Grow your referral network
Marketing expert Sue O’Gorman gives some excellent ideas about boosting your referrals P16
Looking after highprofile patients
Dr Sally Old advises how to protect the privacy of celebrity patients P22
Watchdog inspections get transparent
Hempsons’ solicitor Philippa Doyle outlines the new CQC inspection system P36
By Robin Stride
Independent practitioners are being exhorted to go to work on their fees for 2024 and ‘get real’ about their charges.
According to the chairman of the BMA professional fees committee, many are undercharging and have not fully assessed what they should be asking for.
Dr Peter Holden told a record number of 285 delegates at the association’s annual private practice conference in London: ‘We’ve allowed NHS pay rates to dictate our fees but that is not comparing apples with apples.
‘We have got to stop asking for fees and start telling what the fees are going to be. We are in a marketplace. The market is running in our favour now. Doctors are emigrating faster than training.’
Stressing that the views in his speech were his own, he told his mixed audience of established and would-be private consultants and GPs that doctors had got to be paid properly in future.
Dr Holden, who helped negotiate the new contract for NHS GPs under Labour in 2004 which gave them a reported average 30% increase the following year, said: ‘I think we have got to start playing hard ball now.’
He challenged his audience to ‘start telling patients the contractual relationship when you see me
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privately is between me and you –how you settle my bill is your problem. And the insurers need to get this.’
Insurers had got to stop the ‘nonsense’ of telling patients ‘this doctor is not on our approved list.’ That was tantamount to defamation. What they needed to tell patients was: ‘We wont pay your fees.’
It was the patient who had come to the doctor and the consultant’s contract was with the patient, not with the insurance company.
He told the audience, which included 100 online, the message to insurers should be: ‘We are open to negotiation but we are not going to be imposed on.’
Dr Holden recommended doctors use a BMA fees calculation tool
designed to show them how much it costs to provide their services so they can decide what to charge and do not lose money.
The fundamental principle behind the calculator is that each doctor must decide what take home pay they desire on an individual basis.
He urged them to look at the difference between working time and remunerative time. In salaried employment, all the hours they worked was remunerative time and they were paid to be there.
But, as an independent contractor, they were paid for what they did. If they were kept waiting on an NHS waiting list, they were paid; but if that happened on a private list. they would not be earning.
We have got to stop asking for fees and start telling what the fees are going to be. We are in a marketplace.
Chairman of the BMA professional fees committee
‘Working time is not remunerative time and you have got to calculate your remunerative time and the fee calculator will do that for you.’
He suggested most of the audience knew their gross annual salary, but said a majority of them would not know their net hourly rate. The fee engine could work that out for them.
In answer to his probing from the rostrum, only two of the audience indicated they had got written terms of business.
He remarked that this sort of failure was why so many doctors got into trouble from non- payers and he urged everyone to start behaving like they were running a business. n See page 12
➱ continued on page 4
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Business Dilemmas: My patient wants to join the army Dr Kathryn Leask replies to a query from a private GP asked by a patient not to mention his past drug use P40
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Accountant Richard Norbury discusses the best way for independent practitioners to
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Employers need to engage and listen to disabled employees to help build a supportive culture when everyone can thrive, says Bupa’s Dr Robin Clark P24
Gynaecology: lessons from litigation
Lesson to be learned from high-value gynaecology claims are examined here by Dr Sarah Townley, deputy medical director at Medical Protection P27
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The bell never tolls for thee
Mixing emotions with timing the market is likely to be costly. George Uglow of Cavendish Medical looks at avoiding the temptation to act P38
The importance of backroom staff Derek Kelly of Medserv
By Edie Bourne
Many doctors are missing out on the inflationary increase due on their NHS pension, according to specialist financial planners Cavendish Medical.
The specialist medical financial company has been checking the pensions statements of new clients and seen ‘many examples’ where the standard revaluation figure is wrong.
Doctors contributing to the 2015 NHS pension scheme – who have not had a break in pensionable service of five years or more – should see their pension revalued every year with inflation.
This is at the consumer price index (CPI) rate of inflation plus 1.5%. But many are not receiving
their rightful sum due to payment delays from NHS Pensions.
George Uglow, financial planner at Cavendish Medical, told Indepen dent Practitioner Today :
‘These errors can be difficult to spot, particularly when inflation was low. Now we have seen higher inflation for the last two years, the missed amounts are much more evident.
‘We have discovered that clients who have just started working with us have not received their inflationary increases for several years. It really is worth getting your own position thoroughly checked.
‘This issue can be problematic for retired doctors. They may have drawn their benefits several years ago but have not received the yearly uplift they should have.
‘Once you retire, your pension is protected against inflation by the application of “Pensions Increase” which is linked to the CPI.
‘The current CPI rate used is from last September, when it stood
Too much change to digest too quickly.
That is the fear of some doctors following the issue of yet more detailed GMC guidance to help them cope with the updated version of its ethical standards Good Medical Practice coming into effect on 30 January.
This covers a range of important topics, including maintaining personal and professional boundaries, social media, ending a professional relationship with a patient and producing witness statements.
According to the Medical Defence Union (MDU), which agrees the need for a comprehensive update given the revisions made to Good Medical Practice and announced ear-
lier in 2023, it is still a challenge for doctors to read and absorb the material over the busy winter months on top of their duties and responsibilities to patients.
This was supported by research into the revised professional standards guidelines published in Indep endent Practitioner Today in Sept ember expressing doctors’ concern that they could fall foul of the guidance because there was not enough time to prepare.
Only half (49%) of respondents were confident they would have time to fully absorb the new standards before they are implemented.
Seven in ten (69%) said they would have to read the guidance in their own time outside of work.
But the MDU has warned this figure is likely to increase due to the introduction of the additional commentary on the guidance.
Dr Udvitha Nandasoma, MDU head of advisory services, said he was pleased to see the more detailed guidance related to Good Medical Practice had been published.
‘It is our belief that doctors know how important the guidance is and, as such, it is concerning that they feel they have insufficient time to absorb this and the new More Detailed Guidance over the busy winter period,’ he said.
He said the MDU was supporting doctors to explain what the new guidance meant for them to provide the best care to their patients.
at 10.1%. The rate of CPI from September 2023, which will be applied from next April, is 6.7%.’
The NHS Business Services Authority has been informed of the issue, but has been slow to respond. The BMA is also talking to the authority to encourage corrections.
Mr Uglow added: ‘Doctors are already facing complex issues with their pay and pensions – not only the current pay dispute but the McCloud remedy, too, which could amend years and years of pension taxation calculations.
‘They want to be able to rely on the figures and statements they receive and not have to chase missed payments on the pension they are due.’
Private consultants have been asked by the Independent Sector Complaints Adjudication Service (ISCAS) to take the greatest care to ensure they explain to patients likely costs and who will pay them.
The plea came after a woman contacted the Patients Association for help after receiving a private hospital bill she could not afford for a scan she thought was being done as an NHS patient.
ISCAS director Sally Taber said: ‘Before the event, the patient is believed to have understood very clearly from the specialist that the cost would fall to the NHS, as might be expected.
‘Somewhere in the system a misunderstanding occurred and the patient was billed for the imaging, understandably causing the patient anxiety and stress.’
By Robin Stride
Privately insured patients should be able to benefit from ‘portability’ in their arrangements for cover, according to Mr Richard Packard, chairman of the Federation of Independent Practitioner Organisations (FIPO).
Speaking from the audience after BMA private fees committee chairman Dr Peter Holden’s well received call for doctors to ‘get real’ about what fees they charged, he suggested patients would find this popular.
Patients would be able to choose their consultant if portability was available for insurance schemes so they could take their benefit wherever they pleased.
And they should also be able to choose to top up the fees if they needed to, rather than have the current situation featuring ‘a great amount of so called fee assured arrangements where patients have very little choice where they go to’.
Mr Packard added that if portability was available, it would create a much more equal market for patients, who could then go where
‘Tell
they felt they would like to rather than where the insurer told them to go.
Nathan Irwin, chief executive at Western Provident Association, responded that his company offered portability already. All their customers could choose whoever they went to and would pay the agreed amount for a particular procedure.
He said the reason WPA was not bigger was because a majority of the marketplace provided cover at a lower cost and so that was where most of the business was.
If portability was available, it would create a much more equal market for patients, who could then go where they felt they would like to rather than where the insurer told them to go.
MR RICHARD PACKARD Chairman of the Federation of Independent Practitioner Organisations (FIPO)
So why did WPA not just put fees up? Mr Irwin said this was not in customers’ or doctors’ interests.
The market was so competitive that if he raised consultants’ reimbursements, then he would have to put up the prices for his customers.
They would not leave the marketplace, but just go to one of his competitors where they could get a cheaper deal – ‘Which means you would see the same customer with the same condition but probably get paid less.’
He believed if there was transparency about the prices charged and a single price for a service, then insurers would have to compete on their product composition, on the benefits they cover and on their service levels – not on who could nail down the lowest price.
Mr Irwin argued that consultants’ re imbursements should probably have risen by more than they had done if it was a perfect marketplace.
But that had not been the case because of the dominance of the large insurers. They had artificially suppressed fees and that had probably kept premiums below where they needed to be.
He considered the market was in disequilibrium, a weakness characterised now by waiting times in the private sector and fee pressure.
➱ continued from front page
Doctors were told at the BMA Private Practice Conference to publish their terms of business and ensure their fees reflected all the overheads of their business.
Dr Holden, a BMA Council member, advised doctors to put their fees on their websites and remember to quote VAT, where applicable, as not all private work was VATfree.
They should ensure that their terms of business stated payment timings and clients should sign this and return a copy to them.
Every procedure had ‘to wash its own face economically’, but he warned that specialists were sometimes working and taking someone’s life into their hands for as little as £1.34 an hour after tax.
When assessing what their fees should be, he advised private doctors to remember the days they were not earning anything.
And he urged them to include holidays, sick pay and days for continuing professional development (CPD), plus all their costs, including defence, equipment, subscrip
tions, medical books and journals when calculating their fees.
Dr Holden warned tax rates were punitive and the medical profession’s standards of living were crashing.
While the top of the NHS pay scale for consultants was £126,281, which was a lot of money to the man in the street, they were supposed to be compared with their peers and were well behind what their benchmark colleagues in regional solicitors and accountancy firms were earning.
‘And I think the consultants would have to compete with each other on their expertise, and their skills, and their experience and perhaps also their availability. Consultants could then be fairly rewarded for the skills and expertise that they bring.’
Unless consultants were fairly rewarded for their skills and expertise, there was not the incentive for current consultants to expand their capacity to meet their waiting times or indeed the next generation of consultants to enter private practice.
But Mr Irwin said there was now the chance to make that change because waiting times had created the opportunity for change.
How about making the news today? Independent Practitioner Today is always keen to hear from doctor entrepreneurs willing to share their success stories in private practice – and from independent practitioners embarking on the journey.
Contact our editorial director Robin Stride at robin@ip-today.co.uk
It is very hard to make money from private practice if you don’t have much of it, a consultant general surgeon warned.
Mr Charlie Chan, deputy chairman of the Federation of Independent Practitioner Organisations (FIPO), advised those wanting to do private practice to ‘go for it!’
‘You have to accept you are not going to make masses of money in the first year or two. But if you stick with it, you look after your customers, you grow. Your brand grows.
‘If you look after people, they will come back and they will tell their friends and their friends will tell their friends.’
But doctors would not build up the necessary momentum if they did less than a minimum a week.
He warned newcomers that expenses in a small private practice would amount to a bigger proportion of turnover. Diversification would protect income.
Doctors should not skimp when choosing a PA and should look after them. They could make or break a practice, Mr Chan added. If PAs could not answer phones or reply to emails quickly, then
practitioners would lose business because the inquirer would find someone else.
Those who thought patients would come to them because they were the best were mistaken. Amazon had changed everything and people wanted instant fulfilment.
Mr Chan said a larger team was reassuring for patients and enabled better care for those with cover. Crossreferral to colleagues led to referrals back.
He suggested people should be treated like friends and family. ‘Find out what makes them tick. The people bit is much more fun than the technical stuff. Patients will respect you.’
Practitioners should put themselves in customers’ shoes and ask themselves: ‘When would you like to be seen?’, ‘How would you like to be treated?’ and ‘Would the customer recommend you on Tripadvisor?’ he said.
Criminal investigations into doctors’ behaviour are rare, but if they arrive, then contact your defence organisation at the outset and ensure you have legal advice before commenting.
That was the advice of the Medical Defence Union’s (MDU’s) head of professional standards and liaison Dr Michael Devlin.
He reminded doctors they had an ethical obligation to tell the GMC if they were charged with, or convicted of, a criminal offence or accepted a caution.
Some observers were surprised to hear they might get arrested straight away if the police wanted to speak to them. Dr Devlin warned ‘voluntary attendance’ at a police station ‘is an offer you can’t refuse’.
Doctors should expect to be on the receiving end of asymmetrical power at a police inverview because they were facing specialists inquisitors.
Most people followed what their solicitor told them, but those likely to come unstuck tended not to follow their lawyer’s advice.
Without NHS income, some private hospitals would face serious financial difficulty, according to private healthcare commentator Keith Pollard.
Figures for 2022 presented by the LaingBuisson consultant showed the private take from the NHS was £1,875m, against £1,512m for selfpay (up 70%), £2,479m from private medical insurance and £181m from overseas.
But Mr Pollard told delegates that patients’ private healthcare journey was not good and needed improving. Communications with hospitals and consultants could often be nonexistent. The challenge was to consider patients as customers.
Business startup consultant Mr David Grabowski, managing director at Stonegate Medical Clinic, York, cited lack of consistent joinedup communication as a common issue.
Getting their account right at the outset could be crucial when giving statements and making reports.
If they were not factually consistent, then a challenge should be expected from the police or prosecutor.
Dr John Holden, of the Medical and Dental Defence Union of Scotland, advised any disciplinary process victims to ensure they knew the procedures. Private hospitals were likely to have their own policies.
Doctors should also ensure they knew their Responsible Officer and designated body – surprisingly some did not.
He warned it was not unheard of for doctors not to be covered and to ring up after a complaint.
Independent doctors are viewed as ‘cowboys’
right) rued the lack of integration of records between the NHS and private sector.
The BMA private practice committee deputy chair said: ‘There’s no reason for there not to be a joined up system. But until private doctors are seen as doctors, not cowboys, there will always be that issue.’
She complained private clinicians were not seen as doctors –many of her patients had no NHS GP but had to register with one for a Covid vaccination.
By Douglas Shepherd
Chancellor Jeremy Hunt’s red box contained a mixed bag of financial changes coming the way of independent practitioners in 2024 following his Autumn Statement.
We reported back in November on the key changes in what was billed as the ‘tax-cutting Budget’ –but with the headline taxes we are all familiar with largely left alone, it won’t feel that way for private consultants and GPs paying their dues to HM Revenue and Customs (HMRC).
One bit of good news, however, is that Class 4 National Insurance (NI) for the self-employed will reduce from 9% to 8% from April 2024, with a further abolishing of class 2 NI which the self-employed usually pay.
