Excellence on film
Private healthcare is getting some healthy publicity thanks to a link-up with ITN P10
It’s enough to break you
With 40% of private doctors divorcing, what are the key issues in dividing assets? P18
Tune out the noise
Doctors need to ignore the noise when making decisions about their investments P30
By Robin Stride
Tougher Care Quality Commission (CQC) inspections starting from April are expected to weaken doctors’ independence as private hospitals go all out to win a new ratings war.
Beefed-up ‘under the skin’ inspections are due to start in six weeks’ time following nationwide trials and feedback from the sector.
Under the new regime, first outlined in Independent Practitioner Today last October, all providers will be awarded ratings – outstanding, good, requires improvement or inadequate.
But there is nervousness at some private hospitals following a shock CQC overall rating of ‘inadequate’ last month for the much-lauded Hinchingbrooke Health Care NHS Trust, managed by private company Circle.
Stephen Collier, immediate-past chief executive of BMI group, warned that the relationship between independent hospitals and practitioners would now inevitably change due to pressures brought on management by the new regime.
Outlining the ratings system to a conference of private hospital bosses, he said the well-publicised Hinchingbrooke case ‘demonstrates the scale of the challenge we all face’.
Mr Collier feared that although the road ahead would now feel
In association with
‘bumpy’, the tougher inspections – which judge if care is safe, effective, caring, well-led and responsive to patients’ needs – were ‘a fantastic opportunity’ to show differentiated quality and private sector strengths.
But he said they were also a chance to identify smug complacency, for poor practice to be named and shamed, and dangerous units to be closed.
Effective clinical governance –and a pro-active focus on safety and quality – needed to be at the core of service delivery. This was not an optional bolt-on for already busy people.
He stressed that new hospital ratings were not averages, but would be given on the basis of a ‘worst two’. This meant two ‘inadequate’ judgements on departments in a sea of ‘goods’ were enough to hit the facility with the lowest possible assessment.
Mr Collier, now chairman of the NHS Partners Network, said what was happening with the CQC was further re-inforcement of a private hospital’s obligation to ensure quality across its entire service.
He told Independent Practitioner Today: ‘What we are seeing here is yet another erosion of consultants’ autonomy. The consultant is increasingly being viewed by regulators as part of the hospital’s service delivery for which the hospital has the regulatory responsibility.’
The CQC tested its new inspections in an initial wave of eight private hospitals late last year. A second tranche began last month (January) as first results came out.
Fiona Booth, head of the Association of Independent Healthcare Organisations, said the testing aimed to ensure the approach was appropriate for the private sector.
She told the Healthcare Conferences UK event in London that results of the first inspections were keenly awaited, as they would give everyone a fuller insight into how the proposed inspection regime will translate into ratings, and where modifications to the approach might be needed.
Ms Booth said the months ahead were ‘critical’. The independent sector was keen to ensure that communication between providers and the CQC was ‘swift, open and transparent’ and resulted in a thorough and fair regime.
‘Once these inspections start to take place, our focus shifts to ratings and information. I’m sure everyone across the sector agrees that independent hospitals should, and will be, held to exactly the same standards as NHS ones and that comparable data on them should be published. We want patients to be able to make informed choices about their care.’
continued on page 4
THE ART OF MARKETING: Surgeons at a private care clinic have turned their walls into an art gallery to improve the experience of waiting patients. See page 34 to discover how they achieved their colourful transformation
We’re failing to win the internet race
How the independent sector has failed to meet consumers’ changing demands P12
Figuring out how to gauge quality
The organisation charged with publishing performance data outlines the future P16
The key to getting them in
Communication – in a word – is the key for doctors to attract more patients P23
A hire purpose
A look at the different types of funding available to drive practice growth P26
Top ten tips on revalidation
Some top advice to help private doctors get into gear for revalidation P32
A home with some nice skiing attached
Now could be a good time to invest in that chalet you always wanted to own P38
EDITORIAL COMMENT
The Care Quality Commission inspectors are coming. They may already be near you. Right now. Who really was that chap you just saw in the corridor?
Pilot inspections of private hospitals for the new regime so far have not been without mishaps for some involved and these are for all to see on the commission’s website.
But it risks getting a whole lot worse in April when independent sector establishments are given ratings – outstanding, good, requires improvement or inadequate (see page one).
And these will have to be displayed ‘prominently’ by the
organisation concerned. Bad results will inevitably impact on the business.
‘Transparency’ is the buzzword. But the system has seemed unfair and proved horrendous for some NHS GP businesses who have already been named and shamed.
Hopefully, it will be a chance for the private sector to shine. But, remember, you are only as good as your two worst results.
The most independent of private doctors can therefore expect to find themselves under careful scrutiny from managers, administrators, colleagues and staff . . . as well as inspectors.
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By Leslie Berry
Accountants have underlined financial advisers’ warnings for private consultants also working in the NHS not to be caught out by unexpected tax charges arising from last April’s pension rule changes.
Blick Rothenberg LLP accountant and partner Nimesh Shah claimed ‘thousands’ could be hit by the double whammy.
Firstly, there is now an annual cap of £40,000 in the amount of pension contributions given tax relief and, secondly, a £1.25m limit on pension pots.
Breach this limit and, as previous Independent Practitioner Today articles have explained, you could face a 55% tax charge on the excess.
Mr Shah said: ‘The rules are particularly troublesome to medical professionals who are members of their own private pension and the NHS Pension schemes. To test these new limits, you have to combine private pension arrangements and the NHS Pension Scheme.’
But it was difficult to assess the contributions being made under the NHS scheme, so limits could be unknowingly and easily breached.
‘Medical professionals should be reviewing their pensions as soon as possible but not make any hasty decisions to leave the NHS scheme, as this can still provide valuable benefits despite the tax charges.’
Simon Bruce, managing director of specialist financial planners Cavendish Medical, said his firm had been regularly warning senior doctors of potential problems.
‘The yearly pensions’ cap of just £40,000 is easily breached by the average senior consultant’s income – particularly if in receipt
of a clinical excellence award. In addition, the calculations needed to find your annual pensions savings are particularly complex.
‘Many doctors can come unstuck without realising. The pension contribution on your payslip is not the same as your “deemed contribution” under annual allowance rules. HM Revenue and Custom’s calculations are based on the estimated growth of the pension in the year – sometimes very different to what you have actually paid into your pot.’
He warned doctors the onus was on them to calculate and declare any excess contribution on their self-assessment tax return.
