The application of science Jane Braithwaite presents her top ten most helpful apps for doctors P16
A happy and prosperous 2017 to all our readers
How you can win at the managing game
Using management accounts can track performance and aid decision-making P22
Draw up a rosy future for your family
Why it’s important for grandparents to ‘talk money’ with family P38
By Robin Stride
The Independent Doctors Federation (IDF) has announced ambitious New Year plans to beef up services to members and become a stronger voice in 2017.
It has revealed plans to better represent independent practitioners by taking a more proactive approach and relationship with the many stakeholders, such as insurers, who influence private medical practice.
At the same time, it has announced plans to boost its membership of private consultants and GPs from the current level of around 1,200 doctors.
The IDF told Independent Practitioner Today it wanted to now ‘harness the strength’ of new doctor entrants to the independent sector and develop the range of services it could offer them.
It will also return to the traditional heart of private practice by relocating its offices from The Strand to the Harley Street area in London in April 2017 – and it is
promising space to hold many more meetings locally.
The package follows the appointment last Spring of independent medical business expert Sue Smith as interim chief executive. She has now been given the substantive role of chief executive.
In the last few months, she has been running a review of the strategy and operational background the IDF.
organisation’s administrative team.
She added: ‘But key to the future is to implement an active recruitment programme to harness the strength of new doctor entrants to the independent sector and develop the services that can be offered.
She said: ‘There are a variety of tasks and activities to plan and implement during 2017, all of which are key to strengthening the voice of the membership and the role of the IDF in the independent healthcare sector.’
Ms Smith said IDF members should benefit from improvements being made to the IT infrastructure. These would give the organisation a more dynamic website as a tool for both members and the
‘This includes a more proactive approach to and relationship with the many stakeholders that influence private medical practice, such as the private medical insurers.’
IDF leaders say they want communication with their members, and the body’s corporate sponsors, to be more regular and effective in future. The first newly revived e newsletter was published in December and the website is carrying more news.
Ms Smith said a recurring theme during her review was that in order to be a voice and to be heard, there needed to be sustained and appro
priate feedback on issues affecting the membership.
She said: ‘Messaging is a twoway process, so I look forward to receiving regular feedback from the membership as we strive to become the respected voice representing doctors in the independent sector.’
One worry for the IDF has been a fall in the proportion of younger doctors: those aged under 50 dropped from 28% to 26% last year.
IDF president and council chairman, private GP Dr Peter KingLewis, told the last annual meeting that the federation needed more young members if it was to be taken seriously ‘by those seeking to carve out the future of private practice: the hospital groups and the private medical insurers’.
The IDF will also be keen to expand its membership presence outside the capital. Only 36% of the members are outside London. It has reported encouraging talks with insurers in recent months.
Read Sue Smith in next month’s Independent Practitioner Today
Independent practitioners are being advised to get in financial shape before the end of the tax year – or risk losing money.
And accountants are also reminding busy doctors to beware of leaving paying the tax they owe, and filing online tax returns, to the last minute.
Those missing the 31 January midnight deadline will be fined £100 but for many doctors the cost could be far more if their behaviour triggers a tax investigation.
Accountants told Independent Practitioner Today many doctors still miss opportunities to maximise their taxfree allowances before the tax yearend of 5 April, often due to heavy workloads.
Pension contributions, tax free
ISAs, junior ISAs, investments, inheritance tax, trading structures, disposal of assets and buying equipment now rather than later should all be discussed with specialist medical accountants and financial advisers.
See our round-up on page 44
employed or selfemployed and independent?
the a to Z of health insurance insurance policies and insurers’ rules are demystified by a senior bupa manager P12 trends in the private market a look at notable private market trends of 2016 and how they might play in 2017 P18 give patients a nice ambience How nHS private patient units must prove they are the best of both worlds P30 missions of mercy a doctor who volunteered on a floating hospital narrates his experience P32 employing doctors our legal briefing advises on new legal pitfalls involved in employing doctors P36 caught in a tug of love answers to an ethical dilemma on being trapped between estranged parents P42
Social media has brought many advantages for private doctors’ promoting their businesses –but potential problems too.
One growing worry is the ease with which patients who want more than a professional relationship can now contact their private consultant or GP.
Doctors have been subject to amorous advances via social media and in some cases stalked, harassed and even referred to the GMC by patients alleging a fabricated sexual relationship or assault.
So it is good to see the issue being highlighted by the MDU. It has helped 100 doctors in the
last five years deal with patients making romantic advances.
Undesired attention can range from unwanted gifts, messages and friend requests on social media, to patients turning up at your work or home.
Advice is to involve your defence body as soon as you know of a potential problem, log all inappropriate patient contacts, and politely refuse a gift.
Also review your social media privacy settings, avoid personal email addresses or mobile numbers for work purposes and withhold your number if you have to use a personal phone to contact a patient.
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 have been warned of a new ‘pension hit’ facing many of them later this year following the Chancellor’s Autumn Statement.
The annual amount they can save into a pension after having already drawn benefits is being cut in a bid to stop savers enjoying ‘double tax relief’.
Doctors’ financial advisers said the move, announced by Philip Hammond in his first public test as head of the Treasury, would affect thousands of savers aged 55 or over who have taken advantage of the new ‘pension freedoms’ which came into force in 2015.
The annual allowance – the amount which can be paid into a pension without triggering a tax charge – is currently £40,000 for most people.
For those who have already accessed their pension savings flexibly, the amount that can be paid into pensions annually is currently £10,000. But this limit will now fall to just £4,000 from April 2017 – subject to a Government consultation.
Patrick Convey, technical director at specialist financial planners Cavendish Medical, said: ‘The good news is that despite speculation to the contrary, the Chancellor did not announce changes to the already muchreduced lifetime allowance and standard annual allowance.
‘However, now the Government is keen to crack down on double tax relief being gained by those drawing benefits and then reinvesting the funds in another pension, so it has reduced the money purchase annual allowance.
‘If you have already taken some money out of your private pension, you should consider the
timing and suitability of other planned contributions before April.’
The Chancellor also pledged to tighten the ‘salary sacrifice’ rules that allow employees to forgo part of their salary in return for certain work benefits.
This could affect independent practitioners who take noncash benefits from their own limited companies.
In order to ‘promote fairness’, the tax and National Insurance breaks available for benefits such as gym memberships, mobile phone contracts and private medical insurance contributions will be stopped from 2017.
Pension arrangements and childcare vouchers will be protected, but, from 2021, salary sacrifice schemes relating to some company cars and school fees will also be eliminated.
Doctors who are buy to let investors could be hit again as Mr Hammond announced that letting agents’ fees which are currently paid by tenants will be removed. These fees could be passed on to landlords.
In more positive news, the income tax threshold will be increased to £11,500 from £11,000 from April. The higher rate income tax threshold will rise to £50,000 by the end of the current parliament in 202021.
tell US yoUr Story
Share your experience of what has and has not worked in your private practice. even if it’s bad news, let us know and we can spread the word to prevent other independent practitioners falling into the same pitfalls. contact editorial director robin Stride at robin@ip-today.co.uk or phone him on 07909 997340
By robin Stride
The Chancellor’s plans to slap yet another increase on the tax people pay for their private medical insurance has been greeted with horror across the independent sector. All agree the insurance premium tax rise from 10% to 12% from June 2017 will ultimately hit private doctors in the pocket. It is the third increase in the tax in just 15 months.
Independent Doctors Federation (IDF) specialists committee chairman Dr Brian O’Connor said: ‘Health insurance is discretionary. This added premium tax will have a major impact. The total insurance bill for a family will increase, reducing available funds for health insurance.
‘Families will either opt out of insurance altogether or, alternatively, opt for cheaper policies with limited and frequently inadequate cover.’
He told Independent Practitioner Today : ‘This is a short sighted move by the Government who ought to be encouraging greater uptake of private medical insurance when the NHS is so stretched.
‘Surely it is not too radical for a government with a safe majority to provide incentives rather than erect barriers for the uptake of health insurance policies?’
Association of Medical Insurance Intermediaries (AMII) chairman Stuart Scullion said: ‘As an industry, we know these increases in insurance premium tax will push consumers away from the private
The Government should support, not penalise, people with private medical insurance because they relieve the burden on a struggling NHS, according to an insurance boss.
Bupa Insurance chief executive Alex Perry warned that the latest rise in insurance premium tax ‘makes no sense’.
He said: ‘The Government has announced three rises in less than two years on what is a completely misguided tax when it comes to health insurance.
‘It punishes those who take responsibility for protecting their health. Health insurance should be zero rated like it is in many other countries and like life or critical illness insurance in the UK.’
The Chancellor’s Autumn Statement bid to hit private patients yet again came despite new Bupa UK research showing that 58% of people believe health insurance should be taxfree just like life or critical illness cover.
As many as 57% of people agreed with the statement that ‘people who pay for health insurance are being punished by Government for looking after themselves’, with a quarter (24%) strongly agreeing.
Bupa said 50% of the general public thought it is unfair that people choosing to pay for health insurance are taxed on top of the taxes they pay to fund the NHS.
The October 2016 research found that 70% of people believe those paying for private healthcare are relieving pressure on the NHS.
Richard Norris, Bupa’s director of consumer sales, claimed it made no sense that health insurance was taxed, but life insurance was not.
He argued: ‘People choosing to protect their health on a daytoday basis should be treated the same as those who plan to protect in the event of death. Both are about health and both are important.
‘There’s also the important argu
healthcare sector and simply add further strain on the NHS.
‘I believe, in making this decision, the Government is thinking purely of generating revenue in one area and not considering the wider implications, particularly for the NHS and health sector.’
He said Chancellor Philip Hammond’s suggestion that the tax was a taxation on the insurer and not the insured customer was ‘naïve at best’.
Mr Scullion added that health insurance was exempt from insurance premium tax throughout much of the EU.
Before the Chancellor’s announcement in the Autumn Statement, he met with MP Craig Tracey, chairman of the All Party Parliamentary Group on Financial Services and
ment that health insurance is helping to take pressure off the NHS, and that this is a choice which Government should support, rather than punish through a tax which has risen twice in the past year.’
Price is the main reason people say they do not take out health insurance, with 58% believing it is too expensive.
Bupa research last October showed that 52% said that NHS rationing would prompt them to consider purchasing health insurance. Of those already with health insurance, 55% said a further increase in taxation would make them think twice about continuing their cover.
Insurance, to express concerns about the two previous increases in the tax.
The AMII chairman asked the MP to forward the industry’s concerns to the Chancellor directly and hopes he will chair a new intermediary roundtable meeting to discuss the issue further.
Mr Scullion urged everyone in the industry to come together. He said: ‘I do think we are an easy target and we need to work in partnership and start lobbying now.
‘My fear is the Treasury has an agenda to equalise insurance premium tax at the same level as VAT as soon as possible without giving due consideration to the wider implications for the healthcare sector as a whole.’
See page 6
Would be and new private doctors were shocked at a seminar to hear just how tough market conditions are for many in private practice.
Organiser Keith Pollard, of Intuition Communication Ltd, reflected: ‘I think the message was an eyeopener for them. The feeling was that it was a lot harder to build up an independent practitioner business than they realised.’
He warned 70 doctors of various specialties: ‘The private healthcare sector has become far more competitive over the last five years.
‘The market has changed significantly. In essence, supply exceeds demand. That means consultants have to work harder and smarter to build their private practice. It’s no longer good enough to just tell people you’re great at what you do.’
Another speaker at the London meeting, Bupa UK’s medical director for health insurance Dr Steve Iley, said: ‘The PMI market is going down, and it will continue to go down. Let’s not kid ourselves, the UK health insurance market is smaller than it was in 1995.’
Dermatology practice The Skin Care® Network has opened a new clinic at 204 Fulham Road in central London to cater for a growing demand for its services.
The business was founded in 2010 by consultant surgical dermatologist Dr Howard Stevens, who has had a distinguished career in the NHS, where he led many innovations in the provision of skin cancer care.
The Skin Care® Network now provides screening, diagnosis and treatment of all skin conditions for both adults and children at its two centres in central and north London, and also at a number of independent hospitals in the capital.
With eight senior consultants and a team of specialist dermatology nurses the network has an international reputation, in particular as a worldclass centre for screening and for the treatment of skin cancers.
Dr Howard Stevens:
‘Our recent expansion in Chelsea was brought about in order to meet increasing demand from patients’
It also provides a range of advanced cosmetic treatments, often after medical and surgical treatments, but told Independent Practitioner Today : ‘Unlike some other organisations, we do not employ “beauticians” and the like.’
Dr Stevens said: ‘Our doctors and nurses are well aware that patients can be anxious, having suspected a problem, and the practice has a policy of ensuring fast access to senior consultants at the two main centres in Barnet, and now in the Fulham Road in Chelsea.
‘Our recent expansion in Chelsea was brought about in order to meet increasing demand from patients.’
The Skin Care® Network was the first dermatology practice in London to have the benefit of high level multidisciplinary teams to review treatment programmes of more complex skin cancer cases and other conditions, ensuring that patients receive the benefits of the very latest care techniques.
Skin Care® Network said it was
often the first practice in the country to install the latest equipment.
An example was the installation of the first Vivascope confocal microscope which can allow dermatologists to immediately identify abnormal cells or mature cancer cells under the skin without the need for cutting out samples, which then have to be sent away for examination, sometimes resulting in patients waiting anxiously for days for the results.
Dr Stevens said: ‘What this new technology does is to provide a fast diagnosis, reduce the number of unnecessary biopsies and we can monitor a suspect area of the skin – painlessly and non invasively – over long periods.
‘It can provide a diagnosis where there have been uncertainties before and it can help to monitor treatments and also show us when treated skin has returned to normal.’
Doctors have been reminded by a defence body to adopt a patientcentric approach to the consenting process.
Recent Royal College of Surgeons’ guidance states that doctors must focus on the specific needs of the patient by explaining treatment options and taking reasonable steps to ensure they are aware of all material risks.
This follows on from last year’s landmark ruling in the Supreme Court case of Montgomery v Lanarkshire Health Board, which crystallised the law in relation to informed consent and more specifically issues around the amount of information a patient is entitled to receive before making a decision.
MDDUS medical adviser Dr Naeem Nazem said: ‘In our experience, the vast majority of doctors already work in partnership with patients and fully involve them in the decision making process about their care.
‘After all, obtaining informed and valid consent from patients for any planned investigation or treatment is a fundamental principle of medicine, recognising the importance of patient autonomy. However, doctors should be mindful of a recent shift towards the consenting process becoming more patientspecific and tailored to the needs of each individual.’
Whereas past court judgments in the UK have tended to rely on a ‘professional standard’, there has been a move to adopt a ‘reasonable patient standard’, with the medical profession no longer solely responsible for determining which risks are material.
The MDDUS said the Montgomery case is important to all doctors involved in consent discussions with patients, as it sets out what is expected in terms of information disclosure.
Dr Nazem said: ‘Crucially, what a patient regards as significant
may not accord with their doctor’s view. Therefore, a doctor is unable to determine, unilaterally, what is reasonable to disclose to their patient.