Meanwhile NI for employees will reduce from 12% to 10% from 6 January 2024.
But as specialist medical accountant Ian Tongue has pointed out, these savings are likely to be offset by the freezing of income tax rates and the changes to the 45% tax threshold announced at the Spring
Budget. See his detailed analysis and tips on page 12.
Andrew Pow, board member of the Association of Independent Specialist Medical Accountants (Aisma), said: ‘The bigger picture, however, is that because income tax thresholds remain frozen until 5 April 2028, more people are paying more tax at higher levels.’
Confirmation that the minimum wage is to increase by 9.8% will be setting alarm bells ringing where any doctors’ staff are paid the minimum wage or slightly higher. Accountants warned that higher-paid employees would
expect their pay to increase proportionately.
Meanwhile, The British Dental Association (BDA) condemned moves in the Autumn Statement that could withdraw free dental care from the long-term sick, while offering no additional resource to support the rebuild of NHS dentistry.
It said the threat to withdraw access to free NHS dentistry from those not actively seeking work would inevitably hit vulnerable patients with higher needs the hardest. Dental care is thought to be among the ‘additional benefits’ set to be lost alongside free prescriptions and legal aid.
BDA chairman Eddie Crouch said: ‘The Chancellor offered no hope to the millions struggling to secure care. He failed to offer a penny to a service on the brink, just pulling away care from the patients who need us most.
‘The Treasury will decide whether NHS dentistry has a future, but there’s no sign this Government is willing to step up.’
Dr Layla McCay, director of policy at the NHS Confederation, claimed the Chancellor had missed the opportunity to get the NHS back on track following the impact of strikes on patient care and already-tight budgets.
‘Independent experts have said that the costs so far stand at £1.7bn, yet only £800m has been allocated and mainly by raiding budgets elsewhere, which will cause long-term harm to the NHS’s ability to transform its services.’
Siva Anandaciva, chief analyst at The King’s Fund think-tank, said: ‘The Government’s NHS funding announcements have now become caught in a vicious cycle of inefficient emergency cash injections and unrealistic expectations of what the NHS can deliver in return.
‘To avoid the NHS facing a crisis every winter, ministers need to make long-term decisions that can bring demand, capacity and efficiency back into better balance.’
The Autumn Statement includes what the Association of Medical Insurers and Intermediaries (amii) calls responsible public spending, tax cuts, welfare reforms and measures to encourage business investment.
These policies are expected to boost business investment, increase employment, and enhance the economy’s potential output.
It chairman, Dave Middleton (pictured right), comments:
‘Chancellor Jeremy Hunt’s Autumn Statement is centred around incentivising work and reforming welfare to expand the workforce.
‘The industry recognises the importance of assisting individuals in returning to work after experiencing longterm unemployment caused by illness or disability. Utilising incentives
instead of penalties may prove to be more effective and compassionate.
‘We believe that it is important for the Government to address the root causes of economic inactivity and provide support to individuals with fluctuating conditions who are not receiving the necessary assistance through the NHS. Implementing incentives for employer support can help prevent employees from leaving their jobs.
‘Employerprovided benefits, such as health insurance, can often reduce absence levels. Additionally, group income protection insurance can cover longterm sick pay and provide vocational rehabilitation to assist individuals in staying in or returning to work.
‘We strongly advocate for expanding workplace support to retain individuals with disabilities and those with health conditions. However, relying solely on “occupational health” is too limited.
‘Employers have broader options, such as health insurance, employee assistance programs, health initiatives and specialised support services provided through income protection insurance that includes vocational rehabilitation. All these measures enhance retention, productivity, health outcomes, and work participation.
‘At this stage, the Government has indicated that additional tax incentives may be introduced.
‘If the Government offers tax relief for options such as health insurance, employee assistance programs and wellness initiatives, and if employers combine these with strategies that promote prevention, productivity and improved health outcomes through employee retention, it will lead to increased employment and greater business productivity.
‘This, in turn, benefits society through higher tax revenue.’
By Olive Carterton
Patients are being ‘forced’ to go private or risk permanent sight loss – and the situation is getting worse, according to eye experts.
Over three-quarters (79%) of optometrists have patients experiencing significant delays of 12 months or more for their NHS secondary care referrals, follow-up appointments or treatments.
This marks a rise from 72% at the same point last year and almost a fifth of optometrists (19%) now have at least 20 patients facing this situation.
The figures come from the Association of Optometrist (AOP), whose survey examined the experiences of more than 1,000 high street optometrists across the UK. Its findings show 81% have patients who have been forced to pay for private treatment within the last six months due to long NHS waiting lists or potentially risk permanent sight loss.
Currently, 640,736 people are waiting for NHS ophthalmology appointments in England alone –an increase of more than 12,000 since the AOP released figures in March 2023. Almost 20,000 have been waiting more than a year.
The association says the Government must commit to a national approach to eye health services to ensure patients can access care quickly close to home.
Many essential appointments currently happen in hospital, but
waiting times for follow-ups and treatment could be significantly reduced if care provided by optometrists was commissioned consistently, it believes.
AOP chief executive Adam Sampson has written to the new Parliamentary Under-Secretary of State for Primary Care and Public Health, Dame Andrea Leadsom, asking for urgent action.
He said: ‘We’re now in a desperate situation. Patients are being forced to spend their savings on private treatment to avoid losing their sight – not to mention the many where paying for private care is simply not an option.’
Many optometrists working in the community already successfully provide follow-up services in some parts of the UK.
At Sight Opticians in Peterlee,
Association of Optometrists (AOP) data highlights concerns expressed by private providers and their staff who deliver ophthalmology and optometry services.
David Hare, chief executive, Independent Healthcare Providers Network (IHPN), said members recognised the problem all too well.
‘We know that NHS waits are having a significant impact on patients and that many are taking the decision to go private as a
County Durham, all routine referrals are triaged with their local hospital and any extra tests needed, such as internal images of the eye or visual fields assessments, are carried out before the secondary care appointment.
Optometrist at the practice Adam Smith says: ‘We have a longestablished extended service and have seen the huge impact it can have. It reduces both unnecessary referrals to hospital when certain care and tests can be carried out in a local practice. Patients are saved the wait while also getting more appropriate care faster.’
Marsha de Cordova, Labour MP for Battersea and chairwoman of the All-Party Parliamentary Group on Eye Health and Vision Impairment, said: ‘England is the only country in the UK without an eye
Almost a fifth of optometrists have at least 20 patients facing delays of over a year
81% say patients are being forced to pay for private treatment, including cataract surgery and help for glaucoma and agerelated macular degeneration, or risk sight loss due to long NHS waiting lists within the last six months
The Association of Optometrists (AOP) calls the situation an ‘emergency’ and is urging Government to use eye care services on the high street, nationwide to slash the backlog and ‘end the postcode lottery of commissioned eye care services’.
It says huge numbers of high street optometrists are qualified to offer the extended services required to take the burden off the NHS
health strategy. Despite the worrying backlog, the Government still refuses to introduce a strategy that will ensure better health outcomes for patients.
‘A national approach will remove the postcode lottery of care and reduce the risk of patients getting stuck on hospital waiting lists and in turn prevent the avoidable and irreversible sight loss we’re seeing today.’
result. The AOP’s data reinforces our own research in that respect.
‘We welcome the acknowledgement by the AOP that the independent sector is a crucial partner in delivering highquality, prompt services for patients.
‘Ophthalmology is a specialty where an increase in independent sector activity has led to many more patients being seen –particularly in terms of cataract procedures.
‘Some months this year have seen an almost 200% increase in activity compared with 2019, before the pandemic, making it one of the very few specialities where more NHS patients are being seen than before the pandemic.’
He added that optometrists’ expertise and commitment contributed significantly to identifying and addressing eye conditions promptly ‘and we need to do what we can to empower them to deliver’.
By a staff reporter
Practice Plus Group has won the LaingBuisson ‘Hospital Group of the Year’ award for its chain of hospitals offering affordable private surgery.
The win reflects the changing face of private healthcare users amid record NHS waiting lists, with around half of Practice Plus Group’s private customers having never used private healthcare before.
It is adamant it will remain predominantly an NHS provider, offering hip and knee replacements, hernia surgery and cataracts surgery to NHS patients – often with shorter waits than in large NHS trusts.
This year, it launched a subbrand, Wellsoon, using its experience of delivering high-volume, low-complexity operations to a high quality to offer surgery at low, fixed prices in four to six weeks.
While treatment is available for insured patients, 90% of people choosing Wellsoon are paying for themselves. The same fixed prices are standard across all their hospitals and are provided up front.
Patient John Wilson, aged 70,
from Nuneaton, Warwickshire, said: ‘I have never used private healthcare in the past, but my hernia pain was like two knives being stuck in and twisted and it was just getting worse. I had to stop walking, working, enjoying my hobbies. I was facing at least a year’s wait once on the list for surgery, but there were days I could barely move.
‘Last Christmas, my wife was busy getting everything ready for family coming over and I couldn’t get out of the chair to help. It just stopped me in my tracks. We got a quote for a private consultation in Birmingham for £500.
‘The price of a consultation at Practice Plus Group was £95 –about the cost of a meal out with the family – so I went along and was so impressed that I booked in. I had the surgery a few weeks later and it was worth every penny. I’ve got my life back…’
LaingBuisson commented: ‘The price promoted is the price the patient will pay and, importantly, Practice Plus Group’s pricing is at the lower end of price ranges – primarily because they employ their surgeons and clinical staff and focus on a limited number of highvolume procedures and pathways.
‘For consumers, this is a real shift in offering affordable options, particularly to those new to private healthcare.’
Jim Easton, chief executive of Practice Plus Group, said: ‘There is undoubtedly a growing demand from people for whom paying significantly less than the traditional private model is very important.
‘Our focus is on high clinical quality and patient-centred care. Our hospitals are friendly, clean, bright and modern.
‘You may not find all the trappings traditionally associated with private hospitals, but our patients tell us they don’t want to pay for the things they don’t need.
‘We’re seeing builders and other tradespeople and self-employed customers, who need to get fit for work, and retirees who don’t want to waste two years of their lives losing their mobility, their fitness and independence.
‘People are driving 40, 50, 60 miles to come to us.’
Mr Easton added: ‘I’m proud to be offering people an option other than long waits on the NHS or the traditional private route.’
See our feature article ‘Private group doing what the NHS used to do’ in our October issue
Nearly 1,000 guests attended the annual glittering event celebrating the best in health and social care in the spectacular ballroom at the Park Plaza Westminster Bridge in London.
The 18th LaingBuisson Awards recognised 29 winners across six categories, including social care, clinical services, innovators and leaders, investors and finance, property and advisers.
Finalists from 395 entries were chosen by an independent panel of judges using a secure online judging platform.
LaingBuisson executive chairman William Laing said the awards offered providers and advisers a valuable opportunity to acknowledge and
celebrate the most inspiring and innovative contributions to the sector.
‘This year’s nominations showcased an array of impressive projects, organisations and professionals, all passionately dedicated to significant health and social care causes. The judges faced the formidable task of selecting winners from this outstanding pool, reflecting the continued growth and excellence of the awards.’
WINNERS INCLUDE:
CLINICAL SERVICES:
HOSPITAL OF THE YEAR: CLEVELAND CLINIC LONDON
‘An impressive example of what a hospital of the future could look like, making good use of latest technologies and IT. Data creation and information to enable patient health intervention is within the fabric of the Cleveland hospital.’
HOSPITAL GROUP OF THE YEAR: PRACTICE PLUS GROUP
‘The commitment to outcome measurement, while complementing competitive registry work for joint implementation is truly impressive.’
BEST IN HEALTHCARE OUTCOMES: SCHOEN CLINIC NEWBRIDGE
‘This is a particularly complex clinical area and the outcomes reported are highly commendable. It’s good to see a service which is nationally under such pressure developing an effective approach. Excellent examples of excellent practice in the mental health field – autism inclusive treatment pathways exemplary.’
INNOVATORS AND LEADERS:
PUBLIC PRIVATE PARTNERSHIP OF THE YEAR: ALLIANCE MEDICAL
‘An impressive large-scale partnership delivering on ambitious goals, with a particular highlight being reduction in performance against diagnosis waiting time standard.’
MANAGEMENT EXCELLENCE: CROMWELL HOSPITAL
‘Strong commitment to improving staff experience through engaging and listening to staff in a meaningful way. Its commitment to investing in training and development, providing opportunities for employee recognition and creating an inclusive environment has translated to improved employee NPS scores.’
INNOVATION IN HEALTH TECH: GUY’S AND ST THOMAS’ SPECIALIST CARE
‘This is an excellent example of innovation and technology pushing boundaries and improving the patient experience in a highly complex area of clinical practice. This work is game-changing and shows clear value to people, to clinicians, to the organisation employing it and to the wider health and care system.’
HEALTH COVER PROVIDER OF THE YEAR: BUPA
‘Bupa has clearly shown a commitment to its people and wider stake-holders, the inclusive culture of Bupa is commendable.’
London private providers group gets new name
Healthcare London is the new name for the private healthcare providers group supported by the Department of Business and Trade.
Originally badged The London International Healthcare Council, the group includes a range of independent providers and is also open to the NHS, of which two central London trusts are currently understood to be involved, with others being approached for inclusion. The purpose of the group is to put London on the medical tourism map in a much greater way than it ever has been before.
PPU Watch will report on progress in future issues.
Independent Practitioner Today announced the group’s formation
in June – see our front-page story in June entitled ‘Drive to boost London’.
ISCAS urges PPUs to join Competition and Markets Authority (CMA) executive director
Michael Grenfell has written to NHS England to prompt action by NHS trusts to comply with the law and get private patient units (PPUs) to submit consistent data.
His letter states: ‘Despite the Order having been in force since 2014, and compliance having been required since 2016, our monitoring shows that compliance among a minority of hospitals is unsatisfactory. . .
‘Levels of compliance have been particularly low among PPUs. For example, as of August 2023 no PPU had provided PHIN with publishable data on health outcomes. …
‘Given the poor compliance performance of PPUs to date and the fact that PPUs are now some of the larger non-compliant providers, we would like to explore more efficient ways to ensure that PPUs provide the information to PHIN that is legally required of them regarding their private work.’
Sally Taber, director of the Independent Sector Complaints Adjudication Service (ISCAS), said: ‘This letter will hopefully also encourage PPUs to subscribe to ISCAS. Seventeen are currently subscribed but progress remains slow.’
ISCAS points out that NHS trusts should be ensuring any patients have access to an external review stage should they have a complaint that cannot be solved – a service not covered within NHS trusts without such external support.
Further growth and record revenues for NHS trusts in England
England’s NHS trusts achieved significant growth in private patients incomes but are still not operating at pre-Covid levels, according to Housden Group analysis of the 2022-23 annual accounts.
Total revenues rose £102.2m to £645.7m for NHS trusts in England (£543.5m in 2021-22), an 18.8% rise. Revenue growth was much higher last year at 70.8% and £267.6m but this was the first year of the ‘Covid bounce-back’.
