Reach out to connect with patients
Medical marketing expert Catherine Harriss shows how to be found by potential patients P18
When the media starts snooping
Advice on coping with being the subject of an undercover investigation P32
See page 34
Avoid a bumpy crash landing
Simon Brignall explains how to have a happy landing amid all the financial turbulence P38
By Robin Stride
2023 has dawned with chilling warnings from a consultants’ leader – and others – about a tougher road ahead for doctors in private practice.
According to the new chair of the London Consultants’ Association (LCA), they now face some of the most challenging times he has seen in two decades of independent practice.
Mr Ellis Downes warns in this digital issue of Independent Practitioner Today of a wind of change ‘blowing hard in the independent sector’.
He observes: ‘The future of private healthcare is unclear. There is clear evidence that recently appointed consultants are less attracted to private medicine.
‘This may be because of startup costs, lower remuneration rates from insurance companies compared to more established colleagues, increasing administrative overheads and their ability to boost incomes without significant expenses by doing additional paid NHS work.
‘With colleagues retiring, this will, in the near future, lead to a
significant shortage of doctors in the independent sector, with severe consequences for patient care and indeed the healthcare system in this country as a whole.’
Mr Downes, a consultant obstetrician and gynaecologist in Harley Street, calls for disincentives to independent practice to be acknowledged and challenged in order to maintain the sector’s longterm health.
His comments come as many independent practitioners’ businesses face their highest inflation ever and are about to be squeezed financially in all directions from the Chancellor’s tax hikes announced in the autumn.
Hospital Consultants and Specialists Association (HCSA) president Dr Naru Narayanan criticised lack of action on the pensions tax trap ‘driving senior hospital doctors into early retirement’ and said they would be discouraged from taking NHS overtime by a lower 45% income tax threshold.
Specialist medical accountants are encouraging doctors to book a review of their affairs to ensure they are working in the most taxefficient way.
Financial advisers Cavendish Medical stress it is important for advisers and accountants to have the same objectives and work together to ensure no opportunities are missed.
Simon Brignall, director of business development at Civica Medical Billing and Collection, fears possible turbulence ahead for independent practitioners’ finances.
He said more than 90% of his company’s clients had been billing above their 2019 levels with many seeing a 50% increase in self pay activity.
But the UK was yet to see the full impact of inflation.
Reductions in disposable income were more likely to impact younger and middleaged consumers and so firms’ discretionary decisions about employee contracted healthcare might face difficult choices when budgets were tight.
‘This is not to say that the medium to longterm outlook for the private sector is not positive, but to highlight that the shortterm could prove to be a little choppy,’ Mr Brignall said.
He gives some useful tips to ensure practices are best prepared for rougher times (see page 38).
Jane Braithwaite, managing director of Designated Medical, forecasts some private healthcare growth as patients try to dodge long NHS waiting lists, but she warned that many would be incredibly cost sensitive and unable to afford the extra expense.
She said: ‘Costs in every area are increasing, most significantly in terms of salary expectations.
‘It is still hard to recruit good staff and our current employees are hoping for significant pay increases so they feel they are at least standing still in terms of their financial wellbeing.
continued on page 3
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COMMENT
We wish Independent Practitioner Today readers a happy new year, and really hope you have one, but it will be 12 months of more challenge ahead.
The squeeze is very much on, as our top news story this month and feature articles make all too clear.
Plans for hefty tax rises for higher earners, in the autumn’s financial statement, will kick in before you know it and inflation has been going through the roof.
Many independent practitioners have difficult decisions to make in the run up to April, not least how they are going to reward the worthy staff they employ.
An NHS pensions ‘consultation’ is underway to try and give more flexibility for many, but still there is no help proposed for the devilish lifetime and annual allowance, which gnaws away at ever more doctors’ pockets.
Huge dissatisfaction in health
care professions and threats of industrial action across the NHS has, as we have witnessed over the last few weeks, brought widespread additional angst for those struggling to provide a service.
With record waiting lists ahead of Christmas, the Government announced the setting up of a task force and plans to use independent healthcare capacity to reduce NHS patients’ waiting lists.
We are all for using spare capacity, even if those doing the work are – as a worried Royal College of Surgeons of England has said –the same depleted workforce.
But what must not be allowed is a return to the pandemic situation when independent sector consultants lost all their income and practices collapsed as a result.
The independent sector can support the NHS to clear the backlog, but not at private patients’ expense.
The tax implications of going green Sustainable business will increasingly be on the agenda in 2023. Accountant Julia Burn shares some ideas for doctors in private practice P12
My partners have left me in the lurch
Our Troubleshooter Jane Braithwaite responds to a cry for help from a doctor whose partners drop the news that they’re both retiring P16
litigation after retirement
Even after a long period of retirement, doctors can be subject to a clinical negligence claim. The MDU’s Dr Claire Wratten gives some advice P22
A check list to perk up your finances
What are the quick wins for your financial peace of mind? Dr Benjamin Holdsworth of Cavendish Medical picks out ten issues you need to address P24
The paperwork you have to cough up
Hempsons solicitors Vicky Rowlands and Emma Summerfield outline the rules of disclosure and give key tips about record-keeping in everyday practice P41
Help with gun licence application
Medico-legal expert Dr Kathryn Leask explains what to do if you are asked to complete documentation for a patient requiring a firearms licence P46
PLUS OUR REGULAR COLUMNS
Countering inflation: Round-up of the tax hits on investments
Richard Norbury of Sandison Easson looks at the tax issues to consider with common investment areas P48
Doctor on the Road: The SUV’s next step of development
Motoring correspondent Dr Tony Rimmer is impressed with VW’s new entry-level coupé: the Taigo P50
Profits Focus: Cardiologists perform well despite Covid-19
Specialist medical accountant Ray Stanbridge analyses the financial performance of cardiologists P52
By Edie Bourne
New proposals to change the NHS Pension Scheme do not go far enough to tackle the punitive tax issues consultants are facing, according to specialist financial planners Cavendish Medical.
Back in September, the then Health and Social Care Secretary Thérèse Coffey announced ‘Our Plan for Patients’ which included plans to:
Offer ‘pensions recycling’;
To fix rules unfairly linking the NHS pension to inflation;
To introduce a series of measures to increase retirement flexibilities.
Now a consultation has been launched to gather feedback on these key components, which is expected to last until February with new measures introduced in Spring.
But critics say that, unfortunately, the consultation does not include specific strategies to address the wider issue of doctors forced to retire early or reduce hours due to the annual or lifetime allowance taxing their pension growth.
Patrick Convey, technical director of Cavendish Medical, explained: ‘In his recent Autumn
Statement, the Chancellor Jeremy Hunt did not address the very real problem of pension tax driving our senior doctors away from their jobs.
‘However, the former Health and Social Care Secretary’s [Hunt’s] announcement in Parliament that some smaller measures would be taken forward was welcomed.
‘Sadly, we can see that while some of these new tools could be useful for those nearing retirement, the wider workforce, particularly those in middle career positions, will not benefit unless we see widespread change.
‘As it is, there is already confusion over some of the measures announced. For example, pensions recycling was one such proposal. This is where employees who have opted out of the NHS Pension Scheme can ask their employer to pay any unused employer pension contributions as additional salary.
‘It could be an effective policy, but the rules are not yet clear and it is not being followed by all trusts.’
Mr Convey said at the time of Ms Coffey’s speech there was some confusion over whether trusts would be ‘encouraged’ or ‘man
dated’ to offer this opportunity to senior doctors.
But without a mandate in place, it could be a lottery as to whether doctors could take this useful option.
Cavendish Medical had spoken to several trusts as part of its work with clients and not all were ready to adopt this scheme. Some were offering recycling now but had imposed a range of conditions that must be met for eligibility.
Continued Mr Convey: ‘For example, one trust has indicated that an employee would not be able to reduce their programmed activities without its permission. In other cases, the trusts insist that the applicant has received advice from a financial provider about opting out before proceeding.
‘Hopefully, this latest consultation will ensure a mandate is put in place for pensions recycling and other pension flexibilities to make opportunities available to all employees.
‘Anyone confused over the latest proposals or considering their future should always seek help from specialist financial planners who understand the benefits and nuances of the NHS Pension Scheme.’
➱ continued from front page
Jane Braithwaite, managing director of Designated Medical, said:
‘Higher costs will put pressure on profits, and for businesses with small profit margins, the next 12 months may be hard to survive without borrowing.
‘And many are still paying off money borrowed to survive the pandemic’.
Her greatest concern is for
employee wellbeing and morale.
‘The current economy is bad news for almost everyone and people are dealing with increased pressure at a time when they are already pretty exhausted. Businesses will need to work hard to keep their teams feeling secure and motivated’.
But self pay expert Liz Heath, author of market analyst LaingBuisson’s annual self pay
reports, told the BMA’s annual private practice conference before Christmas that it did not appear economic factors were having a significant impact on selfpay – so far.
The meeting heard nine in ten private hospital operators and hospital groups were easing the financial burden on consumers by offering ways to assist them to spread the cost of their self pay treatments.
Senior doctors have given the thumbs down to the Government’s pension consultation to ‘fix’ pension rules and ease their tax burden.
The plans fall short of longterm solutions according to the BMA’s pensions committee chair Dr Vishal Sharma (pictured below) who said they appeared to be ‘too little, too late’.
His team, and other interested parties, were given eight weeks from before Christmas to consider the detail and respond.
But he warned: ‘Doctors will continue to incur sky-high and completely unexpected tax bills, simply by continuing to provide care for patients; care that they desperately need.
‘At a time when staff are facing unprecedented pressure, this is devastating for morale and it’s unsurprising that people are planning to leave in their droves.’
He complained that although a proposed partial retirement option and greater flexibility for recently retired doctors returning to work had potential benefits, the issues caused by the annual and lifetime allowances were not being directly addressed.
‘These are not just issues for doctors nearing retirement, but they are also increasingly influencing the decisions of midcareer consultants and GPs, for whom partial retirement would not be an option.’
By Douglas Shepherd
Consultants are being warned they are breaking the private practice complaints code if they respond separately to patients’ official complaints rather than jointly with the private hospital.
Concerns over several incidents have prompted The Independent Sector Complaints Adjudication Service (ISCAS) to write to providers pointing out this practice is unacceptable.
The code covers complaints about doctors and other healthcare professionals working within subscribing organisations, even where they are not directly employed by the organisation and have been granted practising privileges.
ISCAS told independent healthcare providers (IHPs) in a statement: ‘ISCAS does not deem it acceptable for consultants with practising privileges – or other persons engaged by the IHP – to write
separate responses to complainants and send their responses to complainants directly.’.
The complaints watchdog director Sally Taber told Independent Practitioner Today she believed some instances of consultants breaking the rules were unintentional: ‘They may be unaware of the rules – even some providers are unaware of the rules.
‘In recent months, there have been a number of cases. But the patient should get a united response that is from the hospital and the consultant.
‘The patient has to be assured the hospital and consultant are on the same wavelength. Otherwise, with one saying one thing and another saying something entirely different, the patient will feel unhappy with the outcome of their complaint.
‘There has to be a united response – it wouldn’t happen in the NHS because consultants are employed.’
ISCAS has directed providers to
Sally Taber, director of the
its position statement on complaints management and practising privileges, which clearly states that providers who subscribe to its services – the vast majority – are required to provide a single response to a complaint.
‘This ISCAS position mirrors the position of the Care Quality Commission (CQC) in defining staff in the broadest sense. The CQC define staff as “all persons employed or appointed for the purpose of providing a regulated activity”.
‘The response to complaints
shall be based on an investigation that involves all relevant persons, whether those are staff who are engaged through an employment contract, agency/bank staff or those who have been granted practising privileges.
‘IHPs may need to obtain statements or feedback from those granted practising privileges in addition to other members of staff; however, they should be incorporated into a single response to the complainant from the IHP.
‘The position of ISCAS is that the single response to a complaint should incorporate feedback from all relevant clinicians including consultants with practising privileges.’
The statement adds that providers who continue to permit multiple points of communication and responses to be forwarded to the complainant will be deemed to be non-compliant with the ISCAS Code.
Doctors can expect increased private hospital emphasis on moving closer to ‘net zero’ in 2023.
More than 1,500 private healthcare sites run by 50 independent providers have now signed up to their trade body’s pledge to achieve the target by 2035.
To mark COP27 and the one-year anniversary of the Independent Healthcare Providers Network (IHPN) industry-wide target, a new report sets out the sector’s progress in reducing carbon emissions.
The IHPN’s document entitled ‘ Clearing the air – How the independent healthcare sector is working to achieve net zero by 2035’, shares independent healthcare providers’ experiences in reducing emissions.
Measures taken include:
Developing ‘greener theatres’, including the cessation of the use of desflurane to reduce anaesthetic gas emissions;
Replacing older machinery and equipment with newer, more energy-efficient kit;
Making greater use of renewable energy sources such as solar power;
Increasing energy efficiency in healthcare settings, including through better insulation and use of LED light bulbs;
Establishing green ‘champions’ to drive improvements and identify opportunities to further reduce their carbon footprint.
The IHPN pledge builds on the NHS’s target to achieve net zero by 2040. It has promised to deliver a
wide-ranging programme of work to support members on their journey to net zero, including around issues such as:
Sustainable medicines;
Developing carbon reduction plans;
Understanding net zero and social value;
Sharing best practice on how to reduce emissions across their organisations.
Chief executive David Hare said providers were demonstrating some new and innovative ways of tackling the climate change emergency.
‘We know how important reducing carbon emissions are not only to independent healthcare prov iders, but also to their
160,000-strong workforce, as well as suppliers and, of course, patients themselves.
‘And this report acts as a marker in the ground – reflecting the work achieved in the past year, but also signalling that so much work still lies ahead.
‘As the trade association that represents independent healthcare providers, we will continue to support our members to deliver their net zero ambitions and play our part in improving the health of our planet.’
IHPN’s voluntary industry-wide pledge was launched in November 2021 and aims to achieve ‘Net zero for scope 1 and 2 by 2035 and Net zero for supply chain by 2045’.
See page 44
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Private GPs have been shocked to hear they have little chance of getting top marks in Care Quality Commission (CQC) inspections.
Their hopes of gaining an ‘outstanding’ rating have been dashed by health watchdog inspectors who consider the highest accolade is designed more with NHS GPs in mind.
The issue was raised in a speaker’s question time at the BMA’s annual private practice conference by the leader of the Independent Doctors Federation (IDF).
President and chairman Dr Philip Batty tackled a CQC chief to complain that GP members were reporting inspectors saying the achievement of excellence in private practice primary care was near impossible.
Dr Sean O’Kelly, chief inspector of hospitals and interim chief inspector of primary care services at the CQC and just four months into his appointment, replied he did not see why excellence in inde-
pendent primary care was more of an issue than in the health service. He said he did not understand that and suggested the issue could be looked at outside the meeting.
Dr Batty told Independent Practitioner Today that GP members, who were providing excellent care in the private sector to complement a lack of capacity in the NHS, had asked inspectors about the outstanding rating after meeting all CQC’s five criteria standards.
EYE EYE: The first and 500th surgical patient of an ophthalmology clinic returned during a promotional open day to thank consultants and staff for their life-saving treatment. Newmedica in Newcastle-uponTyne opened its doors to the public to look round their
facilities and meet the specialists. Newmedica Newcastle is run by operational director Amanda Bargewell (centre, right, with first patient Janina) and has a team of four local consultants: (left to right) Mr Ayad Shafiq, Mr Gerard Ainsworth, Mr Nicholas Wride and Mr Mustafa Kadhim.
He said it was disheartening to hear inspectors had informally said they were unlikely to get an ‘Outstanding’ ‘because that’s more geared to the NHS practices’.
Dr Batty later reported he had attended ‘a very constructive meeting with the CQC’.
‘I made the point – and they certainly listened. I was informed there are private GP providers who have achieved an outstanding grade.
‘It seems there may be some variation with inspectors. They assured me they will communicate to inspectors that this is meant to be a level playing field and private GP providers should not feel in anyway disadvantaged.’
Dr Batty said he had not been made aware of any problems like this encountered by consultants.
Have you had similar experiences to some IDF GPs with the CQC? Write to robin@ip-today. co.uk
The Independent Doctors Federation (IDF) has broken through the milestone of 1,500 members.
President and chaiman Dr Philip Batty said much of the growth was via doctors wishing to be connected through the organisation’s ‘excellent’ revalidation team.
