursing Practice: KIMS Hospital – Anne Hatswell, Interventional Suite Team, Cardiac Patient Care
Primary Care Provider: SSP Health – Dr Shikha
Pitalia and Dr Sanjay Pitalia
Private Hospital Group: CircleHealth
PUBLIC PRIVATE PARTNERSHIP
Alliance Medical and NHS England
TRAINING & REHABILITATION
Brain Injury Rehabilitation: Headway Hurstwood Park – The Rediscovery Group
SOCIAL CARE
Autistic Spectrum Services: Community Integrated Care – Spencers Villa Staff Team
Care Pathways: Making Space – Ashwood Court
Excellence in Dementia Care: MHA – Epworth House, Music Therapy Team
Personalisation: The Christie Clinic, HCA Joint Ventures – Adding Value to the Radiotherapy Experience
INDUSTRY INNOVATORS AND LEADERS
Entrepreneur: Julia Senah, Almond Care
Innovation in Care: The Harley Street Clinic –Radiotherapy Research Team, Lynsey Rice
Innovation in Technology: Aspen Cancer Centre
London – Heart Sparing Radiotherapy
Outstanding Contribution: Richard Smith, Homes Caring for Autism Ltd
Spaces are filling up for an exclusive pay and pensions seminar for private doctors on Monday 22 February in London.
Independent Practitioner Today is joining with the Royal Society of Medicine to present: ‘Your fees, your pension – your future: how doing nothing is not an option.’
There will be talks from top speakers Ray Stanbridge, of Stanbridge Associates specialist medical accountants, and Simon Bruce
of Cavendish Medical, plus plenty of opportunity to ask questions.
The free event at the RSM in Wimpole Street, begins with 7pm registration for a 7.30pm start and ends at 8.30pm with a onehour drinks reception and chance to mix with Harley Street colleagues.
In April 2016 private doctors will see a host of regulatory changes which could impact on their finances: a lower lifetime allowance limit, a cut to higher
earners’ annual allowance rates, and higher taxes on company profit dividends.
The Chancellor’s consultation on pensions tax relief could also mean significant changes.
As ever when storm clouds gather, your main priority should be to check the status of your own finances. Does your wealth need protecting? Do you have a plan for the future? This is the ideal time to review your current situation and
ensure your longterm security. Mr Stanbridge will review trends and show how to adapt to take advantage of new opportunities and avoid potential hazards. He said: ‘The next five years will see major changes in the structure and delivery of UK private practice. This exclusive event is for Independent Practitioner Today readers, RSM members and invited guests. Apply for registration: www.rsm. ac.uk/feespensions2016.
By a staff reporter
Half of 138 doctors responding to a defence body survey say they worry more about complaints or practise differently as a result of being sued or investigated by the GMC.
Another 27% (37) of respondents have either considered leaving the profession or stopped working as a doctor and 10% (14) suffered health problems following the complaint or claim.
The Medical Defence Union (MDU) asked doctors involved in
a GMC complaint or negligence claim over the last five years for their views on how they found the experience.
Some 45% (62) of respondents said it was either horrible and the worst experience of their lives or very bad and disruptive. 51% (71) said they found the experience upsetting but manageable or unpleasant. Just 4% (five) said it was neutral or not as bad as expected.
Dr Caroline Fryar, MDU head of advisory services, said 80% of medical claims of members were successfully defended in 2014
without a financial settlement –but that made an investigation no easier for the individuals involved.
‘Doctors often continue to work throughout investigations which can be lengthy. In many cases, this can lead to sleepless nights which can affect doctors’ working and personal lives. In extreme cases, clinicians can develop mental health or drug and alcohol problems which may impair their clinical judgement.’
A minority of doctors reported positive reactions. An obstetrician who lectures on litigation said it
was helpful to have been on the receiving end of a claim when talking to colleagues.
Nearly 40% of doctors (53) said their case took between one to two years to complete, but in 20% of cases (28) it was three to five years and 5% of respondents (7) said their case took over five years to resolve.
The commonest incidents leading to investigations were a delay or failure to diagnose which accounted for 42% of cases (58), followed by surgical problems or complications 22% (31) and a delay or failure to refer 12% (17).
Nuffield Health has submitted a planning application for its stateof-the-art hospital and wellbeing centre in Manchester city centre (see Independent Practitioner Today, July-August 2014).
The £75m 12,200m2 three-floor building will have:
30 consultation rooms;
60 patient en-suite bedrooms, eight critical care beds;
Six operating theatres;
A diagnostic imaging suite.
Innermost Healthcare in Cardiff has become the first UK clinic to offer pregnant women the chance to play music to their unborn babies in utero.
The clinic, directed by consultant in fetal medicine Dr Bryan Beattie, uses the Babypod, a small vaginal device that allows unborn babies to clearly hear soft music and sounds.
Dr Beattie said: ‘Motherstobe will often play music to their unborn babies to help stimulate them and aid their development, but sounds inside the womb are very muffled, so the baby does not benefit from the full experience.
Research showed it often had little effect.
‘Babypod offers music and sounds at a safe, soft level inside the womb, giving babies a completely new, crystalclear experience.’
The Babypod is set at a volume of just 54 decibels – the equivalent to a hushed conversation or soft, ambient music – so it has no negative impact on fetal hearing. The device carries no batteries, Bluetooth or radio frequencies. It comes with headphones for the mother to listen to the music at the same time as the baby.
Dr Beattie said the device connected the mother and baby in a
shared experience, so was beneficial for both in the lead up to birth. It also gave scope to assess fetal behaviour in terms of hearing ability.
The umbrella group for private doctors has said it accepts that the inspection watchdog, the Care Quality Commission, has to put its prices up.
The Independent Doctors Federation (IDF) says the CQC’s plan for a 10% fees hike is fair enough when spread over four years in a bid to smooth out charging anomalies between different branches of medicine.
A spokesman for the IDF’s regulation committee said: ‘All things considered, we believe this to be a fair increase over a period of four years and are pleased to see that there generally seems to be more of a level playing field in existence now, although we are puzzled as to how dentists remain yet again exempt from an increase.’
See feature on page 39
The
of Cornwall is the new patron of the The London Clinic hospital.
The hospital was opened in 1932 by The Duke and Duchess of York, who later became King George VI and Queen Elizabeth.
Private doctors have been given new opportunities working in London’s Canary Wharf at a new healthcare centre offering multispecialty consultation, diagnostics, treatment and wellness services for local residents and professionals.
The facility, open seven days a week and until 8pm on weekdays, is the first of a number planned for the UK, South Asia and Africa.
LycaHealth chief executive Dr Manpreet Gulati, who is a radiologist, said: ‘Our mission is to combine our expert knowledge and personal service with technological innovation, to deliver an exceptional and highly per
sonable experience to our clients.’
The centre, at West Ferry Circus, offers online appointment booking and access to records by patients or their doctors ‘anywhere in the world’. It aims to deal with 85% of patients at outpatient level.
LycaHealth is the latest venture by entrepreneur Subaskaran Allirajah, chairman of Lyca Group, the international mobile virtual network operator. He said: ‘Manpreet has a powerful vision for the future of healthcare which is much more patientcentric than the current provision and is driven by his personal experience.
Lyca Health chief executive Dr Manpreet Gulati with London Mayor Boris Johnson, who opened the firm’s Canary Wharf Clinic in November
‘It was that vision that attracted me to launch LycaHealth. The new centre is a stunning facility for professionals based in Canary
By Susan Hutter
Good news for doctors in 2016, arising from the Autumn Statement, is that Chancellor George Osborne will not be interfering with the popular capital gains tax (CGT) relief known as ‘Entrepreneurs Relief’. It was widely predicted that he might.
For doctors selling a business asset which includes shares in their own qualifying trading companies, the effective rate of CGT on the gain is only 10%. This is for sale proceeds of up to £10m over a lifetime. And this is in place until further notice.
There was also no Uturn on the
reduction in corporation tax rates, currently 20% on companies’ profits. These are being decreased to 18% from 2020. This is more New Year cheer for doctors trading as a limited company.
Employers’ workplace pension contributions were to rise by 1% to 2% from October 2016, but that has been delayed to the start of the 2017 18 tax year on 6 April 2017. This is great news for doctors who employ staff, as it means a real saving of 1% of the gross salary paid.
No more pension changes were announced, although we expected some clarification which did not transpire. But, from 6 April 2016,
the Annual Allowance, effectively the maximum contribution payable into a pension scheme, is being cut for those with £150,000+ incomes.
The allowance up to 5 April 2016 is £40,000 and the reduction will be that, for every £2 of income over £150,000, it will be reduced by £1 to a £10,000 minimum.
The lifetime allowance is being cut from £1.25m to £1m. All those who have superannuation and/or private pension schemes should take advice before 5 April 2016.
Susan Hutter is a specialist medical accountant with Shelley Stock Hutter
See her Accountant’s Clinic on page 8
Spire Healthcare says there is ‘no truth’ in consultants’ rumours of its interest in entering the London market with a hospital in planned development at the Earls Court exhibition centre.
Development director Mr Neil McCullough told Independent Practitioner Today the group had not even looked at the site.
The second largest hospital group has declared its intention to
open somewhere in the capital, but said it had not got any sites yet.
There is permission in the Earls Court master plan for a private hospital of about 11,278m 2 (122,000ft2) and a health centre.
Wharf and surrounding areas, and as we grow we’ll be targeting other areas with similar healthcare requirements.’
‘Let’s screen complaints’
A defence body has urged the GMC to do more to get complaints against doctors settled faster.
Medical Protection medical director Dr Rob Hendry said the high proportion of investigations closed with no further action, indicated there needed to be more emphasis on triaging complaints. And he claimed the current threshold for opening an investigation might be too low. He was speaking after a GMC report highlighted that 1,428 of 2,750 complaints investigated in 2014 were closed without further action.
Doctor Care Anywhere is working with parents’ website Mumsnet to supply expert medical content for a new Baby Bundle app, designed to give new parents all the information and help they need, from pregnancy test to preschool.
The digital healthcare service was founded by GP and medical director Dr Farzad Entikabi to provide online video and phone GP consultations seven days a week, 365 days a year from 8am10pm anywhere in the world.
As 2016 gets underway, Susan Hutter (right) says it will be vital to maximise your practice’s productivity and efficiency. Here are her top tips
REGARDLESS OF the size of your business, whether you are a sole trader or have ambitious plans to grow your practice, it is vital you do not neglect back office procedures.
Consider these areas:
IT – it is vital that the practice software is up to date and can provide data to cope with the financial management.
All users should have sufficient and regular training.
The system should provide timely and accurate data. It is almost impossible to run the practice without this.
The financial records should be kept up to date regularly. It is not advisable to write them up just once a year. Track receipts accurately so that slow payers can be chased up quickly.
Cash is the lifeblood of any business and therefore cash flow planning is crucial.
It is generally recommended that an independent practitioner keeps at least three months’ working capital in the practice bank account to cover such things as:
Salaries, including the practitioner’s own drawings;
Premises expenses;
Office and stationery expenses.
It is also important to put aside money for HM Revenue and Customs – for
instance, monthly PAYE, annual corporation tax or bi-annual income tax, depending on the trading vehicle.
Invoicing patients and insurance companies should be dealt with on a weekly basis and someone competent should manage and chase money owed.
Practices will need to capture all income and expenses that may have been paid
in or out of a non-practice bank account.
This sometimes happens by mistake or often where insurance companies insist on continuing to pay to a ‘sole trader’ bank account even after incorporation. Once again, regular scrutiny is advised.
☎ As far as the practice inhouse team is concerned, it is important to have strong PA/secretarial backup (Independent Practitioner Today, November 2015).
It is also worth looking at one employee, depending on the size of your business, who can deal with all things financial.
Often the external accountant can provide advice and practical assistance here – for example, an implant of staff from the accountancy practice to post and reconcile the financial records on a monthly basis.
Many consultants in private practice also have an NHS appointment. If the practice is operated by a limited company, from a tax point of view, it is better to leave as much money in the company as possible.
Money drawn out, either as a dividend or salary, will be taxed at income tax rates. Most independent practitioners are higher-rate taxpayers, forking out at least 40%, although companies only pay tax at 20%.
Therefore, work in conjunction with the external accountant in order to plan a sensible dividend policy. Doctors should not leave themselves short of funds, but there is no point in drawing out money that they do not need.
The above ideas should be incorporated into the running of your practice in order to improve productivity and efficiency. On technical matters, specialist advice should always be sought.
Susan Hutter is a partner at specialist medical accountants Shelley Stock Hutter
For the last 18 years, we have been helping healthcare organisations manage and transform their operations, both in the UK and abroad.
We exist to help independent practitioners start, transform and grow their practices and businesses. We help to plan and develop medical facilities and to market healthcare services using all available communications channels and technologies. While you concentrate on caring for patients, we aim to take away the burden of managing your practice or business.
We build unique teams for every situation and change that team as your needs change and, uniquely, we have experts who can deal with crises who are available 24x7. We combine clinical expertise with commercial sense; we see the full picture and we provide support when and where it’s needed most.
We work with both public and private sector healthcare providers, and we have an enviable track record in operations management, clinical advice, consultancy and development.
For an introductory discussion, please call Peter Goddard on +44 (0)203 356 9699 or mobile +44 (0)780 314 4954 www.worldwidehealthcare.co.uk
I HAVE WORKED in private healthcare for more years than I care to remember and have been privileged to have personally managed many hospitals: in central London, Oxford, Chelmsford and Colchester.
And I’ve had regional director responsibility for groups of hospitals in the south of the UK and the London region.
During all of this time, the question ‘What makes a good private hospital?’ has often been raised –and always generates huge debate, normally centred on whom you ask the question to in the first place.
However, there are a number of key criteria that must be in place if the hospital is going to succeed and prosper.
The first key criteria is: Location, location, location. Being within striking distance of the local NHS trust is a must. Central London is different, as several trusts are within most hospital catchment areas and one of the reasons they do so well.
The more convenient and less time it takes for the consultant body to travel to their private practice the better.
It also enables mutually beneficial shared services with the trust, such as pathology, specialist nursing and resident medical officers to be instigated.