Some doctors will not know they are heading for a substantial tax bill until they receive a letter from the NHS Pensions Agency, long after the relevant tax year has closed.
Mr Bruce continued: ‘Add to this the fact that many of the tax letters our clients have received have been wrong – mainly down to the agency allocating a backdated award to the wrong tax year – and you soon realise why an expert eye is needed to avoid generating unnecessary tax bills.’
‘Since April 2012, the overall limit to lifetime allowance has been reduced by over 30% to just £1.25m. If the value of your pension rights exceeds this figure, it may be useful to apply for the Government’s new protection plan, Individual Protection 14 (IP14) which will allow you to protect your current pension fund value up to £1.5m.’
Cavendish said it had helped many new clients who were previously poorly advised – either because former advisers or accountants did not consider it or did not wish to advise on the complex NHS Pension.
By Robin Stride
All private healthcare providers and Responsible Officers are facing a GMC quizzing to check their doctors are not being put in a position where they could be violating Council guidance on financial and commercial interests.
This includes offering incentives that could affect the way independent practitioners prescribe, treat, refer or commission services.
The GMC is also exploring the possibility of recording doctors’
A new Aesthetics Business Expert Network aims to help aesthetic business owners to find ‘creative and effective solutions to their business issues’.
The group promises free resources, business workshops, networking, insight, interviews, reports and training. It holds its first regional business workshops in the Midlands in June. More information from Pam Underdown at info@aesthetic-bt.com.
commercial interests on the Medical Register.
And it is reviewing the Competition and Markets Auth ority (CMA) report which ‘highlights the potential for conflicts of interest to arise when doctors refer patients for medical treatment’.
The GMC’s measures were announced after the BMJ’s editor in chief Dr Fiona Godlee proposed all UK doctors’ financial interests should be included in a publicly available and searchable register, updated as part of annual appraisal.
She warned that ‘unless the GMC is serious about regulating doctors’ financial conflicts of interest, insidious inducement schemes will continue to reward private hospitals groups and some doctors at the expense of patients, the very people that the GMC is obliged to protect.’
As we went to press, the Federation of Independent Practitioner Organisations (FIPO) was awaiting judgment on its appeal to the Competition Appeals Tribunal (CAT) over the CMA’s requirement
‘Why competition law does not work for doctors’ is one of the topics being explored at the BMA Private Practice Committee’s annual conference on 30 April at BMA House, London.
Other subjects include billing, limited companies, financial issues, CQC registration and inspections. There will be separate sessions for specialists starting out, established private consultants and GPs.
Speakers include accountant Ray Stanbridge; CQC chief inspector of hospitals Prof Sir Mike Richards; PruHealth’s director of clinical risk Dr Keith Klintworth; Dr Robert Hendry of the MPS, and competition law specialist Aidan Robertson QC.
The conference is aimed at all doctors wholly or partly in private practice and those looking to set up. Details: email confunit@bma. org.uk or phone 020 7383 6137.
Aesthetic website The Consulting Room has launched www.cosmetic-recruitment.co.uk to help employers and people looking for work in the aesthetic industry. The website encompasses the recruitment needs for everyone, from aestheticians and cosmetic surgeons to receptionists and sales reps.
Director Ron Myers said that, as
an owner of an aesthetic clinic, he knew how difficult and costly it was to find new staff, be it managers, laser therapists or medical practitioners with experience in this small, but growing, industry sector.
‘The aim is to help reduce the amount of time, difficulty and cost associated with filling those vacancies,’ he said.
The website covers all types of jobs
on publication of consultant fees. AXA PPP was awaiting results of its separate appeal.
Following CAT’s quashing of part of the CMA’s final report affecting HCA having to sell hospitals, and remitting it back to the CMA to reconsider and reach a new decision, the hospital group said: ‘We will continue our discussions with the CMA to ensure a correct analysis of the market.’ For any appeals update, see www.independent-practitionertoday.co.uk
Big opportunities are emerging for innovative and cost-effective healthcare providers across private, public and voluntary sectors, according to market analysts LaingBuisson.
The challenge is to offer a range of specialist services in new ways, away from traditional hospital settings, it says.
In a report called Primary Care & Out-of-Hospital Services, the company says the latent market for reconfigured services could be £10bn to £20bn a year, involving expansion of home healthcare, telehealth and telecare, and disease management.
Other opportunities lay in ‘whole pathway’ commissioning with the prospect of integration of primary, community and hospital services alongside social care.
The GMC annual fee, paid by doctors with a licence to practise, rises by £30 – from £390 to £420 – from 1 April 2015. GMC fees up £30
Honesty pays when faced with a Care Quality Commission (CQC) inspection, according to a consultant who also works as an inspector.
Dr Linda Patterson, consultant physician at The Royal Orthopaedic Hospital NHS Trust, advised hospital managers and doctors at the meeting that it came across much better to tell the truth.
She told them they should say up front when they knew there
were areas of concern with particular issues – and then point out that they had already devised an action plan.
‘If you say you are all-singing, dancing and wonderful, it’s not a very sensible strategy.’
Dr Patterson said the inspection team gather on-site evidence by observing care, what people, carers and staff told them, studying the care environment and facilities, and reviewing docu -
A consultant with experience of three CQC inspections in the recent past urged organisations to start preparing now if they had not done so already.
And he suggested teams support one another by running mock inspections.
Dr Nick Jenkins, consultant in emergency medicine at Wexham Park Hospital, Slough, Berkshire, warned there would be no time to get prepared once they were told the inspectors were coming. And he urged managers to
engage clinicians – especially consultants.
Dr Jenkins said: ‘I think there are way too many people who think that somehow, because they do the things they are expected of them, that somehow that’s outstanding. That is not going to work when the CQC come to visit. That’s what I’ve learned.’
In his hospital, the clinicians were asked in advance: ‘Do you know what you need to know if the CQC is coming to talk to you?’ followed by: ‘Where is the evidence?’
ments and records. She advised that if a hospital or clinic had a ‘vision’, then it needed to make doubly sure that all their staff knew what this was.
Simple things could give a good or poor impression. There were some easy actions that could be taken ahead of a visit – for instance, ensuring there were no empty hand gel containers, decluttering and seeing that noticeboards were updated.
CQC inspections for some big NHS hospitals have brought as many as 80 inspectors visiting at once. Private hospital managers are hoping they visit them by coach because they fear their car parks are too small to cope. Inspectors may be around for four days – and make sudden visits at nights and weekends when hospitals do not expect them.