But he hoped to see more members joining because they wanted to network, join the social events, have some fun, support each other and learn.
As many as 90% of private hospital operators and hospital groups are now doing something to help patients spread the cost of their self-pay treatments.
Independent healthcare adviser Richard Gregory, director of strategy at Chrysalis Finance, told existing and would-be private doctors these were mainly interest-free loans over six to 12 months, and interest-bearing over 24 to 60 months.
Arrangements to spread the cost had become a fundamental way of securing self-pay business, because if patients knew at the start that they could pay in instalments, they would be more likely to engage with those making the offer.
Mr Gregory said payment options were growing strongly, but he criticised the independent sector for failing to make it easy for consumers to navigate through quite complex offers.
He advised delegates, who attended online and in person, to pay attention to what people’s expectations were of them.
Liz Heath, author of market analyst LaingBuisson’s annual selfpay reports, said it did not feel as if economic factors were having a significant impact on self-pay, but 2022 figures would show the true scale of demand.
Evidence to mid-November suggested a self-pay market with a promising growth trajectory that looked sustainable.
And self-pay interest was particularly evident in the younger generations who wanted something immediately and were less allegiant to the insurance route.
David Hare, chief executive of the Independent Healthcare Providers Network (IHPN), said the impact of cost-of-living increases was a big unknown for the sector, but providers had not seen an effect so far.
He thought self-pay drivers were likely to persist and 50% of people had indicated they would consider using private healthcare –which was far more than before Covid-19.
A BMA private practice survey of 1,113 responders has uncovered a widespread view that the union is a left-wing organisation and hostile to independent practice.
BMA private practice committee co-chairman Dr Jeremy Lawrance revealed that comments had included:
‘BMA do not appear to offer any support to members working in private practice’;
‘As an independent consultant, I am self-employed and therefore the BMA provides no help whatsovever’;
‘The (private practice) committee has done nothing in the last year’.
But he told the meeting that the private practice committee was now getting a lot of support from the association’s leadership and hoped to see ‘big changes in the next year’ to improve BMA support in future.
Dr Lawrance disclosed that a former chairman had said there were no meetings with insurers for ten years, but recently the committee had conducted meetings with the large insurers. These were ‘frosty’ at first, but he reported ‘a little bit of progress’.
No doubt it will be tackling a ‘disturbing’ report at the conference that a consultant failed to get
recognised by an insurer because it already had enough doctors in the doctor’s specialty.
Dr Lawrance said many insurer negotiations had been challenging, but were generally amicable and he pointed out there was no obligation on the insurers’ part to meet the BMA because it was not a trade union for private practice.
The committee’s primary demands were:
1. Fee uplifts;
2. Annual inflationary rises;
3. Allowing top-up fees; 4. Abandoning ‘low-pay managed care and preferred providers’.
He said : ‘I’m paid more than a
colleague younger than me and it is ridiculous.’
Dr Lawrance advised delegates they had a choice and could consider which insurers they were willing to work with. However, waiting list initiative (WLI) work might be more lucrative and less demanding.
But he warned against getting a foot in the door for low remuneration – which was self-defeating.
‘As long as doctors do the work, insurers see no reason to raise fees – and we feel that doctors need to decide on their lifestyles, what their take-home pay should be and decide on where they do private practice.’
Some fees were dropping and he pointed attendees to a BMA fee calculator which could help them assess how much their time was worth.
There had also been meetings with private providers HCA, Spire, Ramsay, Circle, the Cleveland Clinic and other bodies such as the Competition and Markets Authority, the Private Healthcare Information Network and the Federation of Independent Practitioner Organisations, he said.
Patients were increasingly seeking private care due to waiting times and more options in the independent sector, according to a market development specialist.
Mr Ali Bahram, senior associate at Mansfield Advisors, giving an upbeat talk on the changing landscape and future of private practice, said more options were opening for GPs.
One insurer’s private online consultation number had risen from 2,000 to 42,000 a month and private GP appointments had significantly increased.
Asked by Civica Medical Billing and Collection’s Simon Brignall about the potential for the consultant employee model outside London he replied: ‘I wouldn’t hold my breath.’
He doubted private operators would offer consultant employee status away from the capital, although if independent hospitals were to report how well these contracts worked, then it might have some traction.
Starting up a private clinic could be ‘a real headache’ around compliance issues and indemnity costs and many younger consultant s were considering their options.
Employment might seem attractive when 10-15% of self-employed income would go to back-end operations of the business. But he did foresee the One Welbeck model of consultant partnership picking up outside of London.
Two of three new physicians who have joined London’s Mayo Clinic Healthcare have taken salaried jobs. Dr Safia Debar’s focus areas include stress management, executive health screenings, women’s health and hormone health, and tailored medical examinations
Dr Helen Mitakidis (right) specialises in family medicine, infectious diseases, travel medicine, women’s health, preventive medicine, tailored medical examinations and executive health screenings.
Dr Sarmed Sami, a gastroenterologist, is self-employed and provides services via a consultancy agreement at the Mayo’s outpatient clinic.
The founder and director of Digestive Health UK is also an associate professor with honorary positions at University College London Hospitals NHS Trust and University College.
Dr Sarmed Sami
The mission of the London Consultants Association (LCA) is to promote good practice as per the Patient Charter, carry out good governance, support both professional medical organisations and individual consultants working in the private sector and, most importantly, to promote patient choice and good quality care.
My time in office as chair of the LCA from late 2019 was dominated by the pandemic, which required an adjustment of its operations and re-evaluation of how we could continue to support our consultants and patients.
Early in the pandemic, private hospital providers entered into a contract with the NHS to ensure that there was sufficient provision of beds, ventilators and facilities to meet the anticipated escalation in demand.
The medical professionals who provide the expert care on which this market is founded were not involved in the contracting agreements and overnight the private healthcare market ground to a halt.
Many consultant colleagues offered their services to support the national effort, but, as a result, their private practice was disrupted and has only recently restored to pre-Covid-19 activity.
In March 2020, consultant practitioners working partly or wholly in the independent sector lost all of their income as practices collapsed.
A LCA consultant survey describing their concerns was published by Independent Practitioner Today in July 2022. The nature of the emergency meant
that there had been little time to consider the implications of what was, in effect, a short-term nationalisation of the private sector.
The pandemic-induced closure of private hospitals and clinics had increased the general mood that the consultant body feels their expertise is under-valued.
The LCA, with the support of Richard Packard of the Federation of Independent Practitioner Organisations and David Hare, chief executive of the Independent Health care Providers Network (IHPN), and Keith Hague of Goddard and Hague Recruitment, helped kick start the process to allow the market to recover.
The LCA had to rework how we ran meetings and events. We continued voicing concerns and inciting conversation and action from organisations such as the IHPN and the private medical insurers in Independent Practitioner Today and Financial Times
Together with our sister organisation FIPO, we appealed with the Government, the Competition and Markets Authority (CMA) and liaised with IHPN to ensure that consultants and their patients were better supported during the pandemic.
In 2021, the LCA reported via Independent Practitioner Today the significant concerns of its members at the three stages of a consultant career:
In the first five years when newly appointed;
During the next 15 to 20 years during peak activity;
Finally towards the end of their career.
At all stages, there were frustrations with the significant increased costs, financial and administrative, of private practice with fees having remained static for many years.
Insurers’ attitudes
An important issue common to all remains the attitude of private medical insurers to consultants. Much of the profit from private practice flows from consultant choice by patients, not by choice of the institution.
The LCA feels that the consultant body has not appreciated the power of their position, including where to admit patients and the choice of where to perform investigations.
External pressures and changes in the market resulted in a situation discouraging to both existing consultants and those who might have been considering entry. The activities of the insurers threaten the ability of patients to choose the consultant with the expertise most relevant to their needs.
The activities of the insurers threaten the ability of patients to choose the consultant with the expertise most relevant to their needs.
DR MARK VANDERPUMP, Outgoing LCA chair
The LCA supports consultants in all phases of their private practice, most importantly those younger consultants attempting to navigate through the difficult early phase of setting up a private practice.
We offer newly-appointed consultants a support network, including an appraisal service access to senior members providing mentorship. Medico-legal training was greatly enhanced by regular meetings generously supported by Guatam Chawla of Hempsons solicitors.
The LCA has introduced corporate membership and I am very grateful for the support of Pharmacierge, Incision Medical Indemnity, Civica Medical Billing and Collection, and Medserv.
I also wish to thank all members of the committee for their support and I am especially grateful to Rosemary Hittinger for all her efforts, including continuing to monitor the activity of the Private Healthcare Information Network with which all consultants must now engage.
I am delighted that Ellis Downes has agreed to be the new chair (see story opposite).
As the new year gets underway, private consultants face some of the most challenging times that Mr Ellis Downes, the new chair of the London Consultants’ Association (LCA), has seen in two decades of independent practice. Here he spells out why
The independent medical sector, working in partnership with the NHS, has established itself over many decades as a vital pillar of healthcare.
Why do most doctors go into private healthcare? The opportunity to increase income is an obvious factor, but this is only a small part of it.
I believe that the ability to give high-class individualised highquality healthcare where the doctor-patient relationship is paramount is the over-riding reason.
A consultant-led service, the ability to introduce innovation –within governance guidelines –and a degree of control over working practice are also key drivers.
But the wind of change, is as we all recognise, blowing hard in the independent sector.
Traditional ‘practice privilege’ models, where doctors treat their patients in private hospitals, are transitioning to new models of delivery of medical care.
Salaried consultants, chambers models and fixed contracts are now becoming more common in private practice.
It remains to be seen whether these new models of working will
replace the traditional working practices.
The future of private healthcare is unclear. There is clear evidence that recently appointed consultants are less attracted to private medicine.
This may be because of start-up costs, lower remuneration rates from insurance companies compared to more established colleagues, increasing administrative overheads and the ability to boost incomes without significant expenses by doing additional paid NHS work.
The future of private healthcare is unclear. There is clear evidence that recently appointed consultants are less attracted to private medicine.
MR ELLIS DOWNES, New chair of the LCA
With colleagues retiring, this will, in the near future, lead to a significant shortage of doctors in the independent sector with severe consequences for patient care and indeed the healthcare system in this country as a whole.
It is vital that these disincentives to independent practice are acknowledged and challenged to maintain the long-term health of the sector.
I hope in the next few months that the LCA will have a significant membership drive. I know from feedback from colleagues that
challenging insurance companies individually can be difficult.
A collective approach to ensure fair remuneration is undoubtedly going to lead to greater success than the current prevailing environment.
We practise medicine in challenging times. I hope the LCA, working with insurance companies, private hospitals groups and political stakeholders, will robustly ensure that the interests of our members – doctors undertaking private healthcare – are strongly represented for the benefit of future patients.
I am proud and honoured to be the new chairman of the association and look forward to working with the board as we try to give our patients the very best care in some of the most challenging times I’ve experienced in over 20 years of consultant practice.
I want to pay tribute to my predecessor, Dr Mark Vanderpump, for his hard work and devotion and am delighted he is continuing to serve the LCA as vice-chair.
Mr Ellis Downes is a consultant obstetrician and gynaecologist in Harley Street
Consultants do not have to work in the capital to join The London Consultants’ Association (LCA).
It welcomes members from further afield and aims to offer a friendly and accessible forum for specialists in the private healthcare sector.
The LCA also hopes they will share experiences, knowledge and
expertise with one another and be seen as a respected voice of influence.
A busy annual social programme includes:
Two ‘influential speaker’ dinners and there are informal quarterly Friday networking lunches providing doctors with small forums for forging business links;
Sponsored cocktail-hour socials are a chance for introducing new members;
A medico-legal group, run in conjunction with Hempsons’ solicitors, many of whom write regularly for Independent Practitioner Today, convenes four times a year over alternating working breakfasts and dinners to keep
members up to speed on case law and practice.
LCA leaders envisage that a varied programme of topical talks on medical, educational, legal and business development, delivered in person or virtually, will increasingly form the bedrock of its member support.
See www.london-consultants.org.
Compiled by Philip Housden
Spencer Private Hospitals, the wholly owned subsidiary of East Kent Hospital University NHS Foundation Trust, has reported a 24% rise in turnover to £15.8m in the year ended 31 March 2022.
This shows a continued recovery from the Covid-19 pandemic during which it dedicated much of its capacity to supporting NHS efforts throughout 2020.
In the 2021-22 annual accounts recently published, the trust reported private patient revenues of £719,000. This is a 10.7% decrease on the previous year and a significant outlier when compared with the average 47.4% growth so far reported across all England NHS trusts.
University Hospitals of Leicester have published their muchdelayed 2020-21 annual report and accounts – the final trust to do so.
Publication of these and the prior year accounts were delayed over a year beyond the NHS deadline date once the trust board was made aware during the 2018-19 external audit (June 2019) of issues regarding its finances, accounting treatments and controls.
The trust accounts for 2020-21 reveal private patient income fell that year from £2.8m to £1.6m and from 0.3% of total income to 0.15%.
This is a decline of 41% and in line with the overall Covid-related fall across all England trusts of 44%. At the time of writing, the 2021-22 annual accounts are yet to be made public.
Spencer Hospitals’ chief executive Di Daw recently retired after 20 years with the company.
She joined Spencer as matron and has been chief executive since 2011.
During this time, Spencer underwent a period of significant expansion and now provides clinical services from each of the trust’s
main sites at Margate, Ashford and Canterbury.
She is replaced by Geoff Bailey, who has previously held the posts of hospital director of HMT’s Sancta Maria Hospital, Swansea, Glamorgan, and also of Nuffield Brighton Hospital, and has a prior career in the pharmaceutical industry both in UK and internationally.
Tell us your news. If your private patient unit has achieved something special or if it’s planning to expand or merge, please get in touch and let us know. Contact Philip Housden (right) by email at philip.housden@ housdengroup.co.uk
The new Clatterbridge Private Clinic in Liverpool, a specialist cancer care clinic, has been rated ‘Good’ with no improvements needed following an unannounced CQC inspection.
This was the clinic’s first inspection since opening in 2021. Chloe Parr, general manager of the Clatterbridge Private Clinics, said: ‘The team are thrilled with the outcome. It’s a true testament to the clinical team, the administrators who support them, and the expertise of the consultants.’
Clatterbridge Private Clinic is a joint venture between The Clatterbridge Cancer Centre NHSFT and Mater Private.
They have two clinics in Wirral and Liverpool, which are home to some of the most advanced treatment technology and equipment in the UK.
A range of cancer treatments
including chemotherapy and radiotherapy as well as a variety of other innovative and highly specialised treatments such as immunotherapy, brachytherapy and proton eye therapy, catering to both local and international patients.
The Clatterbridge Centre NHSFT reported private patient revenues of £3.15m in 2021-22 annual accounts, with that income inclusive of the reimbursement of trust staff and non-staff costs and services supplied to the Clatterbridge Private Clinic.
This is a 12.9% increase on the £2.8m achieved the previous year and is 1.46% of total trust income. This is the 13th highest proportion of NHS trusts in England and fifth outside London.
Philip Housden is director of the Housden Group
Moorfields Private, the private patient brand of Moorfields Eye Hospital NHS FT, has opened an outpatient and treatment centre in New Cavendish Street in the heart of London’s medical district.
The facilities include:
11 consulting rooms and 12 outpatient procedure rooms and five supporting nurse rooms;
A refractive laser suite and operating theatre suite;
A minor ops room for day surgeries and intravitreal injections ultrasound and pharmacy.
The new location, open from October 2022, is in addition to private services provided from the City Road campus.
Speaking about the facility, Andrew Robertson, director of private care, commented: ‘Moorfields is world-renowned as a centre of excellence for ophthalmic care, and we are delighted to have extended our services in the heart of London’s clinical district.
‘This fully refurbished building, with its laser eye surgery suite, operating theatre and consulting rooms, provides patients with more choice when accessing private services and treatments.’
Moorfields reported private patient revenues of £37.2m in the 2021-22 annual accounts, up £12.9m and 53.1% on the previous year, and £6.3m up on preCovid income.
Its private earnings are now 14.7% of trust revenues and place the trust second only to The Royal Marsden in the NHS although the trust has dropped to fourth highest grossing trust by revenues after Marsden, Guy’s and St Thomas’ –boosted by the merger with Royal Brompton – and Imperial.
Moorfields Private’s financial surplus is re-invested into Moorfields Eye Hospital to support NHS patients and services.