The second key criteria is: Understanding and supporting the local healthcare economy. Most successful private units have a core of specialties that support the local market: normally orthopaedics, general surgery, gynaecology and ophthalmic surgery.
These are the ‘bread and butter’ for the hospital. However, it is important to understand what specialist areas the trust and its consultants are involved in or have a desire to develop.
Knowing this will help the private provider invest in the right equipment and specialist staff to become the ‘centre of excellence’ for more complex specialties such as spinal surgery, cardiac surgery and cancer care.
BY PETER GODDARD Director of Woldwide Healthcare Associates
The third key criteria is: Partnering with the consultants. What do I mean by that? Over the years, I have walked into many private hospitals to find large areas of space underutilised and/ or expensive medical equipment left idle and gathering dust.
On more forensic questioning of the hospital team, it normally transpires that the consultants that were expected to use the facilities or equipment were not involved in the planning or selection process and therefore, unsurprisingly, they do not support the investment going forward.
Private hospitals are most successful where they involve the consultants in ‘strategic business planning’ either on an individual basis or, even better, as specialist groups, determining together how to grow the business, improve patient outcomes and grow the reputation of the hospital.
The fourth key criteria is: An excellent management team with clinically lead support staff and a ‘can do’ culture. For me, this is the most important criteria of all.
A private hospital can have the best location, all the ‘bells and whistles’ that money can buy and a willing group of consultants
Private hospitals are most successful where they involve the consultants in ‘strategic business planning’
that want to treat patients, but without the right management team, clinical and support staff, it will never reach its true potential.
Leadership starts at the top and a good chief executive will have a clear vision and mission that is known and embraced throughout the hospital.
The management team should ‘walk the walk’ every day, talking to staff, consultants and patients to gather feedback on issues and test the temperature of the hospital on any given day.
Patient concerns dealt with there and then can mean the difference between potential complainants to very satisfied customers.
Open communication channels for all staff are key to enable them to feel involved and have a voice that is heard. Staff forums, patient focus groups and hospital process improvement teams are just a few examples of involving everyone in the success of the hospital.
Clinical leadership and a safe patient environment sounds obvious, I know, but it is only relatively recently that private hospitals are starting to use the six ‘C’s – care, compassion, competence, communication, courage and commitment – to drive patient care.
An ongoing commitment to training and professional development for staff in the specialties relevant to the hospital show both the staff and the consultants that the hospital is serious about delivering the best patient care.
Ensuring that the clinical management and teams are trained in and understand the commercial drivers of the hospital. Being able to manage a significant budget –operating theatres and wards, for example – is often overlooked and can leave those responsible feeling vulnerable and exposed. And it can ultimately have a disastrous effect on hitting the hospital’s budget.
What do you think makes a good private hospital?
Email robin@ ip-today.co.uk
I believe that focusing on the above criteria will lead to the allimportant ‘can do’ attitude of the hospital, and whether you are a staff member, consultant user or patient, will only enhance your experience and encourage you to be an advocate of the hospital. n
I WAS MUCH amused by Mr Dev Lall’s comic piece in the November issue of Independent Practitioner Today on how one’s NHS secretary should not be allowed to handle one’s private practice.
If it was not intended to be comic, it was, at best, misguided and, at worst, patronising.
Mr Lall’s first mistake is that he appears to be employing the wrong sort of person. He should be seeking to engage the services of a qualified medical secretary, not a private secretary or a PA.
A medical secretary is easily recognisable from her CV, which will state that she holds a diploma from the Association of Medical Secretaries, Practice Administrators and Receptionists (AMSPAR).
This is a two year, full time course and requires exams to be passed in medical terminology, typing, health service structures, English and, when I qualified in 1983, medical shorthand at 100 words per minute, as well as the final examinations of four threehour papers taken in one week in June. A PA does not go through anything like as rigorous a training programme.
Rather insulting
It is rather insulting to the medical secretary, and possibly to the consultant employing her, to say that ‘she is hired with little or no thought’. I can only assume that Mr Lall’s bad experience is a result of not only employing an improperly qualified secretary but failing to interview the candidates properly. On the other hand, it would be easy to land a job working for him.
I was also tickled by his description of the activities that he has observed while strolling past the ‘secretary pool’. He presumably considers himself to be too PC to use the term ‘typing pool’.
How terrible it is that these women are busy doing all sorts of frivolous and unnecessary things that are irrelevant to her actual job of being glued to the phone. Perhaps the solution is to give each woman her own minimally
BY JENNY TATE AMSPAR, BA (Hons), LLB (Hons), MA Private clinic administrator
Regular columnist Dev Lall wrote about the importance of secretaries answering phones in our November issue
Over the years, the medical secretary has become both more accessible and less respected. Her job is vital but invisible
furnished room, but including, of course, a phone, to which she is locked from 8.30am until 5.30pm and be forbidden to waste time having meal and toilet breaks. All forms of leave would, naturally, be disallowed. And heaven forbid that she should be able to relieve the stress by discussing problems with her colleagues.
The constant ringing of the phone is a relatively new factor in the life of the medical secretary. When I first started work, the phone rarely rang and, when it did, it was usually an internal call from another department or, depending on the day, from the consultant requesting one’s presence in the clinic or on the ward round.
Over the years, the medical secretary has become both more accessible and less respected. Her job is vital but invisible. Watch any medical drama on television and you will see doctors, nurses, therapists and all sorts of ancillary staff, but no medical secretary. She occupies in the medical hierarchy a position analogous to the Victorian governess: she is regarded as socially and intellectually inferior to the medical staff
To say that a secretary working in the NHS is not capable of handling private practice is nonsense
but a cut above the jolly mass of porters, cleaners and catering staff. Staff and patients assume that she is somewhat dim and needs to be talked to as if she were lacking in basic cognition. I remember during one orthopaedic ward round, a patient was reading a novel by Joanna Trollope. The registrar, wishing to show off his cultural awareness, groped his way towards a remark about Barchester Towers. When I helped him out by explaining that the two authors were indeed related, he looked at me as if I were a sow that had learnt to dance Swan Lake.
Varied role
The phone calls that the medical secretary has to deal with are not just about appointments. They can be complaints, inquiries about costs and about the competence of the doctor and his/her areas of expertise, people wanting their results even though the medical secretary is not authorised to give out results on the phone, requests for repeat prescriptions, a query they forgot to ask the doctor in clinic, wrong numbers, queries about transport – I once had to tell someone how to get from Manchester to central London – and anything else that a patient wants to know but is too trivial to ask the doctor. These inquiries generate work: notes need to be pulled because
doctors will not otherwise know who the patient is, messages left, results chased, which means making more phone calls and all sorts of other tasks which take the secretary away from her desk.
In addition, let us not forget that the medical secretary is most poorlypaid of all the professional secretaries, earning considerably less than legal secretaries and PAs, even though her training is more rigorous than either of those roles and the job far more demanding.
There is limited or no opportunity for career progression and she undergoes no continuing professional development. She must carry all the responsibility but has none of the power.
To say that a secretary working
in the NHS is not capable of handling private practice is nonsense.
The training is the same for every medical secretary regardless of whether she chooses to work in the NHS or in the private sector. But, yes, Mr Lall, if you increase your NHS secretary’s workload by foisting your private work onto her, you will have problems.
I also take exception to Mr Lall’s comment about ‘issues of politeness, education, phone manners and so on’. Some of the supposedly best educated people, doctors included, are among the most illmannered and socially inept that I have encountered. He would do well to bear in mind
that patients can be very rude, especially on the phone. They will speak to the medical secretary in a way that they would not dare to speak to the doctor’s face.
It is much easier to harangue an anonymous, disembodied woman on the phone than it is to rant to the man who holds the power to write their prescriptions and sign them off work.
The argument for not using an answering machine does not hold up. It is very difficult to answer every call the moment it comes in. What about those patients who ring out of hours?
Many a Monday morning have I come in to messages left at midnight on Saturday or at Sunday lunchtime. The answerphone is
needed to pick up calls when the secretary is busy on another call or is away from her desk.
And it is annoying when people don’t leave a message. Perhaps the solution is to have those NHS secretaries, whose sacking Mr Lall so blithely calls for, sitting by the phone 24 hours a day, seven days a week without breaks. Oh no, that won’t work, because they are not competent enough.
I suggest that Mr Lall gives his medical secretary, if he has one, a muchneeded week off and does the work himself so that he can find out exactly what it involves.
I don’t like being told how to do my job. And your secretary doesn’t like being told how to do her job either. n
Many consultants may be unaware how competition law can affect the way they work. Ann Pope (left), senior director for anti-trust enforcement at the Competition and Markets Authority, explains why it’s important to understand the rules
In August 2015, the CMA issued fines for the first time against a membership organisation of medical professionals for breaking competition law
IF YOU are a consultant working in private practice, do you know who your competitors are?
This may seem like an odd question when caring for patients is your primary focus, but it is an important one that you need to ask yourself if you have a private practice.
Competition plays a vital role in ensuring that consumers receive the benefits of a well-functioning market – namely, lower prices, more choice and better quality. And this includes patients paying for treatments directly or via insurance.
We all rely on competition to protect our interests as consumers when we buy supplies or services for our businesses or in our everyday lives, so it’s important to ensure you are not behaving anticompetitively in the way you conduct your own business.
Cartel-like behaviour
The Competition and Markets Authority (CMA) is the Government agency responsible for preserving and promoting competition in the UK.
It does this for the benefit of consumers, but also to encourage markets to grow and be more productive, which underpins the UK economy. Where businesses try to reduce competitive pressure by collusive means, this can be a breach of the law and can result in severe penalties.
In August 2015, the CMA issued fines for the first time against a membership organisation of medical professionals for breaking competition law. The case serves
If you work as part of a group, it’s vital to check that you’re not discussing or sharing information that could land you in trouble
as a reminder that cartel-like behaviour can occur across any industry and that competition law can apply to all private-sector businesses.
It also means consultants, regardless of their specialty, should make sure they know what to look out for when they are acting in a private capacity.
Working in a group
There are many benefits to forming partnerships with fellow consultants – not least the sharing of administrative costs, joint purchasing of services and the pooling of skills and experience to deliver positive outcomes for patients.
However, if you work as part of a group, it’s vital to check that you’re not discussing or sharing information that could land you in trouble. This will largely depend on how you work together and whether you are part of the same economic entity.
If you and your fellow group members work as part of a limited liability partnership (LLP) or limited company and only apply your services via this intermediary, then you are part of one economic unit and any discussions you have internally about fees would not be a competition issue. The situation becomes more complicated if you also work as a sole trader outside the group, as well as being a member of a group, as decisions made internally within the group could then be used to influence your commercial conduct as a sole trader –such as the fees that you may
No colluding: how we have covered the topic of price fixing last month (top) and in September
charge for specific procedures.
Furthermore, if you do work within a group such as an LLP, you must be mindful of the fact that other LLPs and groups active within the same medical specialism are still your competitors. Any choice about fees or whether you intend to accept an insurer’s or facility’s package price should be made independently and not as a result of discussion with other consultant groups.
This was where CESP Limited encountered problems, as it was a membership association which facilitated the sharing of sensitive information across a number of separate, competing LLPs.
In many ways, it echoes the risks that many trade associations face when bringing large groups of likeminded businesses together.
Where such organisations act as a platform for competing businesses to share, discuss and potentially agree commercial actions, this can jeopardise genuine competition and those involved can be in danger of breaking the law.
The CMA has a duty to enforce competition law where it finds it has been broken, but it also has a role to play in educating and helping businesses to comply with it.
Following the CESP Limited case, we want to advise private medical professionals so that they are aware of what they need to look out for and ensure they don’t make the same mistakes.
Following the case, the CMA issued an open letter to the medi-
A membership organisation of ophthalmologists called the Consultant Eye Surgeons Partnership (CESP Limited) had been set up to offer a range of benefits to a large group of individual consultants.
These consultants were working together in local groups across the UK, arranged as limited liability partnerships (LLPs), with each LLP in turn being a member of CESP Limited and having a representative on its board.
Aside from offering administrative and cost-saving benefits, CESP Ltd was also formed to bolster the negotiating power of consultants when dealing with private medical insurers.
On behalf of its consultant members, CESP Ltd negotiated package prices with insurers to set a fixed price for a range of procedures, including cataract surgery, one of the most common ophthalmic procedures.
The way in which CESP Ltd coordinated the conduct of its members resulted in a breach of competition law.
As each of the individual LLPs were separate economic units, they –and their respective ophthalmologists – should have been in competition with each other.
Under competition law, it is illegal for competitors to share sensitive information on subjects such as pricing or individual commercial intentions. Doing so can influence how each business or trader sets its price or strategy and can lead to competitors aligning their behaviour – the result being that there is reduced incentive to offer a truly competitive price or service.
CESP Ltd facilitated this sharing of sensitive information and fixed the package prices its member LLPs offered to insurers, and even recommended that its members refuse to accept a particular insurer’s fee levels.
These actions were taken in the interests of increasing revenue and profitability for the consultants by removing competition between them. The absence of such competition can mean higher prices, which will ultimately have a knock-on effect for patients, who may end up paying more through premiums or self-pay fees.
The outcome of the case was that CESP Ltd had to pay a fine of £382,500.
It is important to note that enforcement action, including sanctions, could also have been taken against each of the individual LLPs as well as against individual consultants where they act as sole traders. But the CMA chose not to do so on this occasion.
cal profession to outline the concerns raised by the case and what other consultants need to be mindful of ( see lead news story on page 3).
This is supported by a one-page 60-second summary for practitioners that gives a simple overview of the key things they need to look out for.
To ensure you are competing fairly and legally, we would
encourage all independent medical professionals to read through these materials and reflect on how they may relate to your working arrangements.
If you do have concerns that the way in which you are operating could risk breaking competition law, the best thing to do is to give yourself a health-check and obtain legal advice before going any further.
What sets great businesses apart from the average ones online is their ability to convert qualified web visitors into paying customers. Pam Underdown (right) reveals the secrets of website traffic and conversion
IF YOU have experienced the frustration of having people visit your website but not become patients, you are not alone.