See my full report next month
Philip Housden is director of Housden Group commercial healthcare consultancy
A
look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Clearer pricing in private healthcare was set to benefit patients in 2014, according to the Association of Independent Healthcare Organisations.
Answering criticism about wrong invoices being sent by private units, a spokesperson told Independent Practitioner Today all independent providers were working hard to ensure invoice charges were accurate and clearly laid out – but they should act swiftly to update invoices and charge accurately if any mistakes happened.
She added: ‘Through transparent pricing, as published on providers’ websites, it is becoming easier for
patients to understand the fees that apply for different services.
‘We anticipate that this transparency will be adopted by a broad range of providers, and across more treatments, in the future.’
Treatment sourcing specialists Medical Care Direct (MCD) had voiced concern about the number of wrong invoices being received from private hospitals or clinics, with either overcharging or erroneous charges being most common.
Chairman Jan Lason said: ‘We have been tracking this in detail for the last three months. During August, 11% of invoices received were wrong; in September it was 15% and October 14%.
‘Most of these relate to fixedprice procedures rather than normal itemised bills, so you would think that the scope for error is small. But they are totalling over £20,000 each month – a significant sum.’
Independent practitioners claimed Care Quality Commission (CQC) plans for registration fee increases were unfair compared to proposed charges for colleagues in the NHS.
The Independent Doctors Federation (IDF) said although the watchdog claimed to be fair and consistent and to promote equality, there was ‘clear financial bias and discrimination against doctors working outside the NHS’.
An independent practitioner confessed surprise that she had to conform to National Minimum Wage policies if she employed staff.
She told an MDU private practice seminar she thought she could pay what she wanted because, after all, she was the boss.
Large numbers of senior doctors started the New Year unprepared for potentially massive cash hits due to the pension tax changes coming into force in April, financial planning experts warned.
Specialists advisers revealed that many could face extra tax charges on their pension savings amounting to tens or even hundreds of thousands of pounds.
Experts from Cavendish Medical held teachins to help doctors understand the severity of the Government’s changes.
One adviser said: ‘Many of the doctors we spoke to have read the news reports about these changes but either haven’t had the time to
act or don’t think the figures apply to them.
‘They are shocked when we spell things out.’
Ambitious plans to enable hundreds of consultants to see and treat their private patients in The Shard were unveiled by HCA.
The hospitals group applied for planning permission to relocate outpatient services from the neighbouring London Bridge Hospital onto three floors of the 1,016 foot ‘vertical city’ dominating the capital’s skyline. It said the decision to apply to develop The Shard was hugely influenced by customer demand. Plans were for 80100 consulting rooms to be used by around 300 consultants from a wide range of specialties.
‘What’s a doctor worth?’ was the banner title of a programme of BMA events planned to engage consultants in discussions that could feed into a new contract for their NHS work.
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2023 was a significant year heralding change for the country’s finances – and yours. In this year before the next general election, there were key changes around pensions and other measures that benefit doctors –but some changes that have not.
Ian Tongue highlights what doctors with a private practice business need to know for the year ahead
Probably the single most significant areas of change affecting doctors is around the taxation of pensions.
The medical profession has been calling for a shake-up in this area for years due to the way doctors in particular can be penalised for working harder – making this a disincentive to work more hours.
From 6 April 2023, the pension annual allowance has increased to £60,000 and the lifetime allowance is set to be abolished altogether.
The pension annual allowance is the amount you can save into a pension before incurring a tax charge. The NHS Pension Scheme is complex with regards to how your pension savings are calculated and these usually bear no resemblance to your actual pension contributions.
Couple this with there being three NHS pension schemes and it makes the position difficult to understand for most doctors and results in variable pension growth annually.
The allowance is now £60,000 a year, which is a £20,000 increase, and for those earning less than £200,000 from all sources it is likely to significantly mitigate or extinguish future pension annual allowance charges.
For those earning more than £200,000 from all sources, the allowance is potentially reduced, as it was previously, and this is referred to as annual allowance tapering.
This process adds together your earnings and pension growth/savings and where the combination exceeds £260,000, you lose £1 of the allowance for every £2 above £260,000. This process continues until the allowance reaches £10,000, which is the new minimum, having been just £4,000 previously.
The result is a range of earnings between £260,000 to £360,000 where the pension annual allowance is being reduced. Previously, the range of losing the allowance
➱ continued on page 14
The use of a limited company to trade may be less tax- efficient than previously or be costing you money compared to other structures
was £240,000 to £312,000. Therefore, the change can make a significant difference.
Finally, the calculation of pension growth has been historically affected by an anomaly of when inflation is applied to the figures for tax purposes and NHS Pensions who calculate the growth each year, which was a year out of sync.
During periods of stable inflation, it made little difference, but with the most recent inflationary times, it would have created large swings in pension growth due to timing factors.
Thankfully, these are now aligned and the pension growth calculated each year should be more representative of aboveinflation growth rather than affected by timing differences of when inflation is applied within the growth calculations.
The lifetime allowance is related to the overall value of your pension(s) and, previously, if they exceeded a set figure for the lifetime allowance, you would suffer a tax charge when you come to take the pension(s).
It was never a ceiling on the size of pension you could have, but was a key consideration for many doctors when it came to their pension options.
From 6 April 2023, changes to the lifetime allowance were announced such that, while it is technically still in place, there will be no lifetime allowance charges for 2023-24 and the lifetime allowance will be abolished altogether for 2024-25 through future legislation.
Previously, the lifetime allowance had been set at £1,073,100 for 2022-23. However, there remains a restriction on the maximum taxfree lump sum, which is capped at 25% of the previous limit, which is £268,275.
The above relates to the standard pension lifetime allowances, as this area has been subject to change many times over the years. A doctor may have various forms of pension protection which could provide a higher tax-free lump sum depending on their circumstances.
When the above were announced, it was politically sensitive, as these measures were not restricted to the medical profession or public sector and so it remains to be seen whether any changes are made in the next parliament, whoever may be in charge.
While not related to the budget or Autumn Statement, it is important to note that there have been significant new flexibilities introduced in 2023 for members of the NHS Pension Scheme.
These measures offer a significant amount of flexibility regarding your retirement options and further information is available within the members’ section of the NHS Pensions website.
Given all the taxation and pension reforms, now is a good time to
speak with your independent financial adviser to discuss your options and plan ahead.
Limited companies
Trading as a limited company has been a very popular choice for consultants carrying out private work and also for private GPs. The corporate structure allows significant flexibility with regards to earnings extraction and can be more taxefficient depending on the circumstances of the individual.
Over the last few years, the Government has increased the rate of tax paid by individuals on dividends and reduced the taxfree allowance.
Coupled with a significant increase to Corporation Tax from 1 April 2023, the use of a limited company to trade may be less taxefficient than previously or be costing you money compared to other structures.
The income tax rates on dividends increased by 1.25% when the social care levy was announced in 2022, but unlike the National Insurance (NI) increases that were
The effective tax rate of an additional-rate taxpayer earning money through a company and extracting profit via dividends can be as high as 54.51%
revoked, the increase in dividend tax rates remain, resulting in the following tax rates after the taxfree allowance has been used:
Basic-rate taxpayers – 8.75%; Higher-rate taxpayer – 33.75%; Additional-rate taxpayers –39.35%.
For companies, we take a step back in time to having different tax rates depending on the company’s earnings, resulting in the following from 1 April 2023:
Profits up to £50,000 – 19%;
Between £50,001 to £250,000 –26.5%; £250,001 and above – 25%.
To prevent people setting up many companies to spread profits and exploit the 19% rate, the bandings are divided between associated companies. Therefore, if you have more than one company that you are significantly involved in, the higher tax rates may apply earlier in each of those companies.
As a result of the above, the effective tax rate of an additionalrate taxpayer earning money through a company and extracting profit via dividends can be as high as 54.51%.
For those trading through a company and extracting most or all of the profits to higher/additional-rate taxpayers, it may be time to consider your options and alternative trading structures.
Capital allowances are a special deduction against your taxable profits for expenditure on capital items – they are assets that will derive benefits over many years. Assets such as these would historically be given tax relief over many years, but for some time now there have been generous capital allowances available that would allow you to deduct the expenditure in full against taxable profits.
These allowances have varied over the years, but, for the vast majority of doctors, they have exceeded any likely level of expenses incurred.
One of the measures announced in the Autumn Statement was a permanent change to allow full expensing for companies and this was communicated as a substantial tax saving for companies.
No doubt this is true for a large business looking to spend significant sums on equipment and expansion, but it is likely to have limited impact on taxable profits for the vast majority of consultants and private GPs – unless you are involved in setting up your own clinics/private hospitals.
Where you are involved in largescale capital investment the use of a specialist adviser is strongly urged to ensure the maximum tax relief is obtained.
The Budget and Autumn Statement made some key announcements on income tax and NI.
The thresholds for the payment of higher-rate income tax of 40% were left unchanged, which, in the current inflationary economy, brings more taxpayers into paying higher-rate tax.
From 6 April 2023, the threshold to pay the additional rate of tax has been lowered to £125,141 in England and Wales.
This may seem like an odd earnings level, but it is no coincidence that the top of the earnings threshold where you lose your personal tax allowance is £125,140. For Scottish taxpayers, the top tax rate of 47% now applies at the same threshold.
This will bring more taxpayers into the additional rate and top rates of tax.
NI has been the topic of much change in 2022 and 2023 with the previous announcement of the social care levy of 1.25% that was to apply in 2022.
This was repealed in later announcements from the Chancellor and at the most recent Autumn Statement, NI rates were reduced for the vast majority of taxpayers.
For employees, the rate of employee NI has reduced from 12% to 10% within the basic-rate earnings band £12,571-£50,270. These measures apply from 6 January 2024.
For the self-employed, the class 2 rate has been abolished and the highest rate of Class 4 national insurance on profits has been reduced from 9% to 8%.
These measures apply from 6 April 2024.
The national minimum wage saw a significant increase from 1 April 2024 across the various age groups that it applies with the youngest and apprentices seeing over 21%.
The national living wage applying to all 21 years of age and over increased 9.8% to £11.44 per hour. If you employ any staff in your business, it is important that you review your pay rates in advance of the increases to ensure that you are compliant with the new rates. One knock on effect can be on those who are paid above the minimum but are in a more senior position to those on minimum wage, because the gap between them may have narrowed. It is likely therefore that you will need to review your salary levels for all your employees.
Given the higher interest rates available in the current economic climate, doctors with significant savings are likely to exceed the taxfree savings allowance which is £1,000 for basic-rate taxpayers, £500 for higher-rate taxpayers, with no allowance for additionalrate taxpayers.
For those with dividend income, the tax-free amount is £1,000 for 2023-24 and reduces to £500 from 6 April 2024 onwards.
For those with investments that attract capital gains tax, the taxfree amount has reduced to £6,000 for 2023-2024 and reduces further to £3,000 from 6 April 2024 onwards.
For those with ISAs, the Government is introducing measures to simplify these tax saving vehicles and provide more choice and options to move your savings. The annual amount that can be saved remains unchanged at £20,000.
There are a number of changes ahead in relation to the tax system and the effect of these on the taxpayer will depend on their individual circumstances.
For those self-employed individuals who adopt a financial year-end for their business that is not in line with the tax year end, 2023-24 is a year of transition to move your earnings disclosure on your tax return to a 5 April basis.
For many in this situation, it will accelerate tax that would have been payable at a later date, but the reforms allow this to be spread by up to five years depending on circumstances.
If you are self-employed and do not use a 31 March or 5 April yearend for your business, it is important that you discuss your circumstances with your accountant to understand the impact for you.
Cash accounting has been extended to apply to all unincorporated businesses from 6 April 2024.
This means that, by default, you would declare income when received and costs when paid. This is in contrast to the current ‘accruals’ based system, which computes income on an earnings basis and costs on a liability basis. An accruals basis can still be adopted by electing to use that basis.
It is likely that the doctors who will benefit from this most will be those who undertake medico-legal work, because this type of income can take a long time to be paid,
resulting in tax being handed over in advance of receiving payment for the work done.
For others, electing for the accruals basis is likely to be the best option, as it would ensure that your income is fully reconciled to amounts owed to the business, which is a key financial control to ensure that you are being paid for all work undertaken.
MTD as it is referred to is not new and has been particularly problematic for HM Revenue and Customs (HMRC) to introduce. That has led to years of delays.
The basis behind MTD is to report your taxation figures to HMRC more frequently, which, for most, will be quarterly. The submission will be electronic and require suitable software to be used.
These measures apply from April 2026 and no doubt there will be further detail released in advance of this regarding the exact requirements for businesses.
The above covers the most significant areas of recent change that are likely to affect doctors.
As always, it is important you discuss your financial circumstances with your accountant and independent financial adviser to ensure you are best placed in the ever-changing financial world we live in.
Ian Tongue (right) is partner at Sandison Easson & Co, who are specialist medical accountants
Learn the essential initiatives underpinning private practice success in a climate that is continuing to evolve.
Sue O’Gorman presents some excellent practical ideas showing how to grow your referral networks in a competitive environment
BUILDING A ROBUST referral base takes time and continual effort. A combination of providing excellent patient care, clear and effective communication and consistent engagement with a raft of healthcare professionals and hospital staff are all crucial for the longterm success of your practice.
While some, or all, of the below may seem ‘no brainers’, they are all real-life examples of good and bad practice I have witnessed in my many years of working with consultants and in private hospitals.
Hopefully, they will help you navigate some of the pitfalls and embrace good practice for long term referral growth.
Take time to build solid relationships with other healthcare professionals. Pick the phone up to personally thank and introduce yourself to any new referrers. Respond promptly to requests for patients to be seen, especially when that patient is urgent. Ensure your medical secretary is aware of your primary/VIP referrers and they, too, are on board with facilitating any add-on or urgent appointments.
This may sound obvious, but, above all, keep your referrer informed of their patients’ progress, test results and treatment plans. I have seen the detrimental effects to a consultant’s practice of this not being done and the negative impact it has on a referral.
Have a clear understanding of where your referrals are coming from. Consider any practices where you do not currently receive referrals and make efforts to connect.
Find out if the referrer has a specialist interest in a particular area where you think there could be an opportunity to cross refer.
For some referrers, they will expect you on speed dial. This, of course, is a personal choice to do so, but it is generally a collaborative approach that works well for practice growth.
DON’T
Rush or cut short the patient consultation. You risk your reputation being tarnished among the refer-
ring community and you may also jeopardise your practising privileges if the hospital facility you are based at considers you are not compliant with good practice and so risk its good name being tarnished too.
Don’t make the referrer chase you for results and updates. Inform them in advance of any delays to manage their expectations. The patient may be chasing them and if they feel uninformed, it will not leave a good impression and they may be reluctant to refer again.
Track volumes, nurture relationships where you are seeing a steady increase in referrals and identify and understand any downturns –is it customer service-orientated or clinical?
This is a task your medical secretary can support you with, so make time to go through this data together on a regular basis.
Encourage your medical secretary to develop relationships with your referrer’s team. They may well glean a lot of useful information that can help develop your practice.
DON’T.