Doctors and their teams joined a sparkling night for the LaingBuisson Awards 2022 to celebrate winning performances in private healthcare. They were among hundreds of sector-leading organisations gathered at the Park Plaza Westminster Bridge, London, to reflect on the past year.
HOSPITAL AWARD:
King Edward VII’s Hospital
‘It is great to see such strong patient partnership in this service with an excellent commitment to a diverse group of stakeholders and some impressive developments in the last year.’
HOSPITAL GROUP:
Spire Healthcare
‘Judges commented on the clear commitment to Spire’s people and wider stakeholders. This was evidenced by the culture of inclusion, commitment to developing staff and the ability to think outside the box with regards to recruitment of nursing staff in the current climate. The apprenticeship programme will benefit the healthcare system as a whole.’
PRIMARY CARE AND DIAGNOSTICS:
Affidea Group
‘Achieving an average 40% reduction of the dose level in CT scans across their extensive network is an incredible feat, and demonstrates Affidea’s commitment to patients.’
HEALTHCARE OUTCOMES:
Royal Brompton & Harefield Hospitals Specialist Care
‘Recognition of, and response to, evolving challenges in healthcare. New techniques to achieve reduction in waiting times. Their focus on end-toend patient care combined with advanced technology and diagnostics stands out.’
PUBLIC PRIVATE PARTNERSHIP AWARD:
Antser
‘Great example of innovation and partnership working in the behavioural and social care field.’
NURSING PRACTICE AWARD:
Spire Healthcare
‘There is a clear commitment to its people and wider stakeholders. This is evidenced by the culture of inclusion, commitment to developing staff and the ability to think outside the box in view of the current climate with regards to recruitment of nursing staff.’
THE 17TH LAINGBUISSON AWARDS RECOGNISED 29 WINNERS ACROSS SIX CATEGORIES. SEE WWW.LAINGBUISSONAWARDS.COM FOR A COMPLETE LIST OF WINNERS FROM THE NIGHT
Sustainable business will increasingly be on the agenda in 2023. Accountant Julia Burn (below) believes there are issues surrounding recruiting and retaining staff to consider and shares some ideas for doctors in private practice
SUSTAINABILITY IS a hot topic for today’s generation and it is an increasingly important challenge for businesses to ensure that, whatever their objectives, they have the protection of the environment as part of the business strategy.
Many customers like to opt for ethically and sustainably made goods and often avoid businesses that don’t use these.
So what are the top things that medical practices can do to keep on top of this from both a practical point of view and while being conscious of the financial implications?
It is often the case that environmentally friendly products and practices are the more expensive option – so in a struggling economy that also needs to be factored into the decision-making process.
Simple things which can be done
are to try to recycle and re-use where possible. Undoubtably, within a medical practice this is incredibly difficult, as there are many products used which need to be disposed of after one use due to health and safety issues, but every little bit that can be done helps the environment.
Energy-saving is another important consideration, not just for the environment but also for budgeting and cash flows.
The Chancellor announced in the November Budget that the Energy Price Guarantee (EPG), previously expected to last for two years from October 2022, will continue to just April 2024, but set at a higher bill ceiling of £3,000 per year for the average household.
Targeted support for the most
vulnerable will be also provided by additional cost-of-living payments of £900 to households on meanstested benefits, £300 to pensioner households and £150 for individuals on disability benefits.
Based on current price forecasts, it is expected this will mean an average of £500 support for every household in the country. While the extension, even at a higher rate, is welcome at a time of soaring inflation, it’s unlikely to go far enough to help the most vulnerable.
The pressure on consumers and businesses with the ever-increasing price of energy is immense and everyone is tightening their belts, so being competitive with prices while still offering high-quality service is even more vital for businesses.
If you provide vehicles to your employees to carry out their work,
there are a number of tax benefits for businesses introducing electric cars for their workforce.
Company cars provided to employees are a benefit in kind and therefore there is a tax charge levied, but the charge is significantly less if the car provided is an electric vehicle rather than if it is petrol or diesel.
Therefore, as well as doing something ‘greener’ by doing something to positively impact the environment there are also significant tax savings for both businesses and employees.
There are also tax savings for electric cars for companies because the capital allowances are much more favourable for electric vehicles. For new and unused cars where CO 2 emissions are 0g/km or the
Company cars provided to employees are a benefit in kind and therefore there is a tax charge levied, but the charge is significantly less if the car provided is an electric vehicle
car is electric, a business can deduct the full cost from profits before corporation tax for limited companies and from income tax for partnerships or sole traders.
This means that the business is receiving the full tax allowance against the cost of the new electric vehicle when it is purchased rather than petrol/diesel cars, for which some of the higher emission vehicles can only claim capital allowances of 6% per year.
Doctors with VAT-registered businesses are entitled to claim refunds of the VAT cost on charging electric vehicles used for business purposes, but only if the electric vehicle is charged at the business premises.
Many businesses – particularly smaller ones – would not have the space to park electric cars for several hours while charging, so this
policy would appear to deny VAT refunds to countless businesses without such space.
For privately-owned electric cars, charging the vehicle is taxed at the 5% VAT rate as ‘domestic fuel and power’, but only if it is charged up at one’s home.
Charging your electric vehicle elsewhere will incur 20% VAT due to HM Revenue and Customs’ policies on the definition of ‘premises’. People without driveways or who occupy flats, for example, have to charge their electric car elsewhere and will pay 20% VAT instead.
During the November financial statement, the Chan cellor announced that, to ‘make motoring fairer’, from April 2025 electric vehicles will no longer be exempt from Vehicle Excise Duty.
While this will certainly make motoring fairer, because, after all, electric vehicles still contribute to wear and tear of the roads, it’s more likely driven by the fact that, by 2025, over half of new vehicles in the UK roads are expected to be electric.
Despite the above aspects of not always being great tax-wise, it is still beneficial to use electric cars because they are generally more cost-efficient while also being much better for the environment.
It is imperative that we all take a part in trying to protect the environment for future generations. Business owners now cannot avoid building sustainability into their strategy, forecasts and ways of operating.
This could ultimately impact new business as well as helping in hiring and retaining the right calibre employees who place a lot of importance of this.
Julia Burn is a director at accountants Blick Rothenberg and part of the team that advises medical practitioners
2023 is set to be a testing time for independent practitioners’ finances following Chancellor Jeremy Hunt’s Autumn Statement. Richard Norbury (right) sets out what is waiting in the wings and suggests some useful action points for you to take now to limit the damage
THERE HAS been a mixed response to the Chancellor’s changes, but many professional commentators highlight that further tax measures and spending cuts may be announced after the 2024 General Election, regardless of which party comes to power.
The term ‘fiscal drag’ has been used by professional commentators to highlight that although basic and higher rates of tax have remained unchanged, it will, in a period of inflation, bring more individuals into paying higher rates of tax.
Rates of tax remain unchanged, excepting that the additionalrate threshold will decrease from £150,000 to £125,140 from April 2023.
The thresholds will remain unchanged until 2028. The total exposure is an additional 5% on income between these bands, meaning a total additional tax liability of £1,243.
At the time of writing, the reduction in the bands will not apply in Scotland and it will be up to the Scottish Government to decide whether to follow suit.
This change will bring more
taxpayers into the ‘additional rate’ band. Higher-rate taxpayers currently have the benefit of up to £500 as a tax-free allowance on interest, while additional-rate taxpayers lose this allowance and pay tax on all interest.
The tax-free dividend allowance of £2,000 will be reduced to £1,000 from April 2023, dropping further to £500 from April 2024, and the increase of 1.25% that applied to dividend tax rates will no longer be an additional tax rate from April 2023.
TIP: These changes, as well as the additional-rate band change, give an opportunity for dividend tax planning for those operating their private practice via a limited company.
Inheritance tax thresholds remain unchanged to 2028, but the capital gains tax annual exemption of £12,300 – that is to say, the first £12,300 of any capital gain is free of tax – reduces in April 2023 to £6,000 and then to £3,000 from April 2024.
Again, this offers planning opportunities.
TIP: Anyone with investments or property held personally or
perhaps in the process of liquidating a company may want to take advantage of the higher allowance in 2022-23.
The reversal of the additional 1.25% on National Insurance announced by the previous Chancellor Kwasi Kwarteng in his mini-Budget remains, so employer and employee National Insurance will be reduced.
For self-employed profits, the rates for 2022-23 have been altered to 9.73% on earnings between £11,909 and £50,270, and 2.73% on profits over £50,270.
The somewhat odd percentage is to account for the fact that the 1.25% levy was a short-lived affair and only for part of the tax year. From April 2023, the more familiar rates of 9% and 2% will return.
The planned rise in corporation tax from April 2023 will remain, meaning that the small company rate of 19% only applies to profits up to £50,000.
It then increases for profits earned over this amount to either 26.5% (marginal rate profits
between £50,001 to £250,000) or 25% (main rate profits over £250,000).
TIP: The introduction of the higher rates of corporation tax means private limited companies should review their strategy and plan how to take money from the company. For example, it may be more advantageous to pay salaries from the company.
The timing of capital expenditure can be important. If a company is considering investing in expensive equipment or an electric car, from a tax perspective, a delay to April 2023 might result in more tax relief depending on the circumstances.
However, due to the superdeduction on qualifying assets purchased up to 31 March 2023 giving relief at 130%, then there are circumstances when bringing forward a capital purchase would bring about more tax relief.
Reviewing your affairs with a specialist medical accountant will ensure that you are working in the most tax-efficient way.
TIP: If profits in a limited company are likely to be lower going forward – for example, if a doctor
is winding down private practice prior to retirement – then consider a change of year-end at Companies House, which may mean ‘locking in’ more profits at the lower rate of 19%.
This would only work in specific circumstances and is a decision not to be taken lightly.
The introduction of the higher rate of corporation tax means that investment companies will pay more corporation tax. Also, associated company rules will be introduced which can impact on anyone with more than one company, meaning the bands of £50,000 and £250,000 are shared between the companies, leading to the potential of higher rates of tax.
TIP: There may be instances where consultants and their spouse/partner run two completely separate private clinics via the same limited company. At the time of incorporation, this may have made sense due to economies of scale. Separate companies should now be reconsidered, provided they are not caught by the ‘associated company rules’ as explained earlier.
A full review of the associated company position is recommended.
From April 2025, vehicle excise duty on electric cars will apply and the benefit-in-kind tax rate will
increase by 1% a year until it reaches 5% in April 2027. This applies to anyone who has taken advantage of the lower rates either via a limited company or the NHS fleet scheme.
This at least gives some clarity on the plan and confirms that the rates will remain at 2% until the tax year 2024-25.
TIP: Electric cars may well still be a tax-efficient strategy and fund a vehicle that otherwise would be paid from your post-tax earnings.
Once again, despite detailed lobbying and tentative promises, nothing has changed relating to
both the annual allowance and lifetime allowance tax rules on pensions.
The annual allowance tax charge lobbying would appear to have more success in that certain technical changes could benefit individuals this year who would have suffered due to the Consumer Price Index for September 2022 being 10.1%, although these measures would mainly benefit GPs.
The BMA has published details of the above and circulated them to members recently and more information is awaited.
Richard Norbury is a partner at Sandison Easson & Co specialist medical accountants
The introduction of the higher rates of corporation tax means private limited companies should review their strategy and plan how to take money from the company. For example, it may be more advantageous to pay salaries from the company
Our Troubleshooter Jane Braithwaite (right) has been tackling difficult questions arising from doctors in groups in recent digital issues of Independent Practitioner Today. This month she responds to a consultant’s ‘bombshell’ TROUBLESHOOTER: PARTNERS
‘I work in a group with two other partners who have both dropped the bombshell that they are aiming to retire next April. I want to keep my practice going for some years. How do I manage this situation?’
HEARING THAT the other partners in your group are about to retire with relatively little warning can be anxiety-inducing, to say the least.
You might think that your business is about to disappear or that your income is going to significantly decrease. But with a little planning and careful discussions with your partners, this does not have to be the case.
I can also tell you how to manage partners leaving your group through retirement, with ways to facilitate the transition, and how the group could continue to thrive after they have left.
Look to the start of the group
When the group was formed, hopefully contracts and agreements were drawn up. Buried deep in there should be the mechanism for a partner to voluntarily leave the group.
The contract should spell out how much notice the partner should give, what rights they have to any profit in the group at the time of leaving and any obligations of the group to the partner after they have left.
Of prime importance from a clinical standpoint is deciding who is going to look after the exiting partner’s patients and how to facilitate a clear and comprehensive handover.
Financial obligations can be difficult to disentangle, with the issue of ongoing profits derived from patients that the leaving partner acquired being particularly thorny. Hopefully, this should all be spelled out in the agreement signed on formation of the group. Things become much trickier if there was no founding agreement, or the agreement does not cover the retirement of partners.
This situation can only be
resolved by careful negotiation between the remaining partner and those who are leaving.
What should this plan involve?
It is very unlikely that you would be able to convince your partners not to retire, and you probably shouldn’t try. What is important is that you come to a plan that works for you, for them and for the group and its patients.
In the meetings that you need to call to sort this out, it is important that everyone is open and honest about what they want to get from the process, with their objectives and priorities clearly stated.
You may think that your partners want to ensure that they get the maximum value for their ‘share’ of the group, but they may be more interested in an orderly transition and the stability of the group than maximising their personal profit.
The outcome that you need to get from your meetings is a written agreement on how your partners will exit the group. This will protect both your interest and theirs and allow an orderly process for their retirement.
You do not need to shut the group down, but it is unlikely that it will be able to continue in exactly the same way with only one third of the partners left.
Having a plan in place will allow you to prepare for the transition and allow you to make changes to the form and function of the group as you see fit.
What options are there to change the practice?
Before leaping to a decision, it is worth thinking about what form you would like the group to have. Consider how the group was before the partners retired. Were you happy with the structure?
Financial obligations can be difficult to disentangle, with the issue of ongoing profits derived from patients that the leaving partner acquired being particularly thorny
look for other partners to join the group.
While the complexities of recruitment to join a group practice are beyond the scope of this article, there are a few things that are important.
Rather than just co-opting the first consultant that you can find, consider what skills and knowledge would complement your own. Is there particular training or background that may help the group expand revenues and offer new services in the future?
Take time to make sure that all the legal work is completed correctly, with the help of an expert. Ensure that those who join sign a contract, so that everyone is aware of their new responsibilities to the group.
One option might be for you to take over the entire practice by yourself. The advantages of this are that you would have sole control over the direction of the practice and all the rewards of this hard work would be yours.
On the other hand, if the workload was previously shared between three colleagues, you may find that it is not manageable by yourself.
If you do decide to take over your partner’s shares of the group, you will need to decide how you ‘inherit’ their patients.
It is important from a clinical standpoint that the patients experience continuity of care as they transition from one clinician to another.
Your partners may want some form of compensation for passing their patients to you. This could take the form of a one-off payment or an on-going reward dependent on the revenue that the patient brings to the group.
The nature of this financial return should hopefully be spelled out in the contracts that you signed when the group was formed. If this is not covered in any agreement, then it will need to be negotiated as part of the exit process of your partners.
If you feel that the workload is not manageable alone and you wish to keep the current number of patients, then you will have to
If you feel that some of the workload could be managed without the direct input of a consultant, you may be able to employ staff such as nurses to undertake clinical tasks on your behalf. This can help make sure that your limited time is used for activities that only you can perform.
If you do not currently employ clinical staff, careful advice is needed to ensure that you are providing a service that is safe and well-supervised, with on-going training and professional development.
If your partners announce they are going to retire, it is important not to panic. While it may feel like you are about to lose the business that you worked so hard for, this is not the case.
There are a number of ways that a group could continue, either in its current form or by altering its structure.
Change can be uncomfortable, but it is inevitable. This may give you the opportunity to push the group in new directions, with great personal and professional rewards.
If you have any specific questions that you would like answered in upcoming editions, please do feel free to get in touch.
Jane Braithwaite is the MD of Designated Medical, which offers independent practitioners bespoke support across accountancy, marketing, medical PA, HR and recruitment
In 2023, there is still so much that you can do in order to be found by potential private patients. Medical marketing expert Catherine Harriss (right) shares this check list as an aid to doctors who need to increase their reach or those starting out in private practice
YOUR ONLINE profile should be on your website and under your control.
Many an hour of my life has been wasted trying to track down all those responsible for online portal profiles – which do have a purpose and I will get onto these –but everything should be placed on your website, that you own and that you have control over.