The average conversion rate online is less than 5%. However, the most successful business owners are converting visitors at 20% to 30%.
As you know, the medical aesthetic marketplace is a very competitive one; so your business needs to stand out and be visible to the many people online searching today for the treatments, products and services that you offer.
It is your ‘virtual brochure’ and a critical element in prospective patients’ decision-making process. It is not enough to have a website; you need to have one that is a dynamic and ever-evolving representation of the best your aesthetic business has to offer – in a way that matters to your patients.
Does your home page survive the eight-second rule? The first thing you should make sure is that you have something that will keep the attention of all visitors within eight seconds of people arriving at your website.
It’s got to be powerful and it’s got to be all about the patient’s needs and not about you. Don’t use a huge logo or a stock image
➱ p18
that looks the same as everyone else or a photo of a piece of equipment you use.
Use a strong compelling headline with a ‘you focused’ question that gets your visitor engaged and then keeps them reading. The headline is designed to show the reader that this is a page worth reading in full. For example: Are you fed up of your sagging jowls?
Your headline must convey the benefits of what you can do for your patients in a way that matters to them. Remember, at this point, you are not trying to sell your treatments or service.
You can get to that once you have survived the eight seconds. All you are trying to do at this point is to keep the visitor reading and stop them bailing out and moving on. By the way, just by understanding this eight-second rule, you are already light years ahead of 99% of website owners.
Of course, your web designer may tell you that having a headline at the top of the page instead of a pretty picture or graphic is ‘ugly’. My reply to that will be: ‘not as ugly as my bank account will look if I don’t make my website as profitable as it should be’.
Unfortunately, there are a high number of marketers and web agencies who have jumped on the anti-ageing bandwagon in the UK and have been overselling and underdelivering.
There are many aesthetic business owners who have had the wool pulled over their eyes and have been left with a website that doesn’t live up to its promises, while losing thousands of pounds in the process.
There is also a lot of confusion about what works online and what doesn’t, so I am hoping that this article will explain what you should do and what pitfalls to avoid.
First of all, you need to be aware of and understand the fundamental principles and numerous marketing methods that will help to drive people to your website and, once they are there, how you convert them into paying patients.
The ‘Traffic x Conversion Formula’ should drive everything you do online. Most business
Just by understanding this eight-second rule, you are already light years ahead of 99% of website owners
fied prospects that is hard – so think quality, not just quantity. This is especially important if you are spending money on Google or Facebook ads or you are paying people to do this for you.
Free traffic from social media will also help you, as will blogs, videos, testimonials, before-andafter photos and articles.
All of these methods will bring traffic to your website, but it certainly won’t be very quick.
Of course, you need to use these types of marketing strategies to build relations, build trust and add value, but if you need the phone to ring now, then using paid advertising will work – if you know what you are doing –because there are ways that you can make such advertising sustainable and predictable.
owners don’t follow this formula, as they are simply not aware of it.
However, while it is very powerful, it is very straightforward at the same time. Which means that, in its simplicity, people often overlook it.
Everything boils down to two categories only:
1. Getting people to your website; 2. Converting them into paying customers.
Ingrain this formula into your mind from now on and track everything that relates to it. You need to remember this format:
Anytime you are doing something online;
Anytime you are asking your web company to do something for you online;
Anytime someone is trying to get money from you.
There are many companies that will make it sound more complex than this and prey on your lack of knowledge. The big myth we have all been sold by web designers is that if you build a great-looking website, the sales will follow.
Due to this myth, there are many business owners who are not achieving the results they need, simply because they are relying on their web designers for their traffic.
If they are good graphic designer, they will make your website look pretty, but they
won’t be a good website developer who knows how to drive and convert traffic – these are two completely different skill sets.
The Traffic x Conversion formula should drive everything you do. However, one without the other doesn’t work. You could drive traffic to your website using Facebook ads or Google AdWords and that wouldn’t be too hard to do for the right person who has the knowledge. But without the conversion – it doesn’t work.
On the flip side, if you are amazing at conversion and your website is so compelling that people pick up the phone and book an appointment there and then, but you only have one or two methods of driving traffic to your actual website – it simply won’t work for you. You need to have both working at the same time.
1The first thing you need to do is to attract highly qualified prospects to your website.
Highly qualified means prospective patients who are either ready to buy or have a desire to learn more about your treatments and services.
They are doing their research, which can take up to two years in the aesthetics market. It’s the easiest thing in the world to get anyone to your website, but it is making sure that they are quali-
However, if your website visitor is not ready to pick up the phone and book an appointment with you, then you need to do everything you can to obtain their permission to begin a relationship with them. So, what does this mean?
Let me give you an example. Most people use the internet to search for information – so if they are on your website and the phone rings or the baby cries, the chances are they will be distracted and forget all about your website until they are ready to resume their search.
However, if you have a compelling message that grabs their attention the moment the visitor arrives at your website and there is something useful that they can download from you (my ‘lead magnet’ is my 108-page free business and marketing report), then you can add their name and email address straight into to your email auto-responder software – for instance, MailChimp – and start to build a relationship with them over time.
Each of your future emails will provide useful and valuable content and hardly any sales messages (8:1 ratio). This means that when they are ready to pick up the phone and book, you are at the forefront of their mind, as the trust has started to build, because they know you and they like you. For many people, this is completely shifting the purpose of
their website. This may go against the grain of most people, who think the purpose of your website is to sell people something –which it is, but only if the timing is right and the person is ready to pick up the phone.
However, if they aren’t ready to yet and are still in ‘research mode’, then it’s all about getting their permission to start to building a relationship and not losing them to a competitor who has managed to grab their attention.
So why does this process work so well? Because it meets your prospective patients – that is to say, your website traffic – at exactly where they are in their buying journey. If you think about it, there is a very natural fit of how people use the internet that integrates into this particular sales process.
Think about when you go online and you are potentially going to buy something online. You are using the internet as an information-gathering tool, no matter what you are doing: booking a holiday, looking for a new outfit or researching a restaurant for your anniversary. You spend the first part of your online search gathering information in order to make a buying decision.
So the minute you try and break this principle and immediately try to get money from people who are only using the internet to gather information, your website won’t work as well, because it’s not how people use the internet. They have in their mind that they are looking for information and knowledge. And at the back of their mind they know that they are going to buy at some point. But if they aren’t ready, then your website fits exactly where they are in their buying journey.
It’s all about stepping in the shoes of your patients, because it meets your patients right where they are. Remember that your visitors are always only one click away from leaving you and going somewhere else.
Next issue: The power of Facebook advertising and social media
Pam Underdown is chief executive at Aesthetic Business Transformations
See ‘website revolution’ page 32
PROMOTING YOUR PRACTICE
Hey Doc, you really don’t need PR. What you need is … news generation. Tingy Simoes shows why
IF YOU’VE been with me for the length of this series on the relationship between independent practitioners and the media, you should be coming to the big conclusion.
This is that good PR can be a strong, credible and, above all, cost-effective way of broadcast that can bring untold, genuinely incalculable rewards to your reputation.
Maybe, just maybe, when done well, it’s not the fluffy format it’s traditionally judged to be: a whirlwind of lunches, goodie bags and a luxury only afforded by global brands with money to burn.
Yes, you, humble (ahem) you, can make headlines – even globally.
Godspeed. Hire an agency! Launch a campaign! Revel in the glory of identifying, naming and owning your own syndromes, cures, technologies and trends. Own that space online and in the consumers’ minds.
But before you pick up the red phone, let me just clarify that, after everything I’ve said, it’s not PR you need.
The media relations I’ve been describing all along is not really PR. When you’re ready to embrace the clout that the press can unleash, turbo-powering your practice and making you a household name, be aware that it’s not exactly PR you need.
The shark tank
It’s an entirely different beast and not one at which many excel: it’s called news generation and it involves identifying an agency that comes the closest to being, or thinking like, investigative journalists themselves.
If you’re going into the shark tank, you’re going to need more than armbands – and today I will gift you protective gear. Believe me, Bear Grylls himself would turn and run from the savage ferocity of a desperate PR pitch.
Remember, publicists make a living out of selling, and they have to be extremely talented, smart and charismatic to achieve results.
If you ask journalists, many would snort that many PR agents are not terribly different from double-glazing salesmen or the call centre folk who ring you at dinner time to talk about mis-sold premium protection insurance.
The most important decision,
bar none, is whom you’re going to choose to bat for you. Every result you have stems from that single decision. What agency will be saddled with representing you and your offering, protecting your hard-won reputation and deliver bountiful and positive placements in the media to help your practice grow?
News generation
PR companies cannot offer guarantees, but you can choose one that comes closest to being able. This is not achieved through PR; it’s called news generation.
If you have hundreds of thousands of pounds of marketing budget, then don’t think twice and choose advertising.
Advertising is guaranteed, audited, you know the date your piece will come out and it will include your glorious logo, phone numbers, Facebook pages/Twitter feeds, a listing of your mind-blow-
ing achievements and highlight just you and only you.
A single ad in the Mail on Sunday can cost over £50,000, so if you’re lucky enough to be able to afford it, hey, fill your boots.
But, if, like the majority of independent practitioners, you can’t afford advertising on news channels, you need to make the news.
You need a group of strategists who think like journalists and, through the medium of news generation, get you as close to the security of formats like advertising and buying keywords – but at a fraction of the cost.
Before allowing the sirens to enter the hallowed portals of your practice, brace yourself to resist their seductive song. You’re dealing with wily creatures here and you need to be one, too.
Demand: what is their success rate? For every announcement they make, how likely are they to
secure cover? They might not be able to say 100% (no PR can), but how close to it can they get and can they prove it? And when they do secure coverage, how extensive or positive is it and how/who developed the angle?
I currently work with a client who had spent nearly half a million pounds worth of free treatment on the advice of their previous PR agency. They were told this was the only way to get journalists to write about them. The truth is, this is the only way to get cover when you’ve failed at coming up with any original hooks.
Freebies have their place. So do competitions and reader offers for certain skincare or beauty products.
But has the agency actually made national headlines, differentiating you from other providers? Have you become known for something unique? Has your name become synonymous with anything specific in the public’s
Grill them: where are the ideas for stories coming from – is the agency being creative, coming up with unique angles?
eye or are you just another sports injury/dental/aesthetics practice?
Grill them: where are the ideas for stories coming from – is the agency being creative, coming up with unique angles? Or are you the one constantly being forced to suggest possible themes?
Original thought
Do they keep asking you for case studies, but have never suggested a survey or alternative options?
Demand original thought. It’s the one thing that the big companies do not have a monopoly on.
You can benefit equally from a keen and talented one-man freelance outfit or a small boutique agency as you could from a massive one with hundreds of staff.
In fact, it’s been my experience that enormous companies that represent global brands can occasionally be, dare I say, slightly lazy on originality and therefore in the area of news generation.
Because, really, how hard can it be to promote brands like Virgin, Easyjet, Apple or Nike?
With budgets running into the hundreds of thousands, they can afford to rent a posh venue, organise a ‘journalist round-table’ – doublespeak for a paid-for news conference – and give out a bunch of free expensive goodies or send the editors away to a spa weekend at a luxury destination.
Try doing this with a sexual health clinic as a client (free chlamydia tests, anyone?) or a treatment for acid reflux. Maybe induce heartburn in a journalist first, then offer surgery?
Be prepared to question. Do they understand the intricacies of what you do as a clinician? They might not be medically trained, but can they proactively look at a conference programme or your lectures and pick out a few subjects that might tickle the mainstream media?
Are they aware of the magical fairground that is pubmed, and the wide range of peer-reviewed studies therein to bolster your product or treatment?
As a private doctor, PR can be your best asset, your strongest marketing tool, your fully-stocked arsenal against competitors. But they cannot think like PRs. They must think like investigative journalists and make you the news.
When a good reporter puts together a story, their editor expects views and independent counterviews, they expect backing statistics, they expect a human-interest element to tug at readers’ heartstrings.
These things take time to put together, but they’re the reason why, when they are collated by the publicist, the journalist receives the entire package with gratitude and is much more likely
to consider running it, because their job is 95% done.
Here is the difference. In PR: ‘Dr X treats knee wrinkles. Have a free treatment, Mr Journo.’
In news generation: ‘A new syndrome called “Kninkles” is on the rise in the South-east, due to the increasing overcrowding of trains [insert rail statistics] which forces women to stand for long periods of time during their commute –even influencing current fashions, as retailers report that demand for lower-hemmed skirts is at an all time high in London [quote from Next/H&M].
‘A study recently published in Lower Limb Journal showed a rise of 30% in women seeking treatment for the condition. Dr X, a specialist in leg anti-aging, has come up with a novel approach utilising radiofrequency and ultrasound technology which zaps the offending sag…’
The story is placed, we promote
As a private doctor, PR can be your best asset, your strongest marketing tool, your fullystocked arsenal against competitors
the #kninkles hashtag via social media and the client buys DrKninkles.com – they now, indisputably, own that space.
Ask: does the agency promise to churn out tons of releases a month? What do they think they’ll be announcing – you have a new cleaner, new furniture or Tracey in accounting was promoted?
Always look for quality over quantity: anyone can promise numbers, but do you really care if you’re in Fishkeeping Weekly or FreePortal.com?
I hope you’ve enjoyed this series. I look forward to reading about you in the news – where you’ll find most of my clients!
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The recent well-publicised disagreement between Chelsea Football Club manager José Mourinho and the team’s doctor Eva Carneiro has highlighted some difficulties that may arise when working in sport. Dr Rachel Birch (right) outlines what you need to know before you take to the field as a sports team medic
BEFORE AGREEING to be involved in a sporting event as a doctor, you should find out as much as you can about the role and the expectations that would be placed on you. You must ensure you have appropriate professional protection, whatever aspect of sports or spectator medicine you are undertaking. Even if your participation in a
sporting event is voluntary, you should approach it as you would any paid employment and ensure you meet the certification requirements for the sport.
GMC registration and a licence to practise are mandatory. But some semi-professional and amateur events may require further certification and training.
When assessing if you have the appropriate skills, as a general rule of thumb, ask yourself ‘would I feel comfortable acting in the required capacity in the course of my everyday work?’