Be vague about where your referrals come from or simply expect your medical secretary to know. This is your business, your reputation and your brand.
Understanding your referrers, their needs and any gaps in your service provision will help you stay current and one step ahead in an ever-competitive climate.
Ensure you have dedicated staff to handle inquiries, offer timely appointments and follow-up with patients and referrers.
A disorganised administration process may give the impression that these standards apply to your clinical practice too.
Ensure you have cover on the phones over the lunch period, as this is often when patients will contact you. Asking the patient to leave a message is simply provid-
➱ continued on page 18
ing your competitors with the opportunity to ‘steal’ the patient away from you.
Review the various access points into your practice and ensure they are optimised. For example, is your Bupa profile verified? Is your hospital profile accurate and includes all of the procedures you offer? Are your contact details up to date? Do you offer patients remote consultations?
Consistently run late or overbook appointments so that your clinics run over and your patients become agitated. They are very likely to inform others, including their referring GP. Reputation is everything and much harder to rebuild once damaged.
Don’t have a very ‘busy’ website with endless text and diagrams. The general rule of thumb is that a patient should be able to find the information they need within three clicks of landing on your website.
A good home page and contact page are likely to be the two they will spend the most amount of time looking at. Information overload can simply leave the patient frustrated and confused. Your website is there to help optimise your conversion rate from inquiry to booking.
DO...
Engage positively with hospitals’ marketing and business development teams. They are there to support you and it is in their interest for you to have a successful, thriving practice at their facility.
They have strong links with many of the GPs, corporates and embassies, all of whom are referral sources into your practice. Make sure your hospital profile is up to date so staff can reach you easily and can understand the types of patients their call centre teams can refer to you.
Ask to be included in opportunities to speak at events, many of which attract good volumes of GPs and allied health professionals and a great opportunity for you to showcase your practice and clinical expertise.
Include information in your talk
The general rule of thumb is that a patient should be able to find the information they need within three clicks of landing on your website
about the facilities at the hospital and why you like working there. This will go a long way to ensure you are given other opportunities in the future, as it demonstrates a collaborative approach.
Be prepared to develop a series of talks you can offer at any time. You may be asked with short notice to speak at an event.
Encourage satisfied patients to write testimonials or take part in case studies which the hospitals will also use for PR purposes which will help further promote your reputation.
Arrive late for your presentation if asked to speak at an event.
I have seen consultants still writing their presentation five minutes before they start. Everyone’s stress levels are heightened and it does not give a good impression to the referrers, who have taken time out of their busy schedules to be there, if you come across as frazzled and unprepared.
Don’t be shy about handing out your business cards. If you have given a compelling and informative talk, referrers will want to know how to get hold of you.
Pop your mobile number on the card too if you are comfortable doing so, it is a sure-fire way to get those referrals coming in.
Don’t expect the hospital to be responsible for building your private practice. They are there to support and guide you.
Many consultants consider it the hospital’s job to grow their practice for them and have turned down patients on the basis of not being provided a full clinic list. Private practice takes time to build and saying yes to one patient referral one week will result in two the following and before long, you will have your full clinic lists.
The staff recognise your support and will likely want to help you grow your practice if you help them accommodate patients.
DO…
Clearly identify the demographic and psychographic characteristics of your target audience. It is important to understand their needs, preferences and behaviours
You may need to consider investing in working with an agency who can help you attract your ideal patients and pinpoint how and where they ‘shop’
to tailor your marketing efforts and obtain optimum return on investment.
Ensure your online presence is consistent with your messaging and values of the service you offer – referred to as ‘on brand’. This should apply to all digital platforms where you appear.
Your specialty may lend itself well to social media, especially in the current climate with the continued rise in self-pay patients, who often turn to the internet to seek out their specialists.
You may need to consider investing in working with an agency who can help you attract your ideal patients and pinpoint how and where they ‘shop’.
LinkedIn, for example, is an effective way to engage with the allied health professional community who will be able to refer patients your way if your content is relevant and informative
Subspecialise to differentiate. This will help make you stand out from your competitors, and referrers will be more likely to send their patients to the ‘expert’ for specific conditions.
DON’T
Try to do this yourself. Not only does this take an inordinate amount of time, but navigating the various elements of online marketing can be frustrating and having a third party view this through the eyes of the patient will have a greater impact.
The above form the basis of just some of the essential initiatives that underpin private practice success in a climate that is continuing to evolve.
But one thing remains throughout and that is that maintaining a positive and professional image in private practice will always be crucial for both referrer and patient satisfaction, retention and growth.
Coming in our February issue: ‘What next?’ The pros and cons of a sole practitioner versus a group practice.
Sue O’Gorman of Medici Healthcare Consultancy provides services to help healthcare professionals think and act commercially. For further information, Sue can be reached at www. medicihealthcareconsultancy.co.uk or by phone on 07985 456487
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Effective communication is essential in healthcare because it significantly impacts patient satisfaction, understanding and outcomes. Neil Davies discusses what patients are looking for from private healthcare
FINDING WAYS to stand out over your competitors has never been more important than it is now.
Longer NHS waiting times mean more patients are looking for a private doctor. One-in-eight Britons used private healthcare in the last 12 months, with a further quarter considering it.1
Regardless of the method potential patients use to reach out to your business, a swift response can dramatically improve outcomes.
According to a recent YouGov investigation, the main advantage of private healthcare for patients is speed, with over half saying the top reason they went private was to be seen quicker (53%).1
The same logic applies when patients are getting in contact with private practices. If you don’t reply quickly, patients will look for someone who does.
At my company, Cymphony, we offer a lead response service that guarantees a response time of under five minutes.
Research shows that sub-five minutes is the optimum response time to capitalise on inbound leads.
And, yet, the average business takes 47 hours.
It’s little wonder that doctors
and patients alike feel frustrated. This isn’t guesswork anymore; a solid communication strategy leads to more appointment bookings and reduces no-show rates. The tangible impact results in growth as well as an increase in revenue, profitability and satisfaction.
Your online presence as a private practice is your digital shop window.
Potential patients will be quick to cast judgement based on your online output. Social media channels and online reviews play a huge role in attracting new business and maintaining a strong reputation.
Social media outputs need to be tailored to your audience; the most common age range for someone having a private medical procedure last year was 55 to 59.2
It’s essential to understand the preferences and browsing habits of your primary demographic to ensure your marketing efforts resonate with them.
In the age of online transparency, fostering genuine, positive feedback is paramount. A recent BBC article shed light on the pitfalls of fake reviews, revealing that
several clinics faced a backlash for purchasing such endorsements.3 It’s crucial to implement reliable feedback systems that consistently gather authentic reviews. Postprocedure engagement, such as seeking patient feedback, not only conveys that you value their input but also provides actionable insights for continuous improvement.
A potential patient’s decision to choose one private practice over another often hinges on its relevance to current medical trends and its overall preparedness to offer the most sought-after treatments.
By diligently researching and analysing available data, practices can anticipate and respond to emerging demands in healthcare. For instance, data from the PHIN website reveals that between Q3 2019 and Q3 2022, there was a significant rise in hip (+73%) and knee replacements (+58%).
A private practice that keeps abreast of such trends can better prepare in terms of medical expertise, equipment and other necessary resources, positioning themselves as industry leaders. Moreover, these insights not only enhance the private prac -
tice’s operational strategies but also its marketing campaigns, ensuring they’re reaching out to potential patients with the most relevant information.
Therefore, a well-informed practice, backed by data-driven insights like those from the PHIN website, becomes a more appealing choice for patients. They can trust that such a practice isn’t merely adapting to medical advancements but is actively shaping its future.
Alongside the speed of your communication, its accessibility is equally vital. If potential customers face obstacles in booking an appointment or reaching a representative, they are likely to turn to alternatives.
Today’s customers have diverse communication preferences, including Live Chat, social media, websites and phone calls.
In 2024, it’s essential for prac -
In 2024, it’s essential for practices to offer multiple interaction channels, extending beyond conventional 9-5 working hours
competitors, but it’s important you show the difference.
1. YouGov: ‘One-in-eight Britons turned to private healthcare in the last 12 months’.
2. PHIN: Private market update, March 2023.
3. BBC: ‘Warning over medical clinics using fake Google reviews’.
Neil Davies (below) is managing director of communications specialist Cymphony. https://cymphony.co.uk
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Celebrity patients often come with the private practice territory. Dr Sally Old (below) advises how to protect their privacy
IT CAN be challenging when you may be involved in treating highprofile people such as celebrities.
And it can be much more difficult to protect their personal and medical information, as the media has a limitless appetite for healthcare stories with a celebrity angle.
But high-profile patients deserve the same level of confidentiality as everyone else.
What should I do if a journalist contacts me?
If a journalist contacts you, do not feel panicked or pressured into speaking to them immediately. Ask for their name, publication and contact details – so you can respond to them in your own time.
Unfortunately, journalists are unlikely to go away if you just ignore them, so it is advisable to call them back.
Sadly, there have been instances where people have tried to get
information about a high-profile patient by posing as a legitimate inquirer, such as a family member. Ensure that appropriate patient consent is in place before sharing any information with a third party, including family members.
If you are contacted by someone who says they are a close relative of a patient, take the necessary steps to check they are who they claim to be. For example:
If taking a call from someone claiming to be a GP, you could check that they know the patient’s NHS number;
If receiving a phone call, take the caller’s number and ring them back after checking the number is valid.
Unfortunately, none of these systems are completely secure. If you are ever in doubt, it is wise to respond via a more secure medium than over the phone, such as in writing via email.
In the majority of cases, the most appropriate response if you are asked by a journalist about any patient will be to state that you cannot comment because of your duty of confidentiality.
Even if you believe that the patient has put information into the public domain, this doesn’t mean that you are free to comment or confirm the details without their expressed consent.
This is especially true, as any comments you make could find their way into a story, even if you believe you are ‘off the record’.
In some cases, it might be appropriate to contact the celebrity patient and explain that you have been approached by the media. You should reassure them that your duty of confidentiality means you will not comment about their treatment without their consent.
The patient may appreciate a
warning and may, depending on the circumstances, take the opportunity to draft a short statement. If this occurs, then it is advisable to make a note of any discussion and the precise wording of any statement.
What should I have in place to protect patient confidentiality?
It makes sense to have practice policies and procedures in place to prevent any inadvertent confidentiality breaches.
These include ensuring records are protected from unauthorised access.
All staff should already be aware of their duty to uphold patient confidentiality and have been trained to do so.
However, you may want to remind them in case they are tempted to tell close friends or family about a celebrity patient.
Nor should social media be used to discuss individual patients, however secure the user’s privacy settings.
In summary, if the media ask about a patient under your care, explain that you cannot comment because of your duty of confidentiality and take steps to prevent unauthorised access to records.
Also, beware of discussing patients where you can be overheard, such as in the reception area and avoid commenting on cases via social media.
Bear in mind that even seemingly superficial details could be identifiable.
Additionally, MDU members can also seek advice from our press office, who can help guide you through the complexities of dealing with the media.
Dr Sally Old, is a medico-legal adviser at the Medical Defence Union
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Over half of people with a disability or long-term or chronic illness told a recent survey that it is a barrier to progressing in their career.
Employers need to engage and listen to disabled employees to help build a supportive, inclusive culture where everyone can thrive, says Dr Robin Clark (right)
THE REWARD and Employee Benefits Association (REBA) in association with Bupa carried out a survey of over 300 employed people identifying as disabled, having a long-term or chronic illness or an impairment or condition.
Its aim was to better understand the lived experiences of disabled employees and workers with longterm or chronic illnesses or conditions and it informed a report entitled Disability in the Workplace 2023
According to the Office for National Statistics, there are 4.9m disabled people in employment in the UK and one in five of the working population is classified as disabled. A further 2.5m people are economically inactive as a result of long-term sickness.
The Equality Act 2010 explains when someone is considered to have a disability and so is protected from disability discrimination.
The Advisory, Conciliation and Arbitration Service (ACAS) summarises the law as saying that someone is disabled if both of these apply:
They have a ‘physical or mental impairment’;
The impairment ‘has a substantial and long-term adverse effect
on their ability to carry out normal day-to-day activities’.
People with progressive conditions, and conditions or impairments that are automatically classed as a disability, including cancer, an HIV infection, multiple sclerosis (MS), and a visual impairment, are also protected by law.
The lived experience of respondents at work
Employees that identify as disabled, having a long-term or chronic illness, impairment or condition, are an under-represented talent pool.
Employers have an opportunity to recruit, retain and maximise diverse talents, but must focus on appropriate workplace design, human resources policies and reward and benefits strategies.
The findings highlight that respondents want to work and be productive. While many said that they have a positive work experience, more than half of respondents believe that their disability, illness or condition is holding them back. This points to a need for employers to be willing to listen and act on individuals’ needs.
There are 4.9m disabled people in employment in the UK and one in five of the working population is classified as disabled
While engagement and culture are important in supporting disabled employees, the benefits they receive also have a key role to play in creating a positive working environment, especially if they can drive the financial security that respondents want and need.
The survey asked respondents about the types of benefits their employer already offers to them.
Although some people said that they find it hard to get the acknowledgement and support they need in the workplace, they say they are willing to share details of their condition or impairment at work.
The survey found that 65% of disabled employees indicated they would be willing to talk openly about their experiences to help employers better understand their needs.
Employers can grasp the opportunity to have more effective conversations between employees and line managers, team colleagues and HR representatives.
Employees want support, fairness and understanding
Its findings showed a close link between employees who receive benefits that support flexibility, financial support and enable people to manage their condition and those who said they would recommend their employer to other potential colleagues.
The top six employee benefits disabled employees currently receive are:
37% who have access to well-being services to manage their condition, such as mindfulness apps, would recommend their employer (compared to 13% who do not)
28% who have private medical care would recommend their employer (compared to 14% who do not)
27% who have mental health benefits appropriate to their needs would recommend their employer (compared to 12% who do not)
24% who have flexibility in their job design would recommend their employer (compared to 13% who do not)
20% who have access to services that help manage their condition would recommend their employer (compared to 7% who do not)
15% who have their salary paid via income protection if they are unable to work would recommend their employer (compared to 6% who do not).
Many of our respondents felt positive about the support they
Our survey respondents wanted to work with their employers to break down barriers to help build a supportive, inclusive culture. ➱ continued on page 26
Employees who say they would not recommend their employer to another disabled person also receive significantly fewer benefits, highlighting the importance of a varied benefits offering.
receive, with 66% of them saying their employer does all they can to support them with their disability, condition or impairment.
But others said they were unable to have vital conversations with their employers about their disability and wanted greater recognition of their condition at work.
Flexibility is the top benefit that respondents value and that could help employers better support them.
However, just 18% of employees who identified as disabled, having a long-term illness, impairment or condition currently have access to flexible working compared to 30% of those who did not identify as disabled.
This could relate to different perceptions of what flexibility means and how it is interpreted in workplace policies.
Many of our respondents saw ‘flexibility’ as tailoring working patterns to their individual needs to better manage their condition and work in ways that enable them to be most productive. This contrasts with the traditional, one-size-fits-all policy approach to flexible working.