Tip from consultant physician Dr Linda Patterson, of The Royal Orthopaedic Hospital NHS Trust and an inspection team chairman: Put yourself in the patient’s shoes – ‘What does it feel like to be a patient or visitor, carer or relative in this organisation?’
Dr Jenkins added: ‘It’s no good – and this is something consultants find it really hard to understand – to say: ‘It’s good because I say it is.’ Nor would it wash to say they had always done things a certain way in the past.
He quoted from American lecturer and management consultant W. Edwards Deming: ‘A bad system will beat a good person every time.’
Dr Jenkins also advised honesty. ‘If you tell them at the start, at least it won’t upset them when they find it.’
Doctor managers and hospital representatives were advised to ensure they read the new CQC regulations and its latest inspection reports and then assess how they would fare.
Former hospital group boss Stephen Collier, chairman of the NHS Partners Network, prescribed some needy medicine for those who are anxious about upcoming CQC visits.
He advocated the following ‘well-led organisation’ check-list:
Is there a clear governance struc-
ture that includes the operational head of the organisation?
Are responsibilities and accountabilities clear and effective?
Is there a pro-active approach?
Does the organisation breathe quality and safety or is it just lipservice?
Do things change in response to experience?
Is the culture positive and open – are staff supported and do they feel so?
Mr Collier challenged hospitals and units to assess their culture by
assessing whether it was really open and fair and supported learning and innovation.
He advised managers to check policies and implementation at the sharp end, to monitor levels of challenge and assurance in practice, and to check the front line. What was the care really like?
Staff communication was vital. What did staff really think? Did they believe nobody ever listened to them? Did they think the organisation was really run for profit, not for patients?
CQC inspectors can get it wrong, so check their draft reports for accuracy and ensure corrections before publication. One doctor said he thought mistakes could happen because it appeared report-writers did not start from scratch every time; they pasted in data from reports on other units.
The first CQC report under its new private regime found Nuffield Health Tees Hospital safe, effective, caring, responsive, and well-led.
➱ continued from front page
Fiona Booth, AIHO chief executive, said the CQC’s proposed approach followed the NHS acute trust hospital model, but with some modifications to take account of the differences between them.
These were, notably, alternative governance structures, staffing arrangements, the focus on elective provision and the fact that many independent institutions offered single specialty services rather than a range of more general treatment and diagnosis.
AIHO would continue working with the Private Healthcare Information Network to publish a range of standardised outcomes data for those using the private sector.
An eye care company has been warned by the Information Commissioner’s Office (ICO) to stop sending nuisance text messages or face further action.
Over 4,600 people registered concerns about Optical Express (Westfield) Limited in just seven months.
They reported the unsolicited messages to the mobile phone networks’ Spam Reporting Service indicating they had not given permission for the company to use their details for marketing.
The Glasgow-based business, which has branches across the UK, had been sending out texts that included details of a competition to win free laser eye surgery.
Dr Annabel Bentley has joined independent diagnostics provider InHealth as group executive medical director. She was most recently medical director at Bupa’s insurance division, where she led the introduction of medical reviews for knee arthroscopy and other treatments and was responsible for the development of the insurer’s relationships with over 35,000 consultants and therapists.
Andy Curry, enforcement group manager at the ICO, said thousands of people who had not signed up for marketing services received these nuisance messages.
‘We have issued this enforcement notice as a warning to the company that using people’s data without their consent is not acceptable. Any breach of the notice would be a criminal offence.’
It is a breach of the Privacy and Electronic Communications Regulations (PECR) to send text messages to people for marketing purposes without their prior consent.
People who get an unsolicited text message are being advised to
avoid replying and report the message using the survey available on the ICO website.
Spam texts can also be reported to the network operator by sending them, free of charge, to ‘7726’. The networks are also working to block the worst offenders.
The ICO has published detailed guidance for companies carrying out marketing, explaining their legal requirements under the Data Protection Act and the Privacy and Electronic Communications Regulations.
This covers the circumstances in which organisations are able to carry out marketing over the phone, by text, by email, by post or by fax.
Kent’s first open heart surgery procedure has been carried out at the new £120m KIMS Hospital, Maidstone, featured in last month’s issue. A whole surgery team undertook three coronary heart bypass grafts, led by Mr Inderpaul Birdi. Lead cardiologist Dr Phyllis Holt said bringing patients back to the county was a primary aim of KIMS. More local patients would be able to avoid journeys into London for cardiothoracic surgery in future. Chief executive Jayne Cassidy, working with NHS commissioners to develop future plans, said: ‘Delivering excellence for patients through the NHS framework remains one of our key priorities for the future.’
Doctors go to bankers and lawyers with their financial headaches –and these professionals are increasingly coming back to the medical profession with their problems. The numbers of people treated for workplace stress-related conditions hit a new high last year with a notable rise in young adults from banks and law firms.
New figures show an ‘alarming’
trend, according to Nightingale Hospital, London. Many want ‘talking therapy’ for stress and anxiety.
The hospital also reports a significant increase in patients seeking urgent appointments, with at least 75% of inquirers saying they needed to be seen immediately.
Dr William Shanahan, consultant psychiatrist and hospital med-
ical director, said: ‘I have noticed a 25% year-on-year increase in patients presenting with workplace stress.
‘Often they are from large legal firms and banks, where even at the bigger firms, mental health problems are not managed well. Managers who are the cause of the stress are frequently those charged with investigating the problem.’
BMA council chairman Dr Mark Porter has hit out at the extent of ‘creeping privatisation in the NHS’ since the Health and Social Care Act.
Talking after a BMJ investigation found a third of NHS contracts were awarded to private-sector providers since the Health and Social Care Act came into force, he said: ‘Enforcing competition in the NHS has not only led to services being fragmented, making the delivery of high-quality, joined-up care more difficult, but it has also diverted vital funding away from front-line services to costly, complicated tendering processes.’
Hospital operator Ramsay Health Care UK has signed a ten-year contract with IMS MAXIMS for the latter to provide an open source electronic patient record (EPR) system and clinical modules to improve patient satisfaction and outcomes.
The software suite includes a patient administration system, and solutions for order communications and results, eDischarge, integrated care pathways, theatre scheduling, bed management and clinical noting.
It also offers electronic prescribing, medical device integration, voice recognition, direct booking capability, and a pharmacy system. The technology will be deployed across all the company’s 32 sites, with an average of 1,500 active concurrent users of the system at any one time.
The European Foot Institute has a new UK clinic in Hove, West Sussex. It is headed by orthopaedic consultant Mr Dirk Nowak, who will fly over from Germany once or twice a month to operate on patients. Mr Dieter Nollau, who set the institute up in 2007, has retired due to illness.