You must ensure you have the specific expertise required for the
The health and the welfare of a patient must prevail over the interests of any competition, economic or political considerations
role and that your skills are up to date. Ideally, you should also acquire an adequate knowledge of the sport, including the risks and possible injuries that participants may sustain and ensure you are familiar with the guidance of the sport’s ruling body.
At professional boxing matches, for example, an anaesthetist must
be present in case of injury that compromises the airway.
You should clarify whether the venue will provide appropriate equipment or whether you are expected to bring your own.
It is your responsibility to ensure that equipment is in good working order, regardless of who provides it.
So it is worth checking any equipment available complies with the ruling body’s requirements. Some regulated sports, such as horseracing, require specific equipment to be available at the racecourse.
Even though you may be providing medical services to a semiprofessional team or individual, be aware you may also need to provide first aid for spectators. If you are, remember that you are expected to act within your competence and you may need to refer serious matters to a local hospital’s accident and emergency department.
There may be an ambulance crew present at the site and you should be familiar with the local emergency services and any relevant protocols.
You may wish to contact the Faculty of Sport and Exercise Medicine 3 or the British Association of Sport and Exercise Medicine 4 for training and further advice.
As a specialist, sportspeople may be referred to you for a variety of reasons, such as health screening or treatment of specific injuries. We advise specialist consultants to avoid working in a way that might create the expectation that a duty of care is owed to the club rather than the sportsperson. It is important to avoid complications that may arise with regard to paperwork.
Medical Protection advises doctors here to:
Not enter into a written or oral contract with an employer (team or club) to treat employees (the sportsperson) for financial or other reward.
Only accept referrals from other healthcare professionals, not from clubs or coaches directly. Address any professional fee notes to the patient and not their employer. If fees are to be settled
by the employer or their medical defence organisation, the patient should be asked to forward them on. Alternatively, written confirmation may be obtained from the patient that all fee notes should be sent to the employer or their medical defence organisation.
Review any existing relationship with a patient’s employer carefully to ensure there is no liability placed on you to employers or third parties. This would be done by reviewing existing contracts or arrangements.
You may be faced with pressure, expectation and even criticism from clubs, sponsors and agents. You may also find yourself pressured by individual sports players to stay on the pitch or go back to their game earlier than you would recommend.
The interests of the patient are paramount and there are risks to the sportsperson if you do not put their best interests first at all times.
There may also be risks to you as a doctor if you do not act with integrity and honesty.
You should be mindful of GMC guidance:1
You must make the care of the patient your first concern;
You must provide a good standard of practice and care;
You must be honest and trustworthy in all your communication with patients and colleagues;
You must work in partnership with patients, sharing with them the information they will need to make decisions about their care.
Additionally, the Faculty of Sports and Exercise Medicine has published its ‘FSEM Professional code (2010)’.2 This reiterates and refers to GMC advice and also states specifically:
The health and the welfare of a patient must prevail over the interests of any competition, economic or political considerations; Decisions on fitness of a patient who is a professional sportsperson to perform physical activity should be determined on clinical grounds and should not under most circumstances be influenced by third parties such as coaches, management or family members of the patient;
When the health of a patient is
at risk, a practitioner must strongly discourage the patient from continuing training or competition and inform them of the risks of continuation.
If you treat sportspeople who are in the public spotlight, you may receive media attention.
As with all patients, confidentiality must be maintained at all times and you should not offer any comment to the press about the patient.
If you are a GP in practice, even the fact that a patient is registered or has been seen is confidential information and should not be disclosed.
If you are treating a well-known sportsperson at your practice, ensure that all reception staff are warned of the possibility of inquisitive journalists and advised not to provide any comment.
Your primary responsibility is to the patient, even if you are a club GP. You must not disclose any medical information to the club, or anyone else, without the express consent of the patient. This is the case even if there are financial or employment regulations in place.
If you see a patient as a one-off or outside of the club, you should seek the consent of the patient to inform the team medic or any specialists.
You should explain the purpose of such communication – to ensure ongoing care and monitoring – but if consent is withheld, you should not disclose any information.
If you are required to provide treatment to any sportsperson or spectator, you should document your assessment and treatment clearly and retain this record.
This will be important should the patient require follow-up treatment. It will also provide evidence of the care provided and advice given, in the event of a complaint or claim.
Many doctors agree to provide GP services to a club or sportsperson and, in many cases, the work might be identical to their day-today work.
But it is worth remembering
that sportspeople may have concerns specific to their sport. For example, an injured muscle in a sportsperson is going to have important implications for their ability to continue in the sport and they are going to want the issue resolved quickly.
You may have a lower threshold for referral to orthopaedics and physiotherapy in these circumstances.
As a GP, familiarise yourself with the effects of any medicine you prescribe to a sportsperson. While it is their responsibility to ensure they do not take anything that could be seen as performance enhancing, certain medications can enhance performance, including some available over the counter, so take care when prescribing.
Finally, make sure your work with any sports teams or people does not conflict with the care you offer other patients.
Any commitment outside your regular work should be adequately protected and you should contact your medical defence organisation to discuss the matter further with them.
If you wish to work with a sporting team or sportsperson, you must be clear on the indemnity arrangements beforehand. If you are agreeing to be a doctor for a club or for individual players, it may be that clubs and sports associations could provide the professional cover.
As the GMC states, it is your professional responsibility to ensure that you have adequate indemnity cover for every role that you undertake.1
References:
1. GMC: Good Medical Practice (2013). www.gmc-uk.org/guidance/good_medical _practice.asp
2. Faculty of Sports and Exercise Medicine: Professional code (2010). www.fsem. ac.uk/media/4207/professional_code_ 1july_2010.pdf
3. Faculty of Sports and Exercise Medicine. www.fsem.ac.uk
4. British Association of Sport and Exercise Medicine. www.basem.co.uk
Dr Rachel Birch is a medico-legal adviser at Medical Protection
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The leading UK charity for doctors, medical students and their families has been offering support through difficult times now for over 175 years. Leslie Berry reports
WHEN CRISIS strikes, whether through illness, injury, bereavement or disability, the Royal Medical Benevolent Fund (RMBF) is there to help doctors.
Its help ranges from financial assistance through grants, loans and money advice, to a phone befriending scheme for those who may be isolated and needing support.
The RMBF occupies a unique place at the heart of the medical profession, not least because it is led and guided by doctors.
Most of the trustees’ board, and over 250 volunteers, come from a medical background, whether they are current practitioners, retired doctors or family members. They say this means the organisation understands the unique pressures facing doctors daily.
In 2014-15, 60% of people who applied to the RMBF for assistance were seeking help for mental health or addiction problems. This is up from 40% in the previous year, and is typical of an emerging pattern observed by the charity.
RMBF chairman Prof Roger Jones says: ‘When it comes to problems that affect a doctor’s ability to work, independent practitioners can be just as vulnerable as any doctor.
‘Working in private practice presents its own challenges and difficulties and doctors across the board have generally been slow to
seek and accept advice and treatment, for physical as well as psychological illness.’
The other shift in demographics seen is towards younger doctors applying for help and support.
More than two-thirds of 2014’s applicants were aged under 40. These are people at the beginning of their career – the future of the medical profession – who have not yet had the chance to build a financial safety net for when crisis hits.
The charity is developing programmes to aid medical students, and to provide information and career advice for doctors that may help them before work problems become more serious.
It supported 212 beneficiaries with financial assistance in 2014, and 66 of these were helped to
return to work, remain in employment or receive training.
The RMBF aims to ensure all practitioners know about the support it provides and asks all doctors to spread the word to colleagues, at meetings, at conferences or online and through social media.
Dr Kudrati
‘A trained ophthalmologist, I was out of work for over 16 years following the onset of severe and aggressive Crohn’s disease. My only source of income during this time was Incapacity Benefit.
‘At the time of my application to the RMBF, and following some improvement in my health, I had been considered fit for work, but while actively seeking suitable employment, I was facing difficulties restoring myself to the GMC register.
‘The RMBF was able to help with this, and after successful completion of an induction programme, I was able to return to practice and to begin work as an honorary clinical assistant in the out-patient department of London’s Western Eye Hospital.
‘The RMBF was also able to help with the purchase of necessary ophthalmic instruments, unavailable from any other source, necessary for the evaluation and diagnosis of patients.
‘Initially unpaid, the RMBF also provided me with extra help for the increase in my day-to-day living expenses incurred as a result of my return to work.
‘I am pleased to say that the post then led to my being contracted on a fairly regular parttime basis, as a paid locum tenens member of staff, thus enabling me to regain my full independence.
‘I had never imagined, during my long illness, that any of the above was attainable, and I do not believe now that, without the sympathetic consideration and dedicated assistance of the RMBF, I would have ever made a return
to the medical profession and to be enabled, once again, to serve the needs of patients.’
Dr Groves
‘I came to the UK in 2004 after graduating from medical college at Punjab University. In 2008, I gained full GMC registration and had experience working in psychiatry, neurosurgery and paediatrics.
It is difficult to put into words the positive impact they have had during this difficult period of my life and my wife and children’s lives
‘After the birth of my child, and living as a single parent, I was diagnosed with post-natal depression and, as a result, suspended from work in 2011. My savings had run out, and I only had state benefits to help me manage the mounting costs of childcare.
‘I sought help through medication and online cognitive behavioural therapy and, while my health did improve, the pressures I was under made it too difficult to return to full-time medical work.
‘The RMBF provided me with a monthly grant and a provision towards my childcare costs. They also helped me to retrain and improve my skills. I am happy to say that I’m now back in employment, thanks largely to the support of the RMBF.’
Dr Thomas
‘In 2013, I was suffering with depression and anxiety, and I had been out of work for six years. I approached the RMBF because I needed help getting back to work.
Returning to medical work after such a long absence meant I was required to do the GP induction and refresher scheme. The RMBF paid for the assessments and
examinations that were part of the scheme, as well as other backto-work costs.
‘Two years later, I was back on the GP Performers’ list and starting a new job. They also helped me with living expenses while I was out of work and provided one of my sons with a student grant for his first year studying at university.
‘I sincerely thank the RMBF for all their help, kindness and support through the difficult years. I will never be able to repay what the fund has done for me
‘It is difficult to put into words the positive impact they have had during this difficult period of my life and my wife and children’s lives.’
Dr Lewis
‘You never know when your life is about to change suddenly. Back in 2013, I was a trainee surgeon and our first child was on the way, life was great.
Its support was invaluable while we slowly put our lives back on track. I am now working full time again and I am indebted to them
‘Then one day when playing football, I suffered a cardiac arrest. Lying on the floor of the pitch, I was shocked back into a normal rhythm using a defibrillator, but, during the resuscitation, I suffered a cerebellar stroke which resulted in me being in a coma for ten days.
‘I was then in hospital for a month recuperating. At the time, my wife was also on maternity leave and with both of us out of work we were struggling to make ends meet. I could not see a way forward.
‘During this difficult time, the RMBF helped to cover our living expenses when my sick pay was reduced to 50% and while I made a phased return to work.
‘Its support was invaluable while we slowly put our lives back on track. I am now working full time again and I am indebted to them.’
Dr Lambert
‘I was 26 and working as a junior doctor when I felt a lump on my breast. I visited my doctor thinking it would be something benign, given my age. However, I was diagnosed with breast cancer.
‘To undergo treatment meant I was unable to work. Unfortunately, my sick pay ended and I had no one to turn to for support, which meant my financial circumstances started to deteriorate.
‘Fortunately, the RMBF offered to support me financially with my living expenses while I recovered. Without them, I am not sure how I would have made it through that difficult time. I am now back at work and will forever thank the charity for helping me.’
Thinking about continuity income can do a lot for your profit line, says surgeon Mr Dev Lall
A BIG PROBLEM with private practice is that you need to ensure you have a constant stream of new patients, as many will only be seen once or a few times before their treatment is complete and they can be discharged from follow–up.
This is truer in certain specialties than others, of course. A general or orthopaedic surgeon will only need to see the majority of their patients perhaps two or three times before discharge.
But an oncologist or breast surgeon will follow up their patients for much longer, often for many years, because of the natural history of the conditions they treat and potential for late recurrence of disease.
Many specialists need to be constantly promoting and marketing their skills and expertise to generate more patients to replace the ones that have been seen. This is both stressful and also an ongoing practice expense.
If this applies to you, another problem is that it means your future income is unpredictable. You have no idea how much your practice will generate next week or next month because you don’t know how many patients you will see or procedures you will perform. So what can be done? There is quite a bit a clinician can do to reduce the need for generating new patients.
Case mix
I’ve long talked about the importance of ‘knowing your numbers’
because you can then determine the success or otherwise of critical aspects of your business – profitability, return on investment and the success of a given marketing approach, for example.
But knowing your numbers can help to increase the profitably of your practice in other ways, too.
So, for example, 80% of a given consultant’s private workload might comprise only five or six different conditions out of the myriad conditions they are capable of treating.
Now, if you were to break down the income each condition generates, you might find the following figures:
Condition A: £1,000
Condition B: £900
Condition C: £750
Condition D: £1,400
Condition E: £350
So, on the face of it, to increase their practice income most easily, the consultant would be best advised to increase the number of patients they treat with condition D.
However, if I were to tell you that Condition E actually required long-term follow up – several years or more – then it would quickly become apparent that even though an initial treatment only generated £350, the overall income was by far the highest, as you would generate two followup appointments annually for many years.
So, in this example, the best way for this particular consultant
to grow their practice might be to get more patients with Condition E rather than D or A, because, over the long term, they would generate greater revenue.
One example of this in practice is ophthalmology. A consultant might have expertise in treating both cataracts and glaucoma, but even though patients with cataracts generate more income and are quick to treat, they need no long-term follow-up and can be discharged.
On the other hand, patients with glaucoma, while generating lower income initially over the longer term, are much more profitable because of the extended follow-up they need.
Now, I know insurance companies have different approaches to paying for follow-up appointments, so, yes, that can be a hurdle, but always remember why patients come and see you privately in the first place.
Reasons include speed, consultant-only care, choice, pleasant environment and so on. But they also come because they want to see you specifically. They like you personally and form a relationship. And this could easily mean that even if their insurance will not cover follow-ups beyond a certain time, patients may well be willing to pay for it themselves – if you give them the choice.