Tailoring benefits and support to individual needs helps employees to thrive: 59% of respondents agreed that this helped them in their working life.
Survey participants who did not identify as disabled were also asked the same question, with almost identical results. 54% said benefits help them thrive at work, showing that this is also a challenge for the wider workplace.
Benefits personalisation across the workforce is high on employers’ priority lists, according to REBA’s Benefits Design Research 2023. And 70% of employers saying they plan to increase benefits choice, flex and/or personalisation within the next two years.
Being inclusive means blending diversity, equity and inclusion (DEI) policy, education and reasonable adjustments.
Feedback from respondents shows that inclusivity, understanding and recognition are important parts of workplace culture, as well as employers being prepared to make appropriate
Flexibility is the top benefit that respondents value and that could help employers better support them
Bupa employs 23,000 people in the UK providing services to its patients, residents and customers every day. Its people must reflect the diversity of its customers in order to serve them best and help us deliver its purpose of helping people live longer, healthier, happier lives and making a better world.
Bupa firmly believes that ‘everyone is welcome’ and becoming the Official Healthcare Partner for ParalympicsGB encouraged it to take this commitment further, both inside its business and in calling for change in wider society.
The report shows there is always more to do. No one should feel like they cannot disclose things about themselves for fear of hindering their career.
adjustments so that employees are able to participate more fully at work.
Respondents were asked whether they would recommend their employer to other disabled employees.
Almost two-thirds (64%) said that they would, with just 20% categorically saying they would not recommend them and 16% neither agreeing or disagreeing.
Respondents with a negative view of their employer were more likely to include benefits linked to financial security, especially income protection, in their dream package, suggesting that financial security if they are unable to work would make them feel more positive about their workplace.
Flexibility is once again a significant factor, with a 13% difference between those who felt positively and negatively about their employer, suggesting that respondents who feel positive may already have sufficient flexibility in their job role.
We asked respondents who identify as disabled, having a longterm illness or an impairment or condition what employee benefits they would prioritise if they were able to design their own package.
The top five dream benefits for disabled employees were:
Income protection (50%);
Support with everyday health costs (43%);
Paid-for counselling/mental health support (43%);
Payment if diagnosed with a critical illness (38%);
More flexibility in job design (38%).
Dr Robin Clark is medical director of Bupa UK Insurance and Bupa Global
This leads to presenteeism and poor physical and mental health. People are at their best when they can bring their whole selves to work and a happy, healthy workforce is essential for business performance, productivity and talent retention.
Bupa firmly believes that creating an open culture, embedding inclusion and celebrating difference is better for business.
On a practical level, this means listening and taking specific, individualised, tangible action to support people’s needs. Bupa believes in equipping its people managers to have these conversations and commit to being truly flexible; both with the ways that they work and through the benefits and support that the organisation provides.
Bupa is on a journey to becoming truly inclusive, and it is still learning. Through listening to its people, it has audited its physical spaces, language and culture and reviewed the healthcare benefits it offers its people to make them inclusive, accessible and tailored to their needs.
This means providing greater access to mental health and physiotherapy support, GP appointments at evenings and weekends, as well as vital services such as cancer checks, menopause support and health assessments.
Bupa has also partnered with Career Ready, a UK-wide social mobility charity that connects young people from underrepresented backgrounds with employers.
In 2023, Bupa focused on driving greater inclusion and more employment opportunities for young disabled people, offering more internships and via its corporate clients to boost employment opportunities for young disabled people.
Bupa’s three key insights are:
1
Build workplaces where everyone can reach their potential. Find out how Bupa is championing inclusive workplaces here: www. bupa.co.uk/business/inclusive-workplaces
2
Help line managers support all employees. Give managers access to resources that help them understand and learn about employees’ differing needs. They will then be able to make relevant day-to-day adjustments as well as support long-term career aspirations. Bupa has a wide selection of materials to help support line managers, including bite-sized videos and guides. Topics include:
Disability inclusion in the workplace: video guide
Supporting employees with long-term health conditions: video guide
Supporting neurodiverse employees: video guide
3
Create an inclusive, supportive culture. Bupa’s Workplace Health and Wellbeing Academy is an educational programme designed to provide businesses with exclusive insights and practical tools to help them understand how best to look after employees’ health and wellbeing. Its clinical experts share the latest insights on key health and wellbeing trends and resources to help businesses build actionable plans that really make a difference. Go to www.bupa.co.uk/business/ the-bupa-academy-for-workplace-health-and-wellbeing
by Dr Sarah Townley (right)
THE COMMONEST underlying causes for high-value clinical negligence claims involving independent gynaecologists over the last 12 years at Medical Protection have been:
Inadequate surgical technique; Failure to involve a specialist; Poor postoperative care; Inadequate consent process; Insufficient documentation.
Let’s look at claims experienced by consultant gynaecologists working in private practice in the UK we saw between 2010 and 2022, specifically excluding any obstetric care.
The commonest outcomes due to alleged poor surgical technique were bowel perforation – predominantly small bowel – nerve injury, arterial injury and bladder/ureter injury.
Subsequent to these injuries, concerns were often raised that the injury was not identified during the operation and hence a significant delay in treatment occurred.
In addition, the choice of operation and approach was also questioned in several claims, particularly when more conservative options were potentially available.
In multiple cases, the gynaecologist was criticised for not involving a specialist during the assessment or treatment of the patient, but ➱ continued on page 28
most commonly this involved the failure to involve a general surgeon when the patient presented with a complex surgical history pre-operatively or during the operation when complications occurred (see box on page 29).
Sadly, this could in some cases be due to a simple failure in communication as to when the pre-operative assessment or operation were taking place.
Criticism of postoperative care mainly arose from failure to identify the complications of surgery –commonly bleeding, bowel perforation and infection – in a timely fashion, often due to inadequate monitoring or failure to act on clinical signs – raised C-reactive protein level, hypotension, abdominal pain – leading to a delay in treatment.
Availability of the consultant or difficulty in contacting the consultant postoperatively also featured within several claims.
Clinicians are increasingly aware of the necessity to provide adequate detail of the risks and benefits of any procedure or treatment they are providing.
While concerns still arose that the patient was not warned of specific risks or complications, it does appear the expectation is that the consent should be now more tailored towards the individual patient rather than just the general treatment offered.
For example, advising the
patient regarding increased risks of complication/infection due to regular intake of immunosuppressant medication.
Often the vulnerability identified in relation to consent was the failure to advise of alternative options, the option of no treatment or offer a second opinion.
Finally, in investigative procedures, it became increasingly clear that it was required for a detailed consent procedure to include not only the risks and benefits of the original investigative procedure, but also any subsequent treatment that would be undertaken during the operation and for this to be clearly documented.
Not unexpectedly, documentation was often a critical factor in the decision as to whether a claim should be settled or defended, as clear documentation can clearly demonstrate what actions or discussions have or have not taken place.
In many cases, there was often an alleged failure to document in sufficient detail the consent process – options offered, risks/benefits advised – reasons for choosing a particular procedure, the operation note or evidence of adequate postoperative review/assessment.
Simple errors in documenting test results or passing on incorrect test results to colleagues, particularly within the IVF arena, also featured within these claims.
Dr Sarah Townley is deputy medical director at Medical Protection
We are very aware that it can be incredibly distressing to discover that a patient is unhappy with their care, to the extent that they feel the need to bring a claim against you.
There are several steps gynaecologists can take to minimise their risk of a claim or adverse incident occurring:
1
Be alert to the possibility of adjacent organ injury perioperatively, particularly small bowel injury, and have a low threshold to involve specialist colleagues at an early juncture.
2
Consider and discuss with the patient all treatment options, particularly more conservative approaches when they are appropriate.
3
Have a low threshold for involving specialist colleagues, particularly in the pre-operative assessment of complex patients. Ensure you have a clear process in place for informing any specialists involved of when and where their input will be needed.
4
Document a clear post-operative plan of when and how you should be contacted if any complications arise, how often observations should be undertaken and which other specialists should be involved if required.
5
Undertake a thorough consent process. Ensure the patient is aware of the risks, benefits and complications of the procedure, but also any alternative or subsequent treatment options. Consider whether the consent process needs to be tailored to that individual, depending on any comorbidities, medications or social history. Ensure you are up to date on the latest GMC guidance on decision-making and consent.
6
Consider the use of supporting information such as patient information leaflets to ensure full patient understanding. Use of these should also be documented in the records and regularly checked to ensure they are up to date and still fit for purpose.
7
Ensure you have included sufficient detail in your records, particularly in relation to treatment options discussed, the consent process, operative note and postoperative plans and reviews.
Mr T, a consultant gynaecologist, saw patient A in their private practice in relation to persistent menorrhagia and ovulation pain.
Patient A had an extensive history of abdominal procedures due to inflammatory bowel disease and had recently been diagnosed with an ovarian cyst.
Mr T had discussed at length the different options available for treatment with Patient A, explaining the risks and benefits of each, with the patient deciding that a total abdominal hysterectomy and bilateral salpingooophrectomy was their preferred choice.
Due to their abdominal surgical history, Mr T arranged for Patient A to see Miss B, a general surgeon for pre-operative assessment. Miss B advised of the potential for multiple adhesions to be present and agreed they would be willing to assist if required.
Mr T planned the surgery for a Wednesday at the private hospital, assuming that Miss B would be present, as they usually had an
operating list there that day, but did not inform Miss B of the date in advance to ensure availability.
During the operation, Mr T found loops of small bowel firmly adhesive to the peritoneum and the uterus and had difficulty identifying the left ovary. At this stage, Mr T called Miss B
for assistance, but there was no reply due to Miss B being on holiday.
Mr T decided not to call another general surgeon and continued with the operation. During the operation the small bowel was perforated but not identified at the time. The perforation was diagnosed postoperatively, by which time the patient required a temporary ileostomy and prolonged ITU stay.
A claim was brought against Mr T for proceeding with no general surgeon available, failure to call a general surgeon when adhesions were discovered and failure to work within the limits of their competence.
The claim was settled, and Mr T reflected and recognised that they would have a lower threshold for involvement of a general surgeon in similar circumstances in future. They also acknowledged that clear documentation of the process required to confirm the attendance of a general surgeon was essential.
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The Independent Healthcare Providers Network (IHPN) annual summit was buzzing after attracting 135 people from 86 organisations across the sector. David Hare reports on the positive mood of private health businesses
IT’S ALWAYS great to see the industry come together and I felt it was an excellent opportunity for us all to get into one room to connect and discuss the issues pertinent to us.
I was absolutely thrilled with the event. I felt we really got into the meaty issues facing the industry. There was a really positive sense in the room about where the market is headed and that was reflected in conversations I had.
There was much focus on the political environment – including what a change of government will mean for independent and private healthcare.
We considered the future of the NHS and independent sector relationships in the context of the Elective Recovery Taskforce and what providers can do to tackle workforce challenges and contribute to a sustainable health system. We also looked more specifically at the private market and what the future may hold.
We thought this year’s event was probably one of the best ever in terms of the quality of speakers,
We thought this year’s event was probably one of the best ever in terms of the quality of speakers, the insight and the value of the debate and discussion
the insight and the value of the debate and discussion.
The Spectator’s Isabel Hardman, who recently published an excellent book on the history of the NHS, did a brilliant question and answer session with our chairwoman, Seema Kennedy, reflecting on the history of the health service and the independent sector, with some consideration about her take on the current political leanings.
A politics of health session was packed out, with Sean Phillips, head of health and social care at
the Policy Exchange and Tom Hamilton, head of social policy at Public First, speaking with me and Danielle Henry, assistant director of policy and programmes at IHPN.
Earlier in the day, we spoke to Alan Milburn about what a Labour government could mean for the independent sector.
As health secretary in the Blair cabinet, and faced with not dissimilar challenges, it was fascinating to hear his take on the parallels, similarities and differences with today’s world.
His tongue-in-cheek line that ‘Liz Truss may have been right’ on the need for economic growth –with the caveat that she got the diagnosis but very much not the treatment – was one of the lines of the day.
Our roster of brilliant speakers included the then Secretary of State for Health and Social Services
Steve Barclay. Ironically, given that so much of the day was spent talking about the charged political
context, this was to be one of his final appearances and speeches in the role.
He announced that the target of opening 160 community diagnostic centres will be met a year early, and held a Q&A session answering questions on workforce, community provision and innovative models of care.
Mr Barclay also announced that some patients waiting more than 40 weeks will now be contacted and offered the opportunity to travel to a different hospital for treatment.
This is good news for patients. The fact that patients waiting a long time for treatment will be offered additional choices of providers, who may be able to treat them more quickly, is welcome and a big step forward in delivering the commitments of the Prime Minister’s Elective Recovery Taskforce.
At IHPN, something we have been working very hard on is building a political consensus and a shared understanding across the
political spectrum of the crucial value of the independent sector in both delivering and supplementing NHS services – recognising the additionality and expertise in the private sector.
This will, of course, entail engaging with the new Health Secretary, Victoria Atkins, and her new ministerial team to build on the solid foundations already in place.
In that vein, from across the aisle, it was very good to hear more positive comments of the Shadow Health Minister, Wes Streeting, following a speech he gave to the NHS Providers conference, where he elaborated on how he wants to ensure GPs have a stronger obligation to offer patients choice of provider at the point of referral.
The summit also gave us an opportunity to highlight new research which showed how businesses are turning to medical insurance and occupational health support to help keep staff healthy and attract new talent.
New polling, undertaken by Savanta on our behalf, found that a quarter (25%) of all businesses now offer private medical insurance for their employees, with a further 20% planning to introduce it in the next year.
Further, nearly a fifth (18%) of employers are planning on introducing occupational health services over the next 12 months, as they take action to counteract concerns at lengthening NHS waiting lists having a significant impact on the health of their staff.
The trends are particularly evident in medium and large businesses, where almost two-thirds (64%) said they were concerned about the risk of long waits and, here, nearly a third (32%) were considering private medical insurance in the next year, with 35% intending to bring in occupational health.
Over a quarter (27%) of all businesses – increasing to over a third (35%) of those employing in excess of 1,000 people – say that sickness absence rates have increased in their organisation over the last 12 months.
Recent Office of National Statistics data showed that more than 2.6m people now do not have jobs because of their ill health.
New research shows how businesses are turning to medical insurance and occupational health support to help keep staff healthy and attract new talent
The provision of private medical insurance and occupational health services are becoming an important factor for job candidates making decisions about where they work
The majority of businesses (52%) also say they are concerned that the current NHS waiting times may increase sickness absence rates at their organisation – a figure that rises to six-in-ten businesses with more than 1,000 employees.
The Financial Conduct Authority’s Financial Lives Survey showed there are now 6.9m people in the UK who have private medical insurance. More than threequarters of these policies (76%) are provided as a workplace benefit. In the last five years, the total number of people covered by private medical insurance has risen by one million.
We think the findings show that businesses are being proactive in ensuring the well-being of their workforce.
And we know from our research that pressures on the health service are a real concern for businesses – they are having an impact on staff absence rates and productivity.