‘Instead, doctors should seek to make a sharedcare decision with their patients, discussing every relevant issue for that individual patient.’
The defence body said it had encountered cases where there was a failure to effectively communicate the risks and benefits of a procedure to the patient. It had also noted cases arising from a lack of detailed discussion between doctors and their patients regarding alternative treatment options and potential outcomes.
Dr Nazem warned that this lack of communication and failure to involve the patient in choices regarding their care could result in a communication breakdown and ultimately erode the doctorpatient relationship.
‘As part of the consenting process, patients should be given sufficient information regarding diagnosis, prognosis, need for the procedure, potential material risks and benefits, likelihood of success and potential followup treatment as well as the alternative treatment options – including doing nothing.
‘There are, of course, some exceptions, such as providing lifesustaining treatment in an emergency.’
Consent: patients and doctors making decisions together states that doctors should ‘share with patients the information they want or need in order to make decisions’ and ‘maximise patients’ opportunities, and their ability, to make decisions for themselves’.
Janene Madden (above), new boss of London Bridge Hospital with effect from 1 January following seven years as head of The Portland Hospital, has forecasted an exciting year ahead.
She said: ‘As the campus develops, my aim is to build on London Bridge Hospital’s reputation as a centre for medical excellence across a full range of specialties.’
Ms Madden also thanked her colleagues and the consultants she had worked with who made The Portland ‘the world class, patientcentred hospital that it is’.
Under her leadership, the hospital developed plans to double the size of its children’s facility, already the largest in the UK. In February 2015, planning permission was granted for a £20m expansion.
She also supported some of the UK’s leading consultants to bring the latest life improving treatments to The Portland, putting it at the forefront of new medicine – the hospital was the first in the private sector to perform a selective dorsal rhizotomy.
Aida Yousefi has taken on the role of interim chief executive of The Portland Hospital alongside her role as head of The Harley Street Clinic.
By Robin Stride
Two big developments in 2017 should bring greater transparency to the private healthcare sector, according to the chief executive of the independent hospitals trade body.
Fiona Booth, of the Association of Independent Healthcare Organisations (AIHO), said hospitals knew there was more the sector could do to address concerns around transparency.
She promised AIHO would be working hard to get this right ‘in order to better inform the decisionmaking process for patients’.
Ms Booth told guests at an AIHO reception in London she believed the sector would soon have greater confidence to talk about the positive contribution it made to the UK’s healthcare economy.
This would result from the Private Healthcare Information Network’s (PHIN) publication of performance data that was, for the first time, comparable to the NHS.
Also in 2017, she said all independent acute hospitals will have been inspected by the Care Quality Commission (CQC) with aligned performance indicators and to the same reporting standards as trusts.
Ms Booth said she believed the independent sector was ‘full of good news’.
She added: ‘Our sector is also hugely innovative and we have so much to share in terms of experience and expertise not just in terms of developing treatments, but in finding new and efficient ways of working that make best use of resource.’
Ms Booth said AIHO would continue to keep members informed of the wideranging implications for independent healthcare providers arising from the UK’s leaving the EU.
Read the patients’ view, page 8
Healthcode has refreshed all three elements of its ePractice suite –ePractice biller, ePractice biller Plus and ePractice manager – to improve the navigation, search functions and overall intuitiveness.
The company has also enhanced its ePractice App so users can carry out essential management tasks securely when out of the practice.
These include adding and updating patient details, sending e bills to insurers, viewing outstanding balances and upcoming appointments, and looking up clinical codes.
The latest App for iPad version has been developed in native iOS,
so controls and navigation have a familiar user interface for Apple users.
Managing director Peter Connor said the system redesign made it quicker and easier to manage transactions and allocate insurers’ payments covering several invoices.
He said: ‘Features such as the quick menu enable users to switch to another function from anywhere in the system, while a quick search function allows users to
Consultant radiologist Dr Tony Lopez, chief executive of Incorporated Health Ltd, has led 12 consultant oncologists to raise a large slice of the £2.77m needed to buy a fixed facility PET CT scanner at BMI Mount Alvernia Hospital, Guildford, Surrey.
The scanner, the first in a private
UK hospital outside London, will be installed by the end of July 2017.
Dr Lopez said: ‘It is very exciting and shows what doctors can do collectively with an independent business partner in the private sector.’
His company, formerly The Imaging Clinic Ltd, works in part
nership with consultants to raise capital to install diagnostic imaging, endoscopy and other equipment into private network hospitals and clinics.
BMI and consultants paid 35% each of the Guildford project cost with Dr Lopez’s company paying the remainder.
look up patients, invoices or available appointment slots and apply filters to the results.
‘It means consultants can speed through routine admin tasks and devote more time to their patients.’
Proton Partners International will launch a major genomics programme following the opening of its cancer treatment centres.
It has signed a ten-year lease to establish a research centre at the Life Sciences Accelerator building in Liverpool, due to open in 2017.
The building is the first part of a ‘health campus’ which is set to surround the £335m new Royal Liverpool Hospital.
Proton said the programme would collate, analyse and distribute data from its treatment centres which will support its broader research work with the University of Liverpool’s physics department.
The company’s first proton beam therapy centre – and the first to be built in the UK – is under construction at Newport, Wales, and will be offering proton beam therapy treatment. A second centre in Northumberland is also
Claremont Hospital and Sheffield Orthopaedics Ltd’s foot and ankle surgeon Mr Chris Blundell (right) has been elected as the new president of the British Orthopaedic Foot and Ankle Society.
He said: ‘Some of our key aims are to encourage interest in foot and ankle surgery among orthopaedic surgeons, support basic science and clinical research into foot and ankle surgery and build links with foot and ankle surgeons in other countries to share best practice and new surgical advances.’
Beaming smiles: Prof Karol Sikora, Dr Steven Powell and Mike Moran at Liverpool’s Life Sciences Accelerator Building
under construction and another is being built at Reading, Berkshire.
Dr Steven Powell, director of Liverpool Life Sciences Accelerator, said: ‘The Liverpool Life Sciences Accelerator brings the latest medical innovators to the
city of Liverpool so that our patient population can benefit from their expertise.
‘Proton Partners International is one of our first tenants and is set to make a big impact in healthcare.
‘This data will not only be useful for our purposes but we hope to share it with our clinical partners.’
Prof Karol Sikora, the company’s medical director, said: ‘The future of cancer treatment is about personalisation. Understanding the differences between cancer and normal cells in an individual increasingly requires detailed genomic knowledge.
‘Together with advanced imaging technology, this will help to decide the best possible way of delivering radiotherapy as well as chemotherapy.
‘Optimising cancer treatment will require the in-depth study of large data sets from a huge number of patients,’ Prof Sikora added.
Bupa has agreed to acquire the UK’s leading private dental provider, Oasis Dental Care, from Bridgepoint, the European private equity group, in a £835m deal.
The insurer said the move was a significant milestone in its strategy to offer customers high-quality dental services.
Bupa will become a major dental provider in the UK’s £7.1bn
opinion By STuART SCuLLION, chairman, Association of Medical Insurance Intermediaries (AMII)
dental market, with more than 2m customers, over 1,800 clinicians and 420 clinics.
Bupa UK managing director David Hynam said: ‘There’s strong customer demand for high-quality, value-for-money dental services that are convenient and easy to use.’
The transaction is subject to regulatory approvals.
I HAv E PRE v IOUSLy described the increases in insurance premium tax as being an illconceived and ill-thoughtthrough levy in part driven by the previous Chancellor’s desire to deliver a balanced fiscal policy. But at what increased patient numbers and cost to the NHS?
so, as it has a direct impact on the NHS.
Where consumers want to participate in private care, and have the financial means, we should be encouraging them to do
There are currently around 10.6% of the UK population insured and using private healthcare services. It could be significantly more.
In my own business, the single biggest factor affecting cancellation of policies is cost, particularly among older consumers.
At a time when they have the greatest propensity to claim and
for treatments which typically incur the greatest cost, we are driving them back into the NHS.
We need to think differently. Instead of increasing insurance premium tax, we should remove it from healthcare products much as they do in many states in the EU.
Instead of driving people back into the overstretched services of the NHS, we should reintroduce tax relief on consumer premiums to encourage those willing and able to do so to buy health insur-
ance products and services, which will reduce the drain on the NHS. This could be achieved in a number of different ways. But my message is loud and clear: there must be greater co-operation and cohesion between the public and private sectors. We need joined-up thinking.
Taken from his address to the AMII Health and Wellbeing Summit in London on the same day the Chancellor announ ced the latest insurance premium tax rise
By a staff reporter
An accountant who hijacked doctors’ and nurses’ identities in a £40,000 tax fraud has been jailed.
Sharjeel Iqbal, aged 29, of Lakelands Drive, Bolton, used his position as an NHS finance worker to hijack the identities of 59 carefully selected cardiologists, midwives, nurses and other NHS staff who were genuinely due tax refunds.
He submitted claims without their knowledge and diverted the money to his own bank accounts.
Sandra Smith, assistant director at HM Revenue and Customs (HMRC) Fraud Investigation Service said: ‘This was a well-organised, professional attempt to manipulate the UK tax system for personal gain. As an accountant, Iqbal was in a position of trust and well aware that he was breaking the law.
Lead consultant Dr Hany Elmadbouh demonstrates his open MRI scanner
A new consultant-led private group practice in Peterborough, Cambridgeshire, says it has recruited 35 consultants to join its team.
Patients at the Avicenna Clinic are being offered a range of specialties such as general surgery, diagnostics and testing and spinal care.
Dr Hany Elmadbouh, lead consultant and radiologist, said: ‘It is an exciting time in private health care and I am delighted and encouraged with the response the consultants have shown.
‘The clinic will be a centre of excellence, specialising in minimally invasive surgery, imaging and image-guided intervention techniques.’
Avicenna Clinic will also offer the first Hitachi Open MRI facility in East Anglia which is useful for patients who suffer from claustrophobia or obesity.
This allows patients to benefit from MRI scanning technology in an open layout without experiencing unnecessary anxiety or physical discomfort associated with the more usual enclosed imaging systems, which typically have a tunnel-like scanning area.
The North Street clinic plans a launch event for key people in the local healthcare community.
‘He stole personal data, forged signatures on tax repayment documents, submitted false claims and paid the refunds into his own bank accounts.’
Mr Iqbal attempted to claim £40,277 in faked self-assessment repayments on behalf of nonexistent clients between 2012 and 2013.
But HMRC withheld £14,308 when it detected suspicious activity linked to his accountancy busi-
ness and some of the hijacked identities.
He was jailed for 21 months in November 2016 after pleading guilty at a previous court hearing.
HMRC said Mr Iqbal is a qualified self-employed accountant and the director of his own accountancy practices during the fraud: R T Roberts & Co Ltd, TNC Associates Ltd, which then became ATT Associates trading from premises on St Helens Road, Bolton.
The first independent healthcare acute hospital to be rated ‘outstanding’ overall by the Care Quality Commission (CQC) is Nuffield Health Cambridge Hospital.
The healthcare watchdog’s chief inspector of hospitals, Prof Sir Mike Richards, said management and staff should be proud of their work.
‘Our inspectors found dedicated and caring teams who were skilled and well trained.
‘The hospital used innovative methods of engaging with patients and we were particularly impressed with how it helped to reduce anxiety in young children who were due to undergo surgery.
‘Feedback about care and treatment at the hospital was consistently positive and people were at the heart of this service. We found a number of areas of outstanding practice.’
The hospital offers a range of clinical services including orthopaedics, oncology, urology, gynaecology and ear, nose and throat (ENT), general surgery and a service for children and young people.
Inspectors said outstanding practice included:
The way the hospital leadership team led the service and continu-
ally strived to improve the service for patients.
An innovative approach to reduce anxiety in younger children with a small electric car, which was used for transferring younger patients from and to operating theatre.
Systems and processes to ensure patients’ individual needs were met. This included an initiative to support patients following treatment with a 12-week integrated cancer rehabilitation programme.
Patient care was ‘at the heart of the service’ and there was an emphasis on supporting people emotionally and socially with an on-site charity.
Feedback about the service was overwhelmingly positive with people describing their care as ‘amazing’ and ‘first-class’.
Areas where the CQC believed the provider should consider making improvements included:
Considering auditing the effectiveness of pain relief;
Ensuring bank staff and service staff were up to date with basic or intermediate life support training, and;
Ensuring there was a formal transition arrangement for patients who require end-of-life or palliative care pathway to be transitioned back into NHS care.
By Charles King
senior doctors have been warned time is running out to take advantage of a little-known Government scheme to help retirees top up their state pension.
c ertain qualifying savers can now boost their retirement income by buying extra state pension with an up-front payment.
s ome 1.7m people reaching state pension age in the next ten years will not receive their full state pension because they have gaps in their national insurance record. to claim the new flat-rate pension of £155.65 a week, an individual must hold 35 years’ worth of n ational i nsurance contributions (nics).
now there is a one-off chance to buy an extra portion of pension between £1 and £25 more a week.
this is guaranteed income for life and is protected against inflation. also, in most cases, a spouse or civil partner can receive between 50-100% of the extra pension after the saver’s death. to apply, the saver must have reached state pension age before 6 april this year.
d espite official predictions showing around 265,000 people could take advantage of the option, only 4,000 savers have signed up in the first six months of the scheme. applications must be received by 5 april 2017.
Patrick convey, technical director at specialist financial planners c avendish Medical, explained: ‘Many people who paid into a good workplace pension – such as doctors – were previously contracted out of serPs
‘ d ue to this, they now face a reduced state pension compared
t he body representing private patients has backed competition and Markets a uth ority ( c M a ) moves for greater transparency of fees and hospital charges.
But the Private Patients’ Forum (PPF) said it did not support a proposal to provide patients with a list of insurers who recognise a consultant.
i t said this could infer that insurers’ approval had some significance in judging outcome performance.
in a submission to the cMa, the PPF claimed that insurers had largely adopted a policy of limiting the patient’s choice of consultant and/or hospital.
this, it said, forced doctors into uniform pricing set by the insurers or removed some consultants as options available to the patient. it believed patients might also receive treatment from less experienced or less specialist consultants as a result.
the forum told the cMa it proposed that insurers should be required to publish, or at least tell the insured patient, what they would pay for any procedure.
i t continued: ‘ t he patient can then decide whether to face additional costs – called ‘shortfalls’ – or accept only those consultant/hospital packages that would be funded under the insurance they have.
‘Were such a stratagem to be adopted, it might also resolve the market into a more open and more equitable one in which the self-pay patient does not pay more than the hospital/consultant receives for the insured patient.’
t he PPF said insured patients would see ‘self-pay packages’ detailing total cost for private treatment and make a decision on which to accept by reviewing the P hin data on outcomes against the price and what their insurer would pay.
Patrick Convey: ‘Few people seem to be aware of this option’
to the new maximum. it may well be worth considering topping up by taking advantage of the new rules.’
the Government has now created a new class of voluntary national insurance contributions called class 3a depending on how much extra pension you require, it may cost anything from as little as £127 up to around £23,000 to buy the pension top-up.