Your profile should be written as if you are talking to a friend who isn’t medical. This is not a place for the ego, but instead should be informative and understandable.
The more people understand, the more relevant you become to them, hopefully. Those profiles that consist of lists of what you have achieved mean nothing to a new visitor, but in a context, with simple explanations, they mean so much more.
You need to market yourself I totally understand that this goes against the grain as a doctor, but I am not talking about bragging here.
I am saying that you need to spread the easily understandable word about what you do and how you can help to show that you exist and your experience could be helpful to the right person.
In a series I wrote for Independent Practitioner Today readers in 2014, I mentioned that press releases via the private hospital PR department along with local articles in newspapers seemed to be the mainstay of private practice marketing.
But in my experience, these only ever fell short of what was required. Interestingly though, in 2023, these same press releases online can provide valuable backlinks to your website to aid your rise up Google.
Online articles and large portal websites can also help by linking their Google reputation to yours. The rise of hyper-local journalism means there are increasingly local news websites that focus only on local news.
These, too, can be excellent places to be present and any links
from these websites also help to improve your visibility online.
Interestingly, these hyper-local news websites are increasingly followed by those who were brought up in that same area or want to keep contact with ‘home’, so your reach is often national through a local site.
Facebook groups and pages, Instagram, too, along with Pinterest and Youtube could all have a role to play with how you manage and supply information to your ideal potential patient. It is still the same today, in the conversations I have had with patients, that being found everywhere and keeping up with a consultant’s news is more important than ever.
Rather than marketing, you are informing people of what has happened instead by providing good news stories. We all love a story with a happy ending.
70% of adults say they trust recommendations from family and
friends and we all understand how this works.1 However, online relationships are being built now that stay only online.
I have found that potential patients for my clients have met via social media and, several online conversations later, they book in.
The newly booked patient is booking after taking advice from someone they have never met but has shared their experience through conversation online. This vital communication helps them to understand everything else that they have read about you.
I have witnessed many conversations after posts have been published, many discussing the surgeon or doctor involved. The vast majority have been positive and where the very few have been negative, immediate steps have been taken to explain, help and understand the issues being discussed.
Yes, it’s public, but this is how it is now. More than ever, it is important to know what is being said and to control the conversation too.
The newly booked patient is booking after taking advice from someone they have never met but has shared their experience through conversation online
delivering and exchanging offerings that have value for customers, client, partners and society at large. Selling is marketing but marketing is not selling.
Therefore, for your practice, this means you provide information and conversation about you, what you do and how people benefit in addition to talking about other things that they might find interesting.
Every second, 13 new users are starting to use social media for the first time. People are joining conversations everywhere. Never more so, it is important to be the leader of your tribe.
Marketing content
Over the past few years, I have witnessed businesses fail overnight. The common denominator has been that they all used only one social media site and only this.
While they weren’t in the medical world, they were directly affected by an algorithm change in Facebook and, overnight, hardly anyone saw their posts. Within weeks, they had gone into liquidation. They had no website and subsequently no business.
I have also heard of content being deleted by Facebook without authorisation from the owner.
have found that one channel may fit better than another with the target audience, I always insist that all content has a place on the website.
So, even if that channel is Instagram – also owned by Meta –or Facebook or Pinterest, all the content that appears should originate from the site or copies stored on your website via posts and testimonials.
Becoming a leader for your tribe is important. You are developing a way of business whereby you actively provide information about what you can do and how you can help.
With increasingly amounts of information provided, more people find you or you become more accessible and, over a period of time, you are seen and perceived to be knowledgeable, interested, concerned and helpful. Moreover, people can see the results of your work, which is invaluable.
You are supplying information that people wamt to find, that cannot be found elsewhere. But you are also showing your humanity and your realness, which, in turn, makes people want to come to you.
The definition of marketing, according to the American Marketing Association, is the activity, set of institutions and processes for creating, communication and ➱ continued on page 20
These situations to me are a classic situation of putting all your eggs in one basket. While I
It is time-consuming and
needs correct management so that you are seen as a leader and seen to be more knowledgeable than your peers in the same specialty.
The dissemination of information online makes you easier to be found and, for those seeking information, they can rapidly find you online.
By making yourself more accessible through online methods, your online status rises and you are soon seen as the person to go to.
Are others using social media?
69.64% of small businesses use social media. 2 This is a rise from 12% back in 2014.
How it is used has also changed: 63% of customers expect companies to offer customer service support through their social media and quick answers too.
I have seen a rise in the number of people asking questions using direct message (DM) via social media channels and helped daily with directions to the correct person to provide the right information for them.
Running social media is timeconsuming but effective and worth the investment. Eighty per cent of consumers say that brand familiarity – knowledge of the brand – makes them more likely to buy on social media.3
Buying – or rather booking –an appointment on social media
I have introduced booking systems and they have been gamechangers.
The majority of the bookings came through in the evening or early morning, indicating that the accessibility of booking was seen as helpful and providing all the information needed.
Having access to available dates enabled the decision to be quicker and easier and stopped the inevitable backwards and forwards calls to establish a date. This is valuable time saved.
For this to happen, much forward planning of available information was required, but combining social media with a button linking to the booking system on the website increased the number of bookings.
It was a game-changer in each instance.
By making yourself more accessible through online methods, your online status rises and you are soon seen as the person to go to
Make things easy for your ideal customer: give them the information that they need and the resources to have the control of being able to book a date that suits them.
If Amazon has refined the checkout system to the smallest number of clicks to make a purchase, do you not think that there is a reason for this? We all want online transactions and decisions to be easy and quick.
Humanising social media
Remember that people are looking for help and advice and they will reach out to those who speak a language they can engage with. It is a shocking fact that the average reading age in the UK is nine years of age.
Whether it be factors related to their problem or results relating to their problem, they all need help
Doctors are never trained to be running businesses, but private medicine today is a real business that needs nurturing. This means that each and every aspect of your workplace and the information you provide needs to be analysed and consistently reviewed to see if there is room for improvement.
None of the chain of events that takes place after someone has contacted you or your secretary can occur if they cannot find you.
There are five ways you can dominate your conversation:
1
Create a high-quality, informative yet simple-to-understand website. As an ex-nurse, providing simpler explanations was part of my role. People reading may be anxious or overwhelmed and need to be able to digest explanations easily to be able to make a decision.
2
Create a social media presence that speaks to your ideal potential patient. What do they need to see? What do they comment on most when they see you? Obviously, never combine your personal life with business. Social media is a tool of explanation and illustration.
3
Write regularly or have someone write regularly for you. These posts not only help bring in backlinks that Google loves and rewards with higher rankings, but also the more you post, the more you will be found online.
4
Commission-paid advertising can be so useful in targeting exactly who you want to see as patients. Those clients who have ‘spent some [money] to get some’ have gained the most by a long way. Easily applied budgets can rapidly help a private practice.
5 Pay for local marketing on- and offline. Local search engine optimisation (SEO) will focus on your immediate neighbourhood and can dramatically assist in getting you found.
in generating conversation about you and your service and, most importantly, fully understanding the issues.
This means that the conversation needs to be continued on a regular basis, not just occasionally. It needs to be nurtured frequently using words that all can understand.
Your private practice can’t grow any more than you allow it to. The last thing you want to do is to waste opportunities too. Where you are now is a direct response to what you have done and what you have not done.
More and more people are going to use this vehicle to seek the information they need. Independent practitioners who have made a commitment have redeemed the benefit.
Your role is to examine where you are in this market and actively do something about it if you want to change.
References
1. www.postbeyond.com/blog/socialmedia-marketing-importance/ 2. www.renolon.com/social-media-forbusiness-statistics/ 3. https://sproutsocial.com/insights/ consumer-behavior-social-commerce/
People are using smartphones and tablets as well as other computers to access information far more than ever before. It is expected now more than ever that they can search for a solution and then take action to help their problem.
Catherine Harrissis the founder of MultiWorks Marketing: https:// attractdream-customers.com
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Even after a long period of retirement, doctors can be subject to a clinical negligence claim, so it’s important to act quickly and get the right advice and support from your defence organisation. The MDU’s Dr Claire Wratten (right) reports
claim can arise many years after a doctor’s involvement in a patient’s care.
Among other things, a claim can relate to a delayed diagnosis, surgical errors and poor communication.
The time-scale for bringing a claim for a competent adult begins three years from the date of the alleged negligent act or the knowledge that care was potentially negligent.
For example, claims are being brought against retired gynaecologists many years after insertion of vaginal mesh, on the basis that the patient wasn’t aware of problems due to their mesh until a considerable time after the operation in question.
And if the patient is a child, they have until their 21st birthday to issue court proceedings. If the patient lacks capacity – for example, due to a brain injury – then there is no time limit for bringing a claim.
This means that a claim could arise once a doctor has retired from clinical practice and could come completely out of the blue.
That is clearly a very upsetting scenario. It is essential to contact your defence organisation straight away, who will be able to offer the correct advice and support.
In general, if you receive any kind of correspondence from a solicitor instructed by a patient, do not reply directly to the solicitor. Your defence body can do this on your behalf.
When you contact your defence organisation, it will need:
A copy of the solicitor’s letter;
A note of your request for assistance;
Your contact details
Photocopies of the medical records if they are available to you;
A factual report about your own role in the incident.
You may not remember the details about the patient’s care, but you can base your comments on any records that you have access to and what you would normally do in the circumstances of the patient’s care.
There are various steps to the clinical negligence process, but it is worth being aware that not all of the steps during the process prior to court proceedings being issued
– the so-called pre-action process – may be followed.
Therefore, a retired practitioner may first hear about a potential claim at any of the points set out below.
In general, the first letter that is sent when a solicitor is instructed by a patient – now termed a claimant – to investigate a potential medical negligence claim is a request for their medical records.
If you have retired, this correspondence may be dealt with by your previous hospital and practice, and you may not be aware of it.
But if you do receive a request for your private medical records, then the records need to be disclosed within a month of the request.
Depending on your working circumstances and how long it is since you retired, you may or may not have access to the relevant medical records.
And if the claim has arisen many years after your care of the patient ended, you may have destroyed any private records that you held. Your defence organisation will be able to provide you with advice to ensure that the appropriate consent has been obtained for disclosure and about the disclosure process itself, as well as about what to do if records have been destroyed.
It is worth remembering that a lot of claims do not proceed any further than disclosure of the medical records.
If the claim does proceed further, the claimant’s solicitor may then send a Letter of Notification. This letter may be sent before the solicitor has fully investigated the case, but will set out an outline of the case against you.
Although a Letter of Notification does not require a formal response, it can provide a helpful indication as to the nature of the claim that will be made and your defence organisation can advise you on whether a response should be provided at this stage.
The next stage in the clinical negligence process is the Letter of Claim stage. A Letter of Claim is a formal letter in which the claimant will set out their case in detail. This letter requires an acknowledgement within 14 days, and a
The whole aim of the court timetable is to allow the parties to reach a resolution of the claim – either by way of the claim discontinuing or a settlement agreement being reached –without the case ending up at a trial
out the case against you – called the Particulars of Claim – will generally need to be served within four months. If you are being assisted by your defence organisation, it will instruct a solicitor to accept delivery of the court proceedings on your behalf.
However, if the claimant’s solicitor has not followed the pre-action process, service of court proceedings may be the first time that a retired practitioner becomes aware of a potential claim against them.
formal response within four months of the date of receipt.
In order to investigate the allegations being made against you and provide a response to the Letter of Claim, your defence organisation will need to liaise with you and also obtain advice from independent medico-legal experts.
If you have already notified your defence organisation of the claim, it is likely that the Letter of Claim will be sent to your defence organisation rather than directly to you.
However, should you receive a Letter of Claim directly, given the need for the allegations to be responded to within a certain period, it is imperative that you contact your defence organisation straight away.
Once your defence organisation has investigated the allegations in the Letter of Claim, it will advise you whether a response can be served denying liability or whether the claim needs to be settled with a payment of compensation to the claimant.
At this point, it may well still be possible to resolve the claim informally – for example, the claimant may accept the denial of liability and discontinue the claim or a settlement may be negotiated between the claimant’s solicitor and your defence organisation on your behalf.
But if the dispute is not resolved at this stage, the pre-action process ends and the next step is for the claimant’s solicitor to issue court proceedings. This is the commencement of the formal legal process.
Once court proceedings are issued, the documentation setting
Strict time limits apply once the court process has commenced, so it is vital that you contact your defence organisation as soon as you become aware of court proceedings being issued or served against you and send it any court documents you have received.
Failure to do so can result in the court entering judgment against you in the claim.
The next step will be for a defence to be drafted and served on your behalf, and thereafter the court sets a timetable for exchange of information between the parties.
A statement, drafted by a solicitor on your behalf, will be exchanged for a statement from the claimant, and medico-legal expert evidence obtained by the parties is also exchanged.
Although it is natural to be extremely worried about the possibility of having to give evidence at a trial if court proceedings are issued, in fact this is relatively unusual.
The whole aim of the court timetable is to allow the parties to reach a resolution of the claim –either by way of the claim discontinuing or a settlement agreement being reached – without the case ending up at a trial.
Despite the timetable required by the civil procedure system, claims can take many years to conclude. This can understandably be very stressful, so it is essential you seek advice and support early to allow your defence organisation to guide you through the process and act on your behalf.
See our ‘Keep It Legal’ feature on disclosure, page 41
Dr Claire Wratten is senior medical claims handler at the MDU
What are the quick wins for your financial peace of mind? Dr Benjamin Holdsworth (right) picks out his top ten issues you need to address
WHEN THE economy is looking challenging, it is important to check your own position as a doctor and to ensure you have taken the necessary steps to achieve financial organisation.
Here’s what you should address:
1 Do you have a retirement plan?
The ‘tapered’ annual allowance for those with ‘adjusted income’ of over £240,000 reduces the limit down further – to as low as £4,000 per year for high earners.
NHS Pension Scheme members exceeding the annual allowance in 2019-20 made up a third of the total number of pension tax breaches in the UK.
One of the most challenging parts of our job is helping people who have left any form of financial planning until they are about to retire or, harder still, after they have retired.
Is it clear if your savings will always be able to support your expected standard of living?
Those considering the next stage in life after clinical practice can face competing pressures to assist family on the housing ladder before even accessing their own wealth to replace income from employment and practice.
Engaging early can make all the difference between anxiety and excitement.
2 Are you on the right pay scale?
Not every adviser understands doctors the way we do. We encounter many new clients who have been on the wrong pay threshold for several years in their NHS job or have not received contractual pay rises when they were due.
They may have had poor advice elsewhere or been advised by a non-medical specialist which means key details of their medical income were missed.
Are you being paid what you are contractually entitled to?
3 Have you had your annual pension growth checked?
The maximum amount of taxrelievable pension contributions you can make each year is £40,000 – known as the annual allowance.
Note that adjusted income includes not only NHS salary but also dividend income from private practice and investments, rental income, NHS and personal pension contributions.
This widens the net significantly and will catch out many hospital consultants who might otherwise have considered themselves exempt, as well as many GPs. Check the sums carefully –many annual allowance statements from the NHS Pension Agency have been wrong.
4 Will you exceed the lifetime allowance for pension savings?
The lifetime allowance is the total amount which can be built up in a pension without triggering an extra tax charge. It is currently £1,073,100: frozen until April 2026. Many doctors unwittingly breach the allowance, paying up to 55% tax charges on the excess savings when the fund is drawn. Not surprisingly, the amount of tax revenue raised from lifetime allowance breaches has increased by more than 1,000% over the past decade. Tax revenue has risen from £32m in 2010-11 to £342m in 2019-20. It was just £5m in 2006. Do you know where you stand?
5 Are you aware of the impact of the McCloud remedy?
When the 2015 NHS Pension Scheme was first introduced, older scheme members – those within ten years of retiring – were allowed
to continue in their original 1995 or 2008 NHS sections.
In 2018, the Court of Appeal found this to be discriminatory against younger members in a case brought by judges (named McCloud) and firefighters.
The Government agreed to redress this discrimination across all public sector pension schemes, including the NHS.
A consultation in 2021 ruled that affected doctors have the right to choose which remedy benefits to take – the pension benefits from their previous 1995/ 2008 pension scheme or those from the 2015 scheme – at the time of retirement.
However, the Government has confirmed that new legislation to help deliver the remedy benefits will not be in place until at least October 2023.
It is therefore imperative that you continue to assess your tax position now and pay all necessary tax payments. Your tax position will then be corrected at a later date.