So it’s no surprise to see that a growing number of businesses are looking at putting in place additional support to improve the health and well-being of their staff.
The provision of private medical insurance and occupational health services are becoming an important factor for job candidates making decisions about where they work.
Our recent study, Going Private, found that half of all people would be more likely to apply for a job if private medical insurance was part of the overall package, and it’s particularly attractive to younger people. Over two-thirds of 18- to 24-year-olds said they’d be more likely to apply for a job if private medical insurance was included as a benefit.
Thank you to legal services firm Bevan Brittan for its continued support. It has been our partner for nine years in a row.
I also want to thank the team at IHPN who put the event on. There’s a massive amount of work behind the scenes to run an event like the summit and they did an outstanding job.
BILLING AND COLLECTION
These ten New Year resolutions will help your practice flourish in 2024. Simon Brignall picks out some ‘must dos’
THE BEGINNING of a new year is a time to look to the future and opt to implement change or improvements.
But even with a focus on what is ahead, it can also be a time to review what you have achieved and the challenges you have faced.
So now we have waved goodbye to 2023 we can reflect on what has been a busy year for many of you in private practice.
All the data shows that private practice is continuing to see increased demand because of pressures in the NHS and worrying headlines around waiting lists.
Self-pay has remained at its elevated level and there has been an increase in activity from patients with private medical insurance.
While increased demand is beneficial, managing this can often prove challenging. Busy practices sometimes hide issues around their medical billing; this is why cash flow does not always reflect this increased activity, which can be a common complaint from the consultants who contact us.
Take a look at my ten New Year’s resolutions for a better, more efficient practice in 2024. Even if you only adhere to a few of these in the next 12 months, it could make an amazing difference.
Review the way your work is being billed to ensure you are compliant with the rules and regulations that get communicated monthly from the Clinical Coding and Schedule Development group (CCSD).
Insurer tariffs can also change monthly, and it takes diligence and a keen eye to ensure you are not leaving money on the table.
Ensure that you have a deep understanding of your practice on an operational level. In busy practice life, it can be all too easy to assume that your secretary has everything under control, when, in fact, they are struggling to keep their head above water.
Remember a medical secretary’s workload includes patient bookings, inquiries, record keeping, scheduling theatres and diagnostic tests, invoicing and all aspects of credit control.
Prompt, accurate billing shows the patient that you run a well organised and conscientious practice, which can further strengthen the patient/practice relationship
experience and reflects best on the practice.
Outsourcing procedures such as billing frees up your’s and your secretary’s precious time, enabling more time to concentrate on giving the best care.
5 Check pricing clarity
Make sure that your price structure/policy is clear and that your patients are made aware of it before commencing treatment, so there is no room for ambiguity when it comes to settling the bill.
It is important to be aware of any bad payers so you can decide if you want to continue seeing them to avoid compounding the problem
I often speak to practitioners who have engaged us after their secretary has departed and it is only then when they realise the scale of the debt problem.
If too much practice-specific knowledge is invested in one person, this can be detrimental to the future-proofing of the practice.
By outsourcing this key role, the secretary can focus on the patient’s clinical journey without the need to have those difficult commercial discussions.
3
See that your work is invoiced as soon as possible. Prompt, accurate billing shows the patient that you run a well organised and conscientious practice, which can further strengthen the patient/practice relationship.
Late invoices can be seen as a lack of professionalism by the patient and can impact their willingness to pay.
With regards to private medical insurance (PMI) invoicing, some major insurers now have timelines for invoice submittal, which, if missed, can lead to loss of income.
Taking a structured, timely approach to your invoicing will ensure that you have a consistent cash flow and assist with your debt reduction.
4 Don’t get bogged down
Make sure that you spend as much time as possible focusing on your core skill set, which is treating and looking after the patient. Separating the clinical and revenue sides of the practice as much as possible, improves the patient
A clearly defined fee structure is not only a key component of the Competition and Markets Authority’s rules, but also a vital stage in the patient’s journey and will help the practice ensure its invoices are settled in a timely fashion.
6 Chase, chase, chase
Ensure that your practice has a robust process for chasing any outstanding invoices on a consistent and continual basis until they are paid in full.
Otherwise, you will continue to experience a high level of bad debts. Debt levels of a private practice are typically at 20%, but can run an awful lot higher.
Our average bad debt rate at Civica Medical Billing and Collection is less than 0.5%, which is a 90% improvement on the private practice average.
7 Combat DNAs
A downside to the growth in self-funded activity over the last couple of years has been an increase in ‘Did Not Attends’ (DNAs) for some practices.
To combat this, many practices have implemented a policy of taking payment in advance for selfpay patients.
Consider whether this system would be of benefit to your practice. It is important to be aware of any bad payers so you can decide if you want to continue seeing them to avoid compounding the problem.
8
Manage patient information
Ensure you have management information on where your patients are referred from and whether they are private medically insured, UK self-pay, from embassies or overseas self-payers.
It is only by having access to accurate information about the composition of your practice that you will be able to make informed decisions about your practice for the future.
9
Ensure you have a robust infrastructure
See that you have a robust infrastructure in place to do all the above with a secure IT system, backed up on a daily basis, to help you achieve this. Then you will have peace of mind if the tax inspectors come calling.
10
Consider the outsource solution
If you find you cannot manage all of the above then you need to consider whether you should join thousands of other consultants who have outsourced this crucial element to a professional billing company.
Civica Medical Billing and Collection is the largest medical billing company in the UK – built over 30 years on a foundation of dedicated account management and meeting the needs of a modern private practice.
Simon Brignall (below) is director of business development at Civica Medical Billing and Collection
The Care Quality Commission’s new single assessment framework is getting underway and private healthcare providers are wondering what it means for them.
Solicitor Philippa Doyle (right) outlines the changes and argues that this new way of inspecting, evidence gathering and reporting will provide a far more consistent and transparent approach to regulation
THE CARE Quality Commission’s (CQC’s) long-awaited Single Assessment Framework (SAF) is slowly being implemented, with providers imminently starting to receive information from the watchdog directly.
It is an important time for independent practitioners to understand what this means and how it will affect your service.
While the SAF is badged as a fullscale change in the inspection process, that change sits with the the CQC, not with providers.
It is the CQC which is changing the way it inspects, the questions it asks and how it rates rate and how it reports.
For providers, it is business as usual. And the regulatory framework that underpins the delivery of care has not changed and is not changing.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Fundamental Standards of Care, enshrined in Part 2 of those regulations are here to stay.
All of the good work that you and your teams have done so far and continue to do and all the excellent policies and procedures you have in place can stay.
The SAF is the CQC’s new inspection regime. It says it will regulate in a smarter way, adapting and responding to risk, uncertainty and demand. We have seen clear signs of that already.
CQC inspections were led by risk during and post-Covid. So direct complaints to its helpdesk, whistle-blowing allegations and concerns raised by commissioners led to poorly performing services –or those perceived as being poorly performing – being at the front of the queue when it came to reinspections.
Long gone is the inspection programme where a good service would not expect to see the CQC again for two years.
The four ratings of ‘inadequate’, ‘requires improvement’, ‘good’ and ‘outstanding’ remain. And the five key questions or domains of ‘safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well led’ will also stay.
What’s changing
What changes is the introduction of quality statements, which replace the previous 300 or so key lines of inquiry.
These quality statements are phrased as questions and providers will be judged against the available evidence to show how those questions are met.
Each statement is scored from one to four, based on the quality of the evidence submitted to the CQC.
At the end of the process, providers will be able to see very clearly exactly where their service is doing well and where there are gaps requiring extra attention.
Those providers looking to increase their rating up to the next level will also be able to see how far away from achieving that rating they are and where they need to focus their efforts.
The CQC has very helpfully shared the different types of evidence that might be required to answer each of the quality statements, and this is where the SAF differs for different sector groups.
The principle focus for the independent sector will be the indepen dent doctors group, although you may also offer services under the other areas, so check your registration on the CQC website.
Each sector group will have slightly different evidence require-
What changes is the introduction of quality statements, which replace the previous 300 or so key lines of inquiry
ments, but all the details are available on the CQC’s website for a service to map across each quality statement and what evidence they need to put forward.
The evidence categories are all very familiar, too, and are all based on the work the CQC currently carries out when it inspects a service.
There are six evidence categories, although Outcomes is not applicable for independent doctors:
1. People’s experience of health and care services;
2. Feedback from staff and leaders; 3. Feedback from partners;
4. Observation; 5. Processes; 6. Outcomes.
Number 5 (Processes) is one of the more notable ones for providers to be aware of. This is any series of steps, arrangements or activities which are carried out to enable a provider or organisation to deliver their objectives.
CQC assessments will focus on how effective policies and procedures are. To do this, the watchdog will look at information and data sources that measure the outcome from processes.
For example, it may consider processes that measure and respond to information from audits, look at learning from incidents or notifications, and it will review people’s care and clinical records.
It might be most helpful for providers to look at the quality statements in context.
A CQC PDF on its website, called ‘Independent Health Single Services: Evidence Categories’, will be very helpful to review and consider your service against.
The evidence categories are expressed as ‘we’ statements. The ‘we’ statements show what is
needed to deliver high-quality person-centred care.
Let’s use ‘learning culture’ as an example.
The ‘we’ statement reads: ‘We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.’
The evidence categories the CQC will use to judge and score your responses to those statements are:
People’s experience of health and care services: feedback from surveys;
Feedback from staff and leaders: individual interviews and focus groups, whistleblowing; Processes: duty of candour records, evidence of learning and improvement, incident, near misses and events records.
The evidence submitted is then scored out of 1-4.
4 = exceptional standard; 3 = good standard; 2 = show shortfalls;
1 = significant shortfalls.
So if, for example, the service scored a 2 in learning culture, this would then feed into the overall scoring in the safe domain. The total is calculated and the final percentage is assessed against this score.
The percentage scores are clearly laid out:
25% to 38% = inadequate;
39% to 62% = requires improvement;
63% to 87% = good;
Over 87% = outstanding.
The service can see where they need to do better with quick reference to the lower score. The theory is that the service will be able to submit evidence to the CQC of its improvements, and if the CQC is satisfied with it, the scoring would
be adjusted, which for some services might see an uplift from ‘requires improvement’ to ‘good’. Do be mindful there are some rating limiters.
1If the key question score is within ‘good’ range, but with a score of 1 for one or more statement, the rating is limited to ‘requires improvement’.
2 If the key question score is within the ‘outstanding’ range but with a score of 1 or 2 for one or more quality statement, the rating is limited to ‘good’.
More consistent approach
I am very hopeful that this new way of inspecting, evidence gathering and reporting will provide a far more consistent and transparent approach to regulation.
Evidence is key, though, even more than it ever has been. Providers will be uploading a lot of information onto the provider portal before a visit and the CQC’s analysis of a service will only be as good as the evidence submitted. It is worth engaging with the different questions and what evidence the watchdog is looking for to ensure what you provide is specific and relevant. It is no good telling the CQC everything you know about a subject; you have to actually answer the exam question.
Hempsons has worked with providers for many years supporting them through the CQC process. Our fundamental standards of care training packages for registered managers and front-line staff can help you navigate the regulations, improve the lives of the people you support and tick CQC boxes too.
Do get in touch for more information on how we can support at p.doyle@hempsons.co.uk.
Philippa Doyle is a healthcare advisory partner at Hempsons
ONE OF the greatest temptations in investing is to try to time when to be in or out of markets.
It is logical to want to be fully invested in the equity markets when they are going up and to be in cash or bonds when they are going down.
Yet logic transforms into emotion at times when markets feel a little bit frothy on the upside, such as the late 1990s or even 2020-21, or full of gloom and despair on the downside, such as the depths of 2003 (technology crash), 2008-09 (global financial crisis), Q1 2020 (Covid) or the challenges of 2022 for both bonds and equities.
These temptations are strong. As an example, we can look at US investors’ net flows into bond funds over the past ten years.
The data shows us that whenever bond returns are strong, money flows into bond funds and, conversely, when they are weak or negative, investors tend to sell out of bonds, with 2022 being a prime example. However, this does not make much sense.
It is worth remembering that every decision to get out of any asset class also requires a decision on when to get back in and vice versa.
It would be great news if there was a clear signal that allowed us to make these calls, but as the late John C. Bogle, the founder of asset manager Vanguard, once said: ‘The idea that a bell rings to signal when investors should get into or out of the stock market is simply not credible.
‘After nearly 50 years in this business, I do not know of anybody who has done it successfully and consistently.
‘I don’t even know anybody who knows anybody who has done it
successfully and consistently. Yet market timing appears to be increasingly embraced by mutual fund investors and the professional managers of fund portfolios alike.’
A recent piece of research looked at market timing strategies with respect to equity market, size, value and profitability premiums in the US. In all, the authors looked at 720 possible timing strategies. Of these, only 30
showed any real promise, at least at first.
On further investigation, they were shown to be very sensitive to the time periods under study and how any live strategy might be constructed.
Without deep insight and testing of the robustness of these 30 strategies, it would be easy to see how investors might have thought they had found the elixir they were looking for.
Perhaps this should be no surprise, given that markets do a pretty good job of incorporating new information into prices quickly – and that would include any signal indicating that now is the time to get out of, or into, an equity market. Any new information is, by definition, a random event.
A paper by AQR, a systematic hedge fund manager in the US, stated: ‘Successful market timing is a tantalising Holy Grail for investors, especially when there seems to be persuasive evidence that simple valuation measures can predict subsequent market performance.
‘But, as both researchers and investors have discovered, outperforming a passive buy-and-hold approach is harder than it might seem.’
The costs of getting it wrong –either through making emotional decisions or believing one has some ‘system’ that rings Bogle’s
bell – are likely to be high. Staying invested is a much more effective strategy.
George Uglow (right) is a chartered financial planner with 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.
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:
Business structures (including partnerships)
Commercial contracts
Disputes and litigation
HR/employment
Premises
Regulatory requirements and investigations
Dr Kathryn Leask explains how to respond to a patient who asks for a medical report for an application to the army
QI am a private GP and have been asked by one of my patients to produce a medical report as part of their application for the army.
I have been asked to provide a summary of their past and present medical history and any medication they are on, in addition to any other information I think is relevant.
There was no consent form and although the patient handed in the request personally to the practice, I did contact them to ensure they were happy for me to disclose information about them.
The patient has now provided consent for me to produce the report, but has asked me not to mention a past history of recreational drug use.
There was also a suicide attempt several years ago. The patient was referred to the child and adult mental health services at the time and does not appear to have had any problems since. Would it be appropriate for me to leave this information out, given the passage of time?
AThe request is for their past and present medical history and anything else you feel is relevant. It is very likely that the patient’s past history of drug use and any concerns about their mental health are going to be relevant.
The GMC says you must be honest and trustworthy when writing reports and you must take reasonable steps to check information you are disclosing is correct and, importantly, you must not deliberately leave out relevant information.
The patient needs to be aware that, in order for you to complete
the form honestly, you will either need to include the information about their past history, with their consent or, if they won’t provide their consent for you to disclose this specific information, you will need to acknowledge that the report is not complete and relevant information is missing.