Continuity is so desirable: reduced marketing costs, less ➱ p30
Patients like you personally and form a relationship. And this could easily mean that even if their insurance will not cover follow-ups beyond a certain time, patients may well be willing to pay for it themselves
stress, and greater predictability of income. But adjusting the case mix is only one way of increasing continuity income.
Other forms of continuity
There are many different continuity models, but the key thing they share is that people pay regularly – say monthly – for a product or service you provide.
A good example is subscribing to a golfing magazine. You can easily go to the newsstand and buy it, and the publisher would be very happy. But he would be happier still if you took out a six-month or year’s subscription, and will even give you a reduced cost per issue to encourage you to do so, because this means sales are less variable and income can be predicted some way in to the future.
Another example is Amazon Prime: By paying a certain amount of money each year you get faster postage as well as other benefits. And Amazon gets a more stable and recurring income in return.
So how can you do this in your medical practice? You’re going to have to be creative. As well as the medical treatments you provide, what else do your patients want from you? And what else can you provide for them?
Practically speaking, this boils down to just three things: products, services and information/ support.
Certain specialties lend themselves well to selling products on a continuity basis; for example, aesthetics or cosmetic surgery. You could easily obtain skin creams, ‘white label’ them – in other words, buy them from a manufacturer and rebrand them as yours.
Many companies will do this for you. You can then then sell to customers at a profit as your own product to generate additional revenue. By offering the product as a monthly subscription, you would create a continuity product for your practice.
A similar approach could be taken with different products in allergy, nutrition, smoking cessation, weight loss and so many other practices.
A great way of creating continuity of income is by asking patients to pay a monthly fee for a service you provide
A great way of creating continuity income is by asking patients to pay a monthly fee for a service you provide.
Take general practice, for example. Here you charge patients a monthly fee to join your practice as a private patient.
For that, they get a number of benefits: they can call in and talk to you over the phone if they have any health issues. If they need an appointment, you guarantee to see them the same day or perhaps within 24 hours.
You might pay for a taxi to pick them up from home, bring them to your practice and take them back again – all as part of their monthly subscription. There are a whole host of benefits you could offer.
The benefits are considerable. You get recurring monthly income whether your patients ask to be seen or not and you can provide a far better service to them because you need far fewer to generate a given income. And patients are delighted because they can see how they are getting a great service too.
Selling information or support is a great way to generate continuity income. You charge patients a fee to be part of a group that gets ongoing information and support regarding a given clinical condition.
Ideally, the condition needs to be chronic – such as allergy – or require long-term follow-up or emotional support, such as breast cancer or depression. You could easily publish a newsletter and create an online forum so members can discuss issues with you, but also with each other if they wish. There are many free forums and support groups out there, of course, but there is no reason why you couldn’t set up a paid one of your own.
Continuity income is a gamechanger. It reduces the unpredictability of your income as well as increasing the maximum you can earn. The only limit to what you can do is your imagination.
Mr Dev Lall (right) is an upper-GI surgeon and runs a specialist private practice consultancy www.PrivatePracticeExpert.co.uk
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A professional website presence is a must in today’s online world. But with website average quality scores at a low 34.85% across the UK’s private medical practitioner sector – see box on the right – Joel Calliste (right) suggests three areas to focus on as a priority for your patients and business
1
Website content: it’s more important than design
The ‘copy’ on your website is fundamentally important, not just to patients to know that what you provide is relevant to them, but also for search engines to know to prioritise you in relevant searches.
But it’s not just what you’re saying; it’s how it’s said. Often, private doctor websites seem to be aimed at colleagues within the medical industry, not patients.
Information on treatments and specialties need to talk directly to the general consumer of any age and from any background.
Simple and clear language should be used: What can they expect? What is the benefit of your service? Why have you chosen to specialise in a particular area? Bring personality into your website as much as possible.
2 SEO 101: it’s all about content
We are regularly asked about search engine optimisation (SEO) by businesses who want to make sure they’re meeting all the right criteria to be on the front page of search engine rankings.
Often, the assumption is that it’s all about meta tags and behindthe-scenes trickery, but actually
the most important step in achieving great SEO is to think of a search engine – such as Google –as a person, not a machine.
Search engines have invested a lot in creating a number of algorithms which try to cleverly mimic a person’s search journey. To match what the algorithms are looking for, you need to focus on making sure that your prospective patients know they’ve come to the right place when they have found you.
Prioritise your content. Ask yourself ‘how can I make my website look relevant to the people searching for things I can pro-
vide answers to?’ This is what a search engine will look at first and foremost.
When a patient arrives at your website, are they easily able to understand what it is you do and therefore know that you’re relevant to them?
Trust – the key to success Traffic to a website is the number one goal for most website owners, but what happens when someone arrives on your site?
The world wide web is saturated with websites and therefore when we visit a site, we’re actually programmed to look for reasons not
Smart Medical Web commissioned OnePoll to capture the routes of influence for private medical patients when choosing an independent practitioner. Findings are based on responses from 1,500 consumers who had either had or were considering having private medical surgery or consultation across the UK.
Analysis was carried out by Smart Medical Web, in parallel with desk research undertaken to review the quality of 100 existing private medical practitioner websites to determine an average quality score for the sector.
The average quality score of 34.8% was the conclusion of desk research and analysis of 100 existing private medical practitioner websites across the UK during June 2015.
Websites were benchmarked against five key criteria, recognised throughout the web development world as key indicators of an effective web presence.
100 practitioner names from a well-known directory were Googled to identify which of them relied just on a hospital or clinic profile page, which had their own website, and which had none at all. Exactly half fell into each category of having a website or not.
Eyes have it: an example of a clean, neat home page with all the information a browser needs
to trust it. People have become fatigued and even sceptical. Presenting your business online in a professional manner is therefore just as important as meeting someone face to face.
Being professional isn’t actually just about using a nice design tem-
plate. Please don’t go mad with font sizes and colours. Keep it simple. Two or three maximum should do it. Too many and it can become confusing and look cheap. Part of professionalism is also reassurance that you’re here to stay; something as simple as a
Images can also make or break a site. Ensure all images are high-resolution and tell the story of your business as quickly and as clearly as possible
resolution and tell the story of your business as quickly and as clearly as possible.
Include pictures of any team members, consultation and/or treatment rooms, and the wider environment that your patients will experience when they come to you.
Credibility is huge for trust. Patient testimonials and badges of affiliations and/or reviews can speak 100 words. Third-party endorsement is possibly the biggest advocate for trust. And if you’ve been lucky enough to gain media coverage, include links in your ‘About Us’ page.
landline phone number and nonpersonal email address can do this. Busy private practices could also consider having a ‘Contact Us’ form on the website, with a time-frame for response provided. Images can also make or break a site. Ensure all images are high-
Ultimately, it’s always worth taking a step back and thinking ‘what do I do when looking for an expert or business?’ and then to apply the same filters when viewing your site.
Joel Calliste is a co-founder of Smart Medical Web
When writing a report in a clinical negligence case, you must give a great deal of thought to what the finished product – the macrostructure – will look like. Michael R Young shows how
THE LAYOUT of your report and the quality of the material you use are going to affect the way it is received.
Always use good-quality 100gsm A4 paper. White paper is always best, as it looks very business-like. For the same reason, you must always use black ink.
Because you might bind the report, it is sensible to leave a 1.5inch left margin and a one-inch margin on the right. But some solicitors prefer unbound copies that they can hole-punch and put straight into a lever arch file.
The solicitor may sometimes request double spacing, but generally single spacing will suffice.
Reports should only ever be written on one side of the paper. Having to photocopy both sides takes longer and there is a real risk of the sheets being produced out of sequence.
Some fonts and point sizes look better than others. Arial 8 is too small to be read comfortably but 10 looks clear and crisp and is easier to read. Some people prefer Arial 12, which is bigger still.
An alternative font to Arial is Times New Roman. Times New Roman 12 is the accepted font and size for play scripts.
Headings must be clear. Use upper case for sections headings, which should be left-margin aligned, in bold and underlined, as shown here:
SECTION 1
A SYNOPSIS OF THE EVIDENCE
Keep subsections to a minimum, but if you have to use them, they should be underlined but not in bold, as shown here: The periodontal condition
The whole report must be well spaced, which will make it easier to read.
Keep paragraphs short and restricted to one topic. The question of whether to number paragraphs is one of personal choice.
If you like to number the paragraphs, use a two-number system: the first number is the section number and the second is the number of the paragraph within that section. Numbering paragraphs makes life easier if and when the lawyers start asking you about what’s in your report.
Word-processing programmes enable you to add a header and footer on each page. You should include both a header and a footer in all of your reports. The header should show:
Your title, name and qualifications;
The name of the client;
The title of the report – screening, liability and causation, current condition and prognosis, combined.
This helps the solicitor and barrister, who during a trial may have several reports from several experts in front of them, to easily identify your report/s.
The footer is used for page numbering, which is best as ‘Page X of Y’ rather than just ‘X’, as this reduces the likelihood of tampering. The date the report was complete should also be included in the footer.
The book costs £60, but Independent Practitioner Today has secured discount of a third off for readers, so you pay only £40.
Listen to the audio content which accompanies the book at this website: www.otmoorpublishing.com/audio.
For more information and to order, email stephen.bonner@ otmoorpublishing.com, quoting reference ‘Young/IPT’.
The front cover should show:
The name of the client and the subject of the report; for example, screening, liability and causation, current condition and prognosis, combined;
Your title, name, qualifications and contact details;
The date the report was completed.
Remember that you want your report to impress everyone who reads it, not only with its arguments but also in its presentation. A well-set-out 12-page document bound between two professional-looking covers is a professional report. Six sheets closely typed on both sides and stapled together looks like a tedious memorandum from a miser. The information in them may be the same, but their impact is going to be very different. Invest in a good-quality binder and covers.
Next issue: Microstructure of a report
Adapted from The Effective and Efficient Clinical Negligence Expert Witness , by Michael R. Young, price £60 from Otmoor Publishing
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Consultant
ophthalmic surgeon
Mr Larry Benjamin (pictured right) is a trustee and medical volunteer with blindness prevention charity Orbis UK. He tells us about the skills and knowledge doctors can bring to a medical charity, both in the field and on the board
THERE ARE 39 million blind people in the world and 90% live in a developing country. What’s staggering is that 80% of blindness is treatable or preventable. So millions of people are suffering unnecessarily.
I have been a consultant ophthalmic surgeon at Stoke Mandeville Hospital, Buckinghamshire, for over 25 years and have been involved with Orbis since 2004.
The charity was set up in 1982 and currently has a presence across Africa, Asia and Latin America and is involved in over 40 long-term programmes.
As well as utilising the current DC-10 aircraft – soon to be replaced by an MD-10 – to pro -
vide a world-class teaching, training and operating environment, the organisation also runs hospital-based programmes (HBPs). I am mainly involved with these.
More rewarding
HBPs are more challenging, as there is not the back-up of the high-tech facilities and staff of the aircraft, but also more rewarding when sustainable systems are achieved in less than ideal circumstances.
As well as my role as one of 300 volunteers from around the world who participate in these programmes, I also chair the programme committee for the Eur ope, Middle-east and Africa
(EMEA) region and sit on the board of trustees of Orbis UK.
This gives me a rare opportunity to be involved in every aspect of the organisation’s work, from inception and planning of projects to financial awareness and fund-raising.
It also includes project implementation, results evaluation and longer-term follow-up of cases. From my point of view, this helps to ensure that the charity’s principles, philosophies and organisation are all aligned.
I am acutely aware of the need for careful governance and the absolute requirement for very high clinical standards, including the need for clinical outcome measurements. As an ophthalmologist, I am well placed to assist with this process.
Often I have heard trainees say that they wish to ‘go abroad’ and learn a particular technique, by which they mean practise a particular technique that they may not see in the UK.
I stress to them the importance of having expertise before going abroad and that the concept of practising surgery in developing countries is old-fashioned and damaging. Indeed, what is often needed is a higher degree of experience and expertise to enable good outcomes, provide excellent teaching and training in an environment less forgiving than in more developed countries.
Zambia project
Zambia is a country of approximately 14 million people with around 45% of the population made up of children under the age of 16. Children there are approximately four times more likely to suffer from blindness than those living in developed countries.
Orbis’s involvement in Zambia began in 2011. I first visited that year to take part in an HBP to help develop a tertiary referral paediatric ophthalmic centre – Kitwe Eye Annexe.
We specialised in paediatric cataract and strabismus (squint) and worked with medical, nursing and biotech staff to try to develop a sustainable approach which the local team felt comfortable with.
My hands-on trainee was Dr Chilesh Mboni, a very capable
Children in Zambia are approximately four times more likely to suffer from blindness than those living in developed countries
The challenge remains to find sustainable ways of ensuring that these patients return for care over this extended period of time
surgeon and clinician who picked up new surgical techniques very well and was committed to the philosophy as well as the practicalities of the project.
Typically, an Orbis programme is divided into a screening day, fol-
lowed by a mixture of training in the operating theatre on selected cases as well as more formal lectures or small-group teaching. One of the first difficulties encountered is to get patients to attend for assessment. Although the Kitwe hospital has a good reputation locally, often traditional healing has been tried first or late presentation with poorer outcomes can lead to resistance from local communities.
Hence education is a key part of the strategy in getting engagement from local communities.
After the screening day in 2011, one of the children we operated on that week was a delightful young lady called Grace Kajoba, who had a significant convergent squint (pictured right, pre- and post-op).
Her mother was a nurse and she appreciated the importance of visual assessment to ensure normal visual development in a young child and also wished for her daughter to have straight eyes – a very important social issue.
Paediatric problems
This type of case exemplifies the complexities of paediatric ophthalmology. Not only is it important to be able to get at the population of children with diseases or abnormalities of the eyes and/or vision and accurately assess and, if necessary, operate on them, it is also vital to have in place systems of visual assessment post-intervention – orthoptics, optometry and ophthalmology –that are easily available during the sensitive period of visual development in a child.