By Edie Bourne
Plastic surgeons claim latest cosmetic surgery operation statistics are a clear message to the aesthetic sector – patients are now more inclined to go for the subtle and understated look.
According to the president of the British Association of Aesthetic Plastic Surgeons (BAAPS), people are also doing their research, taking their time and coming for operations with realistic expectations.
Mr Michael Cadier said 2014 figures showed patients were after a refreshed or youthful appearance rather than more conspicuous alterations.
BAAPS believes a more cautious, rational attitude towards cosmetic surgery was reflected in a 9% drop in cosmetic operations since 2013, with some procedures falling considerably more out of favour than others.
‘Tweaked, not tucked’ appears to be the new aesthetic ideal, with
the demand for understated antiageing procedures such as eyelid surgery, face lifts and fat transfer remaining largely un changed –yet more ‘conspicuous’ treatments such as tummy tucks and nose jobs dropping dramatically.
And while breast augmentation kept its top place as the most popular surgical procedure, demand plunged by a quarter (23%).
Despite a boom over the past decade in male surgery, the men of 2014 largely eschewed cosmetic
enhancements, with male figures decreasing by 15% overall.
Nose jobs – last year’s most popular procedure for men – plummeted by as much as 30% and even ‘moob’ reduction sagged by 10%.
Allmale procedures took a tumble, although less dramatically in terms of subtle treatments such as male eyelid surgery, which barely drooped by 4% and became their most popular op.
The ratio of men remained the same, with male patients accounting for roughly one in ten (9%) of all surgical procedures.
Female numbers decreased by 9% overall although surgical liposuction for women rose in popularity by a considerable 10%.
The number of total surgical procedures in 2014 was 45,506 and their order of popularity has shifted for the first time in five years.
The BAAPS welcomed these new trends, attributing them to an increasingly educated public realising that surgery is rarely the quick fix it is widely marketed as.
Liverpool Lord Mayor Erica Kemp opened the city’s new eye centre at Spire One Penny Lane, accompanied by ophthalmologists (from left) Mr Ian Pearce, Mr Austin McCormick and Mr Nicholas Beare. The clinic was renovated by Spire Liverpool Hospital.
Senior doctors have been recommended to snap up new Government savings bonds exclusively available to the over65s.
The 65+ Guaranteed Growth bonds from National Savings and Investments offer 2.8% interest over one year and a fixed annual interest rate of 4% over three.
A saver investing the maximum
£10,000 will earn a £280 return on a one year bond before tax and £1,248 from the threeyear bond before tax.
Specialist financial planner
Cavendish Medical managing director Simon Bruce said after five years of low interest rates these socalled ‘pensioners bonds’ were likely to be popular – particu
Spire Healthcare aims to open a new cancer centre next to the privatelyowned Baddow Hospital in Chelmsford, Essex.
Subject to planning approval, it is hoped to complete the twostorey centre this autumn with two linear accelerators (LinAcs), a widebore CT scanner, consultant offices and consulting rooms and an eightbay chemotherapy suite.
Spire said it worked with ‘a large, supportive group of consultants’ and looked forward to welcoming them to its new facility.
Baddow chief executive Christian Cooper said the development would be a major step in developing plans for a healthcare centre of excellence.
The hospital, opened in 2013, specialises in gynaecology, urology, general surgery, dermatology, podiatry and plastic surgery. It said it would continue operating independently.
A new private GP practice opened at Baddow Hospital this month.
Cancer Partners UK Limited has received a ‘significant funding’ package from The Royal Bank of Scotland to open more treatment centres.
The Hampshire based company, established in 2006 by healthcare specialist investor Apposite Capital, has opened eight purposebuilt centres so far.
larly as they came with a Government guarantee.
‘Typical market interest rates on three year bonds currently only offer around 2.5%, which means the NS&I product provides a 1.5% bonus. However, remember you will pay tax on your interest.’
Investments cannot be withdrawn without penalty.
BMI Healthcare has appointed Jan Thomas as its new NHS commercial director. She joins from UnitedHealth UK. She will focus on developing relationships between the hospital group and its primary care trust partners, aiming to grow the group’s contribution to NHS services.
By a staff reporter
Private doctors in the growing aesthetics market are being offered business help to stay one step ahead of the competition at the Aesthetics Conference and Exhibition 2015 in London on March 7 & 8.
A line up of expert speakers at
The Business Design Centre will share guidance on building, sustaining and growing a practice.
Industry leaders will advise on a vast range of topics including how to make the business more efficient and costeffective, successfully marketing to customers and practising within the current regulatory mar
ket framework. Sessions include VAT, how to create an excellent first impression with potential customers, marketing, sales and branding, and business essentials in the competitive aesthetics market.
There will also be a focus on the use of social media and multimedia content within a business
With mounting pressure on NHS GP services, Clock House Healthcare in Epsom, Surrey, has launched a timely Your Private GP Service.
GPs based opposite the general hospital will offer a named doctor service, urgent appointments and home visits 8am8pm Monday to Friday and 8am2pm on Saturdays.
The company said that with a high proportion of local families where one or both parents commute, it could be difficult to get an NHS GP at a convenient time.
Dr Linda Eve won the title Medical Aesthetic Practitioner of the Year, sponsored by search engine Save Face, at the Aesthetic Awards 2014 in London. She worked in general practice for over 23 years and was a senior partner in Bournemouth, Dorset, until 2005, when she left to fully pursue her interests in cosmetic medicine.
right)
INTENSIVE CARE: BMI The London Independent Hospital has opened a new Level III ITU. There are six beds with five isolation rooms and capacity for three patients requiring high-dependency Level II care. The unit also provides renal dialysis for outpatients needing treatment for other conditions. Critical care manager Sharon Ash said the investment would allow expansion of services for UK and international patients.
A leading sports medicine specialist and physician to TeamGB over the last five Olympic Games is leading the clinical team at a new clinic launched this month (Feb ruary) in partnership with Nuffield Health. Consultant Dr Rod Jaques heads
the Gloucestershire Sports Injury & Exercise Medicine Clinic, based at Nuffield Health’s Cheltenham Hospital.
His key objective is to provide a premium service for private patients who need specialist treatment.
marketing strategy, plus guidance on brandbuilding.
A sales workshop will advise practitioners and front of house staff on how to maximise selling opportunities.
See www.aestheticsconference. com for the full agenda and to register.
Independent practitioners with aesthetic businesses should think of gearing up now for business fireworks in November.