The person who has requested the information will clearly draw their own conclusions from this and the patient needs to be aware of that.
On reflection, the patient may feel it would be better for the information to be included with an explanation of what treatment
was provided and reassurance that this has not been repeated. It is then up to the army to decide whether this will have an impact on their application.
Information that you deliberately exclude from the report may come to light later and you may need to justify your decision not to mention it. If you were unable to do so, this could leave you vulnerable to criticism.
Dr Kathryn Leask (right) is a medicolegal adviser at the Medical Defence Union
Granting parental access to a child’s records is discussed here by medico-legal expert Dr Kathryn Leask
QI am a consultant paediatrician with a small private practice. Currently, I am looking after a three-year-old child whose parents are going through a difficult divorce.
Both parents share custody of the child. There is a lot of thirdparty information in the notes about each parent.
We use an electronic notes system which allows online access. Normally, we would allow parents to access the records, but I am concerned in this case due to
the animosity between them and the fact that there is thirdparty information.
I do think it would be in the child’s interests for the parents to have access to the records but have understandable concerns.
AUnless there is a reason not to, it is better to try to treat both parents equally and maintain your relationship with both of them for the sake of the child.
It is important that you are able, and feel comfortable, recording third-party information in the child’s record if it is clinically relevant.
If you were to allow both parents online access, you would have to make sure this was redacted,
If you were to allow both parents online access, you would have to make sure this information was redacted, which may be difficult or impossible
which may be difficult or impossible and there is always the risk of something being missed and inadvertently disclosed.
One way round this would be to allow them both access via a subject access request at reasonable intervals, so that this was not an onerous task.
In addition to providing information at these intervals, you could also agree to update them with any new information if there was, for example, a significant illness.
‘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 was a busy year for news affecting consultants and GPs in private practice in 2023. In case you missed some of it, Independent Practitioner Today here presents a round-up of some of the key stories we covered on line via our weekly news e-alerts and in our monthly digital editions
JANUARY
2023 dawned with chilling warnings from a consultants’ leader –and others – about a tougher road ahead for doctors in private practice.
According to the new chairman 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 and in our features section on our website 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 the ability to boost incomes without significant expenses by doing additional paid NHS work.
Mr Downes, a consultant obstetrician and gynaecologist in Harley Street, calls for disincentives to independent practice to be acknowledged and challenged to maintain the sector’s long term health.
His comments come as many independent practitioners’ busi
nesses face their highest inflation ever and are about to be squeezed financially in all directions from the Chancellor’s tax hikes announced last 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 threshold.
Specialist medical accountants are encouraging doctors to book a review of their affairs to ensure they are working in the most tax efficient 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 over 90% of his company’s clients had been billing above their 2019 levels, with many seeing a 50% increase in selfpay 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 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 short term could prove to be a little choppy.’
He gives some useful tips to ensure practices are best prepared for rougher times (see page 38 of our digital edition and ‘How to avoid a bumpy cash landing’ on our website).
Jane Braithwaite, managing director of Designated Medical, forecasts some private healthcare growth as patients try to dodge long NHS waiting lists, but warned many would be incredibly costsensitive 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.
‘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.’
Lucrative expert medical witness work may be harder for some doctors to find following action launched by the Expert Witness Institute (EWI).
Becoming an expert witness gets harder
Consultants are increasing their fees by up to onefifth in the runup to the new financial year.
Big inflation – higher in the medical sector than the UK’s national double digit rate – has prompted a widespread review of pricing structures for self pay work.
Many specialists are attempting to catch up after realising they have fallen far behind, because they usually never considered annual adjustments.
With the scrutiny of expert witnesses increasing in recent years, the courts have responded with both criticism and some severe penalties for individuals who put themselves forward as expert witnesses but who clearly do not understand the role or their obligations.
But the EWI believes its new certification of expert witnesses will drive improvements in expert witnesses’ quality and provide lawyers with a pool of experts they can rely on to deliver.
Following two successful pilots, The Expert Witness Institute is rolling out its new Certified Expert Witness Membership, a ‘goldstandard’ register of experts whose knowledge, skills and practice have been thoroughly validated by the Institute.
This will assure lawyers that by instructing an EWI certified expert, they are enlisting a professional who understands their role and can ultimately deliver.
To get EWI certification, applicants must already be highly experienced experts, with the assessment process building on the vetting procedures in place for EWI membership.
Simon Berney Edwards, chief executive at the Expert Witness Institute, said: ‘Our hope is that as the new certified scheme gains greater levels of recognition among the expert witness and legal community, it will encourage existing expert witnesses to seek certification so they can instantly demonstrate that their practice as an expert witness has been assessed and validated.
‘For newer expert witnesses, this sets out a standard to aspire to.’
Some reacted after specialist medical accountants last month recommended that Independent Practitioner Today readers should check their charges to see they at least kept pace with escalating costs.
One participant said increased self pay volume could limit fee rises here, but some consultants were reportedly being charged more per hour for the consulting rooms they used for this work.
Consultants who revise their fees are being asked to ensure they update their pricing information held by the Private Healthcare Information Network (PHIN).
Consultants have welcomed a pledge to limit the amount of information to be made freely available about their private patient outcomes.
Their response follows a new report from the PHIN saying that, for specialists, publication into the public domain of measures beyond volume, length of stay, patient feedback and links to registries is not currently recommended.
It explained that other measures – required by theCMA’s private healthcare ‘transparency’ order of 2014 – were ‘not yet appropriate for use as publicly available comparators – for example, because the quality and power of the data limits valid, statistical comparison.’
In a document, supported by the CMA, PHIN said it would continue to keep these issues under review in consultation with stakeholders.
But the advisers warned them to be careful about discussing pricing with colleagues, because the Competition and Markets Authority (CMA) has been scrutinising the medical sector and has fined businesses where it believes uncompetitive practices have taken place.
Alec James, a partner at Sandison Easson specialist medical accountants, said: ‘It is not surprising to see the fees rising like they are, given the cost of living and inflation rates.
‘I would envisage costs will increase for consultants, particularly in relation to clinic and staff costs. Ensuring their fees are increased accordingly in preparation of this is important.’
Meanwhile research is currently underway to examine and analyse price movements in hospitals’ selfpay packages.
The Federation of Independent Practitioner Organisations (FIPO) said it was pleased the CMA had accepted PHIN’s recommendations to limit the publication of consultant level metrics until more valid information can be made available.
It added: ‘FIPO has long argued that outcome metrics derived from hospital episode statistics are not a suitable vehicle to differentiate clinical performance.
‘Realistically, patient choice of consultant is limited anyway, as it is only self pay patients who are not constrained when choosing their consultant.’
‘Fix your failures – but do it quick!’
That is the message to independent consultants and private hospitals from the competition watchdog after it gave ‘name and shame’ publicity to providers for failing to fully comply with the requirements of its Private Healthcare Market Investigation Order 2014.
The CMA wrote publicly to two hospitals citing their failure to provide data for publication on performance and patient outcomes so that prospective patients had information they needed to compare consultants and healthcare providers.
Asked how many more hospitals are about to get similar letters, a spokesperson told Independent Practitioner Today: ‘It’s difficult to give an exact figure, as many hospitals are compliant, while many others are nearly compliant. The same is true of consultants.
‘As a result of publicising these letters, we expect many more will fix their failures, but they need to do so quickly.’
CMA executive director of markets and mergers, David Stewart, said 75% of consultants had provided their consultation and treatment fees for publication, so it was
‘ramping up’ enforcement action to ensure remaining hospitals and consultants who broke the rules would face the consequences ‘so patients don’t lose out’.
Legally binding directions or court action would be used if necessary.
A boom in overseas patient numbers is being forecast for private doctors in London under a new initiative to present the city as the ‘go to’ destination for independent healthcare.
Private hospital providers, collaborating on phase one of the project, have attracted support from the Department of Business and Trade and, if successful, then it could be widened to promote other areas of the UK.
‘And we haven’t been that protective about our knowledge. We have been willing to share, we are willing to collaborate, which is what’s making the big difference. It is a new age of collaboration.
‘There are still lots of patients coming to London, but there are a lot more out there in markets that are relatively untapped and none of us have really any big presence in.’
The surge in the number of selfpaying patients is continuing and now being experienced nationwide, according to a leading analyst.
Self pay expert Liz Heath says growth in demand for self pay is being seen across all areas of the UK, including areas that have not traditionally been private healthcare ‘hot spots’, such as Wales and Scotland.
The author of the newly published fifth edition of LaingBuisson’s Private Healthcare SelfPay UK Market Report states that research from multiple sources shows many patients are viewing a private doctor option for the first time.
But she warns they may have little knowledge of how to navigate the system and need support along the way.
One of the team involved told Independent Practitioner Today : ‘What we are intending to do is to put London on the medical tourism map in a much greater way than it ever has been before.
‘So the idea is we bring in a lot more international work into London in markets where we are not currently operating.’
Other past initiatives to increase the international patient footfall in London had proved disappointing. But Elizabeth Boultbee, head of global markets at the London Clinic, added that she was confident in the project’s success.
‘The difference in this is the providers and the chief executives have got together and said “we want to make this happen”.
‘They have provided funding, the initial funding for the project
‘Inaccurate contact information or a lack of response gives a poor impression to a potential patient in a climate where we are all used to immediacy and “on demand” services,’ Mrs Heath says.
‘Affordability is frequently cited as a key decisionmaking factor by patients and visibility of consultant fees is a positive step.’
LaingBuisson’s pricing analysis found there is still a vast range in some cases between highest and lowest prices.
Mrs Heath added: ‘The guide price for a primary knee replacement varies across the UK between around £9,000 and £17,000 which, from a consumer perspective, is unhelpful and confusing. The average guide price in 2023 is £13,781, a rise of 5.17% on 202122.’
A new series of videos is on the way to help doctors and hospitals in the private healthcare sector comply with their responsibilities when patients make complaints. Consultants and GPs working in over 300 independent hospitals, clinics and other companies who subscribe to the Independent Sector Complaints Adjudication Service (ISCAS) are required to follow the body’s rules for complaint handling.
But in a rising number of cases the ISCAS Code has not been followed properly, leading to further dissatisfaction from patients who are wellaware of the correct procedures.
Now the service has produced four new tenminute training videos which it wants all doctors, managers and staff working in subscriber venues to watch and follow.
The videos cover general complaint handling principles under the ISCAS Code and stages one, two and three of complaints management procedures.
ISCAS director Sally Taber told Independent Practitioner Today that, in the last year, there had been a high number of complaints about how complaints were being handled.
‘People haven’t been acting in adherence to the code. It’s a disappointment. There has been a level of misunderstanding by subscribers, but patients must have the assurance the code is going to be followed.’
Doctors fear workload pressures could expose them to falling foul of new GMC ethical standards guidance due to the time needed to prepare.
They voiced concerns about digesting and implementing new standards setting out what it means to be a good doctor in a survey by the Medical Defence Union (MDU).
As reported on Independent Practitioner Today’s news section (22 August 2023), a major revision of the GMC’s core guidance Good Medical Practice has been published following a consultation last year.
But it has emerged that, based on the draft guidance, only 15% were confident the new standards could be delivered in their work environment.
Seveninten doctors (68%) said they were unsure about this and nearly one in five (17%) felt this could not be done.
The MDU said: ‘Crucially, only half (49%) were confident they would have time to fully absorb the new standards before they are implemented with seven in ten (69%) saying they would have to
read the guidance in their own time outside of work.’
Its survey of 610 doctors, mostly consultants and GPs, found 96% had made use of the current standards and 62% found them helpful in knowing what was expected of them. The new guidance takes effect from 30 January 2024.
The MDU warned doctors would be challenged to read and absorb the revised standards over the busy winter months on top of their daily duties and responsibilities to patients.
Director of medical services Dr Caroline Fryar said: ‘There is much at stake for doctors as failing to follow the standards could lead to a fitness to practise investigation, something nearly half of those responding to our survey (43%) were concerned about.’
Consultants are gearing up to increase their private practice commitment as independent sector analysts predict a record year for the sector.
As many as 43% of specialists responding to a joint Independent Practitioner Today/MDU survey signalled they were likely to grow their business over the next five years.
Another 43% expected their private practice workload to remain the same in the foreseeable future, but 14% said they were unsure about what would happen.
Consultants’ numbers in the sector will be boosted by a tranche of doctors who are currently planning to take up private work.
Half of the doctors responding to the survey, who currently only worked in the NHS, thought they were more likely to be in private
practice over the next five years, while 28% were unclear.
Asked if they still did, or intended to, work for the NHS work alongside their private commitment, 77% said yes, 9.6% said no, 8% were unsure and 5% said they were not working for the health service.
For three quarters of consultants, their biggest motivation to work privately was financial. 43.6% cited greater job satisfaction, 36% considered it gave them a better work/life balance, while for 34% it represented a new challenge/experience.
Marketing yourself or your practice was, perhaps unsurprisingly, seen as the biggest challenge to becoming a private practitioner (58.%).
This was followed by impact on work/life balance (47%), arranging indemnity for themselves or employees (44%), and managing patient data (41%). Patient satisfaction was an issue for 8%.
More than six in ten doctors placed running a business as their biggest challenge faced or anticipated when in private practice. Complying with tax requirements came in next (54%), billing patients (47%) and protecting patient data (35%).
Nearly a third mentioned their other concerns as navigating the Care Quality Commission (CQC) regulating requirements and dealing with patient complaints and patient satisfaction issues.
Consultants expressed a huge appetite for learning more to help them with their businesses.
Financial planning, including tax, National Insurance and PAYE, came out top (57.2%), with support for marketing and establishing a private practice while maintaining existing NHS commitments both wanted by 36% of respondents.
These were closely followed by complying with data protection obligations (34%), professional/ corporate indemnity (33.2%), complying with CQC require
ments (30%), and ‘how to estab
lish a private practice and ensure it stands out from the crowd’ (28%).
Independent practitioners are losing out due to system failures in turning high levels of private
healthcare inquiries into bookings.
Although a record year for many in private practice is predicted in 2024 the sector is likely to treat fewer than it could if the patients’ journey was made much easier.
Improving the efficiency of the journey from a phone call to treatment is seen as vital by marketing advisers.
Independent Practitioner Today columnist Sue O’Gorman, of Medici Healthcare Consultancy, advised that increasing NHS wait times across many specialties and rising self pay inquiries means there has never been a better time for doctors to take a long hard look at their practice.
She advised they should ensure they have a watertight process to capture patients at the point of inquiry.
‘Many patients will be considering cost even if insured and will want to understand up front if the specialist accepts their insurer and if there are any out of pocket expenses such as shortfalls.
‘Coupled with easy access to online information, patients increasingly will conduct their own research to identify the specialist with the best reputation, success rates and patient reviews.’
The problem of turning inquiries into bookings was highlighted at this year’s LaingBuisson Private Acute Healthcare Conference, which was told that as many as half of inquirers do not become customers.
But the 200+ audience heard there was a strong potential for providers to improve the various steps across the patient journey to make it quicker and nicer.