This is usually up to about the age of seven or eight years. Organisationally, this is a challenge in the most efficient of healthcare systems and so in developing countries it is doubly so.
Over the last year, the paediatric co-ordinator at Kitwe Eye Annexe has ensured an almost 100% return rate at six weeks for children who have undergone surgery. Through counselling and support, he ensures parents and care-givers understand the importance of coming back for followup appointments. He also follows up with phone calls and Orbis can support with funds for transport if appropriate.
However, since children require consistent follow-up over a number of years post-surgery, the challenge remains to find sustainable ways of ensuring that these patients return for care over this extended period of time.
Orbis tries to develop programmes which take account of the whole system needed to address the above issues and makes them sustainable within the local health economy.
Young Grace did well and the
picture above shows her post-op result. However, unless patients like her have access to regular follow-up with repeat refractions (glasses testing), visual development assessment and ophthalmology clinical assessment, she may have straighter eyes but may have no better vision.
The top picture on the previous page shows a community screening clinic which took place during our visit and the picture below it shows the screening clinic at Kitwe hospital.
The bottom picture on the previous page shows a group of children waiting for their cataract operations during the programme.
Data collection and analysis is an essential and pivotal tool in any healthcare system which wants to be able to demonstrate its effectiveness in terms of patient-based outcomes.
Recently, we have implemented electronic patient records, which will allow data collection offline in the field as well as live and online in the hospital setting.
This will give Orbis the facility to collect and analyse local programme data, but also, in time, start to establish a world-wide database of outcomes. Then it will become ever more important in demonstrating not only clinical effectiveness but also allow us to
later becomes an overriding factor in paediatric cataract surgery. Similarly, the type and style of intra-ocular lens implants may also play a part in determining long-term results and avoiding complications such as secondary glaucoma some years later. These considerations become much more relevant in the younger, developing eyes of children.
Recently, Orbis was selected as a partner by the Department for International Development for its UK Aid Match scheme. This means that, until the 3 February, every pound raised by Orbis will be doubled by the UK Government.
demonstrate to donors and governments the returns, both fiscal and economic, of their investments.
Paediatric cataract management surgery is a particular area of my work and is technically demanding but rewarding and fun to teach.
As with all paediatric ophthalmic cases, the follow-up and assessment and treatment of the subsequent visual development is crucial, but also the nature of the equipment, drugs, devices and disposables used for children becomes much more important.
A simple example is the use during surgery of a visco-elastic device. This is a slightly gooey substance which is used inside the eye to protect the corneal endothelium (inner lining), which is itself essential for corneal clarity.
In the UK, a cheap substitute (HPMC) is often used in adult cataract surgery by experienced surgeons for routine cases and this has been mimicked all around the world.
But in children it is much more difficult to do the surgery safely using HPMC and indeed it is likely that long-term outcomes may well be worse unless the genuine, more expensive substance is used.
Making this case is difficult where economic issues are important, but being able to look at the long-term outcomes and the possibility of corneal failure years
This exciting opportunity will be used to further develop the paediatric project in Zambia. Now that the new paediatric unit is running well, with extensive specialised training completed, further work is needed to raise community awareness in primary and secondary care. And traditional healers need to be worked with to ensure early and appropriate referral of children in need of help.
The money raised from the ‘Vision for Zambia’ appeal, will enable the charity to prevent and treat blindness in over 105,000 children in the country over the next three years.
The Orbis Flying Eye Hospital (see Independent Practitioner Today, November 2013, p36) and the HBPs that Orbis run, provide a unique educational and teaching environment for all aspects of a sustainable eye care project.
I am proud to be associated with the organisation and humbled to take part in its work in the field as well as in the programme team and board. This sort of opportunity enhances my experience and working life and undoubtedly gives me advantages in my NHS and private work too.
Until 3 February, all donations to Orbis will be doubled by the UK Government, helping them to prevent blindness in twice as many children. To find out more or to make a donation, visit www.orbis.org/zambia
Mr Larry Benjamin is a consultant ophthalmic surgeon at Stoke Mandeville Hospital and at BMI The Chiltern Hospital, Buckinghamshire
THE CARE Quality Commission (CQC) has to comply with Govern ment policy to achieve full chargeable cost recovery by 2020 at the latest.
This means that the full cost of the CQC’s chargeable activities must be recovered through fees from providers.
The proposed fees increase equates to just over 10% for independent doctors.
This consultation isn’t about whether you agree with how much the increase will be, but primarily over what period it will come into force.
There are two options being proposed to allow the CQC to meet HM Treasury’s timeline. The first is over a two-year period, 2016-18, and the second is over four years, 2016-20.
Practically, this means that an independent doctor with one registered location currently paying an annual fee of £1,679 will see a proposed increase to £1,851.
This can be achieved either in two years – see Annexe A on the right – or stretched out over four years – see Annexe B on the right.
The annexes relating to independent doctors are on pages 31 (over two years) and page 36 (over four years) of the CQC report.
Please note that independent doctors are part of the Community Healthcare Services and should not be confused with the Primary Medical Services.
There are three questions asked in the consultation document:
1
In setting fees for 2016-17, which of the two options for achieving full chargeable cost recovery would you prefer CQC to adopt (please select one option): Option 1 – recovery of the fees
amount over two years between 201618 as set out in Annex A or;
Option 2 – recovery of the fees amount over four years between 2016-20 as set out in Annex B?
2 Would you prefer CQC to adopt another option for setting fees for 2016-17? For example:
If there are aspects of this proposal that you do not agree with, please explain why. This consultation is open to all providers of health and social care activities. So it is important that independent doctors respond, as there may well be colleagues in other sectors who feel the proposed rises for independent doctors is very
small in comparison to their own and, as such, may well voice their opinions in Question 2.
The 2016 Fees Consultation Document is available at the CQC website: www.cqc.org.uk/content/health-and-social-care-feesconsultation.
A version of this story was posted on our website after we last went to press
Martha Walker is a medical management consultant specialising in CQC registration and compliance
The proposed fees increase equates to just over 10% for independent doctors
A different option for how and when CQC should achieve full chargeable cost recovery;
A different option on how we divide fees between different types of provider.
Please explain what option you recommend to CQC and your reasons for proposing this.
3
Do you agree with our proposal to maintain full chargeable cost recovery levels for the dental sector by decreasing their fees in 2017-18?
Yes;
No;
Not applicable.
The Association of Independent Specialist Medical Accountants is a national network of firms advising over 3,000 medical practices across the UK. For some of the best advice available on accounting, taxation and pensions, visit our website and find your nearest AISMA accountant.
Private medical practices are often small businesses that involve close working relationships between staff and close contact with patients. Consequently, they are at a higher risk of receiving difficult allegations of sexual harassment, warns Fiona McLellan (right)
THIS ARTICLE sets out the statutory framework for sexual harassment in the workplace and provides practical guidance for dealing with these sensitive, complex and costly cases.
The Equality Act 2010
The Equality Action 2010 (‘EqA’) prohibits discrimination in the workplace. Under the EqA, workers are protected against discrimination, including harassment and victimisation related to nine prescribed protected characteristics,
which include sex and sexual orientation.
The EqA provides protection against discrimination to individuals in employment, which is widely defined to include individuals working under a:
Contract of employment;
Contract of apprenticeship;
Contract to do work personally.
This means individuals who would ordinarily be classed as self-employed are likely to be afforded protection against discrimination if the contract under
which they work obliges them to perform the work personally, meaning they cannot substitute or subcontract the work to someone else.
Sex/sexual harassment
The EqA provides protection against three different forms of harassment, specifically:
➀ Unwanted conduct related to sex that has the purpose or effect of either violating a person’s dignity or creating an intimidating, hostile, degrading, humiliating
or offensive environment for that person;
➁ Unwanted conduct of a sexual nature that has the purpose or effect of either violating a person’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that person; and
➂ Less favourable treatment of a person on account of rejecting or submitting to unwanted conduct of a sexual nature.
When assessing the effect of alleged unwanted conduct, three factors must be considered, namely:
❶ The perception of the complainant;
❷ The other circumstances of the case;
❸ Whether it is reasonable for the conduct to have that effect.
This is therefore a subjective assessment balanced by relevant factors such as the nature of the relationship between the parties – i.e. status/seniority – and the sensitivity of the complainant. If a complainant is overly sensitive, the conduct complained of may not constitute harassment.
What is unwanted conduct?
Unwanted conduct is not defined in the EqA, but case law has developed clarification on how this will be assessed.
For example:
❏ It is well-established that there is no need for a worker to have stated that conduct is unwanted before it can constitute harassment;
❏ A one-off incident can constitute sexual harassment;
❏ The fact that a worker might have suffered in silence, even for years, does not mean that conduct cannot constitute harassment. This is likely to be relevant in cases involving junior/younger workers being harassed by senior/ older staff – a common dynamic in the practice environment;
❏ A worker’s participation in sexual banter would not preclude conduct being unwanted and harassment. The participation could be a coping mechanism or because the worker did not wish to show discontent for fear of reprisals.
What constitutes sexual harassment?
Sexual harassment can take many forms. It can be verbal, non-verbal and/or physical and take the form of unwelcome advances, touching, sexual jokes, displaying pornographic images or sending material of a sexual nature.
Some behaviour is easily categorised as sexual harassment; for example, a male colleague commenting on a female colleague’s body. However, often the position will be less clear.
For example, the Employment Tribunal (ET) determined that a female worker, who was aware her male colleagues were downloading pornographic images but was not shown the images and did not complain at the time, had not been subjected to sexual harassment.
But the Employment Appeal Tribunal (EAT) overturned the ET’s decision and found that there had been sexual harassment because the conduct clearly undermined the claimant’s dignity.
Action employers could face ➫ Internal action
Workers who believe that they have been sexually harassed may raise internal complaints (grievances) about their treatment.
This would usually necessitate an investigation followed by a formal meeting at which a decision
would be made and the right of appeal offered. If the complaint was upheld, it could result in disciplinary action against the harasser.
It is important to ensure an even-handed and sensitive approach to such complaints and that they are managed by trained impartial senior members of staff who understand the organisation’s policies and the potential implications of the internal complaint process.
Regardless, these processes can be time-consuming and create difficult practical issues for small employers with limited resources.
For example:
If the complainant raises a serious harassment issue but states that s/he does not wish it to be addressed formally. Ordinarily if an issue is sufficiently serious, it would be imprudent for the practice not to take steps to investigate notwithstanding the complainant’s position;
Consideration will have to be given to whether or not to suspend the worker accused of sexual harassment, which could impact on the running of the practice;
The issue will be sensitive and the confidentiality of those involved will require careful consideration. In small practices, maintaining confidentiality is likely to be impossible, thereby creating staff morale problems and resulting in limited resolution options;
The need to notify relevant regulatory bodies and when this should be done.
A worker who has been harassed can also raise proceedings in the ET, which is a public forum, thereby creating reputational issues for a practice/practitioners. ET litigation can be complex and protracted and it is usually necessary to take legal advice about how best to handle ET claims. Further, the compensation an ET can award, if a claim of sexual harassment succeeds, is uncapped and, depending on the nature/impact of the harassment, could be significant.
In successful claims, in addition to awarding compensation for loss flowing from the harassment – for instance, lost salary if the
Allegations of sexual harassment can be complex and require sensitive management to avoid an adverse effect on the operation of a practice and a detrimental impact on staff morale, as well as reducing the risk of employment tribunal litigation.
Practices should therefore consider the tips below as a means of assessing and reducing the risk of harassment arising and to equip them to manage harassment issues robustly, including utilising the ‘reasonable steps’ defence:
☞ Introduce/review policies on equality/harassment, which set out in clear terms what constitutes acceptable/unacceptable behaviour and the consequences of acting in breach of the policies
☞ Ensure that the practice balances a friendly and open working environment with appropriate professional standards. Regular staff feedback sessions/surveys could provide a means of identifying inappropriate conduct allowing it to be nipped in the bud
☞ Ensure policies on equality/harassment are regularly reviewed and are highlighted to all new staff at the induction stage
☞ Train managers responsible for handling allegations of harassment on the practice’s relevant policies and provide refresher training from time to time
☞ Ensure staff understand that they should raise concerns about harassment (discrimination) and that the practice has a zero tolerance policy
☞ Take legal advice at an early stage to ensure that matters are handled appropriately from the start and a lack of action/the wrong action does not create intractable issues
worker resigned as a result of the harassment – an ET will also make an ‘injury to feeling’ award to compensate for the distress caused by the discrimination.
The current average award for sex discrimination in the ET is £23,478 and injury to feeling awards span a range from £600 to £30,000 depending on the severity of the discrimination.
In a recent case, the ET awarded a 22-year-old zero-hours worker
£19,500 injury to feelings in relation to an eight-month period of sexual harassment by the worker’s manager, which involved asking her about her sex life and, on occasion, touching her, kissing her neck and simulating sexual intercourse with her.
Despite complaining to another manager, nothing was done and when subsequently a formal complaint was raised, the actions of the employer in investigating the complaint were cursory and no action was taken against the harassing manager.
Employers are vicariously liable for the actions of their staff in the course of employment whether or
not the employer knew about/ approved of the conduct.
Conduct carried out in the course of employment would be likely to include not only acts committed in work premises during working hours but also at staff events, whether or not organised by the employer, such as parties and after-work drinks, as well as work-related social media postings.
Employers can defend sexual harassment claims by demonstrating that they have taken reason able steps to prevent discrimination. Examples of steps employers seek to rely on the ‘reasonable steps’ defence are:
Implementing relevant policies and procedures – that is to say, a bullying and harassment policy;
Issuing the procedures to all staff;
Training staff responsible for managing the policy on its application and on equality and diversity matters more generally;
Taking appropriate action in response to allegations of discrimination.
Fiona McLellan is a partner at Hempsons
Damage limitation is the theme in this month’s selection of readers’ questions, answered by Dr Oliver Lord (right)
Independent Practitioner Today has joined forces with leading niche healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes’ of free legal advice.
Advice is available on:
Business structures – Ian Hempseed
Commercial contracts – Faisal Dhalla
Disputes – Hilary King
HR/employment – Fiona McLellan
Premises – Lynne Abbess
QI have just been contacted by a journalist from a local newspaper who is investigating a story from one of my private patients.