Research by private health care search engine WhatClinic.com found inquiries for quick treatments in the month before Christmas are significantly higher than the rest of the year.
Dermatology clinics and beauty salons with online bookings for lunchtime appointments received 49% and 46% more inquiries in November last year compared to the monthly 2014 average.
Inquiries for zerorecovery time medical aesthetics clinics were also up by nearly a quarter (24%), and facials and makeup inquiries rose by nearly a fifth (17%).
IPL skin rejuvenation tops the list as seeing the biggest rise (263%) in inquiries, with many people opting for three to five quick sessions a week apart in the lead up to December.
Inquiries into facial rejuvenation treatments, as a whole, are up 245%, and laser skin resurfacing inquiries were up by 180% in November.
Cellulite treatment has also seen a surge in popularity in November, receiving more than twothirds (67%) more inquiries than the monthly average for 2014. There was a 206% rise in varicose veins treatment inquiries over the same period.
IN RECENT years, there has been a movement in the private medical profession towards ‘one-stop shops’ of certain specialties, which lend themselves to trading as centres of excellence.
Many specialties are suited to trading in these centres, including urology, gynaecology and orthopaedics.
The centres aim to have all the services that the patient would need in one building for the relevant specialty.
For example, for orthopaedics, this would include not only the various consultants specialising in each area of the body, but also physiotherapists, acupuncture, massage therapy and all scanning equipment.
These centres are now being set up by new entrepreneurs in the market, not just the usual players that we have become used to.
Succession planning
One of the biggest problems that consultants face is planning their retirement and finding someone to take over their practice when they would ideally like to take things a little easier.
These centres provide an ideal opportunity for a consultant with, say, five or six years left to practise to wind down in an organised manner.
Financial advantages
Many of these centres are prepared to pay an established consultant a capital sum for their practices, which, subject to agreement with HM Revenue and Customs, will be regarded as sale of goodwill and so subject to capital gains tax.
This is charged at a lower percentage than income tax. If the transaction is planned properly, one should be able to obtain Entrepreneurs Relief, which means that the effective rate of tax payable on the capital sum would be 10%.
As always with these matters, it is important that specialist advice is taken.
For consultants who are just starting out, joining a centre is a way of fast-tracking the build-up of their practice. The centres attract a wider patient base due to their reputation. The newly qualified consultant will then receive a decent share of referrals quite early on in their career.
Working in a group practice –which is effectively what this is –should reduce overheads regarding premises, staff costs and professional fees.
Furthermore, better terms can be negotiated for other goods and services due to the purchasing power of the centre.
Many consultants do not really like the stress of running their own practice, so, by reversing into a centre, this would be taken care of for them to a large extent.
As long as the centres are well run, this method of working should provide a better experience for patients, and quite possibly NHS patients where the NHS contracts out to these centres.
But there are, of course, downsides which need to be borne in mind:
Depending on the details of the offer, consultants are unlikely to have as much control over running their practices as in the past. For many, this is a bonus, but some may not like it;
Consultants are likely to face competition within their own building;
Consultants will be expected to work as part of a team. Some may relish this, but some may find this difficult, especially if they have been a ‘loner’ for most of their career.
How does the deal work?
Typically, the company owning the centre will make an offer to the consultant to buy out their practice for a capital sum.
In return, the consultant’s practice will be owned by the centre. The consultant will receive a salary and, typically, bonuses based on individual performance. These payments will be taxed at source under PAYE.
Also, potentially, a share of profit from other parts of the operation to which the consultant contributes – for example, scanning – could be paid. Consultants will need to be ready to negotiate.
As well as accountancy advice, consultants considering such a move will also require legal advice.
The advice will need to include due diligence checks for the acquiring and selling companies, dealing with the sale and purchase agreement and tax advice. These centres may not be right for everyone, but they do have a lot of things going for them and, before long, they may well become the norm in the medical profession.
Susan Hutter is a partner at Shelley Stock Hutter LLP
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practice is getting some healthy publicity thanks to co-operation between the Association of Independent Healthcare Organisations (AIHO) and ITN productions.
Fiona Booth reports
AIHO IS DELIGHTED to have partnered with ITN Productions over the course of the past year to create a new programme about independent healthcare.
Independent Healthcare Focus is an in-depth look at a number of aspects of the role and contribution of independent providers to the UK’s healthcare economy.
There are a lot of misconceptions about independent healthcare and we wanted to address these by demonstrating the diversity of providers in the sector and the innovative care they provide.
As the programme clearly shows, our patients are not just the very wealthy or those who are insured.
And the sector offers a range of services to NHS patients. Independent healthcare and a system of care that is free at the point of need can, and do, work very well together.
Naturally, an in-depth programme about any sector can
come with challenges as well as opportunities.
However, having seen a similar programme about another trade body, we quickly agreed that it would act as a useful and important showcase for the diversity and impact of the sector.
We were also impressed by the high quality of ITN Productions’ film-making, and its willingness to meet with representatives from across the sector and to gain a deep insight into its workings, and how it differs from the NHS.
We hope that this insight is reflected in the quality of the different films that make up the programme. We were delighted that ITN presenter Natasha Kaplinsky introduced the programme as well as conducting an interview with myself and providing the links between each of the films.
As well as the important, highquality services the independent
sector provides, we also wanted to inform people about the innovative practices and technologies currently being pioneered by teams at independent hospitals.
This is an area that is perhaps less widely known, but it is a crucial part of the independent sector’s work and Independent Healthcare Focus offers a fantastic insight into this activity.
For example, we see the exciting work that Prof Prokar Dasgupta is doing with robotic keyhole surgery, as well as the ground-breaking techniques the sector is developing to transform the way we care for patients with dementia.
Quality and patient safety and satisfaction are at the heart of all care provided by the independent sector and we were very pleased that ITN Productions were able to speak with some patients that have experienced this type of care.
The Care Quality Commission’s chief inspector of hospitals, Prof
Sir Mike Richards, rightly highlights in the programme that the CQC is absolutely committed to transparency and having a level playing field for hospital inspections, whether they be NHS or independent sector.
This means that patients can be certain that the care they receive from an independent provider is of the highest quality.
Senior producer at ITN Productions, Elizabeth Fisher-Robins, has worked hard with us to achieve this successful programme. She says: ‘It has been great getting to know and understand the quality services the independent healthcare sector provides and the role it plays in the wider health sector.