Mr convey continued: ‘the cost decreases as you get older, so the
longer you live, the better value the deal represents. Few people seem to be aware of this option –even other financial planners –perhaps because the class 3a title is confusing in the already complex world of pensions.
‘ i f you are of the right age to apply, you could stand to benefit from paying out a lump sum now in order to receive guaranteed index-linked payments for life, but it does depend very much on your own individual circumstances.
‘You should remember that a state pension top-up is taxable as income, which will be an important consideration. For some, isas can prove to be a better bet or you may choose to defer your state pension.’
to apply, men must be born before 6 a pril 1951 and women born before 6 april 1953.
t he Private h ealthcare i nformation network (Phin) has warned hospitals that data completeness and quality must improve rapidly. its annual report revealed data was ‘far from perfect with much work required on completeness, validity and accuracy’.
Phin said: ‘no organisation has yet submitted data of sufficient completeness and quality to sup-
port publication for patients with confidence. notably, no organisation has yet submitted usable data on measures of improvement in health outcome (P r OMs). t his must improve before april 2017.’ P hin urged hospitals to fully engage consultants in checking and improving data, ‘at the same time reassuring them that the data will be fair and accurate’.
an economist has warned private doctor investors that inflation is on its way.
nick Beecroft, founder and chief executive of hP economics, told a cavendish Medical evening seminar in London he thought 5% was a possibility in ten years’ time. asked if doctors should be more or less worried about their private pension due to Brexit and donald trump’s election, he said these
factors drove uncertainty in the markets.
t here would be volatility for one or two years, but ultimately Us growth would be stronger than otherwise and, in the long term, feed through to markets.
Mr Beecroft said a balanced investment portfolio would flourish and he encouraged doctor investors to avoid knee-jerk reactions when investing.
With increased pressures in the health sector and a growing ageing population, we are seeing more and more patients in need of medical care.
But what can sometimes be difficult is establishing the best course of medical care for our patients – whether that is a course of medication or a referral into a clinic or onto a consultant.
if your patient needs treatment for an illness, if they are suffering from multiple conditions and need some medical care, if they need rehabilitation or if they simply need further diagnostic investigations to get to the bottom of what’s wrong, admitting your patient into a general medical team could be the best option for them.
Medical admissions can be particularly effective for patients in need of a quick diagnosis. For many who have multiple issues and feel generally unwell, they can get to the bottom of what’s wrong within 24 hours with the reassurance of 24-hour medical care.
it’s also beneficial for patients who have a long-term health issue, such as backache that has suddenly worsened.
h owever, according to new research commissioned by BM i h ealthcare, many GPs aren’t aware of some of the general medical options available for their patients, with 50% of those surveyed unaware that BM i healthcare has a general medical admissions service at a number of its hospitals.
t he research also found that GPs currently refer general medical patients to the nhs or privately on average three times per week, with the most common general medical conditions including elderly medical care, infections, diabetes, asthma and falls.
Mutiple problems
in addition to this, i tend to find that the majority of elderly patients who come through a general medical service have multiple problems. We therefore often have patients who are gen-
Through a general medical service, the patient can be admitted instantly and have peace of mind that they are receiving fast and efficient treatment and the medical care they need
erally feeling unwell but are unable to pin down what is wrong.
For patients such as this, the last thing they want is to be pushed to the back of the line at a & e , because it is not the right place for them, or to be added to a waiting list to see a specialist. through a general medical service, the patient can be admitted instantly and have peace of mind that they are receiving fast and efficient treatment and the medical care they need.
BM i ’s research also found that the top three most important considerations for GPs when referring patients into a medical service are:
1. a fast and efficient admission process (32% stated this); 2. 24/7 access (31% stated this); 3. a service they can trust in (19% stated this).
But less than a third (30%) of GPs are satisfied with the nhs general medical service,suggesting there is a gap in the market for a service that accommodates the requirements of GPs and patients.
BM i h ealthcare recently launched a new general medical admissions service offering patients who require medical care somewhere to turn to.
t he new service, which is initially available across 14 of BM i
healthcare’s hospitals, is led by a team of consultant general physicians to provide round-the-clock care and treatment for a broad range of conditions and illnesses.
the BMi general medical admissions service provides 24/7 direct access with a fast and efficient admission process.
i t is consultant-led so all patients have the reassurance that they are being cared for by an experienced consultant physician, backed by medically trained nurses, physiotherapists, occupa-
tional health therapists, providing high-quality, personalised care.
Patients also have the comfort of their own private ensuite bedroom so that they can focus on what’s important: getting better. You can admit your patients for medical care directly through calling the medical team at your local BM i h ealthcare hospital and answering a few questions to ensure they are suitable for admission.
Once admission is agreed, your patient can make their way to the hospital, where they will be assessed by their consultant physician within four hours of admission. the service is insurerapproved, but patients should check with their insurance company before proceeding with any treatment. alternatively, patients can choose to pay for themselves.
to refer your patients into BMi healthcare’s general medical service, visit: www.bmihealthcare. co.uk/healthcare-professionals/ general-medical-admissions.
HCA He A lt HCA re UK scooped the Private Hospital Group of the Year 2016 title at the laingBuisson annual healthcare awards in london.
Judges recognised the company’s commitment to developing networks of facilities both in london and Manchester.
HCA chief executive Mike Neeb said: ‘2016 has been a positive year with the consolidation of our brand and notable developments in the Shard and the Manchester Institute of Health and Performance, and I look forward to a 2017 of continued development, growth and innovation.’
t he hospital group’s key 2016 achievements included: ➲ t he launch of a £30m outpatient and diagnostics centre at the Shard. the 70,000ft2 facility includes 78 consulting rooms plus 12 treatment rooms, with the ability to accommodate up to 600 selfpaying and insured patients a day.
the facility also features a reha
bilitation gym which includes an antigravity treadmill, gait trainer treadmill, watt bike and video motion analysis.
➲ the launch of Manchester Institute of Health and Performance.
A unique partnership with Sport england, Manchester City Council and City Football Group brings together leaders from elite sports, grass roots community sport, worldclass healthcare and local government to deliver cuttingedge facilities to the local community.
➲ Continued investment in technology, including MAKO and rOSA robots for groundbreaking orthopaedic and neurological surgeries.
➲ the launch of fixedprice treatment on more than 50 procedures across the network.
➲ HCA UK held its inaugural ‘Question of Quality’ conference, bringing together 140 delegates from independent sector providers, NHS partners, top clinicians, researchers and regulators to dis
cuss safety and best practice in healthcare.
➲ Sarah Cannon r esearch Institute UK made presentations at the annual and highly regarded e uropean Society for Medical Oncology (eSMO) and American Society of Clinical Oncology (ASCO) conferences and were des
ignated an eSMO centre for integrated oncology.
➲ Its cancer services were recognised on the world stage, being named the ‘International Cancer Centre of the Year 2016’.
➲ HCA UK was named Health Investor’s Hospital Group of the Year.
Innovators and Leaders
entrepreneur: Midway Care Group
excellence in training: Centre for dementia studies
Innovation in Care: royal College of Physicians
Innovation in technology: Boost, Bupa
Management excellence: roC northwest Ltd
Public Private Partnerships: alliance Medical Limited
CLInICaL servICes
Healthcare outcomes: the royal Marsden nHs Foundation trust
Mental Health Hospital: st andrew’s Healthcare
nursing Practice: royal Marsden nursing team, the royal Marsden nHs Foundation trust
Primary Care & diagnostics: Concierge Medical Practice
rehabilitation: Crystal Palace Physio Group
Health insurance policies and insurers’ rules can seem confusing to the uninitiated, especially consultants new to private practice. So, this month, Bupa’s Dr Tim Woodman helps demystify the world of insurance and equips you with the important information that you need to know
Helping doctors nd optimal candidates to complement their teams, from reception sta through to medical secretaries & practice managers.
Having worked in the medical sector 15+ years, we fully understand our clients’ requirements.
Focusing on establishing long term relationships with clients to ensure continuity.
Located in the vicinity of Harley Street, enabling us to meet our clients in person to discuss their speci c requirements.
For further information contact our team.
UThoRisATion: Patients should call their health insurer to authorise any diagnostic tests or treatment before they begin. They will need the procedure code to do this.
Pre-authorisation lets the patient, and you, know that the tests or treatment the patient needs are covered by their health insurance policy.
This might sound like common sense, but sometimes a patient’s policy may be subject to an exclusion that’s specific to them; for example, if they have a pre-existing condition that their insurer is unable to cover.
Once the test or treatment is authorised, the insurer will give the patient a pre-authorisation number, which you should use when invoicing for that test or treatment.
Acute conditions are what health insurance is designed for.
The Association of British Insurers defines an acute condition as a disease, illness or injury that is expected to respond quickly to treatment which aims to return
the patient to their previous state of health.
Health insurance covers the cost of medically necessary, planned private consultations, tests and treatment for these conditions.
bEnEFiT limiTs are the rates up to which consultants can claim from insurers for treating their customers. Insurers set these to give patients certainty about the cost of their treatment.
c h R onic condi T ions are not usually covered by health insurance. Patients are covered for specialist consultations until a chronic condition has been diagnosed, but need to go back to the care of their GP for the ongoing management, screening and monitoring of the condition.
The ABI defines a chronic condition as a disease, illness or injury that has one or more of the following characteristics: it needs
long-term monitoring; ongoing or long-term control or relief of symptoms; it requires rehabilitation; it continues indefinitely and it has no known cure or is likely to come back.
d i A gnos T ic TE s T s are covered by a patient’s outpatient benefit (see below). Insurers usually reimburse hospitals for the delivery of outpatient diagnostic tests. However, some will re-imburse consultants who perform diagnostic tests using their own equipment in an outpatient clinic or consulting rooms, provided they have a separate agreement with the insurer covering this.
EX c E ss E s are the amount that patients need to pay towards their private treatment and are applied once every policy year that the patient claims.
So, an excess could apply twice to a single course of treatment if the patient’s treatment begins in one policy year and continues into the next policy year.
Excesses usually range from £0 to £500. Choosing a higher excess can help reduce a person’s monthly premiums.
When a patient makes a claim, their health insurer will write to let the main policy-holder know whom they should pay the excess to – for example, their consultant, therapist or recognised facility –and the excess should be paid directly to them, not the insurer.
EXpERimEnTAl TREATmEnTs and procedures are not usually covered by health insurance. Bupa assesses whether a treatment or procedure is experimental or unproved based on established medical practice in the UK; for example, drugs outside the terms of their licence or procedures that have not been satisfactorily reviewed by NICE.
FEE AssUREd is what insurers call consultants who charge within their benefit limits.
This is important, as it means we can reassure patients that they won’t face any unexpected surgical or anaesthetists’ bills for eligible treatment claimed on their health insurance.
gEnETic TEsTs used for screening purposes are not covered by health insurance, but may be covered when used as part of diagnosis.
So it is wise to check that the patient has pre-authorised the test with their insurer before going ahead.
hospiTAl nETwoRks are groups of hospitals that people buying health insurance can choose from, depending on their budget.
Networks excluding central London hospitals are cheaper, as having hospital treatment in central London tends to be more expensive. At Bupa, we have a range of networks to choose from.
innovATivE mEdicinEs are sometimes covered by health insurance. At Bupa, we will consider requests to fund experimental drugs and innovative treatments – for example, drugs that have not yet received a licence for the medical condition in the UK but have in the US.
Our clinical evaluation process usually takes two working days.
JoinT REgisTRiEs and other similar databases to monitor outcomes are important to health insurance patients, as they help demonstrate the high quality of treatment available. This is why insurers encourage consultants to participate in such activities.
kEloid scARs and other scar treatments aren’t usually covered by insurance, so it’s important to check whether a patient’s treatment will be funded under the terms of their policy before beginning it.
locAl AnAEsThETic cosTs are usually included in the surgical fee for all procedures. By local anaesthetic, we mean topical or infiltration. To find out more, visit the insurer’s schedule of procedures. Bupa’s can be found at: www.codes.bupa.co.uk.
moniToRing, screening and preventative treatment aren’t usually covered by health insurance (see chronic conditions).
• 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
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
nhs TRA ns FER s to privately funded care at a private hospital should only take place when the patient has a clear diagnosis and treatment plan, it is clinically safe to transfer them and the transfer is not straight to the intensive care or high-dependency unit.
Bear in mind that health insurance patients transferred to private hospitals for diagnostic purposes may be responsible for the costs of their care if the condition that is diagnosed is not eligible for funding by their insurer.
oUTpATiEnT bEnEFiT covers tests like X-rays, consultations with a specialist surgeon or doctor and therapies like physiotherapy.
Patients can choose to have outpatient benefit limits of £500, £750 or £1,000 to help reduce the costs of their monthly premiums.
Once patients have reached their outpatient limit, they need to fund further private appointments themselves.
pRE - EX is T ing condi T ions are any diseases, illnesses or injuries that the patient has received medication, advice or treatment or experienced symptoms for a period of time before they began their health insurance.
The length of this period will
depend on how the policy is underwritten. For example, someone who has cancer in the past is unlikely to be covered for cancer treatment in future if they take out a new policy.
QUAliTy oF cARE is measured by insurers in terms such as of patient satisfaction, clinical safety and incidents, as well as complaints and patient-reported health outcomes (PROMs).
Insurers need to demonstrate quality of care to their customers, who are paying extra for their private healthcare.
The information collected and published by the Private Healthcare Information Network (www. phin.org.uk) from April 2017 onwards will enable patients to search for and identify consultants and hospitals who best meet their healthcare needs.
So it will not only be invaluable in helping insurers demonstrate the quality of care available to their customers, but also help consultants to understand their quality when compared on a likefor-like basis with their peers.
R E cognis E d cons U lTA n T s are those whom insurers will reimburse for treating their customers. To apply for recognition, most insurers will ask consultants to supply details of their training and qualifications, and proof that they hold appropriate indemnity insurance.
sE l F - REFERRA l is available for patients with some conditions. For example, Bupa patients with suspected bowel and breast cancers, mental health symptoms,
and muscle, joint or bone symptoms can call their Bupa helpline and one of Bupa’s advisers will be able to help them access treatment.
s ho RTFA lls are what insurers call the difference between the benefit limit they offer and the consultant’s charges.
Some health insurance customers prefer not to be asked to make further contributions towards the cost of their care, which is why insurers offer policies that promise no shortfalls.
T REAT m E n T is defined, by the Association of British Insurers, as surgical or medical services –including diagnostic tests – that are needed to diagnose, relieve or cure a disease, illness or injury.
UndERwRiTing for health insurance is how an insurer decides the terms upon which it will accept a person for cover based on the information they supply.
There are two commons methods used: full medical underwriting or moratorium underwriting. Full medical underwriting means that the insurer considers a person’s medical history at the point of joining.
This won’t affect the cost of their policy, but may mean that the insurer is unable to cover the person for conditions they already have – known as medical exclusions.
New medical conditions occurring after the start of the person’s policy will be covered immediately, subject to the policy terms and conditions.