What is the best way for independent practitioners to pay themselves? Richard Norbury (below) explains the different tax-efficient strategies
FOR VARIOUS reasons, many doctors have structured their affairs so that they trade via a limited company. The benefits include being tax-efficient and keeping them under thresholds for tapering of the pension annual allowance.
But, due to tax legislation changes, regular reviews should be done to ensure this is still the best trading structure – and, if so, how best to extract the funds.
Corporation tax rates have recently increased, meaning the first £50,000 of profit is taxed at 19% and the next £200,000 of profit is then taxed at the effective marginal rate of 26.5%.
We must remember that companies are a separate legal entity and often individuals will be both a director (officer) of the company and a shareholder.
The two separate distinctions are important, as this allows different methods of payment.
& EMPLOYEES
Salaries
Paying a salary to yourself and family members may now be more tax-efficient than it was in the past due to the corporation tax rate changes.
In addition, employees’ National Insurance is not pay able up to £1,048 per month and can be a tax-efficient way to extract funds from a com pany. For those consultants who are fully private, this option is often the most taxefficient.
In the past, most consultants did not pay themselves a salary due to already having an NHS salary, but recent changes in the National Insurance limits and corporation tax mean this should be reviewed.
Remember that the company may be required to operate a Pay As You Earn (PAYE) scheme and
report to HM Revenue and Customs (HMRC) the amounts that are paid over each period –usually monthly.
Failure to do this may result in penalties and interest payable. The amount of salary paid, especially to family members, should be justified and at a market rate for the work being done within the company.
Electric cars have been very popular in recent years, as this allows payments
directly from the company and attracts tax relief at source.
This means directors do not have to pay a lease or hire purchase from their own taxed earnings, which can effectively boost net disposable income without having to extract profit from the firm.
Bear in mind that this may become more attractive now the corporation tax rates have increased, as the tax relief on the lease payments may be higher depending on your profit level.
HMRC views this as if the individual has been provided with an asset in lieu of a salary, so it is taxed under the benefit-in-kind rules.
Currently electric cars are taxed at 2% of the original list price of the vehicle, so, for a car originally costing £50,000, individuals are taxed as if they have received £1,000 in salary.
There is also class 1a National Insurance charge to pay via the company, but the amounts are usually quite low. The 2% benefitin-kind rate is set to increase by 1% a year after 2024-25, reaching 5% by 2027-28.
A company can provide a loan to a director. If this loan is £10,000 or under, then it can be interest-free, otherwise interest can be charged at the approved HMRC rate which is currently 2.25%.
If the loan is over £10,000 and is provided interest-free, a taxable benefit is calculated under the benefit-in-kind rules.
If the loan is still outstanding at the point that corporation tax is payable – usually nine months and one day after the company year end – then a further tax is levied known as section 455 tax at 33.75% of the outstanding amount. This additional tax is effectively a deposit with HMRC until the loan is repaid.
With interest rates rising, this may be an attractive option for a short-term loan from the company, given the low rates imposed by HMRC and the fact that this is going back to your company rather than to a lender.
If you are considering this, then please discuss carefully with an accountant, as regular and repeated loans can attract attention from HMRC and anti-tax avoidance measures are applied.
Each officer or employee of the company can receive up to £150 per head for social functions such as staff Christmas parties. This is a tax-deductible cost in the company accounts.
Often companies will also pay for social functions to individuals who are not employed directly but may be employed by the trust or a private hospital. In these circumstances, this can be paid from a company and, while it is not taxdeductible, it is not paid from your own taxed earnings, which is often beneficial.
There may also be an opportunity to pay gifts to employees and directors and as long as the limits are under the exemption limits for trivial benefits, it is not cash or a cash voucher and is not a reward for the their work or performance.
Much the same way as a salary, a pension contribution can be paid from the company directly.
As with the salary, any payment needs to be justified as part of the overall package paid to an individual. For individuals who want to save additional money towards retirement, this may be an option and becomes more attractive if you are paying the higher rates of corporation tax.
The payment itself does not need to be declared on the individual’s tax return but does need to be considered when tracking the tax on pension annual allowance, especially for individuals who are active members of the NHS Pension Scheme.
The annual allowance threshold has been increased from £40,000 to £60,000 from April 2023, so it may be the case that some individuals have some scope to top up their private pension pot without suffering a tax charge.
Despite the increase in pension annual allowance, this amount may be reduced if your total income exceeds £200,000. This is a complex area and professional advice should be taken if you are considering this option.
The shareholders own the shares in the company and, assuming the
company has sufficient reserves, the directors can vote dividends on the shares and sometimes on different classes of shares.
In 2023-24, the first £1,000 of dividends paid is tax-free. This tax-free amount falls to £500 in future years. The individual then pays tax on the dividend income at the following prevailing rates: ❱ Basic rate taxpayer 8.75%; ❱ Higher rate taxpayer 33.75%; ❱ Additional rate taxpayer 39.35%. Bear in mind that sometimes voting the tax-free dividend can itself cause a tax charge if you are in the band between £100,000 and £125,140, where your personal tax-free allowance is reduced.
Often the advantage of paying dividends is that it does allow an element of control, as it may be beneficial to vote the dividends in certain tax years.
For example, if you have a large salary in one particular year due to additional waiting list initiative work, you may decide not to vote as many dividends, because doing so would take you over certain tax thresholds, such as the thresholds for tapering of the pension annual allowance.
Sole traders and partnerships With the recent tax legislation changes and the rise in the cost of living, individuals may find that they are in the position where they need to extract all or almost all of the available funds from a company in some way, shape or form. In these circumstances, consider whether a sole trader or a partnership model is a better fit.
Previously, the threshold for tapering of the pension annual allowance was restrictive at £110,000, but this has since risen to £200,000.
Extracting profits from companies is challenging, with lots of moving parts. There are numerous flexible strategies depending on the circumstances of the individual, which is why you should discuss your options with a specialist medical accountant who can tailor the plan accordingly.
Next month: Succession planning. Can I sell my private practice? Alec James reports
Richard Norbury is a partner at Sandison Easson & Co, specialist medical accountants
plays a crucial role in supporting medical professionals and practices in today’s rapidly evolving healthcare industry.
As the complexities of healthcare continue to increase, the importance of effective practice management services and medical billing becomes even more evident.
This article delves into the key elements that contribute to elevating healthcare administration standards across the industry and how innovative approaches and dedicated expertise shape the future of healthcare operations.
In the dynamic landscape of modern healthcare, independent practitioners seek greater control over the journeys their patients
take through the system and the efficiency of their practices.
Seamless integration between various practice elements, efficient insurer contact management, increased financial visibility and proactive debt management have become essential factors for the success of healthcare organisations.
Streamlining these administrative processes is paramount to deliver optimal patient care and maintain the overall efficiency and sustainability of healthcare operations.
Innovation has emerged as a driving force behind the advancement of healthcare administration. The industry is witnessing a continuous influx of new technologies and trends that aim to opti-
Derek Kelly (below) gives his view on the evolving landscape of healthcare administration and its pivotal role in supporting medical professionals and organisations
mise medical billing processes and improve the overall healthcare experience.
Robust practice management and medical billing software, for instance, can significantly enhance the efficiency of billing procedures, reducing errors and minimising delays in payment processing.
Additionally, digital solutions that facilitate remote access to patient records and administrative data have revolutionised the way healthcare professionals manage their practices.
Embracing these innovative technologies allows healthcare organisations to streamline their operations, improve communication and elevate the overall quality of patient care.
One of the cornerstones of successful healthcare administration lies in having a dedicated team of experts. This multifaceted field requires individuals with diverse backgrounds and expertise.
From healthcare specialists with a deep understanding of medical procedures and coding to technology experts who can develop and maintain efficient billing systems, each team member contributes their unique skills to the collective success.
This collaborative approach brings fresh perspectives and unique insights, enabling the industry to stay ahead of the curve and respond to evolving challenges effectively.
Trustworthiness and dependability are pivotal aspects of successful healthcare administration. Building and maintaining trust with clients, patients and stakeholders is crucial for fostering lasting partnerships.
Healthcare organisations must prioritise safeguarding the confidentiality of sensitive information and ensuring the integrity of their systems and personnel. By doing so, they inspire confidence and reliance in their administrative processes, establishing a solid foundation for sustainable growth.
Efficiency and effectiveness are core principles that underpin health care administration. By focusing on proactive debt management and optimising billing procedures, healthcare organisations can shorten turnaround times and reduce the time it takes to collect payments.
Effective revenue cycle management enables healthcare professionals to maintain stable financial performance and allocate resources more efficiently.
Moreover, real-time access to financial data and performance metrics empowers decision-makers to make informed choices and adapt to changing circumstances swiftly.
A collaborative and supportive workplace culture plays a crucial role in driving positive outcomes in healthcare administration.
Open communication, mutual support and an environment that values teamwork and creativity foster a vibrant atmosphere that benefits both employees and patients.
Healthcare organisations who cultivate a positive workplace culture experience higher employee satisfaction, leading to improved job performance and ultimately better patient care.
Employees who feel valued and supported are more likely to go the extra mile to ensure smooth administrative operations and
provide compassionate care to patients.
As the healthcare industry continues to evolve, it is crucial to stay at the forefront of industry developments. By embracing innovation, expertise and a relentless pursuit of excellence, healthcare organisations can continually explore new technologies and solutions.
Proactive market research and staying informed about emerging trends enable them to anticipate future needs and challenges, positioning them for sustainable success.
Embracing new technology can automate repetitive administrative tasks, freeing up resources and allowing healthcare professionals to focus on patient care.
Elevating healthcare administration standards is essential for the success of medical practices and the overall quality of patient care.
The industry must embrace innovation, assemble dedicated
Embracing new technology can automate repetitive administrative tasks, freeing up resources and allowing healthcare professionals to focus on patient care teams of experts, prioritise trustworthiness and dependability, optimise efficiency and effectiveness and cultivate a collaborative workplace culture.
By doing so, the healthcare administration industry can consistently improve its processes, positively impacting healthcare professionals and patients alike.
As healthcare continues to advance, the critical role of healthcare administration will only become more pronounced, making it imperative for the industry to continue striving for excellence and innovative solutions.
With dedication and unwaver-
ing commitment to delivering exceptional service, administration will undoubtedly play a significant role in shaping the future of healthcare and ultimately improving the lives of patients worldwide.
At my company, Medserv, our success as the largest company specialising in remote practice management services and medical billing in the UK and Ireland, is a testament to its commitment to innovation and dedication to exceptional service.
By combining a diverse team of experts, cutting-edge technology, and a strong focus on trust and integrity, we have transformed healthcare administration, positively impacting healthcare professionals and patients across the country.
As the industry continues to evolve, our ambition is to remain at the forefront, setting new standards and driving positive change in the healthcare sector.
Derek Kelly is marketing manager at Medserv
A nice, clean and economic car. That’s our motoring correspondent Dr Tony Rimmer’s (right) verdict on the Duster
PRIVATE MEDICAL practice is just like any other business when it comes to a client base that is currently suffering from financial restrictions.
Patients are searching for the best value for money when it comes to health insurance and treatments. Good quality care is a must, but the add-on luxury fripperies are easy to pass up if finances are tight.
It is no different in the car world. Buyers are postponing the expensive transfer to all-electric vehicles and looking for greater value from their family transport.
There are plenty of us medics who would be open to saving as much money as we can when purchasing our primary or secondary household car. Many of the big manufacturers have had this base covered with brands in their portfolio that offer lots of useable features without pretending to offer premium qualities.
The giant Volkswagen group has the Skoda brand, which has a dedicated and loyal following among buyers who would buy nothing else. Another brand, named after the title the Romans gave to Romania, is Dacia, which was founded in modern Romania in 1966.
With a philosophy to build modern, reliable and affordable cars for the Romanian people, sales were strong, but it was only in 1999 when Renault bought the company that there was a strategic shift to sell cars throughout Europe.
The small Logan and Sandero saloons were offered first, but it was not until 2010 when Dacia entered the increasingly popular SUV market to offer a Nissan
Qashqai-sized car, the Duster. In 2013, the Duster was launched in the UK.
Although pretty basic with regard to equipment and interior quality, it represented great value for money and as buyers became more confident about a previously unknown brand, sales grew.
A second-generation Duster appeared in 2017 and, in 2021, this had an update with many improvements made to equipment levels and quality.
Now the Duster has been updated again. It is offered with petrol or diesel engines and there is a top four-wheel drive version for those wanting to go off road.
There are four trim levels and the entry level Essential model costs a mere £17,295; less than most much smaller superminis. Granted, this model comes with steel wheels and no infotainment screen, but it does have electric windows, airconditioning and cruise control.
The models that will appeal to most of us medics are the better equipped £18,295 1.0litre Expression or £19,795 Journey versions which are still relatively cheap but have all the modern conveniences we expect from premium brands.
The 1.0 and 1.3 litre petrol models offer a real-world 40-50mpg average and the 1.5 litre diesel will do 50-55mpg.
So is the Duster great on paper only? Does it deliver on the road in day-to-day use? I have been driving the 1.3 litre petrol Expression model with 130bhp and a manual gearbox; an auto is available too.
Step into the Duster and the first impression is one of roominess.
The seats are firm but comfortable and the dashboard is clear and functional.
The plastics and trim are of reasonable quality, but everything is black or grey – there is no evidence of colour or design flair. However, this is perfectly acceptable at this price point.
It is a car more about function than style and the interior reminds me of the Subaru Impreza from the 2000s. It is much more up to date, though: the infotainment system on this Expression model has Apple CarPlay and Android Auto as standard.
There is enough room for three adults in the back and the boot is well above average in capacity, further strengthening its practical credentials.
On the road, there is no doubt that the chassis is feeling its age, but, again, this is not a car pretending to be sporty. The ride is good and although the body rolls a bit, it is perfectly fine taken through a set of corners on a windy ‘B’ road.
The steering has occasional
Step into the Duster and the first impression is one of roominess
vibrations fed up from the wheels and the gearbox has a definite and direct action when choosing ratios. Performance from the 130bhp 1.3 litre petrol engine is not exactly electrifying, but is perfectly adequate for normal day-today running.
The Duster is at its best in the urban environment where the great visibility and lightness of controls make cross-town journeys a doddle.
I like the Dacia Duster. It is just so honest in its matter-of-fact approach to delivering 95% of what you want from a car but 100% of what you need. Compared to all rivals, it is fantastic value for money.
It is made well, utilising parent Renault’s expertise and the brand has no image hang-ups; refreshing in this day and age.
I would certainly recommend any medic who appreciates good, solid straightforward engineering and design to have a long look and go for a test drive.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Five-door SUV
Engine: 1.3litre four-cyclinder petrol. Front-wheel drive
Power: 130bhp
Torque: 240Nm
Top speed: 119mph
Acceleration: 0-60mph in 11.1 seconds
Claimed fuel consumption (WLTP): 45.6mpg
CO2 emissions: 141g/km
On-the-road price: £19,695
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contact Andrew Schofield at Spot On Media on 0161 408 3912 or email him at andrew@spotonmedia.co.uk
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