He asked me to respond to the allegation that my treatment caused an infection which left the patient in considerable pain and that I was rude and unsympathetic.
I remember this patient was difficult from the outset and the infection was actually caused by his failure to follow my postoperative instructions. I resent having my name dragged through the mud in this way and I’m confident the journalist would drop this if I just told him my side of the story.
Should I give him a comment off the record?
AIt is never advisable to speak to a journalist ‘off the record’. Even if the journalist agrees to an off-the-record discussion, it doesn’t mean he will be receptive to your argument and he may even sense a bigger story if
you are openly critical of the patient.
While your understanding of an ‘off-the-record conversation’ may be that your words are not for publication, be aware that the journalist could easily take a different view.
He may think he can use your words but say that it is from an unnamed source or even decide it is in the public interest to report your comments because they raise questions about your attitude and approach.
He may also go back to the patient and report what you have said – which is likely to result in a bigger story and worsen the situation.
It is best to assume that if you speak to a journalist, then they will record or take down everything you say and will then use it in their story.
With this in mind, it is much better to say as little as possible in order to maintain both your professionalism and your duty of confidentiality to your patient.
You may wish to call the journalist and explain to him that your duty of confidentiality prevents you from commenting on his story. Be polite, keep calm and don’t allow yourself to be provoked into saying more.
The GMC’s confidentiality guidance on responding to press criticism points out that disclosing information without patient consent can undermine public trust in the profession and the patient’s trust in you. Failure to obtain the patient’s consent could lead to a fitness-to-practise investigation.
Of course, it is frustrating not to be able to give your side of the story when there are no such constraints on the patient, but a short-lived, one-sided story in the press is better than being the subject of a patient complaint or GMC investigation, which may thrust you into the media spotlight for much longer.
QA woman attended my dermatology clinic for excision of a lipoma on her thigh because she was concerned about how it would look during her summer beach holiday.
I was able to excise the lipoma without difficulty, but the cavity required a couple of deep,
Some doctors report being concerned that what they say in an apology may be harmful if there is a subsequent complaint or claim. The MDU’s experience is that the opposite tends to be true.
The reasons patients make a complaint or bring a claim are complex, but a culture of openness with a sincere, timely apology may go some way to preventing them or lead to an earlier resolution.
The communication skills required to say sorry are not very different from those you need in any other patient interaction. It will often help to explain what exactly occurred – as fully as you can, bearing in mind that further investigation may be necessary. Once there is context, an apology can naturally flow.
Speak in the first person, just as you would in a natural conversation. ‘I am very sorry that the needle broke’ sounds more sincere and less defensive than ‘the
clinic wishes to express regret that the needle broke’.
You should also think about your body language. Saying the right words but towering over the patient with arms folded may not seem like an apology at all. Make sure you choose a quiet moment to speak to the patient, with open body language and with, perhaps, just one other colleague there.
Finally, think of a meaningful apology as part of a process and be receptive to the patient’s wishes.
For example, she might prefer some time alone after talking with you and you should ensure she can contact you if she has any further worries or concerns.
In some circumstances, you may also decide to reduce or waive fees as a goodwill gesture, but this should never be seen as a substitute for a proper apology.
interrupted sutures in order to close it.
Unfortunately, the needle snapped when placing the second suture. It took about five minutes to locate, as it was deeply embedded in the deeper tissues.
The patient was upset by the additional ‘digging about’ and concerned it would leave a visible scar. I know I should apologise to her, but I’m worried about making things worse.
AIt is always difficult when things don’t go to plan when treating a patient, but an apology is not something that should be feared and can often do more good than harm to your professional relationship with a patient.
Although the patient was upset by the incident, she may understand what happened was an accident and you did your best to put things right and an apology will likely be appreciated and expected. By contrast, if you don’t acknowledge her feelings or empathise, you may risk being seen as aloof or defensive.
It’s important to remember that an apology is not an expression of liability or an implicit acceptance of fault.
• Completely open scanner that is well tolerated by claustrophobic patients
• Weight-bearing scans for spine and joints enable a more precise diagnosis
• Patients who are large or cannot lie down can be accommodated
Dr Oliver Lord is a medico-legal adviser with the Medical Defence Union For more information go online at: www.mri-london.com or call 020 7370 6003 Medserena Upright MRI Centre 114a Cromwell Road, Kensington, London, SW7 4ES
MANY CONSULTANTS will consider treating overseas patients as their practice grows. It makes sense to diversify the business into new areas.
Self-pay and private medical insurance work are the lifeblood of many practices, but the opportunities are many when dealing with overseas patients.
Most of the overseas work will come from embassies – and it might surprise you to know there are 164 based in London.
And most practices that currently deal with embassy patients are also based in London and any consultant or private GP considering overseas work should bear this in mind.
Overseas patients will fly into UK mostly via London airports and will not want to travel across the UK to receive their treatment.
The main embassy patients of UK private medical facilities tend to be based in the Middle-East and the majority come from Kuwait, United Arab Emirates (UAE) and Qatar. To complicate matters further for the specialist, the embassies of Kuwait and UAE are sub-divided into offices.
The UAE has three main offices; Police Liaison Section and Cultural Attaché’s office at 48 Prince’s Gate, South Kensington; a Military Attaché’s office at 6 Queen’s Gate Terrace, South Kensington; and a Medical
Section at 71 Harley Street, Marylebone.
The Kuwait Embassy is at 2 Albert’s Gate, Knightsbridge, and it has a Health Office at 40 Devonshire Street, Marylebone, plus a Military Office at 60A Knightsbridge.
For invoicing purposes, the doctor must treat the offices as separate entities. If you treat a UAE patient sent via its military office, the invoice must go to that office otherwise it may well get misplaced in the wrong office.
Overseas patients will have complex problems and this is one of the main reasons why they travel to the UK for medical treatment.
The patients will normally be
accompanied by an interpreter for consultations. The combination of these factors mean more time will be spent on these patients.
Consultants and private GPs will need to decide on their fees and this should cover any consultations that are conducted such as initial consultations and follow ups. The fees should take into account the extra length of time spent on an overseas patient.
Doctors will also need to decide what the fees will be for any procedures; embassies do recognise Clinical Coding and Schedule Development group (CCSD) codes.
They are also very aware of what private medical insurers reimburse, so bear that in mind.
Once a fee schedule has been
compiled, it is advisable to document it in a letter to the main embassies the practice will deal with. Doing this will avoid misunderstandings in the future.
A letter of guarantee, or LOG as it is more commonly know, is the most important document an independent practitioner will deal with when treating embassy patients.
Without it, the practice will not get paid, so before seeing any patient, a LOG must be obtained from the correct embassy and office. Kuwait Health and Kuwait Military offices issue different LOGs and do accept each other’s. A LOG will ensure that the embassy is aware that one of their
patients will be seeing you and they will pay for the treatment. It will state the doctor’s name, patient details, appointment date and the reason for treatment. It is vital that the independent practitioner checks these details for any inaccuracies however small. If the details are not correct and not rectified, the invoice is unlikely to be paid.
There will be some terms and conditions set out on the LOG that must be followed. They usually consist of time-frames for invoicing and the validity of the LOG in terms of time. Some embassies also require a medical report along with the invoice and LOG.
Once the doctor has invoiced, the embassies will require continually, persistent chasing. This is because the embassies are always busy, particularly the major ones and it is not uncommon for them to have a backlog of invoices waiting to be paid.
A letter of guarantee is the most important document an independent practitioner will deal with when treating embassy patients
The reasons for this vary, but ultimately it is down to the sheer volume of patients that they have to deal with and if not constantly chased, it is likely the invoice will slip down to the bottom of the pile.
If there are issues with the invoice, LOG or medical report, chasing will highlight these a lot sooner than if the doctor waits for payment. Personally visiting embassies is also recommended and on a regular basis.
As mentioned before, many embassies have a backlog, but if the independent practitioner highlights their invoices in person by physically going to the embassy, then payment is invariably quicker.
Consultants and private GPs should also consider suspending seeing any further patients from embassies that do take a long time
If the doctor highlights their invoices in person by physically going to the embassy, then payment is invariably quicker
making payments until the outstanding debt is cleared.
Remember each invoice produced creates a tax liability for the practice and the longer the payment, the more this can cause a cash flow issue.
Therefore, it is very important that any practice considering embassy work has vigorous processes in place to deal with the collection of LOGs and chasing of payments.
The key steps are:
1 Document the fees to the embassies;
2 Always, always obtain a letter of guarantee (LOG);
3 Ensure the LOG is correct in every detail;
4 Issue invoices on time and with the correct LOGs;
5 Chase, chase and chase again.
Gary Nials (left) is the managing director of Medical Billing and Collection
An independent firm offering one to one meetings anywhere in the UK giving advice and help with:
• how to start in private practice
• how to maximise private practice income
• ways to reduce tax payments
• setting up in Chambers/Groups
• limited companies and LLP’s
• financial planning
• record keeping
• computer software
• tax and financial advice re: car purchases
• pensions: NHS, personal and employee schemes
• purchase of consulting rooms and surgeries
• inheritance tax and capital gains tax planning
• VAT
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So you are thinking of passing on your pension to loved ones? Patrick
Convey (right) examines why it may be advantageous to keep your personal pension untouched
THE MERRY-GO-ROUND of the pensions industry continues apace. After countless negative changes in recent years, saving into pensions has become popular again thanks to the so-called freedoms granted by the Chancellor of the Exchequor last April.
At the same time, the pensions death tax was abolished, meaning pensions are also more attractive as an inheritance planning tool. With careful consideration, as well as providing tax benefits on contributions and a flexible income in retirement, pensions can now be used to pass on assets to future generations as part of an overall investment strategy.
Although pensions were exempt from inheritance tax in the majority of cases, they were normally subject to a punitive tax charge –known as the pension death tax –at the rate of 55% if the deceased had started to take income or had taken tax-free cash.
The situation now
Now when someone older than 75 dies, their heirs will pay income tax on any remaining pension at only their marginal rate and no tax charge will apply if they were aged under 75 – subject to them having available Lifetime Allowance remaining.
For example, as a higher-rate tax-paying doctor, you could contribute to a private pension, enjoy
tax relief on the sum and then leave it tax-free to loved ones if you die before 75.
If you die after 75, your beneficiaries can take an income from the fund such as ‘drawdown’ and could be subject to only 20% tax if withdrawn by a basic-rate taxpayer, or zero if your heir is a nontaxpayer and the funds drawn are below the personal tax allowance of £10,600.
Previously, senior doctors may have stripped funds out of their personal pension or self-invested pension (SIPP) in retirement, but this new move will make it much more appealing to keep pension funds invested and to pass these
on to family members in the future. Instead, you could choose to run down other assets such as ISAs first.
Crucially, your heirs can control the level of tax they pay by planning their withdrawals carefully.
And the possibility of passing down accumulated pension wealth does not end after one generation. Your nominated beneficiary can choose their own successor provided their existing pension arrangement allows for drawdown accounts.
Previously, pensions could be left to spouses or dependents. Now
you can nominate a person of your choice, but ensure that you have completed your ‘death benefit nomination’ form or made a will – otherwise your pension provider could end up paying your pension to your estate which could then be subject to inheritance tax.
It is also possible to nominate more than one beneficiary or to skip a generation entirely.
But before deciding to leave your pension for the next generation, remember there can be financial disadvantages for taking pensions in the wrong order and penalties for contributing above set limits.
In April 2016, the Lifetime Allowance (LTA) will be reduced further to just £1m with harsh tax penalties if you contribute above this limit to your pension savings.
If you do face a tax charge after breaching the LTA – a substantial 55% if taken as lump sum – the tax payment method differs depending on whether the charge arose from your private or NHS pension. From your private pension, the tax owed is collected directly from your funds all at once.
However, if you had drawn benefits from your private scheme first and then followed with the NHS pension, your tax charge will be paid by the NHS Pensions
OLD RULES
Pension passed on – Tax free
NEW RULES
Taxed at recipient’s no money yet withdrawn marginal rate
Pension passed on –if tax-free cash 55% tax
Taxed at recipient’s taken or in marginal rate ‘income drawdown’
Agency on your behalf. The money is recovered from your future annual pension income over the course of your remaining lifetime, which is possibly more palatable than losing a large slice of your assets at the start of your retirement.
Remember, though, that paying the charge from your NHS pension does mean you are giving up an index-linked guaranteed pension, so it is important you con-
1. Within member’s lifetime allowance. 2. 45% if drawn as a lump sum in 201516 but recipient’s marginal rate from 201617
sider the pros and cons carefully.
Private pensions can also be accessed earlier than your NHS counterpart, from age 55, so may be your first target if looking to fund a particular project, say paying off the mortgage.
Your number-one priority should be to ensure you have enough assets to fund the type of lifestyle you desire in retirement. Your third age may last two or three decades, so you will not
want to exhaust funds before time nor leave so much to the next generation that you are unable to live fully now.
It is essential to find out which route offers the best outcome for you and your family as part of a long-term retirement strategy.
Patrick Convey is technical director of Cavendish Medical, specialist financial planners helping senior consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
WE ALL know that running a private practice has its ups and downs.
A successful business can falter if there are unexpected variations of internal and external influences.
Unplanned staff changes, local competition or funding issues can all turn a healthy balance sheet increasingly red.
There may come a time when major decisions need to be made to prevent the whole business stalling. A merger or an alternative fund provider may be the
only options available for continued viability.
This scenario is exemplified by the situation that Swedish car manufacturers Volvo and SAAB found themselves in after 2005.
Both manufacturers were owned by large American corporations, Ford and General Motors respectively, who were pulling out of the European arena due to their own problems at home.
Unfortunately, SAAB could not find a long-term buyer, the factory closed and production stopped. Volvo was luckier and in
2009 was bought by Chinese car maker, Geely.
The new owners could have directed Volvo’s future plans with great influence but, with impressive foresight, allowed the Swedish development team to carry on with their home-grown Scandinavian ideas.