Moratorium underwriting means that a person seeking health insurance doesn’t need to provide their full medical history at the point of joining. They just accept that pre-existing conditions won’t be covered unless
they meet the moratorium criteria when they come to claim.
Usually this means that they won’t have:
Received any medication for the condition;
Asked for or received any medical advice or treatment for it;
Experienced symptoms of it for a continuous period of two years while they are covered under this policy.
vERiFying your profile on Bupa’s online directory of recognised consultants, therapists and facilities, Finder (www.finder.bupa. co.uk), lets people know that your practice information is up to date. Verified profiles are easy to spot, as they have a blue tick symbol on them.
wE b-b A s E d billing is widespread among insurers now because it’s an easy way for consultants to make sure that invoices reach the insurer and are paid promptly.
Not only that, but it is more accurate, as there’s no chance of a consultant wrongly coding a procedure or sending through an incomplete invoice by mistake, both of which can delay payments.
It is also better for the environment and safer because sensitive patient information is secure and only visible to those who process your invoice.
X-RAy cosTs and those for other imaging services, such as MRI, CT and PET, are paid to the hospital. The fees that insurers pay hospitals for these services include all materials, interpretation and reporting.
‘X’ codes can be billed to insurers by any consultants who are competent and experienced in carrying out the procedure; they aren’t exclusively for use by radiologists. Equally, radiologists can claim for codes other than ‘X’ codes, provided they are experienced in delivering the procedure.
yE llow FE v ER and other travel vaccinations are not covered by health insurance.
Zik A vi RU s TREAT m E n T and treatment for, or arising from, any pandemic or epidemic disease isn’t covered by health insurance. By pandemic, we mean the worldwide spread of a disease with epidemics occurring in many countries and most regions of the world. By epidemic, we mean more cases of a disease than would be expected for that disease in that area at that time.
Dr Tim Woodman (below) is medical director for healthcare payments at Bupa
Which Apps are you using to make your life easier? Jane Braithwaite (right) presents her choice of the top ten apps for doctors
We have been investigating medical apps and our findings have been somewhat mixed. The majority that we checked out, including Medscape and Medpulse, are very UScentric. apps provided by large medical authorities such as the World h ealth Organisation, function well for a specific purpose, but are not widely useful.
We did find a few gems, though. If you know of any that we have missed and should be on our list, please do let us know.
Pocket Anatomy: Brain/ Heart
You can download the pocket anatomy app free of charge or buy a package which includes Pocket Brain and Pocket heart for £10.99. To quote the company, you can ‘fly around the body with the swipe of your finger’.
We loved exploring this. It would be great for medical students or specialists who need to jog their memory about less familiar parts of the anatomy, and there are quizzes to test your knowledge. You could also use this to explain the anatomy to patients.
Touch Surgery
This fabulous app allows you to practise surgery anywhere. a vast library of simulations is available to download, and you can test yourself in privacy. My daughter enjoyed performing brain surgery!
The BMJ best practice app
The BMJ app instantly provides doctors with decision support information. It’s not as attractive as our number two app, but it links to NICe and other guideline procedures. You can search for and download relevant information and personalise to a certain extent.
Heart rate Instant
This is very simple: the user places their finger over the camera lens and holds it there for a few sec
onds . . . and your heart rate is revealed.
You can upgrade to track your results over time and create fitness plans based on your individual heart rate. This could be a useful tool in an emergency situation or to give patients a degree of control over their health.
Up to Date
Up to Date is amazing. It’s an evidencebased resource tool that can assist you in making the right decision. The information avail
able in the app is peer reviewed and there are 5,000+ contributors: all doctors and clinicians. It’s produced by Wolters Kluwer, and 100 plus UK hospitals and approximately 1,700 independent doctors have signed up too.
GMC CPD App
This app makes the process of recording your continuing professional development (CPD) activity easy to do – instantly. You can make a record on your app. When needed, download a summary report into your appraisal or revalidation process – making a simple, but easily forgotten task, easier to handle.
UMotif
This is the first health tracker that allows patients to compile, log and
app is short for 'application' and this definition can apply to any computer programme. app typically refers to a program on a smartphone or mobile device, commonly described as a ‘Mobile app’ or ‘iphone app.’
why would you
uSe an app?
apps are usually free or economically priced. in June 2016, Google featured 2.2m apps and apple app store came a close second with 2m apps. the most popular are games. Business apps come second with 10.22% of the market share. you can use apps to improve business productivity as well as team performance. apps allow you to carry out numerous tasks while away from your office.
send personal data to their doctor. The data received enables the doctor to provide patients with personalised, professional assistance, but also gives the patient increased control over their behaviour. UMotif currently has 9,000+ users, primarily based in London.
MIMS
MIMS – Monthly Index of Medical Specialities – has been advising doctors for over 50 years about drugs licensed in the UK, providing dosage, warnings and other relevant information. The MIMS app allows access to information on over 2,000 drugs anywhere, anytime.
Read: Personalised Medical and Scientific Journal
This app is US based, but it is increasing globally in popularity. It provides access to up to date medical and scientific research.
There are over 3,000 reviews on apple’s app Store and many users give it a fivestar rating. You can personalise the app so it delivers information that is relevant to you, search specific journals and download individual articles. It’s a great resource.
iscanner
I saved this one until last. It’s not specific to doctors, but it is brilliant and will prove to be incredibly helpful. It allows you to scan documents wherever you are.
You may well be thinking that it’s easier to take a photo, but how easy is it to print the photo?
The quality would be poor and you would rack up a huge ink cartridge bill. With iscanner, you can create PDFs that are easily emailed and stored. This will cost a couple of pounds, but I guarantee you will use it every day. enjoy apping!
Jane Braithwaite is managing director of Designated Medical
Today asked medical billing expert Gary Nials (right) what notable trends he had seen in 2016 and how he thought these would play a role in the year ahead
The self-pay market has seen a general and notable increase in terms of volume and pricing, and there seems nothing to indicate this trend will stop in the near future.
This has especially been the case in London, which continues to be an attractive destination for both workers and tourists alike, with plenty of UK and international patients willing to pay for convenience and quality.
An increase in the self-pay market has also come about through more varied private medical insurance (PMI) policies.
This can be through co-sharing policies, different excess charges or through shortfalls.
From the billing and collection perspective, this means money needs collecting from a patient, and, at times, an unsuspecting patient. So being able to cater for this in your practice is more important than ever to ensure you maintain steady cash flow owing.
Most private practices will rely on private medical insurance work to form the basis of the business.
This is the case throughout the
UK and shows no sign of slowing, although it has been changing.
Change has mainly been seen in the different levels of cover and different types of policies which, as touched on above, has mainly led to more co-payments with patients.
The difficulty with this is patients are not always aware of the charges they will be liable for, even though they are ‘insured’, and often it is left to the practice to have to break this news to the patient.
This is rarely a pleasant experience. However, the sooner this discussion is had, the better and ideally moved on to the patient/ insurer to discuss/argue over rather than the patient/practice, which should always be more medically focused – especially for insurance work.
Embassies continue to be busy, in London especially, despite increasing competition from other major UK cities such as Manchester as well as other countries such as Germany.
Perhaps of significant note is the way embassies in London have increased the reviewing of consultant fees.
In the past, a Letter of Guarantee was just that: a letter that guaranteed payment – with few questions asked.
But in the past 12 months, we have seen a more pro-active approach by some embassies, much like the large private insurers such as Bupa and Axa PPP, to be more concerned with consultants’ fees.
In many ways, this could be seen as a sign of the times, with the oil price hurting a lot of the rich Arab states, who have long been providers of much of the embassy-backed medical tourism into London.
Regardless of the reason, this is
something consultants need to be aware of looking ahead, with more transparency of fees being an increasing requirement of doing work with certain embassies.
This continues to be an important part of private practice work across the UK – especially for the more experienced practitioners. Terms of business continue to be an important part of doing medico-legal work. Payment terms range from 28 or 30 days to payment only on settlement of the case and everything in between.
This increases the need for practitioners to be aware of their terms of business with clients and to have a robust system in place to deal with these variances.
Otherwise, your accounts might look good on paper, but as you enter the New Year and the tax year-end looms, your accountant might start asking awkward questions – and even the taxman too.
In fact, each area of private practice carries with it its own unique problems when it comes to billing and collection. Often a busy practice will ignore such issues as long as the bills are still getting paid.
So be aware that – as with any business – strong cash flow is key, and any good accountant worth his or her money will tell you just that.
Perhaps a New Year’s resolution, looking ahead, could be to review your billing and collection process and make sure it is in good working order.
That might mean putting a more robust process in place to ensure timely collection, which might even require more staffing. Or you could always consider outsourcing to a billing and collection company.
Gary
Nials is
the managing director of Medical Billing and Collection
HMRC tax investigations and disputes create difficult and stressful times.
As an award winning firm of tax experts, our highly experienced partners specialise in resolving problems relating to tax investigations and disputes with HMRC.
To find out, in confidence, how we can help call 0800 734 3333.
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work in Private Practice is big business, so let Code BusteR!
keeP you in the know
every month, the clinical coding and schedule development group (ccsd) reviews its 2,000-plus procedure codes, and more than 3,000-plus diagnostic codes, that form the basis of private medical insurance. it is crucial for independent practitioners and their practices to know these codes, so they bill correctly. if they don’t, then it could cost them money
Changes to note this month
Specialties recently affected include bones, joints and connective tissue/tendon muscle (Code W), skin (Code S), female reproductive organs (Code Q), urology (Code M), abdomen excluding urinary and reproductive organs (Code H), interventional radiology (Code XR), haematology (Code U), radiotherapy (Code X), urinary system and male reproductive organs (Code N).
theRe aRe 10 new Codes
W3720 – Robotic-assisted total hip replacement;
W5820 – Robotic-assisted unicompartmental knee replacement;
S6060 – Laser hair removal, from free flap reconstruction as result of tumour;
Q3510 – Laparoscopic female sterilisation (tubal occlusion);
Q3520 – Hysteroscopic sterlisation;
Q3710 – Reversal of female sterilisation;
M4740 – Ambulatory urodynamic studies;
M3412 – Laparoscopic cystoprostatectomy (with construction of intestinal conduit or bladder);
H5120 – Radiofrequency ablation of haemorrhoids;
W8370 – Autologous scaffold insertion of repairing symptomatic chondral knee defects (including microfracture).
There are six narrative changes: XR936, M3410, M3411, M3420, U0090 and U0020 , one code number change from N1810 to N1750
And there are 54 unacceptable combinations (also known as unbundling): X6575 with X0001, X0002, X0003, X0004, X0007, X0008, X0009 and X0010; E4510 with E3520 ; S0520 with S2500, S2002, S1110, S1740, S1700, S1750, S1900, S2000, S2502, S2503, S3100, S3102 and C1700; S0521 with A7350, S0602, S0603, S0604, S0605, S0632, S0633, S0642, S0643, S1420, S1500, S2220, S4182, S4183, S4212, S4213, S4230, S4720, S2500, S2002, S1110, S1740, S1700, S1750, S1900, S2000, S2502, S2503, S3100, S3102 and C1700; W7761 with W1380
Please remember, however, that codes are not mandatory by insurers. In other words, the inclusion of procedure codes within the
PRoPosed naRRative
Reason foR deClining
Removal of internal tamponade Code C5480 should be used agent from vitreous body (Roso)
Peel of epiretinal fibroglial Code C7982 should be used membrane (eRm peel)
Retinopexy using cryotherapy Code C8440 should be used
CCSD Schedule does not indicate the automatic agreement of individual insurers to provide benefit for this procedure. You need to contact each insurer directly to find out whether benefit is provided.
Code Buster data is provided B y Medi C al Billing and ColleCtion. For Full details, go to the Clini C al Coding sChedule developMent weBsite at www.CCsd. org.uk
Having access to quality management information is essential in running a successful practice business. Ebert Hyman (right) explains how using a set of management accounts can help track performance as well as add value to the decision-making process
It Is a statutory requirement for all limited companies to file their annual accounts following the end of each financial year.
For some, this is the time of the year where you re-engage with your accountant to answer questions on income generated, expenses paid and supply information on your assets and liabilities.
Your accountant will use the information to produce your annual financial accounts, as well as calculate the corporation tax you will need to pay HM Revenue and Customs (HMRC).
Your annual accounts will tell a story of how well your business is performing, giving you the opportunity to reflect on the past year’s performance.
Problem. these figures are now entirely historic and for the most part there is nothing you can do but to accept the past and start thinking about the future.
Another approach
t here is, of course, another approach that puts you in the driver’s seat, where you will be able to keep an eye on all the dif-
ferent aspects of your business on a regular basis, so that you are able to steer the ship back on course should any adjustments be required.
t he alternative approach is quite simply to ask your accountant for more regular – for example, monthly or quarterly – reports in the form of a set of management accounts.
You will then be able to make informed decisions which will affect your business within the current financial year.
t here are several benefits in
Keeping abreast of your performance with regular updates should lead to fewer surprises at the year-end
taking this more involved approach, including:
Better control and understanding of costs;
the ability to compare year-todate performance with previous years;
Forecasting future earnings;
Boosting cash flow;
tax and dividend planning –and much more.
Although there are bound to be some accounting adjustments at the year-end, keeping abreast of your performance with regular updates should lead to fewer surprises at the year-end.
Management accounts
the management accounts do not require a fixed format or layout, and it is therefore reasonable for management information packs to vary between businesses.
But the content of your management accounts needs to provide a management view of the performance of your business, which will be helpful in making decisions and tracking progress.
I would suggest that you ask your accountant to lead with a summary of your performance in the relevant period, which will supplement and complement information presented in the financial reports later on.
t he summary may take the form of short paragraphs highlighting the positives and negatives in that period.
It should aim to give a ‘snapshot’ of key drivers of success including, but not limited to, the movement in revenue, costs and profit, your bank balance, your debtors position and so on.
And it will also be a good opportunity to add graphs, charts and other visual tools which will aid in painting the picture of your current position.
Additionally, your accountant may also be able to produce an indication of what the future may hold (forecasting).
Profit and loss account
the profit and loss account shows your revenues earned, expenses incurred and any profit or losses in the period.
Revenues are shown by income type and there may be several lines, depending on the income source. You may ask for your
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patient episodes to be recorded on one line and medico-legal income in another.
In the same way, expenses will be listed under different headings, all depending on the amount of detail shown in your report.
the report may contain various summaries, each telling a different story. It is important to work alongside your accountant to ensure that the information provides sufficient detail. too little or too much may mean important movements or trends may be missed.
Your accountant may choose to include a comparison between your current and last year’s performance or against a budget – if this has been agreed at the beginning of your accounting year.
t he information can also be presented by month, with the figures side by side. In doing so, you will see how the different lines of revenue and expenses move month by month.
this will not only make it easier to spot errors, but should also fit into any expectations you may have knowing your own schedule and movements in that particular month.
Your accountant should be able to highlight any adverse variances in advance to save time and aid in the discussion.
In addition to the profit and loss report, your accountant should also highlight important ratios pertaining to profitability, shown in percentage terms, making it easier to compare performance across different periods.
Gross profit refers to profit after deducting the cost of sales or direct costs in the case of delivering a service.