If you intend to retire or have retired before the new legislation is introduced, you should be contacted by NHS Pensions and asked to make your McCloud choice retrospectively.
Payments will then be backdated to the time when benefits became payable.
6 Are your financial adviser and accountant working together?
When dealing with large sums of money and critical life choices, you need to ensure your professional advisers have the complete picture of your financial interests and as well as competence in the NHS pension.
Make sure your adviser and accountant have the same objectives and work together to ensure opportunities are not missed.
7 Are you confident that your practice structure is tax- and pension-efficient?
You may well have considered the advantages of trading as a partnership or limited company, but are you really maximising the efficiencies that these can provide?
The tax landscape continues to change significantly and there are now more implications to consider when selecting the best structure for your business.
Have you overlooked the impact your trading structure has on pension contributions and pension tax?
A limited company can contribute ‘pre-taxed’ company income to a pension. Higher-rate taxpayers can put profit straight into a personal pension rather than taking the income as a dividend.
This applies to any director, so it can be particularly useful to contribute to a spouse’s pension if their lower salary means a higher annual allowance or they do not already have NHS pension contributions to consider.
8 Have you thought about the finances of your family?
Are you making the most of intergenerational planning? The introduction of pension freedoms now gives universal access to pension funds from age 55, plus the ability to pass on pensions tax-efficiently on death to family members and other beneficiaries makes pension funding attractive – particularly for some spouses or where the lifetime allowance and annual allowances are less of a concern.
Who will receive your pension fund benefits when you die?
Are your loved ones protected from unnecessary tax charges by considering your inheritance tax position now?
Do you and your adult children have up-to-date wills in place?
9
Are you taking advantage of your available allowances every year?
Are you using ISAs, capital gains and gift allowances or maximising tax reliefs through annual pension allowances to minimise the duty owed to HM Revenue and Customs?
This includes allowances for your spouse and family.
Individuals have an annual capital gains allowance of £12,300. This provides significant opportunities for tax-free investment returns every year.
At the same time, the reduced annual and lifetime allowances are driving a renewed enthusiasm in ISAs as a supplement to pension funding.
They are particularly tax-efficient for higher-rate and additional-rate taxpayers. The ISA allowance is now £20,000 per person, allowing a couple to shelter £40,000 a year from future taxation.
10
How are your investments structured?
Do you have a globally diversified and balanced portfolio designed to withstand market volatility?
Is your adviser supportive in challenging times?
According to peer-reviewed research by asset management company Vanguard, an average investor achieves returns of around 3% more per year with the help of an adviser.
Act now
Doctors are facing another incredibly difficult winter, but finding time to ensure your affairs are in order is paramount when the financial landscape is facing constant change.
Dr Benjamin Holdsworth is a director of Cavendish Medical, specialist financial planners helping 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.
It was a tough year for thousands in private practice. As many began bouncing back from the pandemic and enjoyed a surge in self-pay, others experienced ongoing challenges. And then doubledigit inflation hit everyone.
Here’s a roundup of some of our big news stories affecting private consultants and GPs
A revised code of practice for complaints management in private practice gave independent consultants more say during investigations into patients’ grievances.
The Independent Sector Complaints Adjudication Service (ISCAS) revamp, effective for new cases notified from January 2022, aims to promote a just and learning culture where complaints are positively welcomed.
With complaints in the private sector heading for record levels, the organisation said complaints needed to be investigated thoroughly and fairly – with independent services giving patients fair and accountable responses.
ISCAS director Sally Taber told Independent Practitioner Today : ‘What we’ve found is organisations don’t always take comments from all staff on a particular matter of complaint, including consultants, so we want to ensure we get comments from all involved in the complaints.
‘Frequently, one of the criticisms is that the consultant should have written a statement as well.’
The Independent Sector Complaints Adjudication Service revamp aims to promote a just and learning culture where complaints are positively welcomed
Its comments were backed by the London Consultants’ Association (LCA), which said private specialists would be pleased to practise only with providers who have the correct assurances and governance in place.
Welcoming the Government’s long awaited response to the remaining recommendations of the former Bishop of Norwich’s inquiry into his ‘reprehensible behaviour’, FIPO said it was gratified that the majority of the ‘sensible’ 17 recommendations had been accepted.
It said: ‘Recent cases have highlighted the need for a clear understanding of the responsibility and liability of both hospital providers and consultants.
‘Hospitals will need to accept responsibility for the quality of care in their establishments. This may also require a change in the law in relation to indemnity insurance and the Government intends to report on this in 2022.
The new streamlined code replaced a sevenstage process with four used in the NHS by the Parliamen tary and Health care Services Ombudsman: promoting a just and learning culture, welcoming complaints positively, being thorough and fair, and giving fair and accountable responses.
Private practitioners’ representatives said they were looking forward to ‘a restoration of confidence in the professional integrity of doctors throughout the sector’ in the wake of the Government’s support for recommendations arising from the Paterson inquiry.
The Federation of Independent Practitioner Organisations (FIPO) said rogue surgeon Ian Paterson betrayed the basic principles of medicine and had a devastating impact not only on the patients whose lives he ruined but also ‘on the medical profession as a whole’.
‘Overall, FIPO endorses the Government’s measured response to the inquiry’s recommendations. We hope that their implementation will improve patient safety and restore professional respect and trust for patients choosing to use the private sector.’
Consultants in private practice had been saved from huge losses after taking on billing experts who successfully chased and recouped more than £¾ billion.
That is the value of the outstanding invoices collected from patients and debtors over the last three decades by financial specialists at Medical Billing & Collection (MBC).
The highest figure retrieved amounted to more than £1m for a clinic and £400,000 for an indi
vidual consultant.
But as the company divulged these figures, published as part of its 30th anniversary celebrations, it warned independent practitioners to be on the alert for a mounting threat of nonpayments in the wake of Covid19.
It warned that some problems were likely to come from an increase in selfpay caused by the lengthening NHS waiting lists.
MBC business director Simon Brignall said the pandemic’s impact hit many practices’ finances due to:
Unpredictable incomes and problems with outstanding invoices;
Revenue fluctuations resulting from the impact of various lockdowns and restricted access to hospital facilities;
Cash flow problems due to a combination of reasons such as absences of staff employed by the practice and the administration departments of the insurance companies that consultants bill.
Mounting staff recruitment and retention problems in private hospitals were hitting crisis point and threatening consultants’ support.
According to the former chief executive of the UK’s largest private hospital, HCA’s The Wellington, it was all out war as independent sector bosses scramble to keep posts filled.
He revealed that some were paying golden handshakes worth thousands of pounds to attract nurses to join them.
Bosses were fighting even within the same hospital group to sign up targeted individuals, while other managers faced huge problems with staff, whose loyalty had been financially ignored, working alongside others given £5,000 signing on fees.
Keith Hague – at the Wellington Hospital for 12 years before orchestrating the development of the new Cleveland Clinic in London –warned that some private hospitals were ‘fighting to survive’.
Chief executives were ‘killing one another to try to get hold of staff and not only are they competing against competitor hospitals, they are competing with hospitals in their own group. That’s how tense this situation is’
He said: ‘I know there are some huge problems in terms of recruitment and retention in the NHS, but in the private sector it is absolutely killing the way the private sector works.’
Chief executives were ‘killing one another to try to get hold of staff and not only are they competing against competitor hospitals, they are competing with hospitals in their own group. That’s how tense this situation is’.
Mr Hague, who criticised the lack of retention strategies in the sector, said one hospital offered a senior nurse £9,000 more to join them.
He said his company went to the Competition and Markets Authority (CMA) and requested some relief for private consultants so they could have free hospital consulting rooms and some medical staff costs paid through the hospital group.
But it was ‘just like you were asking the CMA if they would support drug dealers on the street because they had gone out of business. They were not interested’.
Staffing problems could hamper consultants’ and private hospitals’ ability to take advantage of a surge of patients aiming to pay for their own treatment.
A survey from market analysts LaingBuisson’s database – which includes hospitals, clinics, individuals, managers and clinicians – found high confidence in the market, with over 55% of respondents forecasting self pay market growth of 10 15% in the next three years.
And according to Private Healthcare UK, although most demand continued to be in London and the Southeast, interest in private healthcare was rising consistently across all regions.
But market experts feared the staffing crisis could severely hit hopes of a selfpay boom.
Liz Heath, author of the fourth edition of LaingBuisson’s Private Healthcare Self Pay UK Market Report, warned: ‘The challenges around staffing are a real concern given that they impact all aspects of private healthcare services.
‘Adding additional operating
theatre sessions, for example, may not be as simple as it used to be.
‘The theatre may be available, but getting it fully staffed may be an issue. At a time when all indicators are suggesting greater demand for all private services, whether selfpay or insurance funded, this is a real worry to everyone we’ve spoken to across the sector.’
Independent practitioners were recommended to respond to GMC proposals which a defence body warned could have unintended consequences on doctors’ working lives.
The MDU’s concerns follow the launch of its ‘forensic’ analysis of the council’s consultation proposing a shakeup of its ethics handbook Good Medical Practice. Defence experts voiced strong reservations about the scale and nature of the proposed changes, saying some were unclear and failed to reflect the realities of medical practice.
Dr Caroline Fryar, the MDU’s director of medical services, said: ‘It is really important that all doctors read the consultation and envisage how they can see it working in practice.
‘Ultimately, the guidance must work for doctors and we are keen to hear from members so we can ensure their views are heard.’
Asked if she thought some proposals could lead to doctor confusion and result in them getting into trouble with the GMC, she replied: ‘There is a legitimate concern that some of the proposed changes lack clarity.
Consultants’ representatives warned that mounting inflation coupled with other business pressures were creating ‘a perfect storm’ threatening private practice
many are working in and that it supports them to be able to do the best for their patients and for their colleagues’.
Dr Fryar, writing in Independent Practitioner Today , noted many comments had been made about some of the new additions to Good Medical Practice – from displaying ‘kindness’, to obligations not to condone certain behaviour on social media and to have regard for global health when taking account of the resources available to treat patients.
She argued: ‘Kindness, tackling abuse on social media, climate change – all of these issues matter profoundly and are of the utmost importance.
‘However, Good Medical Practice is not a manifesto outlining the aspirations for the healthcare system – it is the principal document by which doctors and their registration with the GMC is held to account.’
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‘The guidance is one of the main tools used by the GMC in its fitnesstopractice processes. That’s why it is so important that this guidance – when finalised – is in the best possible shape. Every paragraph and every word of Good Medical Practice matters. That’s why we are being so forensic of our study of this new version.’ GMC chief executive Charlie Massey said the update was designed to reflect the type of fair, inclusive and compassionate workplaces everyone wanted to see and that were good for doctors and patients.
He said: ‘It is important our guidance reflects the reality of what doctors face and the cultures
Consultants’ representatives warned that mounting inflation coupled with other business pressures were creating ‘a perfect storm’ threatening private practice.
The London Consultants’ Association (LCA) expressed ‘growing fears’ about the future of private practice, while the Federation of Independent Practitioner Organisations (FIPO) voiced concerns that hefty expense increases made it ‘increasingly unattractive’.
n Turn to page
LCA chairman Dr Mark Vanderpump said: ‘A perfect storm of external pressures and changes in
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the market has resulted in a situation discouraging to both existing consultants and those who might have been considering entry.
‘The LCA believes that in the longer term this situation represents not only an existential threat to private practice but also threatens the ability of patients to choose the consultant with the expertise most relevant to their needs.’
He reported that the LCA was seeing consultants frustrated at all levels of their careers over significantly increased costs while fees and reimbursements had stayed ‘static’ for many years.
FIPO stated that consultants’ re imbursements had been continually eroded by inflation since a substantive increase in 1993 and young consultants starting in private practice from 2010 had seen no increase to take account of inflation.
These doctors, whom it said were only recognised by the main insurers if they accepted low reimbursement rates, should have had fees raised up until the beginning of 2022 by an annual 2.36% to keep up with inflation.
The extent of the pandemic’s toll on independent practitioners was revealed in a joint Medical Defence Union (MDU)/ Independent Practitioner Today survey showing over 44% of private doctors felt stressed and/or anxious on a weekly basis.
As many as three in ten admitted to ‘often’ going to work when they did not feel fit or well, with 6.9% strongly agreeing this happened.
Dr Udvitha Nandasoma, MDU
head of advisory services, said: ‘It is worrying that so many respondents feel stressed or anxious on a weekly basis and nearly a third are going to work when they do not feel fit to do so.
‘Consequently, it’s important for independent practitioners to be provided with the necessary support when dealing with the additional pressures.’
He said the MDU provided a 24hour advice line for medicolegal queries and had a peer support network for members facing medico legal challenges, such as complaints, inquests, GMC investigations and claims.
Thirty per cent of doctors told the survey they were unable to spend adequate time with patients (strongly agree 7.3%, agree 22.3%).
However, over 80% said they felt they were making a positive difference to their patients (strongly agree 22.3%, agree 58.8%).
Some 16.5% revealed they believed they could not do their job effectively, while 62.5% thought they could.
Most felt supported by their colleagues, with 15.4% strongly agreeing and 49.6% agreeing they were. Nearly 7% disagreed.
The survey’s 260 respondents included consultants, private GPs and independent practitioners doing other types of jobs. 29% reported a decrease in private practice activity.
Independent Practitioner Today announced that consultants’ requirements to gain and maintain practising privileges were
The extent of the pandemic’s toll on independent practitioners was revealed in a joint Medical Defence Union/Independent Practitioner Today survey showing over 44% of private doctors felt stressed and/or anxious on a weekly basis
giving more prominence to expectations around patient consent and the need for greater transparency about conflict of interest declarations.
IHPN chief executive David Hare said the document would enable greater consistency in how clinicians worked across the sector and give confidence to patients that independent healthcare providers were committed to delivering the safest possible care.
being standardised in all private hospitals as part of a drive to beefup patient safety and improve transparency.
The changes are among several in a new version of the fouryearsold Medical Practitioners Assurance Framework (MPAF) produced by the Independent Healthcare Providers Network (IHPN).
Authors of the 24 page document, designed to enhance the quality of care in the sector, said the content remains consistent with, or was updated to reflect, relevant new or updated guidance or legislation published since 2019.
The practising privileges section was updated to ‘better allow for a risk based approach, directing that a review of practising privileges be undertaken biennially for all medical practitioners and more regularly in circumstances where additional scrutiny is requires’.
A wide range of medical organisations reacted positively to the ‘refresh’.
Strengthened areas included
Consultants were warned they faced enforcement action if they continued dragging their feet over supplying data about their private work for public scrutiny.
We reported that an increasingly tough approach from the competition watchdog would see them publicly ‘named and shamed’ and taken to court if they failed to respond.
The Competition and Markets Authority also warned that some independent hospitals could expect the same fate if they did not hand over required information to the Private Healthcare Information Network.
David Stewart, its executive director of markets and mergers, argued that prospective patients needed the information to make important and sometimes difficult choices about their private healthcare.
He said that while hundreds of hospitals and thousands of consultants had submitted their data, others had failed to make any progress, or even attempt it.
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Media interest in your patient’s care or treatment is a daunting prospect for any doctor, but being the subject of an undercover investigation can be even more challenging. Dr Caroline Osborne-White (right) shows how these situations can be handled
IF A JOURNALIST asks for comment on a patient’s treatment, there is usually time to take stock, discuss an appropriate response with your medical defence organisation (MDO) and prepare for any further media inquiries.
Being the subject of an undercover investigation is less common, but at Medical Protection we have supported some private practitioners in such cases.
Covert media investigations can be particularly unnerving and challenging for doctors, as a journalist may in some cases have posed as a patient and recorded a number of consultations secretly.
This means the journalist already has information – whether that be film footage or a voice recording – and you may feel your options in terms of how to respond are limited. You might also feel deceived and begin to check the patient records or run over in your mind what happened at the previous consultations.
A doctor may be alerted to the fact that they have been the subject of an undercover investigation when the journalist, or perhaps a producer at a broadcast channel, makes contact to ask whether they would like to provide a comment or response.
If this happens, it is understandable to feel irritated and defensive, but try to avoid getting drawn into conversation on what did or did not happen, as anything you say may be construed as a comment and used in the programme alongside the footage or recording.
As with responding to any question from the media, on undercover reporting or otherwise, also remember your duty to protect patients’ confidentiality and to follow GMC guidelines.
You should not reveal any details about a patient’s care or treatment, even if it is revealed that they were an actor or a journalist.