‘We hope that Independent Healthcare Focus will give viewers a real insight into this sector. We were particularly pleased to secure the involvement of some key health sector stakeholders like Stephen Dorrell MP, former chair man of the Commons’ Health Select Committee, as well as Prof Sir Mike Richards.’
At AIHO, we hope that viewers will agree that we have managed to profile a great diversity of independent providers, showcasing the latest innovations and firstclass care they offer.
We hope that as many people as possible will watch the programme on the AIHO website (www.aiho. org.uk/independent-healthcarefocus-goes-live) for an in-depth look at how the sector works.
Ultimately, we want to give patients confidence in the care the sector offers and to help people understand the real contribution independent healthcare makes both to supporting the NHS and the wider UK economy.
Fiona Booth is chief executive of the Association of Independent Healthcare Organisations (AIHO)
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2014 marked ten years of Choose and Book, the online appointment service for NHS patients.
But although it has been criticised by commentators and users, the 10th anniversary highlights a worrying gulf in technology innovation between the public and state sectors.
In this article, Peter Connor (right) argues that the independent sector has failed to keep pace with a seachange in consumer behaviour in the last decade
PEOPLE ARE increasingly choosing to access services, including essential medical treatment, in a way which is most convenient for them. Private-sector providers ignore this trend at their peril.
From initial suspicion, many of us have adopted online shopping with wholehearted enthusiasm. It has taken longer for the web to become a mainstream channel for buying services – some still prefer the human touch – but there can be few people who have not tried internet banking, booking a holiday or flight, buying a cinema ticket or reserving a table in a restaurant.
And, more recently, on-demand mobile app-based services such as Uber (an app for ordering taxis) have allowed consumers to access amenities via their smartphone. Now on-demand apps are even spreading to the world of healthcare.
In the US, a service called Medicast allows users in Florida and California to request a visit via their smartphone from a private doctor to their home, office or hotel room.
Meanwhile, in the UK, the Babylon healthcare app was launched in April 2014, giving patients online access to a health professional, including consultants, who can suggest a diagnosis,
advise them to see their GP or a specialist, or send a prescription to a pharmacy in the patient’s neighbourhood. The service is even registered with the Care Quality Commission (CQC).
There is currently a real buzz surrounding the potential uses of technology in the health sector.
In September 2014, The King’s Fund, a leading UK health thinktank, attracted more than 500 delegates to its fourth International Digital Health and Care Congress and looked at the latest ideas and innovations. These ranged from Apple’s new smartwatch – which records the wearer’s daily activity and heart rate – to robotic surgery.
But access to specialist healthcare is an area where technology has already made a real difference.
NHS Choose and Book was the public sector’s first attempt at creating a central appointments service back in 2004. It enables patients to make an appointment at a time and at a hospital which suited them and to compare providers quickly and easily via a link to NHS Choices which provides ratings and patient feedback.
According to Beverley Bryant, director of Strategic Systems and Technology for NHS England,1 up ➱ p14
to 40,000 patient referrals are made through Choose and Book every day and over 40 million bookings have been made through the system to date.
Of course, Choose and Book is far from perfect – paper referrals are still being used – and it will soon be replaced with a new NHS e-Referral Service, scheduled for Spring 2015, which is intended to increase functionality and improve users’ experience.
It will be interesting to see how the new service is received, but from the perspective of the independent providers, this should be a wake-up call.
To put it another way, there is something missing in this picture of progress.
Access to treatment in the private healthcare sector is still arranged for the convenience of consultants and hospitals rather than patients.
Indeed, from the time they are referred by their GP, the private patient is obliged to take on all the leg work and phone calls –with help from their private medical (PMI) insurer, if they have one – from researching the hospitals and consultants, to making an initial appointment and potentially arranging follow-up appointments for tests and treatment.
According to the Competition and Markets Authority’s (CMA) final report,2 the top reasons for people to purchase private healthcare are:
Reduced waiting times;
Greater availability of appointments;
Quality of accommodation;
Access to a named consultant.
However, if we cannot offer patients an equivalent appointment booking experience to their NHS counterparts, we risk undermining our traditional selling points, which are flexibility and convenience.
The private healthcare sector is a competitive market, which means centralised services such as appointment booking do pose a greater challenge than the centralised public sector. But the latter has demonstrated that the technology exists and it is achievable if we focus on the needs of our consumers.
Healthcode has produced a roadmap which sets out the different types of information that should be available to potential patients.
The essential components include:
A basic directory of services: who does what, where and for whom . . . and when;
A common language or terminology – a consistent way of describing the services available in a way the consumer can understand;
Reliable, understandable Quality and Outcomes information, that is easily comparable to alternative options, both independent and NHS;
Feedback from other patients;
Information about charges for consultations and treatment –and whether this is covered under their policy.
In fact, the groundwork is already underway, even before the CMA published its information remedies. This is thanks to the work of the Private Healthcare Information Network (PHIN), which publishes hospital episode statistics – using Healthcode’s data processing power – enabling patients to search for a hospital by location and procedure.
I am confident that PHIN, as the newly appointed information organisation, can effectively echo the work of the Health and Social Care Information Centre (HSCIC) in the NHS, which sets data standards, collects information and helps healthcare organisations improve the quality of the data they collect and send.
What is needed now is a concerted effort by healthcare providers and PMIs to raise the status of IT within the sector.
For example, I would like to see planning and investment in
information technology receive the same priority as investment in accommodation, equipment and staff; and for industry leaders to become stakeholders in their organisation’s IT development and ambassadors for change.
Most importantly, IT development strategies must focus on improving patients’ experience, as well as organisational networks and hardware.
For our part, Healthcode is ready to work with providers to drive forward the technology at their disposal in the interests of patient choice and accessibility.
This includes helping to coordinate and develop a central appointment booking service which offers the same functionality and convenience as the next generation NHS version.
The internet did not transform our lives immediately. We all remember the interminable wait for a page to load when the worldwide web was in its infancy. The trouble is, that the independent health sector’s IT sometimes appear to be progressing at the same glacial pace.
If we don’t show we are focused on meeting the expectations of our patients, there is a risk that they will vote with their feet
We need to adjust to the patient as a consumer who has become accustomed to convenient, online services.
It is not too late for us to catch up with this new normal, but if we don’t show we are focused on meeting the expectations of our patients, there is a risk that they will vote with their feet.
1. The future of NHS England’s Choose and Book programme; NHS England, 12 May 2014. www.england.nhs.uk/ 2014/05/12/choose-and-book.