Gross profit margin is calculated by dividing gross profit by revenue. the ratio calculates your profitability before introducing overheads,
which are not directly affected by change in business activity.
Net profit – sometimes called operating profit – is calculated by deducting both direct costs and overheads from your revenue.
Net profit margin is calculated by dividing net profit by revenue. By calculating this ratio, you will now have a good understanding of the percentage profit or, in other terms, how many pence you made from each pound you invoiced. the ratios for the purpose of the management accounts will ignore interest and tax.
Keeping an eagle eye on the movement in these ratios will ensure that you are aware of significant changes in revenue, costs or profit.
Provided your accountant has access to your bank statements, they should also be able to produce a report showing your cur-
rent cash flow position, as well as being able to forecast future receipts and payments.
It is true that a profitable business can still fail if it doesn’t have the cash to pay its bills. Monthly reports will help you identify potential future shortfalls, which will enable you to act before problems materialise.
It is important at this point to consider the people or organisations who owe you money – your debtors. It is worth knowing how long, on average, it takes to receive payments against your invoices, whether they are paid directly by patients or through a sponsor or private medical insurer.
If your business keeps detailed records on invoices, it shouldn’t be difficult to calculate your ‘debtor days’. Keep track of this measure and make sure to compare it against previous months or years.
A good ‘spot’ would be when your average debtor days increase, but revenue doesn’t, which may signal an increase in aged debt that will require attention and resources to collect.
t he report should be able to show which customers are slow in paying and you will be able to make a decision on how to proceed with collection.
You may also decide to apply penalties – for example, interest –on overdue accounts if this was communicated to patients or their sponsors prior to receiving the service.
On the other hand, you should also pay special attention to the group of people or organisations to whom you owe money (your creditors).
When paying business expenses, you may have agreed payment terms with suppliers – that is how many days do you have to pay them. Although it is not always possible, an ideal situation will be if the cash from your income is able to cover your expenses and pay suppliers.
Take the following example: Your suppliers expect payment within 30 days, but you currently wait on average 45 days to receive payments from your customers. t he disparity – creditor days
minus debtor days – in this example is bound to place some pressure on cash flow, which may create problems in the future. It is therefore important to be able to recognise any problems before they get out of hand.
If you decide to take some or all of your earnings in dividends rather than salary, it is important to know whether your company is generating profits or has retained profits from previous years. secondly, you actually have to have the cash in the bank to pay such dividends. t he monthly management accounts should give you a good understanding of your current position and the amount of accounting profit you may expect to generate in a particular period.
Considering these together with the cash flow report, you will know whether you can afford such payouts.
It is important to remember that the reports which make up the management accounts take time to produce and may incur an additional charge from your accountant.
the cost of preparing the management accounts will vary depending on the brief and size of your operation, as well as how easy it is to integrate the new process with your current agreement. the work is typically negotiated as part of the overall agreement with your accountant – which will include preparing and filing of the annual financial accounts.
It is worth asking your accountant for advice or to prepare a presentation of what they consider to be the most important indicators for your business. It is not unusual to request a trial period before agreeing to anything permanent.
As with many other things in life, your management information pack will evolve and change over time, depending on your business needs. For many practices, however, having access to quality management information is essential in running a successful business.
Ebert Hyman is a chartered global management accountant and general manager at London Urology Group and 101 Diagnostics
TV doctor and full-time writer Dr Michael O’Donnell (right) continues with more from his new book, Medicine’s Strangest Cases. This month, he relates the case of the Surgical Triple Whammy, London 1840
Before the coming of anaesthetics, patients, heavily dosed with rum or opium, had to be held down or strapped to the operating table.
h ence the most useful, and most admired, of a surgeon’s skills was his operating speed.
one man whose reputation as a surgical speedster spread from his native Scotland to e urope and North America was robert Liston, a daring and successful surgeon who often took on patients whom other surgeons had rejected.
Liston’s operating speed was such that one observer wrote: ‘ t he gleam of his knife was followed so instantaneously by the sounds of sawing as to make the two actions appear almost simultaneous’.
o thers described how, to free both hands during an operation, he would clasp the bloody knife between his teeth. h is achievements were many, but he earned an ineradicable place in medical folklore with one of the strangest operations of all time.
It happened near the end of his career and was the culmination of many adventures he had had along the way. Born in 1794 at e cclesmachan in Linlithgow, West Lothian, Liston studied medicine at edinburgh University and became a surgeon at the r oyal Infirmary where he was rumoured, as were other surgeons, to ‘resurrect’ corpses.
h e was a vain, argumentative and abrasive man and, although he was unfailingly kind and gentle with the poor and the sick, he soon made enemies of his fellow surgeons.
t hey complained about his arrogance – a charge that in
Liston thus performed the only operation in surgical history to have a 300% mortality rate
edinburgh must have raised questions about the relative blackness of pots and kettles – but what really upset them was his habit of operating successfully in the tenements of the Grassmarket and Lawnmarket on patients they had discharged as incurable.
Dramatic operation sessions
When eventually they barred him from the wards, he packed his bags and travelled south to become professor of surgery at University College h ospital in London.
there, he built his reputation as the fastest surgeon in town, and his dramatic operating sessions attracted packed galleries of students and their friends.
An impressive man of 6ft2in (1.9m), Liston would stride across the bloodstained floor of the operating theatre wearing Wellington boots and his bottle-green operating coat, calling to the students who stood in the galleries, pocket watches in hand: ‘ time me, gentlemen. time me.’ his speed sometimes had ‘side-
effects’. o nce, when he amputated a patient’s leg in his standard time of two-and-a-half minutes, his flashing knife also removed the poor man’s testicles.
Yet, despite such occasional setbacks, his reputation for speed built him an enormous private practice. he took a house opposite Buck’s Club in Clifford Street, Mayfair, and his crowded waiting room had a butler in attendance to serve Madeira and biscuits.
Medical student lore
the operation that won him his place in medical student lore was another leg amputation which this time he accomplished in under two-and-a-half minutes. Sadly, the patient died later in the ward from surgical gangrene, as patients often did in the days before antiseptics and asepsis.
During the operation, Liston inadvertently amputated the fingers of his young assistant, who also later died of gangrene, and slashed through the coat tails of a distinguished surgical spectator, who, terrified that the knife had
pierced his vitals, dropped dead from fright.
As modern surgeons point out, with a relish that borders on pride, Liston thus performed the only operation in surgical history to have a 300% mortality rate.
Soon after that historic occasion, the arrival of anaesthesia, first introduced in America, gave surgeons more time to operate, and the high-speed skills of men like Liston became redundant.
Ironically, Liston himself performed the first operation under anaesthesia in e urope. o n 21 December 1846, disregarding the time advantages conferred by the new technique, he amputated a leg in his usual two-and-a-half minutes before growling: ‘this Yankee dodge beats mesmerism hollow.’
Medicine’s Strangest Cases, recommended price £7.99, ISBN 9781910232941.
Published by Portico, an imprint of Pavilion Books
Your first case conference is likely to be a nerve-racking experience, but being well prepared can reduce some of the pressure. Michael R. Young reports
the case conference is where the barrister, the solicitor, the claimant and the experts come together to discuss the case.
the conference may take place face to face, usually at the barrister’s chambers, over the phone or via Skype.
the lawyers will want to keep the travelling costs of everyone attending the case conference to a minimum.
If the barrister is to successfully argue and win the case, he or she has to be totally familiar with and understand every aspect of the case. A case conference is therefore where the barrister:
Will revisit the essential elements of the case and seek clarification from the claimant;
Will confirm the opinion(s) of the expert(s);
Will agree a strategy with the solicitor for the future conduct of the case.
Adapted from The Effective and Efficient Clinical Negligence Expert Witness , by Michael R. Young, price £60 from otmoor publishing
During a phone conference, whenever you are asked a question or you are asked to explain something, resist the temptation to talk too much
ExpEct to have been given plenty of notice about the conference date. this will allow you sufficient time to review the case and for refamiliarisation of the essential points.
You must always confirm your attendance in writing.
When you review the case file, quickly re-read the case notes, your notes and then read your report(s) plus any others that you have been sent. Make new notes if necessary, focusing on any issues the solicitor might have warned you the barrister may want you to clarify.
Look through the case file so you are familiar with its layout and where the various bits of information are located. p ost-it notes on the edges of pages make it easier to find important evidence quickly.
No matter how well you prepare and no matter how well you think you have covered all of the points on which you think you might be questioned you must be able to extemporise.
You can only do that if you know the ins and outs of the case, what you have written and what the other side has said in reply, like the back of your hand. Your weaknesses will soon be exposed if you are unprepared, and it will do your reputation a great deal of damage. on the day of the conference,
allow plenty of time to get there. Know exactly where the meeting is being held. Ask the solicitor for a detailed map if necessary. And don’t be late.
A case conference is a serious meeting, but most are conducted in a relaxed and friendly atmosphere. Give yourself time to set your papers and notes out in front of you before the meeting starts. Make a note of names and role of all attendees at the introductions stage.
Sometimes case conferences are conducted over the phone. preparation for a phone conference is the same as for a face-to-face meeting.
But there is one significant difference. talking to someone face to face allows you to observe the person’s body language and to gauge whether or not he or she is reacting positively or negatively to what is being said. take away this mechanism and the natural tendency is to carry on talking until there is a verbal reaction.
During a phone conference, whenever you are asked a question or you are asked to explain something, resist the temptation to talk too much. Answer the question and then stop. Remember to speak up and that nodding heads cannot be heard.
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’.
Start as you mean to go on. Susan hutter gives her suggestions for some business and financial resolutions you may want to stick to for the duration of 2017
Do make sure you or your practice man- ager write up the practice books and records frequently – ideally monthly or quarterly – so all details are fresh in your/their mind.
this is particularly useful so that 30 days after the financial year-end, the records can be given to your accountant. If you do this as soon as possible after the accounting period, you will find it easier to work out what your practice owes on expenses and overheads at the year-end date and also what is owed to you. (See feature on page 22)
Whenever possible, arrange for your patient/client to pay on the day of the consultation. clearly, when you are working with medical insurance claims, you won’t be in a position to ask for payment then and there. However, do get into the habit of making sure you get the claim over to the medical insurance company as soon as possible and either you or your practice administrator chase any monies due to your practice on a monthly basis.
Do make sure you review your professional indemnity premiums, as there are now more players in the marketplace. If you shop around, you can often get a reduction of up to 20% on your current provider.
Do consider using a professional billing and debt collection company to arrange and chase your invoices. there are even specialist providers who collect monies from embassies should you have a number of patients sent to you via an embassy.
If your business trades as a limited company, do make sure you look at whether your practice has a potential research and development tax (R&D) credit claim. often Gps and consultants are involved with qualifying R&D work without realising they can claim extra tax benefits – for example, in the It field or inventing products for patients.
Resolution 6: Apportion shares in your trading company (practice income)
If you trade via a company and your spouse earns in the lower tax bracket, consider transferring a percentage of the share capital to them.
there are no capital gains tax or inheritance tax implications if you make such a transfer and you can divide the dividends between yourself and the spouse, thereby mitigating the higher-rate tax liability.
Resolution 8: Retire well and plan your exit strategy
If you are within five years of your scheduled retirement date, then do start planning your exit strategy. there are now a number of businesses in the mar- ket which may be keen to buy you out. they tend to want the seller to stay on for between three and five years in order to ‘hand over’ patients.
Resolution 9: Don't leave personal tax return information to the last minute
Make sure you get personal tax return information for year 2016-17 to your accountant by the end of June 2017. Avoid the last minute rush – or panic –and ensure you start gathering the information by the beginning of May.
Resolution 10: Maximise your personal and family wealth in 2017
Finally, for an even more prosperous 2017, consider transferring income-earn- ing assets such as bank deposits and share portfolios to a lower tax-paying spouse. this will help to mitigate your higher rate of tax.
Resolution 7: Keep it in the family – and your business!
If you have children over the age of 18 who work in your practice – this could be anything from filing, book-keeping or It – then you can pay them a salary as long as it is recognised to be commensurate with work carried out.
As long as the child has no other income or the total income is below £11,000 a year, the child won’t have to pay tax and the business gets tax relief on the salary.
next month: some useful pointers if you are looking to sell your practice and want to find the right buyer in the marketplace
Susan Hutter (right) is a partner with accountants Shelley Stock Hutter
To be successful, PPUs have to deliver the ‘Best of Both‘ promise, says Philip Housden. They have to convince consultants that their patients’ experience will match expectations of what they should expect from privately-funded care and give the peace of mind
that comes from having the whole NHS there as back-up
Last month’s article considered how best to ensure that the PPU delivers commercial and service gains for the nhs trust. It’s vital to protect bed capacity for private patients first – but unused private patient bed days should pull in nhs patients to keep occupancy high.
t his way, bed protection maximises the benefit to the whole nhs trust twice: new income and most intensive use of resources.
‘Ring-fencing’ enables the benefits of private care to productively and symbiotically co-exist within the heart of the trust: part of the ‘Best of Both’ approach that
encapsulates what PPUs are about.
It’s now winter, dark outside for longer, and so attention turns inwards. t herefore, I want to develop the inpatient theme a little further, exploring the private patient journey within a nhs trust.
journey
What is that physical patient journey and customer experience like in your PPU and how could it be improved?
there is no doubt that ‘hotel services’ are important to patients. Generally speaking, most patients are not really informed purchasers
or consumers of healthcare, at least not in the sense of knowing the difference between the doctors they might choose or be referred to. and despite informed consent, the same applies in the treatments they are offered and prescribed. most patients, even in the age of the internet search engine and social media, will rely on their GP and hospital consultant to recommend the best course of action.
For insured and self-pay patients who want to ‘go private’, this means the choice of location for treatment will mostly be managed through a conversation with their surgeon or physician.
that choice will be dictated by where the consultant practises, which, in turn, will be a function of location, capacity for that surgeon and the wherewithal of that organisation to support the consultant.
so far, so obvious. But what is perhaps underestimated is the importance of the quality of service that the consultant and their patients receive – and their perceptions of that quality.
and this perception, at least for patients, will be less on the clinical skills, and more on the look and feel of the physical space, the welcome they get, the administration processes they work through, the room they stay in and the food they eat.
a nd what patients tell their consultant makes a great difference to the attitude of that specialist towards their choice of private provider – be that the local independent hospital or the PPU.
It is this feedback that influences the decisions of many consultants whether to try, or keep using, their local PPU.
there is evidence that this is the case, both anecdotally – ask any patient or consultant – and in surveyed opinion.
surveys undertaken across several nhs trusts that are looking to assess local consultant support for potential private patient investments have asked consultants to rate the factors that influence where they choose to practise.
Consultants responding to these surveys have consistently given a high rating to ‘a pleasant environment for my patients’. Indeed, this option scores only just behind ‘access to theatres’ and ‘patient safety’ and even above ‘comprehensive infrastructure’.
t his is relevant because we know that, for patient safety, critical care and 24/7 infrastructure, nhs trust PPUs do deliver benefits for consultants ahead of independent hospitals. t hat’s what they tell us.