This can be frustrating, especially if you are trying to defend your actions or mitigate potentially negative coverage. It is important to remember that even acknowledging that a patient is registered with you would be a breach of confidentiality.
Instead, try to stay calm and professional and find out as much
information as possible – in particular:
The contact details and name of the producer or person who has made contact;
When and where the undercover reporting took place;
Full details of the programme/ channel;
The date the programme will be broadcast;
In what context the film footage or recording will be used;
Who else will feature in the programme;
The deadline for submitting any comment.
At this point, contact your MDO immediately, providing them with any information you were able to obtain. It will work with you on an appropriate approach and response, liaise with the journalist or producer on your behalf, and try to minimise damage to your reputation.
Doctors will rightly ask how surreptitious filming or recording can be permitted in a healthcare setting and whether there is an infringement of privacy. Media are required to ensure that any secret filming or recording is carried out within the remits of Ofcom’s Broadcasting Code, which states that:
‘Surreptitious filming or recording should only be used where it is warranted. Normally, it will only be warranted if:
There is prima facie evidence of a story in the public interest;
There are reasonable grounds to suspect that further material evidence could be obtained;
It is necessary to the credibility and authenticity of the programme.’
It goes on to say that material gained by surreptitious filming and recording should only be broadcast when it is warranted, and that any infringement of privacy in programmes, or in connection with obtaining material included in programmes, must be warranted.
Where broadcasters wish to justify an infringement of privacy as ‘warranted’ in this context, they should be able to demonstrate why in the particular circumstances of the case it is warranted. If the reason is that it is in the
It is important to remember that even acknowledging that a patient is registered with you would be a breach of confidentiality
If you have concerns about a TV or radio programme, you can complain to the broadcaster directly; for example, if you feel that something is factually incorrect or misleading or if you are concerned that patient consent was not sought appropriately for a particular recording.
If a programme has already been broadcast and you believe that you have been treated unfairly – or that your privacy has been infringed without good reason in the programme or in the way it was made – you can complain to Ofcom.
If you have similar concerns about a newspaper or magazine, it should be directed to the Independent Press Standards Organisation.
public interest, then the broadcaster should be able to demonstrate that the public interest outweighs the right to privacy.
Examples of public interest would include revealing or detecting crime, protecting public health or safety, exposing misleading claims made by individuals or organisations or disclosing incompetence that affects the public.
Surreptitious filming
The code defines secret filming or recording as surreptitious filming or recording including the use of long lenses or recording devices, as well as leaving an unattended camera or recording device on private property without the full and informed consent of the occupiers or their agent.
It may also include recording phone conversations without the knowledge of the other party or deliberately continuing a recording when the other party thinks that it has come to an end.
The GMC has produced some guidance on audio and visual recordings that are for use in widely accessible public media.
Paragraph 40 of this guidance makes clear that Ofcom’s Broadcasting Code, which covers all UK broadcasters, requires consent from patients for broadcasting of any recordings to be obtained in a way that is consistent with this guidance.
It is important to remember that sometimes making a complaint or seeking redress via the media can draw further unwanted attention to the issue. Your MDO can offer advice and set out the pros and cons, and it would be advisable to seek its advice before taking action.
Journalists and producers often argue that undercover investigations are important to help uncover poor practice and improve patient safety.
While doctors are under enough pressure without having to worry about hidden recording devices or agendas, it is clear that exposing perceived failings in healthcare through undercover reporting is likely to continue.
A doctor could find themselves at the centre of a journalist’s story at any time – whether undercover or not – but to worry about this unduly may impact on your ability to care for patients effectively.
Be sure to always practise in accordance with GMC guidelines, making the care of your patients your first concern.
Contact your MDO immediately if you are made aware you have been the subject of an undercover investigation or are approached for a comment by media to ensure that you have appropriate advice and support.
Dr Caroline Osborne-White is a medico-legal adviser for Medical Protection
As we put another year between us and the Covid-19 pandemic, Dr Robin Clark, (right) medical director for Bupa Global and UK, examines the emerging trends in healthcare influenced by the pandemic and what this means for our future care delivery
SINCE 2020, digital transformation in healthcare has continued to accelerate faster than forecasted, driven by the changing expectations and behaviours of both patients and healthcare providers.
The Covid-19 pandemic also triggered unprecedented levels and adoption of innovation. For example, the messenger RNA (mRNA) used in Covid-19 vaccines is now being used to develop
vaccines for diseases such as HIV and malaria and scientists are exploring its use in cancer treatments.
Given the now indisputable links between the environment and human health, Bupa, the NHS and other healthcare organisations have set the goal of becoming net zero by 2040.
This will mean they will need to re-examine and re-organise every-
thing from supply chains to delivery of care and disposal of waste to enable them to reduce greenhouse gas emissions.
Volumes of preventative screening and routine care are still reduced and this is likely to lead to a steep rise in the diagnosis of noncommunicable diseases, including cancers and diabetes, as well as the worsening of existing conditions.
While there is some investment
in reducing these backlogs, it will take years and may limit investment in modernising services. Against this backdrop, we see five trends emerging in the future healthcare landscape:
Empowered individuals taking control of their health
There is a continued trend of people empowered to take greater con-
trol over the decisions and actions affecting their health.
The driving force behind this will be the digitalisation of healthcare and increasing availability of personal health records (PHRs) controlled by the individual themselves.
Although PHRs are not new, technologies are now enabling a significant shift in the power balance of health data ownership.
For example, patients can now access their health records via the NHS app and, in future, they will be able to review their GP records more comprehensively than ever before.
And Apple has recently allowed iPhone users to privately share
selected health record data with trusted partners.1
People will collate health data in their personal devices from their homes, connected devices and public and private health records.
This will give them one easy-toaccess, longitudinal picture of their health status and they will be able to select what data they want to share and with whom.
This trend indicates a future where the current concept of who ‘owns’ data is different. In the future, digitally savvy individuals will want to have a greater say in their medical decision-making.
As patients’ involvement in their care grows, so too will their expectation for tools which allow them
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who provides the highest quality care.2
Organisations such as Bupa and the NHS will need to take responsibility for developing these tools and clinicians will need to make sure that they are using these tools to allow the sharing of information.
2A shift from one-sizefits-all healthcare to personalised health via digitally enabled pathways
While they increasingly use these tools, they will be prepared to switch doctor or hospital because they have information on
The digital-first approach to healthcare, accelerated by the pandemic, will result in the development of seamless easy-to-access customer journeys with pathways.
The messenger RNA (mRNA) used in Covid-19 vaccines is now being used to develop vaccines for diseases such as HIV and malaria and scientists are exploring its use in cancer treatments ➱ continued on page 36
At Bupa, we are already enabling this through our digital GP app, our remote skin assessment service using smartphone and a dermatoscope to check potential cancer symptoms, and our condition-specific specialist centres which give patients all initial diagnostic tests and scans in the same appointment for a diagnosis and, if it is not cancer, be given the allclear on the same day.
There will be a focus on the whole person and a holistic approach to health. This shift from a transactional patient-provider experience to a more holistic approach means that individuals will have greater opportunity to prevent health issues before they arise and manage disease.
It will also help improve the quality of life for individuals with chronic medical conditions. The hope will be that this can mitigate the increasing ill-health burden.3
3 Access to large-scale data will be essential to most effectively manage the health of individuals
Individuals’ health data can be collected from many different sources, including health records, test results, claims data, social media posts, data from wearables and home monitoring devices.
The healthcare industry is being transformed by collecting this data and allowing computer analytics to find patterns that humans cannot.
With access to more information, patients will benefit from:
Improved clinical outcomes at lower costs through early intervention and individualised treatment plans;
Real-time disease monitoring and surveillance;
Preventive healthcare through the anticipation of potential negative health events and preventive interventions;
More robust risk prediction for individuals;
More sustainable healthcare due to a reduction in unnecessary interventions and efficient use of resources.
4
Precision medicine has the potential to remove significant waste from the healthcare system
Precision medicine, using genetic or molecular profiling, means that
person-specific information will be known about:
How an individual person’s body works;
What represents a health risk for that person;
The peculiarities of a given pathogen or tumour affecting that person;
How any treatment might affect both person and disease.
It will give patients more accurate and detailed individual diagnoses and will enable quicker delivery of the right intervention, whether curative or preventative, at the right time.4
While it may be expensive in the short-term, over time, it is likely to benefit all healthcare stakeholders.
As well as giving patients faster access to the treatments they need, it will be able to avoid the risks and costs of incorrect or inappropriate interventions, improve outcomes, reduce waste and offer better value for money.
Not only will it help avoid inappropriate, often expensive, treatments, it will cut hospitalisations for serious adverse reactions.
This will ultimately allow for more effective use of healthcare resources. 5 And it will foster a focus on outcomes, as this is needed to implement precision medicine effectively
5Within the context of rising costs, the expectations and needs of ageing populations will drive significant change in how the health of older people is managed
The population is ageing. Globally, there are 703m people aged 65 or over, a number projected to reach 1.5bn by 2050.6
And, as the ageing population increases, so too does the cost of care, not least due to an increase in multimorbidity and age-related conditions – including neurodegenerative diseases such as dementia.
We are now seeing more discussions about ageing across the healthcare sector and wider society – for example, about the changing meaning of ‘working age’ and the effects of a lengthy retirement on mental and physical health.
There are also changing perceptions about end-of-life decisionmaking and we are becoming
Developments in fields including genomics, artificial intelligence, digital medicine and robotics will begin to change the roles of clinical staff to ensure safer, more effective and more personal care for our patients
ing digital and data technologies will create the demand and opportunities for products and services that make life-long care more affordable.
We need to be ready to adapt to new ways of delivering healthcare. Developments in fields including genomics, artificial intelligence, digital medicine and robotics will begin to change the roles of clinical staff to ensure safer, more effective and more personal care for our patients.
more aware of the significant impact that climate change will have on the health of vulnerable populations.
Older people are calling for better quality of life in their later years and they want healthcare services provided close to home and their loved ones.7 The next generation of older people will be the first to be frequent and comfortable users of technology.
Research is also driving a proliferation of emerging innovations to aid the diagnosis and treatment of neurodegenerative diseases.
There has also been an acceleration of research into treatments to help people remain healthier for longer and technologies to help older people live at home for longer.
We need to consider how to support older people during retirement and beyond. The changing healthcare landscape and emerg-
We will need an increased level of digital literacy to support our patients in making informed healthcare choices enabled by technological advances. This digital transformation makes it an exciting time to be in healthcare. Never before have we had access to so much information, both in terms of helping us achieve the best possible clinical outcomes for patients and demonstrating the quality of care we offer in the independent sector.
We also need to recognise that while some patients will embrace the new technology as it evolves and opportunities that it offers them, others will be more cautious. We need to consider appropriate use of personal medical data and how we demonstrate this, as well as the benefits of technologies, to make sure that we do not disadvantage those who are wary or less computer literate.
1. Empower your patients with Health Records on iPhone. Apple, accessed 2021
2. A consumer-centred future of health. Deloitte, 2019
3. The shift from transactional to whole person care (WPC). ICF. (2020)
4. Doing well? Fulfilling the promise of precision medicine. Economist Intelligence Unit. 2020
5. Cost-effectiveness of precision medicine: a scoping review. Kasztura et al. Int J Public Health, Dec 2019; 64(9): 1261-71
6. Our world is growing older: UN DESA releases new report on ageing. United Nations Department of Economic and Social Affairs, published October 2019
7. Long-term care workforce: caring for the ageing population with dignity. OECD, accessed December 2021
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
A drop in private consultants’ incomes was being reflected in record applications to pay less tax to HM Revenue and Customs at the end of January.
Accountants reported a surge in the number of specialists who had applied to have their payments on account reduced because they were not expecting to earn so much as they were.
Those affected were reportedly all in the older age group. Younger consultants appeared to be largely escaping the downturn.
They said some of the downturn resulted from a fall in the market and more new consultants moving into private practice.
Private doctors were being offered the chance to completely escape a mounting bad debt plague that was costing them an estimated average 2% of due income each year.
Independent practitioners’ businesses lost an estimated average of at least £28m alone in uncollected fees in 2012, according to medical accountants.
One billing and collection company reacted with a New Year
promise to guarantee customer doctors 100% recovery of invoices raised.
A spokesman said: ‘We are close to collecting 100% anyway. We will basically take on the debt if we don’t get 100%.’.
Senior doctors were hard hit by tax relief cuts to their pensions in plans announced by the Chancellor. George Osborne’s Autumn Statement announced changes to both the annual allowance and lifetime allowance rates. The annual allowance would be cut from £50,000 to £40,000 from 2014-15. The allowance had already been dramatically reduced
from £255,000 to £50,000 in April 2011.
Plans were also announced to further reduce the lifetime allowance to £1.25m from 2014. This followed the earlier fall in April 2012 from £1.8m to £1.5m.
Dr Paul Flynn, then chairman of the BMA’s Consultants Committee, warned that the change to the tax allowance of pensions savings would affect thousands of doctors – not just the highest earners.
‘Doctors with long service in the NHS could be facing a large tax bill. This is on top of the whole raft of changes the Government is implementing to NHS pensions, including raising the Normal Pension Age and hugely increasing contributions.’
The British Association of Aesthetic Plastic Surgeons (BAAPS) stepped up its fight against ‘cosmetic cowboys’ in a widely reported media campaign drawing patients’ attention to the plight of victims. Members reported a ‘staggering rise’ in problems stemming from non-surgical treatments.
69% of surgeons who responded to a BAAPS survey saw patients suffering complications from temporary fillers and 49% saw problems with semi- or permanent fillers.
Out of those patients who suffered problems with permanent substances, 84% required
corrective surgery or were deemed untreatable due to the damage caused.
Surgeons said complications with injectables happened due to unqualified practitioners administering fillers incorrectly and lack of regulation, allowing unproven substances to be used in the UK.
They said patients thought of these treatments as something easily administered by anyone and were unaware of the risks and side-effects involved with the procedure.
Doctors were being urged by a defence body to consider the medico-legal issues of using Skype for patient consultations.
The Medical and Dental Defence Union of Scotland warned against over-reliance given the limited scope for any examination of patients.
TELL US YOUR NEWS
How about making the news today? Independent Practitioner Today is always keen to hear from doctor entrepreneurs willing to share their stories in private practice – and from independent practitioners embarking on the journey.
Contact our editorial director Robin Stride at robin@ip-today. co.uk
This is your captain speaking: ‘There may be turbulence ahead for independent practitioners’ finances.’
Simon Brignall (below) explains why and shows how to have a happy landing
THE PRIVATE healthcare sector benefited from strong demand in 2022, propelled in no small part by the ongoing problems in the NHS.
There have been multiple data points in recent months, such as from the Private Healthcare Information Network, that showed a 39% increase in self-pay activity from 2019.
At Civica Medical Billing and Collection, our own internal numbers have confirmed this, with more than 90% of our clients billing above their 2019 levels and many seeing a 50% increase in self-pay activity.
With NHS waiting lists around seven million, this tailwind is likely to continue. However, there could be turbulence ahead.
We are yet to see the full impact of inflation fuelling the cost-of-living crisis. This, in combination with the Government’s fiscal response, will likely impact on the sector.
It is worth noting that despite newspaper headlines about squeezed households, many older prospective patients are shielded from the full effect of this, as they either own their own home or have smaller mortgages.
Reductions in disposable income are more likely to affect younger and middle-aged consumers and so discretionary decisions about employee-contracted healthcare may face difficult choices when budgets are tight.
This is not to say that the medium- to long-term outlook for the private sector is not positive, but merely to highlight that the short-term could prove to be a little choppy.
It is always a good idea to make sure your practice is best prepared and so I would recommend making the following pre-flight checks.
One of the best indicators of the impact on any business of economic volatility is previous performance.
The recovery in 2022 resulted in an increase in demand for private healthcare and, as the saying goes, a rising tide lifts all boats. But as the ‘Sage of Omaha’, Warren Buffet, famously said: ‘It’s only when the tide goes out do you see who was swimming naked’. ➱ continued on page 40
Many private practices benefited from increased patient footfall over the past year, but I have had many conversations with consultants who felt they were not getting the full benefit of this activity.
This can be a for a variety of reasons such as
Delays in invoicing;
Reconciliation and chasing problems – especially chasing;
Limited payment pathways.
The first two problems are often a result of staff not being able to manage the increase in demand effectively, while the last is a lack of appropriate functionality.