2. Private Healthcare Market Investigation Final report; CMA, 2 April 2014.
Peter Connor is managing director of Healthcode
See ‘Figuring out how to gauge quality’, page 16
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In our last issue, Independent Practitioner Today reported that the Private Healthcare Information Network (PHIN) had been approved by the Competition and Markets Authority as the information organisation charged with publishing performance measures and fees for independent hospitals and consultants in private practice. Matt James (left) outlines what to expect next
PHIN HAS started 2015 with renewed energy and focus. We spent much of last year working towards approval as the Competition and Market Authority’s (CMA) information organisation and now we have won the role, it is time to turn our full attention to delivery.
It is quite a task.
Over the course of 2015, we must somehow reach out to around 12,500 consultants and get them involved. So, firstly, let me say that we are very grateful to Independent Practitioner Today for helping us make a start.
As a quick reminder from previous articles I have written in this journal, the CMA’s remedies require that all private hospitals in the UK – including day surgery centres, cosmetic specialist hospitals and NHS private practice units – collect and send to the information organisation detailed data in specific formats.
Information required
These cover 11 mandated performance indicators, from activity levels through readmission rates to patient reported outcome measures (PROMs) and patients’
satisfaction rates (see Independent Practitioner Today, November 2014 for the full list).
They must support publication at hospital and consultant level, meaning that you will probably want to get involved in making sure that data produced about you, your hospital and your specialty is accurate, fair and meaningful.
Publication across the whole range of measures is required by April 2017, which, in practical terms, means that hospitals will need to be collecting data in a compliant format from January 2016, so that we have a full year to
measure. Volumes are already low in many areas – anything less than a year just is not enough.
That leaves a fair bit of preparation work for hospitals to do in 2015. Key tasks for most will include implementing better coding for private patient records to match NHS standards, and implementing collection of PROMs for private patients.
Both of those are good news for consultants: better coding means the ability to apply case mix standardisation and risk adjustment to performance measures for the first time, while PROMs will
PHIN will not advocate the publication of meaningless or unfair data: by no means will every measure be applicable for every specialty and consultant for every procedure
need to be extended beyond where the NHS has taken it to be able to report outcomes for individual consultants.
If done right, PROMs offers an affordable and attainable way to differentiate from the NHS. Those two changes will give you new tools to demonstrate the quality of your practice.
Case mix adjustment is, of course, part of ensuring that information is fair and representative of your practice. Along with related concerns such as sample sizes for lowvolume procedures and parttime or new practitioners, this is one of the two areas on which I now expect a thorough grilling when I speak with consultants, particularly at professional meetings.
The use of ICD10 diagnostic coding and related tools such as the Charlson score will be a start.
We cannot know just how effective they will be until we have got a body of data. You may already record other factors such as body mass index or ASA score that could also be taken into account, and we will have to work out how to gather and use such information.
The relevant factors may well vary by specialty.
Frankly, on low volumes and other such concerns we do not know what the answers are yet. We will need to both look at data and work with experts, from specialty associations to statisticians, to find the best approach.
What I can say is that PHIN will not advocate the publication of meaningless or unfair data: by no means will every measure be applicable for every specialty and consultant for every procedure.
But we must work together to find ways to give every consultant some opportunity to demonstrate the quality of their practice through comparative data.
The second area of common concern is around PHIN’s governance. Consultants often challenge me about the influence of the insurers (very little, to date) and about members of our board.
I understand the concerns, but the CMA has ensured that our board will end up balanced and broadly representative of the sector, with two nonexecutive direc
The consultants in the room understood clearly how a better product for patients might also mean a healthier practice for them
If you would like us to speak with the consultant body at your hospital, your professional association or conference, please get in touch by emailing matt.james@phin.org.uk
The BMA’s Private Practice Conference (London, May)
The GMC/Independent Healthcare Advisory Service revalidation group (London, January and May)
The British Orthopaedic Association (BOA) board (London, June)
The Federation on Independent Practitioner Organisations (FIPO) board (London, July)
King Edward VII Hospital’s medical advisory committee (MAC) (London, July)
National Joint Registry MAC (London, August)
The BOA Annual Congress (Brighton, September)
The British Orthopaedic Foot and Ankle (BOFAS) Annual Scientific Meeting (Brighton, November)
Nuffield Health National MAC Chairs’ Conference (London, November)
The RCSEng Cosmetic Surgery Interspecialty Committee, and the working group on Clinical Quality and Outcomes (London, ongoing)
tors of their choice included to guarantee fair play.
Now that we have an official role, there will be a great deal of scrutiny and transparency applied to the way we work and I hope that any remaining concerns will ease over time.
In late November, I was delighted to be invited to speak at Nuffield Health’s National Medical Advisory Committee (MAC) Conference, with the opportunity to address a mixed audience comprising mainly MAC chairmen and hospital directors.
Invigorating conference
My talk was one of four or five aimed at helping attendees to understand the CMA’s remedies from various angles – legal, regulatory, clinical and commercial in addition to information – to be able in turn to help their colleagues back in the hospitals.
It was an invigorating day. Nuffield Health’s commitment to helping their consultants to understand and respond positively to change was bettered only by their focus on the patient, both as patient and customer, which I found exceptional.
I believe that the consultants in the room understood clearly how a better product for patients might also mean a healthier practice for them.
One of the MAC chairmen
raised the issue of how he might produce effective wholepractice information to support appraisal and revalidation.
I was happy to say that PHIN will very soon launch a secure webbased system through which consultants will be able to view all of the data we have collected from hospitals, NHS hospital episode statistics, clinical registries and audits, Friends and Family Test, PROMs and elsewhere.
You will be able to understand what data is available currently about your practice and, I hope, work with your hospitals and professional associations to improve it until it is accurate and valuable.
I said that PHIN would be looking for volunteers to pilot and test the system with, and some of the plastic surgeons present immediately jumped in.
Moments later, everyone in the room had volunteered to take part. That more than made my day.
If 2015 carries on in the same vein of enthusiastic participation in the endeavour to improve the information we can make available, and in doing so make private healthcare work better for everybody, then we can all look forward to a good outcome.
Matt James is chief executive of the Private Healthcare Information Network
Statistics suggest as many as 40% of married independent practitioners end up facing a divorce. Apart from the emotional pain, the financial implications for many are huge.
Mandy Keane and Andrew Yonge (pictured below) highlight key issues to consider when dividing assets on divorce
AS MANY independent practitioners sadly know only too well, untangling a marriage that is ending in divorce is rarely straightforward.
Dividing chattels and financial assets such as cash and share portfolios may be relatively easy, but dividing the equity in valuable assets such as the former marital home and the parties’ pensions can require far more detailed analysis.