Let’s explore what PPUs can practically do to build consultant
confidence in three key areas that deliver a pleasant environment:
Patient accommodation;
hotel services;
Customer service.
1
Patient accommodation although more than half of patients attending for treatment will be short-stay day cases, private patients still hold a general expectation that they will spend time in a single room with en-suite facilities.
In recent years, private hospitals have replaced carpets and curtains with a much more clinical feel and, in the same period, many nhs trust new buildings have included a range of single rooms.
t his has brought the patient experience in private hospitals and nhs PPUs much closer together. t hrow in the t V and some colour and a top-floor view and the PPU can definitely meet
the expectations of consultants and their patients.
2
hotel services
although patients can’t easily judge the surgeon’s competence, they can taste the food. smaller trust PPUs struggle with the delivery of separate menus due to the low daily patient volumes and the difficulty of running a different process within the larger organisation.
But this is not a show-stopper. Working with the trust caterer will achieve a lot.
Experience has shown that investing in crockery, cutlery and presentation, together with delivering food with a smile can achieve the same patient satisfaction ratings as an expensive new menu.
Customer service
t his elusive trait is not related to staff salaries or even staff ratios. But it is directly
related to active private patient services leadership, building a team ethic and sense of PPU brand, and listening to patients and their relatives. these things do not cost money and they are not the preserve of independent hospitals.
PPUs just have to demonstrate to consultants that the trust can deliver on theatres and beds access – it’s the absolute baseline to building a PPU.
But to be really successful, PPUs have to deliver the ‘Best of Both’ promise to convince consultants that their patients’ experience will match expectations of what they should expect from privatelyfunded care and have that peace of mind that comes from having the whole nhs there to back you up. these three issues highlighted above together will deliver a customer service that can meet the expectations of insured and selffunding patients and also will
stimulate the growing demand for amenity accommodation. amenity rates for nhs patients who choose to pay for the comforts of a private room while still remaining within the nhs are typically £250 a night. a welcome income stream for trusts.
Perhaps the local private hospital is shutting down over the holiday period to save on costs, but your PPU should stay open, as there will be insured patients turning up at the hospital front door and consultants will need to have somewhere to admit them.
s o I hope your PPU creates a warm welcome this winter to consultants and patients alike.
Next time: Some thoughts to help you make 2017 a real year of growth
Philip Housden is a director of Housden Group, a management consultancy specialising in commercial support in the healthcare sector
Dr Stephen Alcorn, an Edinburgh-based anaesthetist who volunteered on the world’s largest civilian floating hospital, tells of his experience
The ship, which docks in some of the most underdeveloped countries in the world, provides vital medical care to the world’s forgotten poor.
it is a 16,000-tonne state-of-theart vessel called the Africa Mercy and is run by international charity Mercy ships.
With a crew of more than 450 volunteers from over 40 nations, Africa Mercy delivers free health care and education, specialising in a wide range of medical needs.
i’ve been working as a registrar at the edinburgh Royal infirmary but volunteered with Mercy ships last April for a fortnight during Africa Mercy’s service in Madagascar.
i n addition to working on board, i also played a part in the charity’s capacity-building programmes and helped to train local doctors in safe anaesthesia techniques.
Mercy ships has, in partnership with other organisations, been renovating the operating theatres in the hospital in Toamasina, eastern Madagascar, which is the port where the Africa Mercy was docked.
The anaesthetists there had very limited equipment but have now been given two anaesthetic machines that are specialised for use in the developing world, enabling the delivery of safe anaesthesia even when electricity and oxygen supplies are unreliable.
My role was to train local medical professionals in the use of these machines and safe practice. in the UK, we forget how lucky we are and take for granted that our relatives can be treated urgently.
in Madagascar, that is just not the case because over 90% of the
population live on less than 75p a day.
in addition to treating patients on board, training local healthcare workers is a major part of Mercy ships’ work. i was incredibly proud of my Malagasy colleagues who had to adjust to new techniques and equipment, interpreting and responding to results they have never before encountered, and who rose to the challenge magnificently.
Ultimately, what Mercy ships is trying, and managing, to achieve is an incredible explosion of generosity, love and life-changing medical intervention in a place where people wait years, decades, even lifetimes for what we would take for granted at home. i t is a privilege to be involved in that even in a small way.
i am deeply impressed by their commitment to serving the poor,
and definitely more convinced that the way they are choosing to provide this service is hugely important and beneficial.
Despite having worked in hospitals elsewhere in the developing world, i hadn’t appreciated the massive burden that lack of access to safe, affordable surgery represents.
Mercy ships aims to leave a lasting legacy and a sustainable healthcare system that will benefit communities for years to come.
Developing these local healthcare systems and training local doctors and nurses is a major part of what the charity does. With millions of people facing ruin from the cost of vital surgery, it’s not difficult to understand how inextricably linked to global poverty the lack of affordable health care is.
The majority of Mercy s hips’ patients lack the money and access to be able to receive emergency surgery within a reasonable time-frame.
patients would pay to see a doctor to diagnose them with an illness requiring surgery and then they would be given a list of things they would need to purchase if they wanted their operation.
They often borrow the money from relatives, lenders or by selling possessions. This means that people often have to wait days, or weeks, while they find the money and therefore their condition deteriorates or can become fatal before receiving surgery.
For example, the surgical team in the local hospital performed a splenectomy for a man who had had a road accident two days previously and in that time had lost approximately half his circulating blood volume into his abdomen. s uch life-saving care would have been received within hours of the accident in the developed world, where he would have had access to immediate treatment.
We can forget how lucky we are and take for granted that our relatives, when they develop appendicitis or a bleed after childbirth
mercy Ships uses hospital ships to deliver free, world-class healthcare services, capacity building and sustainable development to those without access in the developing world.
founded in 1978, mercy Ships has worked in more than 70 countries providing services valued at more than $1bn, impacting more than 2.54m direct beneficiaries.
The Africa mercy is like a small city and the crew of more than 400 volunteers from over 40 nations keeps it running.
mercy Ships needs medical and dental professionals, but it also needs volunteers in areas ranging from cooks and teachers to receptionists, mechanics, engineers and information technology specialists.
you can volunteer on a short-term basis, from two weeks to two years, depending on the position. Or you can make a longer-term commitment, initially of two years, for positions that require more continuity and training. All volunteers contribute towards the cost of living on board by way of monthly crew fees.
mercy Ships seeks to transform individuals and serve nations one at a time. for more information, click on www.mercyships.org.uk.
or have a car accident, will be treated urgently and without dis crimination on the basis of wealth. This is one of the many things which makes Mercy ships’ com mitment to providing safe, free, top quality care so radical and necessary.
The work of Mercy ships is lifesaving for patients, families and whole communities and thank them enough for the sacri fice many people within and sup porting the organisation are making to provide basic care and compassion to people who need it.
Over 2,500 surgeries were com pleted during the field service in Madagascar and over 12,600 den tal patients received treatment. This is an incredible achievement.
The volunteers are the lifeline of the ship: there is a real sense of camaraderie and a very support ive environment on board.
Volunteers include everyone from surgeons and nurses, cooks and engineers, all of whom pay for the privilege to work and pro vide free medical service to those in need, in addition to carrying out mentoring and training pro grammes in the local villages.
It’s a virus… in fact, there’s a lot of them about. Caroline Corrigan advises on what to do it you are attacked
If you haven’t ever downloaded a virus by mistake, then you’re one of the lucky people.
unlike those lucky few, most of us at one time or another have had the inconvenience of having a virus downloaded onto your computer and feeling the panic of not knowing what to do.
Solutions in the past were to install an antivirus program or enlist the help of an IT genius to save your personal data. Most of the time this works and most of the data affected is often saved.
What happens, though, when your PC not only holds your personal data like family photos and letters but also highly-sensitive work information? How safe and protected are you from some of the most malicious viruses which are extremely hard to deal with?
Most harmful viruses like Trojan Horse can mess up your PC system, can render it unusable and can even spy on you.
But there’s a new type of virus giving computer-users even more to worry about and these are called ransomware viruses.
These have a completely new agenda. The .zepto virus often makes its way into your inbox through a very clever spam email and, if downloaded, will run behind the scenes completely undetected. While there, it will copy all the files on your computer into encrypted versions and delete the original files.
o nce a file is encrypted, you will be left with the new files which look exactly like your originals, but these files, you won’t be able to open.
When it’s finished, the hacker will inform you of their existence and will even have the courtesy of informing you that they have encrypted all your files. The only
Hacked off: Backing up your files on an external hard drive is the best way to combat ransomware virus programs
way to access these files is to pay to receive a decryption key – thus holding you to ransom until you pay up.
There isn’t a quick fix for the ransomware viruses – once you receive the ransom message, the damage has already been done. No amount of IT genius or clicking on every part of your keyboard will bring that data back. If you opt to pay the ransom –the advice is not to do so – you risk paying the hacker and never receiving the decryption key. Think long and hard about doing this, should you be in this unenviable situation.
so how do you avoid this happening to you?
If you use a computer, make sure all your files are backed up. It’s obvious and very easy to do and
can be the difference between all your personal memories or work data being lost for ever.
you could still fall victim to the .zepto virus or another ransom version and lose any data to the hacker initially, but depending on when you last backed up your computer, it can all be retrieved relatively easily.
It sounds obvious, but avoid opening emails from unknown senders. If something looks suspicious, it probably is, so don’t open it. Remember, this is the most common way for any virus to access your computer.
We recognise that some of MidexPro users use their computer for work as well as personal use and we always advise backing up their data daily. Those who need to access information on the move are moving across to our
new Cloud version of MidexPro.
The new Cloud software allows our users to log in and update files, view patient data and access the e-billing service any time of day and on any device. It’s extremely secure; hosted on Microsoft Azure platform. This new version gives our customers the flexibility of use and peace of mind that their patient files and data are secure in the Cloud.
The new ransom viruses have and will continue to cause concern for any business needing to protect data. use the knowledge of how this particular virus works and make sure you protect yourself and your data.
Caroline Corrigan is operations director at medical practice software providers MidexPro
New legal pitfalls are lining up for doctor entrepreneurs. Jamie Foster and Helen Baxter continue Independent Practitioner
Today’s new series with advice about using doctors to provide services for your business
this is the second article in our series designed to help you understand legal issues for setting up a new healthcare business.
the series looks at issues for doctors setting up a business by taking advantage of increasing use of smartphones and apps and using medical skills outside the traditional routes.
it will take you through the key things to consider in relation to regulation of medical devices, data protection in cloud computing and protecting your intellectual property, among other things.
Here we looks at perhaps the most fundamental issue of all –how you use doctors to provide medical services for your business.
You can, of course, employ doctors or use them as independent contractors, and there is nothing new in that.
But the so-called ‘gig economy’ is changing the landscape for workers, including those in the healthcare sector, and provides interesting opportunities for businesses and doctors alike. Whichever route you choose, it is vital to be clear about the potential risks.
So you have a good idea for a new healthcare business and have gone so far as to develop a business plan and test the waters with potential patients and suppliers.
But now you need to know a little bit more detail about legal, financial and commercial issues to move the project on – from drawing board to boardroom. Here are three issues you need to consider when using the services of doctors in your business.
1
Are you employing doctors or are they working for you as independent contractors? you may see benefits to employing doctors on a full- or part-time basis – for example, certainty, reliability and consistency – though you will, of course, need to understand the legal implications of doing so.
Alternatively, you may wish to engage with doctors as independent contractors, using their skills for short-term engagements or even very short-term engagements – such as the length of an appointment with a patient.
If so, it is essential that you put in place contracts and processes with the doctors to minimise the risk of inadvertently creating an employment relationship.
The law in this area is complex. Just look at the legal challenge uber has been facing from their drivers, who say that they should be recognised officially as workers at the company.
The key point to note is that employment status is determined not just by the contract terms you have with doctors but also by what really happens day to day.
Essential elements for an employment contract to exist: Personal service: Does the individual undertake to provide their own skill and work?
Mutuality of obligation: Does the individual undertake to pro-
vide their own skill and work in return for consideration: a wage or other remuneration?
Control: Is the individual wholly or mainly acting under your direction/control?
There are various other factors to consider, but, without these three elements, it would be difficult for a doctor to assert that he/ she was an employee.
2
How much control do you need to exercise over doctors you work with as independent contractors?
In short, significantly less than if the doctor was your employee. An advantage of engaging doctors as independent contractors is that you can expect them to undertake services with a degree of autonomy. This can allow you to transfer risk from your business to the doctors by ensuring they take responsibility for the medical services they provide.
But, in this relationship, you will still need to ensure that they have the requisite qualifications, experience and regulatory registrations, in particular if you plan to use foreign-qualified doctors. you will want to ensure that your contract with the doctors includes obligations on them to maintain these qualifications and registrations. And, as with every other contract, you will want to monitor and manage compliance with these obligations – the success of your business will depend on it.
3 What registrations and indemnity cover does the business need?
The registrations and indemnity cover the business itself needs, as opposed to those that the doctors working for it need, will very much depend on how the business is structured and the respective responsibilities of the business and doctors.
a common definition is that it is an environment in which temporary positions are common and businesses contract with independent workers for shortterm engagements, often through technology. While the healthcare sector is familiar with the idea of independent contractors, the concept of workers contracting for short-term, even very shortterm, engagements and using technology to do so is relatively new, as it is for every other sector of the economy
The key question is whether the business itself needs to be registered with the Care Quality Commission (CQC). Broadly speaking, if the business is responsible to patients for provision of healthcare services, then it will need to be. But if the business is operating as a platform to simply connect patients and doctors, then the business may not need CQC registration, but the doctors themselves will need to be registered. This is obviously a complex area and one it is essential to get right. Similarly, the potential indemnity cover that the business needs will depend on whether it is responsible to patients for providing healthcare services or not. Indemnity requirements and costs should be considered early on in the planning process.
Jamie Foster (far left) is a partner and Helen Baxter (left) is an associate at Hempsons Solicitors
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.
Whatever your own opinion on the vote to leave the eu, one of the notable side-effects of the subsequent discussion over last summer was British people talking politics.
Not the usual generalised commentary on how bad this or that politician might be or the latest scandal to befall one of the people at the top, but open, frank discourse on personal political beliefs.
a s a nation renowned for our reserved nature and robust avoidance of the three dinner party nonos – money, religion and politics – it was remarkable to hear such passionate debate.
So if we can now talk politics, can we also talk about wealth?
Can you discuss your wealth with your family? Simon Bruce explains why it’s important for grandparents to ‘talk money’
a nd to the people we love the most?
Many find it difficult to talk about wealth at all with our nearest and dearest, particularly as thoughts on money can be influenced by emotion and perceived family sensitivities.
Some of the trickiest conversations can be between generations, where there can be widely different understandings of personal values, the real value of money and how it should be used.
a nd yet without careful planning between family members, too much money can be given away needlessly to the taxman and opportunities to make life
easier in the future are often put off or missed altogether.
With life expectancy rising, we might spend three decades in retirement. t his means that the transfer of wealth might not happen until beneficiaries are in their 50s and 60s.
this may not be the ideal time to receive an inheritance, but, understandably, few people are willing to give away their own funds if they believe they might still need them.