All these issues mean that the practice suffers from cash flow issues, patient dissatisfaction and potential losses in income.
Even a busy practice needs to know what invoices have been raised and what still needs to be actioned. You also need to have access to accurate and up-to-date reporting that shows how much is outstanding.
It is no good having reports that do not reflect the true position of the practice, as this will limit your ability to manage your practice effectively and impede the chase process.
It is not uncommon for me to find that it is larger busier practices that have the biggest issues in this area.
Often it is hard to comprehend that your practice is as much of a business as any other profit-making organisation, given the nature of what you do. For this reason, a consistent cash flow is vital to keep your practice in the air.
Although providing great care for your patients in their time of need is the main priority of your practice, it is important that you do not forget the fuel you need to keep it running.
Issues with your cash flow can have a direct impact on how you operate your practice and how you choose to deliver care to your patients.
It is vital that you ensure your work is invoiced as promptly as possible.
Failing to do this at the correct time can have a knock-on effect on
Although providing great care for your patients in their time of need is the main priority of your practice, it is important that you do not forget the fuel you need to keep it running
where there is an issue that you need to address. For many independent practitioners, this will be practice management software, but a simple Excel spreadsheet will suffice.
Reconciled regularly
Secondly, whatever solution you choose, it is only as good as the data it contains, so making sure that payments are reconciled on a regular basis is key.
The best practice management software in the world will not solve this problem if this key task is set aside when a practice is busy.
A modern practice should be able to offer the following functions to its patients:
E-billing of patients
24/7 payment collection
Credit and debit card transactions
Multiple invoice settlement as one transaction
Payment links for its website
Invoicing and collection preand post-treatment alongside same day, when required
your revenue cycle and make the practice look unprofessional.
Creating your invoices in a timely fashion means that any issues arising, especially with insurance companies, can be resolved quickly and increase your chance of a speedy payment.
It is important to remember some insurance companies have a specified time limit in which you must raise your invoice otherwise they will refuse to pay – leading to lost income for you.
At Civica Medical Billing and Collection, we like to eliminate any potential issues before they occur. We invoice insurers and patients electronically, where possible.
This is an all-round more efficient way to send invoices because it minimises the chances of important documents getting lost in transit and provides evidence of receipt.
This delivery method is also extended to self-payers, where possible, as patients tend to prefer receiving the invoice on their phone, which allows them to be able to pay it with ease.
Know which passengers have paid
This is often something that is easier said than done, because there are two components that need to combine to ensure this works effectively – which is why it often can go awry.
Firstly, it is important to have a system that shows you exactly which patients’ invoices are outstanding and highlights those
The reason this is important is that many insured patients can be subject to shortfalls, excesses and co-payments. The patient is then liable for an outstanding balance, which they will need to be invoiced for, as well as often contacted to explain why this happened.
This can become an extremely time-consuming task. Many patients do not realise they are liable. It is unlikely that they have reviewed the terms and conditions of their policy.
Remember, delays in invoicing only further delay problems being identified and reduce the likelihood of an invoice being paid.
Failure to implement a routinely-followed, robust chase process is the biggest problem most practices experience and is one of the main issues that are highlighted by consultants when I meet with them.
There are many reasons for this and often it can result from a practice’s success.
Of all the steps in the revenue cycle, the chase process is especially liable to be impacted by the 80/20 rule. This is where 80% of the time spent by your admin team is focused on chasing 20% of your outstanding invoices.
It is not surprising that chasing is often the first task to be set aside. That results in an escalation in aged debt, a deterioration in cash flow and the whole issue spiralling out of control.
Our well-structured engagement process sees late payments collected as quickly and efficiently as possible. It is important that whatever process you employ, it is
actioned regularly and subject to the same methodology.
For best practice, you should keep accurate records relating to this activity and action any queries that arise promptly.
Our clients’ patients can pay 24 hours a day via our online payment portal – giving them the flexibility to be able to pay when it is most convenient for them.
We have found that offering this service alongside other unique functionality improves the invoice collection time significantly and means we have a bad debt rate below 0.5%.
The invoicing side of your practice is an important part of the patient journey and offering the full range of payment pathways and options they require should be seen as an integral part of a modern practice (see box above).
There have been many references to the importance of selfpay patients and even practices that see predominantly insured patients still need to invoice patients for shortfalls and excesses.
The start of a new year and the impetus this brings is always a good time to review a practice and implement change.
If any of these checks highlight an area of concern for your practice, then often the best solution is to contact a professional medical billing and collection company to ensure a smooth flight.
Simon Brignall is director of business development at Civica Medical Billing and Collection
Documents and their disclosure are a key component of every case Vicky Rowlands and Emma Summerfield work on as clinical negligence solicitors.
Here they outline the basic rules of disclosure and give some key tips about record-keeping to help you in your everyday practice.
THE LEGAL framework relating to the rules of disclosure in a clinical negligence claim and your obligations as a party to proceedings is vast.
We will therefore focus on the very basic principles forming the basis of the duty of disclosure, specifically within a clinical negligence claim.
What is often referred to as ‘standard disclosure’ requires a party to disclose any document in its control:
On which it relies;
Which adversely affects its own case;
Adversely affects another party’s case;
Supports another party’s case.
The starting point therefore has to be the definition of a document.
Disclosure is often something which is found to be incomplete. It is therefore important to understand precisely what falls within the definition of a ‘document’.
The Civil Procedure Rules provide a very wide definition of ‘Anything in which information of any description is recorded’.
While not a definitive list, this is likely to include:
☛ The full medical records –including any recordings of phone appointments, booking notes made by secretaries or the reception team, clinical notes and correspondence;
☛ Complaint documentation and internal investigation documentation – with some exceptions discussed below – relevant policies and guidelines in place at the time.
When requests for documents are raised during litigation, either by your own solicitor or those acting for the other party, it is important to make a reasonable search for all documents that could be relevant to the case.
Two main types of privilege mean that a document does not need to be disclosed.
1 Legal professional privilege
The usual definition given for this is communications which have the purpose of giving or receiving legal advice. This means that any correspondence prepared during the claim process between you and your solicitor will not be disclosable to the other party.
➱ continued on page 42
Make sure your notes are contemporaneous. If possible, complete the note at the same time as the appointment or as soon as possible thereafter. It is helpful to detail the date and time on the record.
If making handwritten notes, ensure these are legible. Think of your colleagues trying to decipher them without the context you have when preparing them. Similarly, consider any abbreviations you use and, unless these are well recognised, keep them to a minimum.
Ensure you document your name and, if appropriate, sign the record. This is especially important should a patient make a complaint or bring a claim, because identifying the clinician involved in the care and being able to seek their input can be the difference between having a defence and needing to settle a claim.
Make a clear record of what was discussed and what was done during the appointment. This should include any relevant history, any tests/examinations undertaken and the outcome of these, any differential diagnosis and any other steps taken such as a prescription, arranging further investigations, a referral or a follow-up appointment.
Any discussions with the patient and advice given to them should also be detailed.
If you discuss the patient with a colleague, ensure you document whom you discussed them with, what advice/input they provided and the outcome of that discussion. This is especially important when discussing patients with more senior colleagues or seeking input from another discipline.
If you dictate notes or clinic letters and these are typed by someone else, ensure you carefully review them and sign them off before they go into the patient’s notes.
This means that any documents prepared as part of the claim process – such as comments obtained from treating clinicians, or internal communications about the case – are not disclosable.
But, to rely on this exception, you must be able to demonstrate that documents were prepared in contemplation of legal proceedings arising out of the incident.
If a party wishes to run this argument, they have to be able to say that the litigation is the dominant purpose the document was prepared for.
So, for example, if an internal investigation has taken place prior to the claim being brought or even mentioned by the patient, even if it is the same subject matter of a claim which subsequently follows, the documents relating to that investigation would usually need to be disclosed.
These would include any final
complaint response or investigation report, but also any internal communications from within the organisation or comments obtained from clinicians involved in the care.
These documents were not created with the dominant purpose being the litigation and so they would usually need to be disclosed.
However, any documents created following notification from a patient that they intend to claim would usually be protected from disclosure.
During the pre-action process before court proceedings are commenced, the Civil Procedure Rules provide the potential claimant with the mechanism for obtaining disclosure.
The rules relating to this are discretionary and are subject to the claimant establishing that they and the potential defendant
would be the likely parties to the future claim and that it is desirable for fair disposal of the claim and to save costs that such documents would fall part of standard disclosure.
Once proceedings have been initiated, a defendant is under an ongoing duty of disclosure.
You may find that your solicitor contacts you to request disclosure of any available documents and it is important these are provided.
As part of the litigation process, each party has to create a ‘List of Documents’ containing everything relevant to the claim and disclosable – that is to say, it does not fall under either of the privilege arguments set out above. It is extremely important that this is a full and accurate list.
From your perspective as clinicians, one of the most important sets of documents which should be disclosed and included on the List is the medical records.
From our perspective as clinical negligence solicitors, the records are also one of the most crucial pieces of evidence when investigating a claim
Medical records are a well-established and crucial part of clinical practice. They detail what happened during an appointment with a patient.
This includes any relevant history, any investigations or examinations undertaken and the outcome – possibly a diagnosis, a prescription, a referral to another specialty, a follow-up appointment or a conclusion that nothing further needs to be done.
Importantly, the records act as a reminder should you see the patient again or inform other medical professionals as to the appointment should a patient be referred to them or come back at some later time for further assessment.
From our perspective as clinical negligence solicitors, the records are also one of the most crucial pieces of evidence when investigating a claim.
The medical records enable independent medical experts to assess the care provided to advise on whether it was of a reasonable standard and, if any factual disputes arise, a clear, detailed contemporaneous record can be persuasive to a judge as to what happened during the appointment.
In the GMC’s Good Medical Practice guide, it states that doctors must record their work clearly, accurately and legibly and should make records at the same time as
the events you are recording or as soon as possible thereafter.
We have drawn on our experience of reviewing records to provide some advice on ensuring good records (see box opposite).
While we appreciate that time is limited and there is a balance to be struck in what can realistically be recorded, these tips should help ensure your records are an accurate reflection of the appointment and therefore useful should you or anyone else need to review them.
Remember, if you are ever unsure as to whether a document is disclosable, the best thing to do is send a copy to your solicitor so they can advise accordingly.
Finally, from a solicitor’s point of view, if something isn’t documented in the records, it’s very difficult to prove that it happened.
Vicky Rowlands and Emma Summerfield are associates at Hempsons solicitors
Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes of free legal advice.
Advice is available on:
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David Hare explains how the independent healthcare sector is working to achieve the target of ‘net zero’ by 2035
IF THE coronavirus pandemic has taught us anything, it’s that we are very much living in ‘one world’.
Just as it proved impossible to escape from Covid-19 in a globalised world, we also cannot ignore what is undoubtedly the most profound long-term threat to the health of the planet: climate change.
Indeed, not only do rising carbon emissions have a devastating impact on the natural environment, there is growing evidence of their impact on our health.
And as a sector which delivers care for millions of people every year, independent healthcare providers – and the practitioners that work in it – can make a real difference in the nation’s efforts to tackle climate change.
Clearing the air
In November 2022, in time for the COP27 climate conference in Egypt, the Independent Healthcare Providers Network (IHPN) was therefore delighted to publish our report, entitled ‘Clearing the air’, on how the independent health sector is working to achieve net zero carbon emissions.
This is an important milestone and marks one year since we launched our voluntary industrywide pledge for the sector to become net zero by 2035 – already signed up to by almost 50 providers working across over 1,500 sites.
This bold target reflects the commitment from the sector and those working in it to move as fast as possible on this agenda and to recognise that small changes today can make huge differences over the long term.
Our journey to net zero will not be a quick one and will require healthcare providers to interrogate all aspects of their business to cut carbon emissions.
And our latest report captures just some of the new and innovative ways independent providers and practitioners are reducing their environmental footprint.
In addition to the changes many households and businesses are making across the country, such as using more renewable energy sources like solar power or increasing energy efficiency through better insulation and use of LED light bulbs, there has been a particular push in the independent acute sector towards developing greener operating theatres.
As many Independent Practitioner Today readers will be aware, anaesthetic gases are commonly used as part of surgery and desflurane is one of the most common anaesthetic gases used both in the NHS and in the independent sector.
But desflurane is also one of the most harmful and has 20 times the
Our journey to net zero will not be a quick one and will require healthcare providers to interrogate all aspects of their business to cut carbon emissions
groups to drive this agenda, so that those practitioners working on the front line can make improvements and identify opportunities to further reduce their carbon footprint.
This is so important, as we know that tackling the climate change emergency is a key priority for the next generation of medical professionals. And organisations who can demonstrate their green credentials will have a head start in recruiting the most talented graduates in the years ahead.
For providers and practitioners across the independent healthcare sector, the journey to achieving net zero may seem a long and daunting one.
environmental impact of other less harmful greenhouse gases.
Using one bottle has the same global warming effect as burning 440kg of coal. As a result, hospitals across the independent sector have now committed to stop using desflurane and will now focus on using lower carbon alternatives, saving thousands of tonnes of carbon over the course of a year.
Recognising that change comes from the ground up, many providers across the sector have also established green ‘champions’ and other staff engagement
But as the trade association that represents independent healthcare providers, IHPN will continue to support our members and those working in the sector to deliver their net zero ambitions.
This includes delivering a wideranging programme of work to support members on issues such as sustainable medicines, developing carbon reduction plans and understanding net zero and social value.
Because only by working together and sharing best practice do we stand the best chance of succeeding in the fight against climate change.
David Hare (right) is the chief executive of the Indepen dent Health care Providers Network
WHAT ARE YOU OR YOUR PRIVATE HOSPITAL DOING TO HELP ACHIEVE NET ZERO BY 2035?
Please share your progress with Independent Practitioner Today by emailing robin@ip-today.co.uk
Dr Kathryn Leask (right) explains what to do if you are asked to complete documentation in relation to a patient requiring a firearms licence
QI have been seeing a patient for a number of years at my private GP practice. He has various physical health problems and has suffered from some work-related anxiety in the past.
I have received documentation from the police asking whether I have any relevant information about the patient, as he has applied for a firearms licence. As I have not been asked to do this before, I wonder if you could help advise about the process.
AIn April 2016, the Home Office updated guidance on firearms licensing arrangements, and this included revised procedures relating to the health and fitness of licence-holders.
The Government’s main website on firearms licensing is a good source of information. The Home Office also has a Guide on Firearms Licensing Law.
Your role is to share any information which you have reason to believe is relevant to the police’s decision-making process. What is relevant is based on your judg
ment. You should be prepared to justify why you did or did not disclose particular information if you are asked to.
In considering what information to share with the police, you should keep in mind that anything you send them could be seen by the patient if they are subsequently denied a licence and appealed the police’s decision. It is better, therefore, to provide objective, factual information, which would be in line with the GMC’s Good Medical Practice
This says that you must make sure documents you sign are not false or misleading and that you have taken reasonable steps to check the information. It is also important that you do not deliberately leave out relevant information.
The patient is likely to have already consented to the disclosure of medical diagnoses when they completed the firearms certificate application.
If you were considering sharing information other than medical diagnoses, you would then need to consider discussing this with the patient. That would be either to get their consent or simply to inform them of your decision, if you feel that disclosure is required to protect the public from serious harm, as outlined in the GMC’s Confidentiality guidance.
Although ultimately the decision is yours, as well as discussing what might be relevant to the police with your colleagues, you may also wish to contact your defence body.
QI am a private GP and have just received a complaint from the partner of a 37-year-old female patient who presented to me with vague symptoms including weight loss and dizziness. She was a keen sportsperson and had a good exercise tolerance, which was reassuring.
I conducted a number of investigations including various blood tests, all of which appeared normal. Unfortunately, she collapsed at home and was admitted to hospital.
According to her partner, she has been diagnosed with an eating disorder and is now under the care of a psychiatrist.
I hadn’t suspected this at all. How should I best respond to the complaint? The partner has intimated that he intends to refer me to the GMC.
AAt this stage, you can acknowledge receipt of the complaint, but you will need consent from the patient before you can respond to her partner.
However, you can begin your investigation into the complaint. It is important to review the care you provided from the beginning of this clinical episode to identify areas of good practice and areas where, with hindsight, you could have done things differently.
If possible, discuss the complaint anonymously with a trusted clinical colleague or with a peer group. Would they have done anything differently? You can seek advice from your defence organisation with drafting a suitable response once you have the patient’s consent.