School-run favourite
First fruit under this new ownership is a replacement for the 12-year-old, seven-seater favourite of the school run: the four wheel drive XC90. So can this lat-
est large off-roader take the fight to the current premium SUV market led by Land Rover with its Discovery and BMW with its X5 model?
The car is completely new from the ground up and has an advanced lightweight chassis that will form the base for other future Volvo models.
Using all the latest technology, the XC90 is now a much lighter vehicle and this has allowed Volvo to take a brave step in the pursuit of efficiency. It only offers three engine
Volvo’s new owners have come up with the best seven-seat large 4x4 premium SUV on the market, says Dr Tony Rimmer. But for how long?
The whole facia now has a crisp and clean design – very Swedish in character. Materials are higher quality and this Volvo now feels like a premium product and ready to tackle even the Range Rover brand
options and they are all 2.0 litres in size and only have four cylinders.
The D5 twin-turbo diesel is likely to be the biggest seller and produces an impressive 222bhp and can return 49.6mpg. The turbo-charged and super-charged petrol T6 model produces 316bhp and returns 36.7mpg.
Top of the range is the rechargeable plug-in Hybrid T8 which adds an 80bhp electric motor to the petrol T6 engine and can drive up to 25 miles on electric power alone.
Admiring glances
From a styling perspective, the new XC90 is not a pretty car, but it has presence and attracts admiring glances from passers by.
Unique T-shaped LED running lights represent Thor’s hammer –a rather nice Nordic touch – and the square-set front end is both distinctive and handsome.
But the rear is not such a success, although Volvo has managed to reproduce the characteristic shouldered bumper-to-roof taillights of the previous model.
The external appearance may be a bit boxy, but this pays huge dividends when it comes to interior space. Not only is this a full sevenseater but the adult-sized rearmost seats are easier to access than in any of its rivals.
The boot is larger than most hatchbacks with these extra seats occupied and 60% roomier than the old model. With the rearmost seats folded down, the boot becomes cavernous.
Impressively, the second row seats have individual slide and recline function too; a real touch of luxury.
Any of you who own the old XC90 will not recognise the new
modern dashboard layout. The digital display in front of the driver is supported by a huge central touchscreen that controls many functions which used to operated by individual switches and knobs.
Subsequently, the whole facia now has a crisp and clean design – very Swedish in character. Materials are higher quality and this Volvo now feels like a premium product and ready to tackle even the Range Rover brand.
On the road, the modern chassis gives this big SUV great body control and the steering feels more car-like than its rivals. Body roll is also well controlled on the twisty bits, but the ride is a little too firm for my liking.
The optional air suspension would cure this, but it is a £2,150 extra. I had the diesel model on test and any worries about the small engine feeling underpowered disappears quickly, especially when cruising at speed.
Huge leap forward
Although it can be a bit noisy around town, I never felt it was being overworked or was struggling.
The new XC90 is a huge leap forward for the rejuvenated Swedish brand. It is currently the best seven-seat large 4x4 premium SUV on the market and any of you who regularly do the school run and cart the kids and their friends around at weekends would be wise to give it a really close look.
However, Volvo will need to watch its back: Land Rover launches its all-new Discovery in 2016.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Seven-seat hatchback 4x4 SUV
Engine: 2.0 litre four-cylinder twin turbo-diesel Power: 222bhp
Torque: 470Nm
Top speed: 137mph
Acceleration: 0-60mph in 7.6 secs
Overall economy: 49.6mpg
CO2 emissions: 149g/km
On-the-road price: £45,750
ACCOUNTING SYSTEMS come in all shapes and sizes with no onesize-fits-all approach.
But there are some fundamentals that your accounting system must have to prevent financial loss and to avoid to long arm of HM Revenue and Customs. Here I will look at some of the options and requirements of a robust accounting system.
Manual or computerised?
It is rare nowadays to see completely manual accounting records with the use of a written ‘cash book’. But that is not to say that this doesn’t work; after all, it served businesses for decades before computerisation.
The main drawback with manual systems is the lack of information regarding where the business is up to.
For consultants with NHS earnings who are comfortable financially, this may not be an issue. But, for most, they need to know what financial position they are in to budget personally and ensure that they have enough money for the dreaded taxman.
Another drawback can be the inevitable increased accountancy costs for your accountant to trawl through the manual records come the year-end.
Therefore, on the whole, manual systems should be avoided and if you are only armed with a rudimentary understanding of spreadsheets, you can still produce a more useful system than using manual records.
Description;
Amounts – recording gross fee, VAT and net if you are VATregistered.
Using simple filtering tools, you should be able to extract the vast majority of information needed to prepare your business accounts.
It is important to note that, for the vast majority of consultants engaged in private work, you cannot use an accounting system that is simply tracking money received on a ‘cash basis’.
This covers both simple spread sheets right through to bespoke practice management software packages, which have an accounting function built in.
For those with straightforward affairs, a simple spreadsheet should suffice. The minimum key information that needs to be recorded is:
Date work performed;
Patient/client;
Being VAT-registered puts a greater onus on you to keep adequate accounting records.
Welcome to the BVRLA – I’m delighted that you’ve decided to join the trade association that provides a face for the vehicle rental and leasing industry, communicating its messages to customers, the media and government.
Recording when work is performed is an essential feature of the system, allowing your income to be declared on an ‘earnings basis’ rather than ‘cash basis’.
For those that are VAT-registered, you will have a VAT records inspection at some point and HM Revenue and Customs like to see the use of an approved system, otherwise they will perform audit work on the systems to ensure completeness and accuracy.
The BVRLA’s corporate identity, particularly its logo, forms part of that message.
The BVRLA has three categories of membership, each with a logo that members are entitled to use (and, in some situations, are obliged to use). Appropriate use of our logo tells your customers, your suppliers, and the rest of the world that you adhere to the high standards that come with BVRLA membership.
Therefore, the above key information is essential to satisfy the taxation laws.
This brief guide explains how we expect our logos to be displayed – and how they should not be displayed. These are not hard-and-fast rules, and we sometimes depart from them ourselves, but we do expect our members to respect them and to gain our prior approval before using our logo in any way other than described here.
Fee – recording gross fee, VAT and net if you are VAT-registered;
Date received.
The key words from an accountancy perspective are ‘completeness’ and ‘accuracy’ and your system must be able to tick both those boxes.
Unlike the position for most for paying income tax, VAT can be accounted for on ‘cash basis’, as you are acting as a collector of tax for HMRC. Again, your systems must allow the accounting function to produce reports on a ‘cash basis’ and ‘earnings basis’.
If you need a copy of our logo, for use on your printed marketing material, or to go on a page of your website, please contact our communications team, who will be happy to send you an EPS or JPEG version appropriate for your purposes.
On the expenses side, the minimum you will need is:
Date of expense;
There are numerous accountancy packages that are available off the shelf.
If you have any queries about use of the BVRLA logo that are not addressed in this guide, they will also be able to help
Most, however, are designed with general business in mind
Gerry Keaney Chief executive, BVRLA
The most common reason for a consultant being VAT-registered is for performing medico-legal work and if you are in this position, you should ask your accountant to confirm that your systems are adequate.
and therefore will add little value to managing your practice and if you do not have a strong understanding of book-keeping, you can end up in a mess, defeating the purpose of trying to be more efficient.
The more appropriate packages are those that have been written for managing a consultant’s private practice as well as providing a robust accounting function. There are a number on the market and they all offer a comprehensive demonstration before you buy them.
Your secretary may already have experience of using one of these and your accountant should be able to use all of them.
While there is clearly a financial outlay at the start and ongoing fees, these bespoke packages normally pay for themselves in no
time and become an essential tool in managing your private practice.
The key main advantages are that they:
Record income and expenditure in the correct format;
Act as a patient database;
Record patient history and clinical information;
Allow the uploading of pictures for ‘before and after’;
Provide a diary;
Link to the electronic payment systems used by the main medical insurers;
Generate letters and have storage with the system itself;
Have offsite hosting options to allow access for you and your accountant wherever you are;
Include bolt-on modules for other responsibilities – for example, if VAT-registered.
One other point to note is that the costs of purchasing such systems is fully tax-deductible and
therefore the real cost is significantly less.
My advice is to have a demonstration of at least two systems and pick the one that best suits your needs.
Running any business comes with responsibilities to ensure that you comply with a myriad of rules and regulations. This can be daunting, but help is at hand and for those in the correct circumstances, investing in a new system could take your private practice to the next level.
Discuss things with colleagues and your accountant to ensure that you are best placed to get the most from your chosen package.
Next time: New tax year, new structure
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In association with
DO YOU FIND OUR PROFITS FOCUS SERIES USEFUL?
Please let us know if it helps you or not. And if it doesn’t, what other data would you like to see presented?
Email robin@iptoday.co.uk
Consultants
surveyed in our latest unique benchmarking series have achieved a near double-digit profits increase, reports Ray Stanbridge. Additional material from Martin Murray
OF ALL the specialties, ophthalmology seem to be the most volatile in respect of income movements.
Although we have no real concrete evidence, it seems that this has been a function of a switch on/switch off approach to NHS Choose & Book work.
As a result, our income survey here shows further continuing fluctuation.
Our headline figures show that, between 2013 and 2014, there has been a healthy growth of 6% in private practice incomes. They
went up from £117,000 to £124,000.
Costs have shown a more modest increase of about 2% from £51,000, on average, to £52,000.
9% profits rise
As a result taxable profits have on average risen by about 9%, increasing from £66,000 to £72,000.
We talk of averages, but as regular readers know, this is not a statistically valued analysis. Rather it represents a sample of typical consultant ophthalmologists working
Ophthalmologists’ incomes overall have indeed risen. They have benefited from a nice growth in Choose & Book work
around the country in the private sector. Our definition of such individuals includes those who:
Are not in full time private practice;
Have had at least five years’ private practice experience;
Are seriously interested in private practice as a business;
Earn at least £5,000 in the private sector;
Hold either an ‘old style’ or ‘newstyle’ NHS contract;
May or may not be a member of a group or have incorporated.
As we have been finding with other specialties, there are increasing difficulties in trying to provide some consistency in trends.
This is because a number of consultants have incorporated, others have formed groups – which in most cases has a positive upward influence on incomes – while others have increasingly chosen to take on Choose & Book work.
As a result, their per unit incomes fell, but their costs – such as indemnity cover and room hire
– may have fallen even faster.
Changes in the way consultants conduct their businesses and the market operations have seriously distorted results, and our efforts to make adjustments for ‘normalisation’ are increasingly difficult.
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)
Source: Stanbridge Associates Ltd. Additional information: Sandison Easson and Co
An easy to use software system, which fully supports the clinician and office staff and makes the whole process of running a busy Practice a lot easier. Call now for a chat and ask about a free, no obligation demonstration of our comprehensive system that has been designed to save your Practice time and money.
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Use
Ophthalmologists’ incomes overall have, however, indeed risen. They have benefited from a nice growth in Choose & Book work. And it also appears that, despite a flat private medical insurance market in 201314 there has been some growth in higher margin selfpay work.
What has happened to costs? As might be expected, these are more stable than incomes. Staff costs have continued to rise, reflecting a slightly more buoyant appearance in the medical labour market – but more probably continuing
growth in the personal tax free allowance that has encouraged similar rise in ‘family’ wages. Surprisingly, consulting room hire costs have shown no growth. We might have expected this, given that the Competition and Markets Authority was, for the year in question, already hinting that ‘market rate’ costings was to be one of its recommendations.
Professional indemnity costs remained fairly constant over the year. We are aware that some doc
tors are moving to new providers.
By 201314, these new indemnity companies had started to challenge the traditional professional insurers by effecting better tailored – and cheaper – products to those deemed to be low risk.
‘Other costs’ showed some growth. As previously reported, these related primarily to marketing and promotion costs. Younger consultants, particularly, are looking to marketing to increase their businesses. In some cases, we have seen these have been shown to have worked really well.
We reported in 2014 that ‘marketing and promotion was the key to success for ophthalmologists in private practice’. We also commented that NHS contract business provided opportunities.
In this respect, nothing has really changed and our view is generally optimistic.
Insurers’ provisions will probably continue, but at some time, as in the US, this pressure may be reduced. This is when insurers realise that consultants are, in fact, an important element of the supply chain of private medical services.
Next issue: Gynaecologists
Ray Stanbridge runs an accountancy, finance and tax advisory service specialising in the medical profession. Martin Murray is a partner at Sandison Easson and Co, specialist medical accountants
Make sure you don’t miss our next issue, published on 18 February 2016. Only subscribers to the journal are guaranteed to receive every copy and we don’t think anybody who is serious about continuing private practice in the future, when there is so much happening that will affect them, can afford to miss any issue.
Coming up next month:
Don’t miss our free Product Guide 2016 showcasing a selection of goods and services available for independent practitioners
Ways to improve the customer service side of private practice
HCA opens at The Shard
Accountant Susan Hutter looks at the business ideas that are coming to the fore in the medical profession and the best way to structure the practice to take advantage of what is on offer
Pitfalls in private practice – the seven medicolegal sins, examining common areas where independent practitioners can run into problems
A surgeon shares his tips for making your website work better for you
EDITORIAL INQUIRIES
Doctor on the Road – our tester Dr Tony Rimmer gets behind the wheel of the Audi Q7
Our unique benchmarking series Profits Focus looks at the income, expenses and profits of gynaecologists
Medical Billing and Collection’s flow chart will help you get to that pot of gold
The effective and efficient clinical negligence expert witness – our serialisation continues with advice on the microstructure of a report
Starting a private practice: New tax year, new structure
Business Dilemmas answers some ethical conumdrums
Topical legal advice for independent practitioners
For most business owners, social media is confusing and daunting.
Pamela Underdown explains what areas doctors breaking into the aesthetic business should be focusing on
A better way of gifting – useful ways of passing on wealth to loved ones throughout the year
Plus all the latest news and views
ADVERTISERS: The deadline for booking advertising for our February 2016 issue falls on 22 January
Robin Stride, editorial director
Email: robin@ip-today.co.uk
Tel: 07909 997340
ADVERTISING INQUIRIES
Margaret Floate, advertising manager
Published by The Independent Practitioner Ltd. Independent Practitioner
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