Well-known billionaires such as Buffett and Gates have publicly declared they will not leave money to their children at all and the media loves the concept of ‘SKI’ parents: ‘spending the kids’ inheritance’.
But with some consideration, there should be ‘enough’ to enjoy the type of retirement you had envisaged while ensuring you can help your children and grandchildren at the same time.
and perhaps you can help them now, when you are still around to see the positive effects of your giving. With steep property prices for first-time buyers and increased university fees, many young people are forced to look to the bank of mum and dad – and granny and grandpa – to help with some of life’s key milestones.
a first task is to establish practical and tax-effective savings plans. If a parent puts money into a bank
account in their children’s name, any interest accrued above £100 in the year will be assessed under their own tax return, not the child’s. No such restriction applies to grandparents, who can give as much as they like to grandchildren – or other people’s children. there are Government-backed Children’s Bonds from National Savings and Investments. t hese are simple five-year lump-sum investments for children under 16 earning a guaranteed tax-free rate of interest, currently 2.5%. Grandparents can contribute between £25 and £3,000 in each issue of the bonds.
another tax-efficient method of saving for young children is with a Junior IS a which, at present, allows one to contribute up to £4,080 of tax-free savings in cash or investments a year. the key rules are that no capital withdrawals can be made until the child is 18 and if no money is taken out at that time, the account will roll over into a standard ISa any income is tax-free and does not get caught by the £100 income limit on normal children’s savings. the ISa is a useful way to build a nest egg within a tax-sheltered environment, but grandparents need to be aware that – as with the majority of children’s savings products – the child is entitled to spend it as they please at the freespirited age of 18.
If you would like to retain a degree of control, you could consider using a ‘bare trust’. these are regularly used to transfer assets to minors with the investment authority retained by an adult, usually a parent or grandparent. Creating a bare trust is a common way of funding school fees because there is a degree of access to the money before the child reaches 18. the trust can be set up by anyone for a specific child or
children and the trustees withdraw money as necessary to pay for school fees.
t he trustees include, in most instances, the parents, grandparents or guardians who may also have produced the original capital investment.
In this way, they retain control of the funds and the timing and nature of their disbursement. the trust fund does become the property of the beneficiary on their 18th birthday, but, in practice, this information does not necessarily have to be revealed immediately. these trusts are popular because school fees have quadrupled since 1990, with the average cost of sending two children to private school reaching over half a million pounds.
the advantages of a bare trust are that the beneficiary rather than the donor has responsibility for the capital and income held in the trust, and therefore any associated tax.
this can create a golden opportunity for grandparents, as the income from the trust will be taxed as the grandchild’s, who has all of the usual personal allowances. It is likely that the grandchild will be a non-taxpayer, making this route very tax-efficient.
as well as gifting lump sums into trust, there is also the opportunity to make use of excess income by contributing to grandchildren’s pensions.
t he maximum annual contribution to a pension is limited to £2,880. to this, the Government adds tax relief at 20%, increasing the gross contribution to £3,600 within the pension fund. the effect of tax relief and compound interest over the years can result in a solid base being created on which to build long-term security – particularly given that the pot cannot be touched until age 55.
Communicating the value of saving to your loved ones can be paramount to achieving good financial planning across the generations
time to make informed choices and have a greater chance of avoiding inheritance tax issues.
Whatever your intentions, communicating the value of saving to your loved ones can be paramount to achieving good financial planning across the generations.
herein lies the downside for the beneficiary who cannot use the funds for university fees or firsttime property purchases.
a n added incentive for the grandparent making regular monthly or annual contributions is that if this is made out of their own disposable income (not savings), it can be considered exempt from inheritance tax.
Grandparents can also give away ‘gifts’ worth up to £3,000 per donor in each tax year which will be exempt from inheritance tax upon their death. If any part of the £3,000 exemption has been unused in that year, it can be carried forward – for one year only –so the gift can increase to £6,000.
If you are keen to help your heirs with their finances, acting sooner rather than later can pay dividends. you will have more
In doing so, and in being as honest as you can be with each other, we can normally create a clear path ahead which allows the older generation to continue to live their life to the full while younger members get the kickstart they need.
See page 44
Simon Bruce is managing 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.
Consultants being granted practising privileges in a private hospital should get a written agreement outlining a description of their role
By Leslie Berry
Private hospitals have been told by their trade body they have a duty to ensure fees and charges are clear to users of their services.
And they have been instructed that the competition watchdog’s rules on transparency must be complied with.
New instructions say hospitals should be able to demonstrate their practising privileges procedures are unambiguous about the Competition and Markets Authority’s (CMA) order and its require ment for consultants to comply with providing fees and performance information.
If doctors fail to agree, or there are other performance issues, then the hospital would be expected to restrict, suspend or withdraw practising privileges
The Association of Independent Healthcare Organisations (AIHO) says it expects hospitals to inform consultants with practising privileges of the CMA’s requirements and any updates.
AIHO’s document Practising Privileges Principles, produced in response to independent hospital
requests, summarises key legal and regulatory issues arising under practising privileges arrangements. The aim is to ‘prompt and support’ AIHO members into considering these key issues and encourage them to develop local, organisation specific policies to address the principles in this document.
Hospital’s responsibility
AIHO advises hospitals that healthcare regulators have an interest in ensuring compliance with the CMA’s order – especially ‘with respect to improvements in transparency of information on performance and fees that would allow patients to compare services and make informed choices about their treatment’.
AIHO’s document says: ‘The Order states that it is the operator of a private healthcare facility, who as a condition of permitting a consultant to provide private healthcare services, ensures that
relevant consultant supplies private patients with information in writing.’
AIHO adds that the decision to award, or not award, practising privileges should be in writing and there should be an appeals process with defined criteria with input from HR professionals
Before granting privileges, hospitals should have evidence of preemployment checks, relevant to the scope of practice – for example, children – including, but not limited to:
Qualifications,
Professional registration;
Competence/experience;
References;
Disclosure and Barring Services checks;
Relevant occupational health checks – such as exposure prone procedures;
Safeguarding training.
Written agreement
Doctors should get a written agreement outlining a description of their role – including requirements on attendance and oncall, the scope of practice, compliance with professional and other regulation – including revalidation and CMA order and the requirement for compliance with the organisation’s policies.
The 12 page publication says:
‘The valid award, and ongoing maintenance, of a practice privilege agreement is subject to individual professionals working in accordance with the organisation’s requirements for mandatory training and complying with local policies and procedures.
‘These include, but are not limited to, health and safety / fire, infection prevention, information governance, consent, introduction of new techniques/ procedures, integrated records management (for outpatients and inpatients), medicines optimisa
tion (including antimicrobial stewardship), medical device management (including personally owned equipment), patient feedback (satisfaction and complaints), adverse incident management, and duty of candour.
‘Organisations may also define the need for attendance at workshops or training sessions related to organisational culture, cognitive, social and personal resource skills.’
Hospitals are expected to ensure the number of professionals, areas of work and frequency of attendance of those with practising privileges is known and regularly monitored.
Potential suspension
It adds: ‘Those who practise infrequently should be reviewed with the potential for suspension of practising privileges if they are unable to remain familiar with the provider’s policies, procedures, equipment and processes.’
They should also conduct an ongoing review of a consultant’s compliance to all the aspects of the agreement and renewing the agreement prior to expiration.
This would include a review of their continuing professional development, whole practice appraisal and revalidation.
If doctors fail to agree, or there are other performance issues, then the hospital would be expected to restrict, suspend or withdraw practising privileges, and seek advice from the chairman of the medical advisory committee or Responsible Officer.
The document says the process for escalated concerns should be documented, including referral to the professional regulator.
aIHo says its members should be able to demonstrate that their organisational and operational governance supports individual professionals in their practice, including:
emphasising the requirement for individual professionals to practise only within their scope of practice
Maintaining up-to-date policies and procedures that are accessible to those with practising privileges; for example, from home-based office or on a mobile device
emphasising the requirement for the individual to comply with the professional duty of candour and be open and honest when things go wrong
disseminating guidance and lessons learned using systems which those with practising privileges can read ‘in a timely manner’; for example, using smartphones
Maximising the use of IT-based solutions that provide links to support continuing professional development/ revalidation
AIHO adds that all members’ staff should feel able to act if a colleague’s work causes concern and they should be shown how to use the local whistleblowing policy. November 2016
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Independent Practitioner Today readers’ defence questions are answered here by Dr Nicola Lennard (right)
QI have been seeing a nineyear-old child in the presence of her mother for the investigation of possible absence seizures.
The father has written requesting information about the investigations the child is having and the potential diagnoses and treatment.
He says he has parental responsibility. I then discussed the request with the child’s mother and she told me that they were never married; they went through an acrimonious separa-
tion some years previously and she does not want me to share any information with the father. What should I do?
AAn individual with parental responsibility for a child can request access to their child’s medical records.
The birth-mother of a child and married fathers will automatically have parental responsibility, but this can be removed by the court.
Unmarried fathers who are named on the birth certificate of the child will also have parental responsibility, provided the child was born after 1 December 2003 in England and Wales (4 May 2006 in Scotland and 15 April 2002 in Northern Ireland).
Unmarried fathers not named
on the birth certificate can acquire parental responsibility, as can step-parents and civil partners, either by obtaining a Parental Responsibility Agreement from the child’s mother or a Parental Responsibility Order from a court.
A divorced parent will retain parental responsibility, but courts can restrict or remove parental responsibility from an individual should it be deemed appropriate.
If you are unsure who has parental responsibility, it would be reasonable to ask for evidence – for example, by requesting sight of a copy of a child’s birth certificate and/or parent’s marriage certificate.
If one parent raises concerns about the other receiving information, you could ask if they have court documentation showing
parental responsibility has been removed from the other parent.
A child or young person with capacity has the legal right to access their own health records and to allow or to refuse access by others including their parents. This child, aged nine, is unlikely to have developed capacity to make such a decision.
If the child were older, however, the GMC guidance for 0-18 years explains that doctors should take into account the views of a child who has the capacity to make such decisions.
Even if an individual has parental responsibility, disclosure should only be made in this instance if disclosing the information does not go against the child’s best interests.
When assessing a child’s best interests, you can take into account the views of those close to the child and should explore the mother’s reasons for not wanting the information to be shared with the father in this case. However, if the father has parental responsibility and it does not go against the child’s best interest, then disclosure can be made.
If the father continues to have access rights and is at times responsible for the care of that child, it would be reasonable for the father to have knowledge of the child’s medical problems so that appropriate treatment can be sought in the event of an emergency.
A final consideration before disclosure of the records is made is the presence of any third-party information within the record. If the records contain information about a third party, then you will need either consent for disclosure
from that third party or the information should be redacted.
Bear in mind that disclosure of the child’s current address is in itself a third-party disclosure, and, as such, you might wish to consider redacting this information.
QI am a GP in a private practice and recently a patient asked me to sign a backdated fit note for her, stating she had been suffering from diarrhoea and vomiting for weeks.
It was her third week of not attending work, but it was the first consultation I had given her.
I couldn’t find any evidence in the patient’s medical records or out-of-hours services that she
sought medical assistance at any time prior to her appointment with me. What should I do?
AFit Note guidance suggests that doctors may backdate fit notes in certain situations where there is corroborating evidence, such as a previous assessment conducted by another medical professional.
When that is the case, you should include the date of the earlier assessment and an estimated date from which the person’s ability to work was affected in the note.
However, in the situation you have described, you have not been able to obtain any evidence that the patient has undergone an earlier assessment.
If you are not able to verify the truth of a document or sick note, you may be vulnerable to criticism if you sign it. GMC guidance states that you must make sure
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that any documents you write or sign are not false or misleading and you must take reasonable steps to check the information is correct.
It can be difficult to say ‘no’ to a patient in these circumstances, when they might face a difficult situation upon returning to work without a sick note. So it is important that you communicate your decision clearly to the patient, so they understand your decision.
This will not only help to avoid damaging your relationship with the patient but should also prevent a similar situation occurring in the future.
If the patient is so dissatisfied with your answer that they complain, then you should seek advice from your medical defence organisation to determine the best path forward.
Dr Nicola Lennard is a medico-legal adviser at the MDU
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It’s
time to get in shape before the end of the tax year. Ian Tongue (right) shows what you need to consider
With the tax year end of 5 April ever closer, it is important that you maximise tax-free allowances and are best based placed moving into the next tax year.
Frequently, tax allowances are per tax year and if you are married or in civil partnership, they are doubled up. Understanding which ones are available is the key to ensuring that you reduce your tax burden.
the following is not investment advice and before entering into any investments you should seek the advice of an independent financial adviser.
Pension annual allowances
this has been a complicated and ever-changing area over many years and more complications from 6 April 2016 muddy the waters further.
the headline amount that a taxpayer can save into pensions is £40,000 a year. this sounds a lot, but for those in the NhS Pension Scheme, this allowance is often used up. the reason for this is that the physical cash contributions made to the scheme are disregarded and the growth in pension is substituted to compare against the £40,000 allowance.
Changes introduced from 6
April 2016 reduce the annual allowance to as low as £10,000 for those with earnings over £210,000, with a progressive reduction applying from £150,000. this is referred to as a tapered annual allowance.
if you are currently not paying into the NhS Pension Scheme and are caught by the tapering of annual allowance described above, it is vital that you consider your options and review matters with an independent financial adviser, as in certain circumstances you could end up losing a large proportion of tax-free allowances for good.
if you are an active member of the scheme, it is important that your circumstances are being tracked annually by your accountant to ensure that you do not fall foul of the limits.
For those with spouses who are involved in their private practices and who may not have a pension elsewhere, it is a great time to consider your options.
Paying a pension contribution through your private practice is tax-deductible, so this can work particularly well. Discuss matters with an independent financial adviser and your accountant to see if this can work for you.
For those with spouses who are involved in their private practices and who may not have a pension elsewhere, it is a great time to consider your options
Many people are unaware that a child can have a pension which you – or grandparents – can pay into. t he allowance is £3,600 a year and given the number of years for potential growth, it may be a great head start for pension saving.
Discussing your options with an i FA is essential here, as the demands for cash for children are often shorter term, for example university, and these should also be considered.
t he i SA has become a popular investment over the years and the Government has progressively increased the amount you can invest in one as well as the number of different iSAs available.
For 2016-17 the limit is £15,240 and this can be spread across the different types of i SA that are available. t he main ones that people will be aware of are the:
Cash iSA;
Stocks and shares iSA;
innovative finance iSA. each iSA is different in terms of what happens to the money once invested. As you would expect, there is a range of risk associated with each. i t is the job of your financial adviser to ensure that you pick the right one(s) for you. in addition to the above, there are a further four i SAs with an additional one scheduled to come on board from April 2017. these are:
Junior iSA;
help to Buy iSA;
inheritance iSA;
Flexible iSA;
Lifetime iSA (from April 2017).