While you can’t stop a patient or complainant raising concerns
Dr Kathryn Leask discusses how to respond to a complaint involving a patient diagnosed with an eating disorder
with the GMC, you can pre-emptively take positive action by showing insight into the concerns and taking remedial action.
All complaints and clinical incidents are a good opportunity to review your knowledge and skills.
As you didn’t suspect an eating disorder, part of your reflections on this case could include speaking to a specialist in eating disorders and then providing a teaching session to your peers, for example.
You should also review the relevant guidance in this area, such as the NICE guidance. In addition to this, the Royal College of Psychiatrists has produced guidance on the recognition and management of medical emergencies associated with eating disorders.
As well as reassuring the patient that you’ve taken the complaint seriously and used it as an opportunity to improve the care you provide, the GMC also tends to look favourably on registered medical practitioners who proactively address any concerns, meaning that there is a higher likelihood that they may close their investigation without the need to take any further action.
Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union
LONDON MEDICAL, the award-winning outpatient clinic in the Harley Street Medical Area is expanding its weekend opening hours. We are inviting applications for practicing privileges.
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UK inflation rates have recently seen a large rise in response to a variety of factors. Understandably, many doctors are now thinking about how savings and investments keep pace with inflation. Interest and gains on investments often cause tax charges. Richard Norbury looks at practical and tax issues to consider with common investment areas
DUE TO high income tax and potential tax charges on pension growth, many doctors trading as limited companies will not be withdrawing all the available funds from the company.
If you are in this position and the money is building up to sizeable amounts, then these sums can be considered for investing.
Personal savings attract interest which is often taxable at your usual rate of income tax.
Many doctors will not have the benefit of using their personal allowance or starting rate for savings due to the amount of other income earned in their main job.
However, most will have the personal savings allowance available as follows:
Basic-rate taxpayers: first £1,000 tax free
Higher-rate taxpayers first £500 tax free,
Additional rate taxpayers – those earning over £150,000 a year – are not entitled to any personal savings allowance.
Rising interest rates on savings will push more savers into paying tax.
For individuals, there are financial products that may offer taxfree interest and capital gains, where appropriate, such as the individual savings account (ISA).
In relation to companies, there are no taxfree amounts and you will pay corporation tax on your savings interest at the relevant rates, which are planned to rise in April 2023 for any firm earning more than £50,000 profit a year. Therefore, with higher interest and inflation rates, it becomes
harder to ensure that savings do not lose value in real terms due to the Government taking its tax cut from income but giving no tax relief on cost of living increases for your household expenses.
Another common form of investment is that you may hold some stocks and shares or a portfolio of shares.
If held personally, tax liabilities on this type of investment will come in two main forms: income tax on dividend income and capital gains tax when you sell investments.
Dividend income is taxed at the rates shown in the box at the bottom of this page.
For capital gains tax, each individual has an annual allowance of £12,300. This means you can make gains of up to this amount each tax year without paying any tax.
Any gains over this amount are taxed depending on the type of asset and if you are a basicrate or higher rate taxpayer. But, typically, on stocks and shares you would expect to pay 10% tax for a basicrate taxpayer and 20% for a higherrate taxpayer.
In addition to ISAs, for individuals there are other investment products available that attract tax relief such as enterprise investment scheme (EIS).
These investments attract tax
relief to encourage investment in new or start up companies, so there is usually more risk associated with these.
Due to their nature, advice from an independent financial adviser is essential before investing. Companies can also invest in stocks and shares, but need to take care that this does not reclassify the status of the company from a trading company – essentially companies used for private practice income – to an investment company, which can impact on corporation tax rates and longerterm strategies that may be in place.
With this in mind, it is better to take professional advice from an accountant, who can consider your needs on a casebycase basis and set up the relevant structure accordingly.
Dividends paid into your company from other companies often qualify for exemption from corporation tax, but this should obviously be checked on a casebycase basis. In relation to capital gains tax, there is no annual allowance exemption and tax is payable on gains at the relevant corporation tax rate applicable.
Many doctors reading this will have invested, or know someone who has invested, in cryptocurrency.
To 5 April 2023 From 6 April 2023
In the UK, there is no specific tax applicable to cryptocurrency and, instead, it will be taxed via the existing capital gains tax rules or income tax.
Generally speaking, the process of buying and selling cryptocurrency is subject to capital gains tax in much the same way and tax rates as explained under the stocks and shares category of this article. However, there are instances where HM Revenue and Customs will consider that cryptocurrency should be taxed under income tax, but this will generally be when you are being paid in cryptocurrency for work performed or if you are actively mining tokens.
This is a complicated area and it needs to be considered on a caseby case basis. Many of you will already own or be thinking of investing in residential property and a common question is whether that investment should be owned personally or via a limited company.
Personallyowned property has seen changes in tax legislation over the recent years, including the removal of full tax relief on mortgage interest payments for higher rate taxpayers and the introduction of additional stamp duty for individuals purchasing more than one residential property – including your own home.
Tax is payable at the usual income tax rates on the rental profits, but higherrate taxpayers do not get tax relief on the full amount of interest on mortgages, instead receiving an equivalent relief of a basicrate taxpayer while the income is subject to higher rate tax.
A 3% stamp duty surcharge is added on to the purchase of additional homes, which is on top of the usual stamp duty rates applicable depending on the overall purchase price of the property.
Often residential property is owned with other family members, meaning not all of the rental profits are taxed upon you.
Capital gains tax is payable when you sell the property and, as with stocks and shares, this depends upon whether you are a basic rate or a higher rate taxpayer. The difference is that the tax rates applicable to gains on residential property are 18% and 28% respectively.
The annual allowance of £12,300 per individual still applies. Further reductions to the capital gain assessed may be available if you have lived in the property at any time.
In relation to companies, various different structures are used and the best fit would depend on your own circumstances, bearing in mind whether a lender is involved or you are using funds available.
Stamp duty is similar to that
charged on second homes in that there is an additional 3% surcharge added to residential homes purchased via a company. This is a consideration for anyone thinking of moving a personally owned investment property into a company.
Mortgage companies may charge an additional premium on interest for their perceived risk of ownership via a limited company, but it is worth noting that any interest is fully deductible against the rental profits.
A capital gains tax liability arises when you sell the property and, as with stocks and shares, there is no annual allowance exemption and tax is payable on gains at the relevant corporation tax rate applicable.
If ‘high value’ residential property is owned within a limited company, additional tax is sometimes payable which is known as an annual tax charge for enveloped dwellings.
The current threshold for this to apply is £500,000. While not all properties of this value are subject to this tax, at the very least, additional returns and exemptions need to be applied for on an annual basis.
When it comes to comparing personal and corporate ownership of property, it is easy to demonstrate that you will pay less tax on
With higher interest and inflation rates, it becomes harder to ensure that savings do not lose value in real terms due to the Government taking its tax cut from income but giving no tax relief on cost-of-living increases for your household expenses
the rental profits through a company.
However, given that capital gains tax is payable on the increase in value and as a shareholder of the company you will need to extract those funds, the decision is complex and will often not have a clear answer.
When considered over the lifetime of ownership, the savings on rental profits can often be outweighed by the additional capital gains tax or income tax from extraction of the profits from the company. As always, speak to your accountant to discuss your individual circumstances before committing.
The vast majority of investments put your capital at risk, which may not be covered by the financial services compensation scheme.
Therefore, it is essential that you take advice from an independent financial adviser prior to investing and also make your accountant aware of your intentions so they can advise you on tax and accounting related matters.
Next issue: Alec James will be bringing you his top ten tips for your finances in the months ahead
Richard Norbury (right) is a partner at Sandison Easson & Co, specialist medical accountants
Peppy performance and frugal on fuel, this entry-level coupé provides everything a busy medic would want, says our motoring correspondent Dr Tony Rimmer (right)
SOMETIMES THE simpler things in life have the greatest appeal.
When choosing a car to buy, we can be easily seduced by models loaded with high-tech driving aids, high performance and features that are only luxuries and not essential for the true functioning of the vehicle.
Simpler can be better. Lowerspecified cars are better value for money and are not exactly spartan.
This is particularly true nowadays, as the most basic model variants usually come with electric windows, air-conditioning and central locking among other things– as standard.
These thoughts all came to mind while assessing Volkswagen’s latest offering: its small crossover, the Taigo.
I drove several versions with different trim levels and concluded that the model with greatest appeal, to me at least, was the basic entry model.
So where does the new Taigo fit in the increasingly crowded area of Polo- and Golf-sized small SUVs that VW already has on offer?
Well, if you think of the T-Roc as being an SUV based on the Golf and the T-Cross as a smaller SUV based on the Polo, then the Taigo is essentially a coupé version of the T-Cross.
It is supposed to add some style to the rather boxy shape of the T-Cross, but I do wonder whether VW could have gone a bit further with the styling changes – although
that would have interfered with the internal dimensions and passengercarrying capabilities.
Prices range from £23,385 to £27,845.
There are two main engine options: a 1.0litre three-cylinder petrol TSi unit with 95bhp or 108bhp outputs and a 1.5litre TSi unit with 148bhp. Trim options are simple too – the Life, Style and R-line.
The Style adds integrated satnav, 17-inch alloy wheels and sports seats and the top-of-therange R-Line has VW’s digital cockpit.
1.0-litre cars come with a fivespeed manual gearbox as standard with direct-shift gearbox (DSG) automatic option on the 108bhp version.
The 1.5litre 148bhp car comes only with the DSG fitted.
Interior space is on par with a Polo. That means ample room for four adults and their luggage. There is room for a fifth passenger, but it would be a squeeze in the back. Headroom is good and knee room just about adequate.
The driver’s controls are all clear and well laid out in typical VW fashion and although the quality of the interior trim is improved over the T-Roc, there are still some scratchy plastics around the base of the doors.
It is out on the road that the Taigo is a bit of a surprise. The body dimensions are just right for our crowded urban highways and visibility is good too.
The steering is sharp and sporty
The driver’s controls are all clear and well laid out in typical VW fashion. The body dimensions are just right for our crowded urban highways and visibility is good too
in feel and the ride well controlled if a bit on the firm side. Handling is lively and quite fun on winding minor roads and this is helped by the car’s weight – 1,200kg which is about half that of a similarly sized electric vehicle.
I tried all engine variants and the 1.0litre units are peppy and the most suited to the car. The manual gearbox also suits the car well. If you really want an automatic, the DSG is a good box, but felt a little snatchy in the Taigo I tried.
As I alluded to earlier, I think that a base 1.0litre 95bhp Life model would do everything that any busy medic would demand.
It has enough room for child seats and associated paraphernalia and there is enough power for the cut and thrust of urban driving, although, if you want a little more
power, an extra £800 would get you the 110bhp version.
A frugal real-world fuel economy of 45 to 50mpg is not to be ignored.
It looks smart and has enough of VW’s solid build quality to justify the respected badge on the front grille.
In this base guise, it is pretty good value too. If you are in the market for a similarly priced Ford Puma or Kia Xceed, then do not overlook the Taigo.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Five-seat hatchback, front-wheel drive
It looks smart and has enough of VW’s solid build quality to justify the respected badge on the front grille
Engine: 1.0litre three-cylinder petrol
Power: 95bhp
Torque: 175Nm
Top speed: 114mph
Acceleration: 0-62mph in 11.1 seconds
Claimed economy: Combined 51.5mpg
CO2 emissions: 124g/km
On-the-road price: £23,285
Our latest look at the earnings of cardiologists tracks their financial performance over three challenging years. Ray Stanbridge reports
IN OUR 2021 report, we commented on 2019 performance figures for this specialty. Now we are able to report on both 2020 and 2021 figures.
This includes the Covid period of lockdown and we are pleased to provide a formal assessment of the impact of Covid-19 on a typical consultant cardiologist’s practice. As regular Independent Practitioner Today readers are aware, although our survey is not statistically significant, it does attempt to represent a picture at a moment in time
as to what a typical cardiologist consultant in private practice in the UK might expect to earn and spend in his or her practice.
Our overall view is that cardiologists have not had too bad a time during the pandemic. This seems to have been because a lot of patients switched from the NHS to self-pay, at least in the short-term.
Gross incomes fell by about 11% from £152,000 in 2019 to £136,000 in 2021.
Incomes by and large held up in 2020. Costs on average fell by 23% from £48,000 in 2019 to £37,000 in 2021. Cardiologists showed a greater propensity to economise during the Covid period.
As a result of the economic efficiency in the way many consultants conducted their businesses, operating margins rose from 68.4% in 2019 to 72.8% in 2021. Profits though fell by £5,000 on average from £104,000 in 2019 to £99,000 in 2021.
We have commented above on
the main reasons why income fell less than might have been expected during the pandemic.
Most practice costs were reduced during the two years of the pandemic. In particular, staff costs dropped by £3,000 a year from £18,000 in 2019 to £15,000 in 2021, largely as a result of lower activity.
Similarly, professional indemnity costs fell slightly over the past two years reflecting lower levels of insured activity.
We did notice a slight increase in bad debts’ rates again, possibly reflecting patients’ financial difficulties during the pandemicz.
What then of the future? There seems to be some evidence that some patients who returned to the private sector during the pandemic period have remained in it. There is also some evidence of pent-up demand in 2022.
Our initial assessment, based on a very early and incomplete assessment of 2022 figures, suggest that the vast majority of cardiologists in private practice are continuing to do well.
As a result of market changes, and the ways in which consultants conduct their practices, it has become increasingly difficult to report on trends in a consistent fashion.
Consultants now trade in a variety of ways that are different from
the traditional sole trader model –through limited liability partnerships (LLP) or companies or formal partnerships. Others have become partially or wholly employed by their private hospitals. Despite these issues we have done our best to be consistent.
Qualifications for entry to our survey for consultants remained as they have always been. They:
Have to earn at least £10,000 a year in the private sector (previously £5,000);
Have to have either an old or a new-style employment contract with the NHS;
Must not work exclusively in the private sector;
Have to have been in private practice for at least five years;
Have to trade as a sole trader, a limited liability company or as a member of formal partnership or an LLP;
Have to demonstrate that they are seriously interested in the business of private practice.
Next issue: ENT surgeons
Ray Stanbridge is a medical business consultant and has compiled this report on behalf of Stanbridge Associates
Coming in our February issue, published on 7 February 2023:
Conflict has become an increasingly frequent phenomenon in healthcare over the last 20 years. It’s upsetting and timeconsuming for professionals and patients alike. Sarah Barclay, director of the Medical Mediation Foundation, presents a toolkit for understanding and de-escalating conflict with patients
Ten top tips to give your practice and personal finances a financial spring clean. Sandison Easson accountant Alec James picks out some key areas that often get neglected in the everyday rush
If you are starting out in private practice, don’t miss some important learning points from Simon Brignall, of Civica Medical Billing and Collection, to help you earn more and ensure you get paid for the hard work you do
Are you using the right business structure? Kirsty Odell of Hempsons solicitors gives a legal viewpoint on the advantages and disadvantages of sole providers, partnerships, limited companies and LLPs
The shape of things to come: Independent Healthcare Providers Network boss David Hare gives feedback on the sector’s latest Industry Barometer report and how it feels about prospects for 2023
What are you meant to do with your records following retirement?
Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union, (MDU) advises a consultant orthopaedic surgeon – and outlines what indemnity and GMC registration provision you may need when retiring
Why creating an emotional tie with your private patients is crucial. Marketing expert Catherine Harriss reports
The
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GMC regulation – Time for reform. The MDU’s head of advisory services, Dr Udvitha Nandasoma, calls for urgent fitness-to-practise reforms to ensure doctors get a fair hearing
Outsourced remote radiology reporting has increased, with wider ability for radiologists to report from home. While this can speed up the delivery of reports, there are some risks both for the hospital and the private tele-radiologist. Dr Emma Green, of Medical Protection, explains how some of these risks may be mitigated
A new resource to support doctors facing racism at work has been launched by the GMC
Bupa reveals the findings on its latest Wellbeing Index survey
Doctors are asking a lot of questions about the Private Healthcare Information Network. Its boss Dr Ian Gargan answers some of ours
Troubleshooter Jane Braithwaite advises an expanding consultants’ group about the best way to recruit a new partner and ensure it gets the right person
Our motoring correspondent Dr Tony Rimmer gets behind the wheel of the Mazda CX-60 plug-in hybrid.
Was that really ten years ago? We look back at the news for independent practitioners in February 2013
Plus all the latest news and views
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