A Junior iSA can be a good way of saving for children and anyone can top the money up to the tax-free amount for 2016-17 of £4,080.
t he h elp to Buy i SA is a good way for younger people to get on the property ladder. there should be plenty of time to discuss the different types of i SA with a financial adviser in advance of the 5 April 2017 should you wish to consider all the options available.
Tax-efficient investments there are other types of tax-efficient investment available and
these have a maximum allowance per year.
t hese investments are usually pre-approved by hM Revenue and Customs and therefore should carry less risk of non-compliance than others, but, clearly there will be a differing degree of investment risk associated with each.
A Venture Capital trust, or VCt as it is known, is a type of investment for private companies that require funding. income tax relief is currently available at 30% of the investment per taxpayer up to £200,000 a year.
An e nterprise i nvestment Scheme ( ei S) was introduced to encourage investment in small unquoted businesses – that is to say, not listed on the stock exchange. this scheme currently provides income tax relief at 30% up to £1m per tax year.
A Seed e nterprise i nvestment Scheme (S ei S) was introduced back in 2011 and allows largely start-up businesses to attract private funding to encourage enterprise and entrepreneurship. this scheme has a lower investment limit per year of £100,000, but the income tax relief available is at 50%.
each of these investments carries a different level of risk and it is important to obtain the appropriate advice before investing in such schemes.
if you are considering investing in equipment, buying in advance of the tax year-end can usually accelerate the timing of tax relief on this capital outlay.
A scheme to provide 100% tax relief on qualifying purchases continues and 100% of expenditure can be claimed on the first £200,000 of expenditure.
i f you are considering selling assets that would attract capital gains tax, it is worth knowing that each taxpayer has an annual exemption limit of £11,100. therefore, consider the timing of purchases to ensure that your taxfree amounts are maximised.
each taxpayer is allowed to give up £3,000 of their estate tax-free and if the previous year was not
The tax year-end of 5 April is a natural line in the sand for taxpayers and most businesses
used, this can be carried forward. therefore, if you have not done this as a couple, it could be a way of gifting away £12,000 before the end of the tax year without any inheritance tax issues arising.
Before doing this, it is always a good idea to run this past your accountant to ensure that this would apply in your circumstances.
Consider your trading structure
As you approach the tax year-end, it is a natural point to consider the best trading structure for your private practice. Many doctors trading as sole traders could benefit from a change of status to that of a limited company.
For those with modest private practices, the new dividend tax rates applicable from 6 April 2016 do increase the savings available when compared to self-employment and therefore it is important that you discuss matters with your accountant.
For those who are trading as a company and are not extracting the profit regularly, don’t forget to extract dividends to ensure that you use your tax-free allowance of £5,000 (from all sources), as this does not carry over to the next year.
the tax year-end of 5 April is a natural line in the sand for taxpayers and most businesses. the clock may be ticking for you to enjoy significant tax savings and therefore speak to your accountant and independent financial adviser without delay to ensure that any opportunities you have are taken.
Next month: The importance of good record-keeping
Ian Tongue is a partner with Sandison Easson Chartered Accountants
Our tester Dr Tony Rimmer (below) takes to the track in the latest version of an iconic sports car destined to be the choice of many doctors in the fast lane
If you are a bit of a petrol-head medic, you are likely to be prepared to spend a bit extra on something special when it comes to buying your own car.
And if, like me, you have had a lifelong obsession with all things automotive, then there will be one car that you will have wanted to own at some time in your life. That car is the iconic Porsche 911.
The 911 has been around for more than 50 years and has steadily evolved from relatively simple mechanical roots to the technically advanced and sophisticated model of today.
A few major changes have taken place along the way: air-cooled engines gave way to water-cooling in 1999 and, in 2011, electric power steering became standard.
Each new model creates uproar from established enthusiasts who fear the German maker has taken a step too far to dilute the essence of what makes the 911 so special.
We all recognise that, with independent medical practice, change is driven by two major factors: constantly advancing technology and constantly altering rules and regulations. In the motoring world, both factors also apply.
Stricter official rules regarding emissions have stimulated advanced engineering solutions from engine development gurus. Porsche has applied this to the latest version of the 911 by making all engines slightly smaller in capacity and all are now turbocharged. It has even gone a step further with the Boxster and Cayman models by reducing the number of cylinders from six to four and engine capacity to two litres.
Although there has been no alteration to the external appearance of the 911, there have been a few updates to the interior equipment and trim.
The steering wheel is of a new design, the navigation system and smartphone compatibility is greatly improved and the paddles for the Porsche doppelkupplung (double clutch) automatic gearbox now work more intuitively.
But the major changes are in the engine department and the 3.4 and 3.8 litre naturally-aspirated engines in the Carrera and Carrera S have now been replaced by a twin-turbo 3.0 litre flat-six in two different states of tune. It was with great interest that I was able to try several versions of the new car at Porsche’s Silverstone Experience Centre and the surrounding Northamptonshire roads.
As Porsche has huge experience with turbocharging – there has been a ‘full-blown’ 911 Turbo model in the range for 40 years – I was fully expecting the new engines to be really well sorted. But would it mean the loss of
Although there has been no alteration to the external appearance of the 911, there have been a few updates to the interior equipment and trim
character? Would it mean that die-hard 911 supporters would feel disappointed and cheated? Would the successful independent practitioner able to venture into the Porsche 911 buying arena for the first time be disillusioned?
Silverstone experience
Well, the best way to experience just what a modern Porsche is
on a specially-designed circuit in complete safety.
you travel at speeds that are unthinkable on the public road and you experience the full acceleration and braking capabilities while cornering at the limits of adhesion.
What this does is focus the mind on various optional extras you may want to consider. furthermore, it gives you the confidence to know and experience the full performance envelope of your own car which makes you a much safer driver on public roads.
It is also one heck of a lot of fun. Even if you do not have a Porsche on order, you can buy an Experience Day at Silverstone and enjoy a day to remember.
So, having spent a day driving different versions of the new 911 on track and road, I was ready to draw a few conclusions.
This latest version of the Porsche 911 is as brilliant as ever. It looks great, is very fast and remains a comfortable long-distance companion.
you can buy it in coupé, convertible or Targa form with twoor four-wheel drive. It can be used every day, carry more than one passenger (occasionally) and has reasonable space for luggage.
The superbly-built interior is as good as it gets and a drive will always put you in a good mood, even after a long day or stressful clinic.
It may be expensive, but as the old adage goes: you only get what you pay for. If you are ready to treat yourself to a new 911, now is as good a time as any.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
capable of is to drive it on a track, and every new owner is offered a day at the Silverstone Experience Centre as part of the purchasing deal.
This is something that I would highly recommend. Accompanied by a professional driver, you are guided and encouraged to explore the full performance of an example of the model you have ordered
The 911 remains a magnificent sports car. The new turbocharged engines mean that power delivery is more readily available across the whole rev-range which relates better to real world driving, yes, some purists will miss the need to rev the engine towards the red-line but this is negated by greater flexibility for more of the time. Porsche has also been very clever to tune the exhaust system so that the sound is still aurally intoxicating.
Body: Two plus two, two-door coupé engine: 3 litre flat-six twin-turbo petrol power: 414bhp
Torque: 500Nm
Top speed: 190mph
Acceleration: 0-60mph in 3.9 secs overall economy: 36.7mpg on-the-road price: £85,857
Profits for eye surgeons in private practice are looking healthy and the prognosis is good for the future. Ray Stanbridge reports in our latest benchmark analysis
An Aver A ge consultant ophthalmologist’s private practice earnings increased from £124,000 to £129,000 (or by 4%) between 2014 and 2015, according to our latest survey.
It seems that most of this growth was accounted for by Choose and Book work. In some cases, consultants experienced significant growth in this area.
At the same time, we noticed an increase in self-pay, and some signs of a decline in insured work.
Our headline figures suggest that costs rose by about 3.8%
from £52,000 to £54,000 in the year between 2014 and 2015. As a result, taxable profit rose by about 4% from £72,000 to £75,000.
Most costs seem to be stable. There was some increase in consulting room hire costs, though our survey assessed data before the implementation of the Competition and Markets Authority (CMA) rulings from April 2015.
Indemnity costs
There was a small reduction in average indemnity costs. Those consultants with a good claims
aveRage INCOMe aND eXPeNDITURe OF a
Expenditure
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)
Source: Stanbridge Associates Ltd.
It looks as if ophthalmology private practice still flourishes –but we will see next year!
record have chosen to seek alternative insurers in the market; in some cases, achieving significant cost savings.
However, in many cases, the real extent of retrospective cover is not clear. Time will tell whether or not the savings are real.
Office costs showed a small increase on average, for no particular reason. Secondly, there was a small growth in accounting/ legal costs, which seems to have been primarily determined by rounding adjustments.
‘Other costs’ seem to have remained constant at £7,000 for the year. The big jump in ophthalmologists incurring marketing expenses seems to have passed, and many consultants have already had the benefits of spending on this.
A preliminary look at early 2016 figures suggests that ophthalmologists have done quite well. Choose and Book work seems to have still been fairly strong.
We are also seeing an increase in self-pay work as opposed to insured work.
On top of this, the growth of groups and organisations such as Optegra continued to have a positive effect on those involved.
Do you believe your patients deserve access to the latest ophthalmic equipment and the benefits of a specialist eye hospital? Eye health experts Optegra can help.
The UK’s largest specialist eye hospital group, Optegra Eye Health Care, has opened seven ophthalmic eye hospitals across the UK over the past seven years, and Queen Anne Street (pictured) is its flagship hospital.
Celebrating the central London hospital’s first year providing full ophthalmic services within the prestigious Harley Street district, the stunning facilities include a full laser suite, medical ophthalmology rooms, three ophthalmic theatres, and an 11-bed ward offering private patient recovery areas.
Following a £13 million investment, Queen Anne Street is filled with top of the range equipment, offering all the diagnostic equipment you could want across six floors of this stunning Edwardian and Victorianfronted building.
The latest technology
Latest technologies include ReLEx SmILE, which is a 3rd generation, bladeless, flapless, minimally invasive alternative to laser surgery. And Optegra is committed to training to ensure all surgeons are fully up to speed on latest innovations.
So whether you are an Ophthalmologist looking for state of the art facilities, or a physician wanting to refer patients to a highly reputable, trusted and proven ophthalmic team, Optegra wants to hear from you.
Full range of treatments
Consultants within Optegra Eye Hospital London treat the A to Z of eye health care: from vision correction options (laser eye surgery and lens replacement) through to medical treatments for conditions such as cataracts, AMD, floaters, retinal tears, glaucoma, and even pioneering techniques like stem cell transplants in the future.
The hospital even offers innovative services such as a telemedicine service for community Optometrists wanting advice on OCT images.
Counselling and support
And to support patients with poorer vision, Optegra offers a low-vision aid service to help those patients maximise their remaining vision with innovative, practical solutions, and a vision counselling service (in conjunction with the RNIB) to help patients come to terms with their visual impairment.
Optegra also runs a Professional Partnership Programme of education and development with optometrists and opticians to ensure the very best medical treatments are available to all.
Ranked No. 1
In patient satisfaction, Optegra is rated number 1 in category on Trustpilot, an independent review site. To maintain its five-star standard of patient care and safety, the specialist eye hospitals draw on the expertise of its Medical Advisory Committees (MAC), headed by consultant level ophthalmic surgeons who all report into the corporate MAC.
Rory Passmore, Managing Director for Optegra Eye Health Care UK, says:
“We are pioneers in eye health care, focused on delivering the highest clinical standards and an exceptional service to each and every patient.
“We are keen to open our doors to as many patients as possible, as we believe that our first-class facilities and medical teams can truly offer the best treatments.
“To achieve this we encourage referrals from primary care services, and welcome you to come and view our hospital to witness the quality at first hand.
“We also invite surgeons and Optometrists who, like us, are dedicated to delivering an unsurpassed level of treatment to come and talk to us about potentially working together.”
If you are interested in referring patients, or having practising access to Optegra’s specialist facilities, please contact Hospital Director, Jonny Husband, on 020 7509 5400 or email oana.filip@optegra.com
It looks as if ophthalmology private practice still flourishes – but we will see next year!
We reported last year that, of all the specialties, ophthalmology was the most vulnerable to change in n HS waiting list and Choose and Book policies. This trend has continued, with further volatility in ophthalmologists’ earnings.
As reported in previous editions
of Independent Practitioner Today, there are practical problems in trying to record some consistency in trends.
This is because the market, conduct and performance is strongly changing.
Some consultants have incorporated – though HM revenue and
Customs seems to be trying to ensure that the advantages of incorporation are slowly being evaporated.
Other consultants, particularly out of London, have chosen to primarily do Choose and Book work. And others have chosen to pursue group working as the way forward; in some cases, with outstanding success.
All these changes have an impact on incomes and cost structures. As a result, year by year comparisons are increasingly difficult.
note that our definition of consultants who are included in our survey are 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 a year gross in the private sector;
Hold either an ‘old-style’ or ‘new-style’ nHS contract;
May or may not be a member of a group or have incorporated.
Next month: gynaecologists
Ray Stanbridge is a partner with accountancy, finance and tax advisory medical specialists Stanbridge Accountants
Make sure you don’t miss our next issue, published on 16 February. you may not receive every issue if you have not yet subscribed to the journal. Don’t risk missing out on vital topics we tackle next time, including:
how to avoid the isolation trap in private practice
FRee – Independent Practitioner
Today’s 2017 Product guide featuring details of the goods and services private doctors need to know about
Could you be replaced by a robot?
It’s your website … but do you own and control it? gill hall and Nabil asaad, from award-winning solicitors hempsons, have some very useful advice in their Legal Briefing column
Preparing to sell your practice: Some useful pointers if you are looking to sell and want to find the right buyer in the marketplace
MDU medico-legal adviser Dr Nicola Lennard gives advice on two scenarios where patients’ confidentiality is at stake.
Large fees and how to get them – more from our series on Medicine’s Strangest Cases
Where now for the Independent Doctors Federation?
Tariffs and prices for insured and for self-pay patients. Philip housden gives some tips in his monthly column on private patient units
eDITORIaL INQUIRIeS
Top tips for busy doctors – time management
Breaking into medico-legal work: The experts meeting PLUS what you need to know from a billing perspective if you are thinking of expanding into this sector
The 100-year life: Simon Bruce, of financial advisers Cavendish Medical, looks at the impact of life expectancy on the traditional doctor’s retirement
Profits Focus examines the latest earnings trends of gynaecologists
Starting a private practice
Code Buster! Medical Billing and Collection gives an update on the latest codes to help prevent you losing money
Our Doctor on the Road columnist reviews the Skoda Octavia Scout
The CQC has published its five-year strategy setting out its vision for quality regulation, which aims to deliver a more targeted, responsive and collaborative approach. Dr Pallavi Bradshaw of Medical Protection explores some of the issues the strategy may pose for private doctors
PLUS all the latest news and views
aDveRTISeRS: The deadline for booking advertising for our February issue falls on 6 February
Robin Stride, editorial director
Email: robin@ip-today.co.uk
Tel: 07909 997340
aDveRTISINg INQUIRIeS
Margaret Floate, advertising manager
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