The disposal of one’s main residence is generally exempt from capital gains tax (CGT). However, the family home will cease to be the main residence of the spouse or partner who leaves.
If the property is subsequently disposed of more than 18 months after one party leaves, then part of the gain will be assessable for capital gains tax.
The exact amount of the gain subject to tax will depend on the length of time that has elapsed since the separation – above the
18month limit – compared to the entire period of ownership.
The rule whereby the proceeds from the sale of one’s main residence is taxfree can be preserved following a divorce using a socalled Mesher order.
This allows the family to remain in occupation, postponing the sale until a specified event such as children reaching a certain age or ceasing fulltime education.
Such an arrangement is treated as a trust and it should be possible to avoid CGT on the subsequent sale.
With regard to inheritance tax, no charge should arise on the creation of the Mesher arrangement, as transfers for family maintenance are exempt. However inheritance tax needs to be considered when the agreement is wound up.
Where property of any type is transferred from one party to the other on separation, stamp duty land tax is not payable, even where the acquiring spouse or civil partner takes over a mortgage.
Assets can be transferred between members of a married couple or civil partnership without incurring a capital gains tax (CGT) liability, as is widely known. This applies so long as the couple is living together at some stage during the tax year. For example, if one party moved out of the marital home in, say, June 2014, any assets transferred between them in the year to 6 April 2015, would not be liable to CGT at that time.
Thereafter, transfers of assets pursuant to divorce may give rise to a CGT liability. Care must therefore be taken with second homes and other sizeable assets if these are to be disposed of some time after the divorce.
Pensions are unlike other investments such as cash and shares, so if the parties wish to share pensions as part of the divorce settlement, expert advice is required both pre and postdivorce to help the couple and their legal advisers through the options.
The couple may decide to use a Pension Sharing Order or earmark part of the pension for the spouse. Alternatively, the couple may offset pension benefits with other assets.
Pension sharing is often looked at in one of two ways. For example, it may be agreed that one party should receive, say, 40% of the pension fund, but it is important to consider how much income that would generate in retirement for both parties.
Conversely, if the agreement is that one party should receive an income of, say, £10,000 a year in retirement, what proportion of the current pension fund does that require to be shared by way of a Court Order? A report by a suitably qualified and experienced expert will help the parties with these difficult questions.
For members of a defined benefit (final salary) occupational pension scheme such as the NHS Pension Scheme, care is required, as these often allow the exspouse to become a member of the scheme if a Pension Sharing Order is applied.
It is quite possible that one of
the exspouses has not had to deal with pension investments before, in which case they may benefit from specialist advice to help guide them through the options following a Pension Sharing Order.
Senior medical practitioners who have been members of the NHS Pension Scheme for many years will, as a matter of course, now have to consider the implications of both the Annual and Lifetime Allowances each year, as both these allowances have been reduced over recent years.
The Lifetime Allowance is currently set at £1.25m, while tax relief is allowed on pension contributions of up to £40,000 per year.
These allowances will also need to be kept in mind when considering how best to share any pensions as part of the settlement.
These investment thresholds will be important in the post
divorce period if the practitioner is trying to rebuild their pension pot.
Pension rules have been through many changes in recent years. Consequently, practitioners should regularly review their pension savings and potential benefits, but especially during and after divorce, to ensure a fair outcome for both parties. Appropriate advice is therefore vital.
Mandy Keane is a partner and Andrew Yonge a senior consultant at accountancy and financial services group Smith & Williamson
Disclaimer
By necessity, this briefing can only provide a short overview and it is essential to seek professional advice before applying the contents of this article. No responsibility can be taken for any loss arising from action taken or refrained from on the basis of this publication. Details correct at time of writing.
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HCA’s The Lister Hospital has launched Project World Class in its drive to deliver a five-star hotel service. Chief operating officer Suzy Jones (left) shares her dream with Independent Practitioner Today, while Concetto Marletta (right) describes the training involved
CUSTOMER SERVICE is integral to the reputation of any organisation, whether it is a corner shop or a world-leading private hospital.
High-quality customer service builds reputation, increases the chances of repeat business and provides a competitive advantage.
In an aim to further build its new and existing customer relationships, HCA’s The Lister Hospital in London recently embarked on an exclusive five-star training programme: Project World Class.
Delivered by Totally Indispensable, experts in international luxury hotel service, Project World Class aims to differentiate The Lister Hospital from its competitors through its standards of service.
A five-star hotel service is the next stage in providing luxury hospital care and The Lister Hospital is the first to take on the challenge.
Suzy Jones, the hospital’s chief operating officer, explains why they decided to take on the challenge: ‘It is our vision to make The Lister Hospital the hospital of choice, and to do so we need to ensure all patients leave feeling positive and happy about the experience and the care they received.
‘We want them to tell others of the exceptional service and excep-
tional care. The effect on staff morale and positivity is equally amazing.
‘I met with Totally Indispensable just over a year ago when I was looking to raise the standards of service within the hospital to that of a five-star hotel. The brand is widely accomplished in training London’s top hotels and high-end brands, but has never previously worked within a hospital.
‘It was an exciting concept for both of us. We spent several months working together observing the way in which we work and areas where we may want to focus.’
Concetto Marletta, founder of Totally Indispensable, says the training took eight months from the assessment to the final result.
‘The initial assessment began with a mystery patient at the hospital, who stayed for a week and allowed us to observe the way in which a patient is likely to be treated.
‘Simultaneously, one-on-one interviews and focus groups with the management team and the employees were conducted, as well as surveys to assess exactly where the hospital currently stood with regards to its customer services.’
Ms Jones continues: ‘Following The
the assessment, the company sent us a lengthy report based on their observations and interviews with both the managers and the staff.
‘This consisted of a 128-page report outlining the strengths of the hospital and the opportunities to improve, especially with regard to the need to promote consistency in the provision of services. From that moment on, Project World Class was born.’
According to Mr Marletta, the project was one of refinement and sophistication. ‘We mapped out the exact course of a patient’s journey to include all potential interactions and measure the parameters of achievements. We then produced a manual of service standards for the hospital to enable them to achieve consistency in their customer service.
‘The training programme itself
involved educating all staff of the hospital on the importance of the change to reduce resistance and promote the transformation. The hospital had to design a service that individualises each single patient.
‘It has all kinds of people coming through its doors – from celebrities and aristocracy to middle-class parents and workingclass people – and part of the training is to know how to deal with each of these people.
‘Other defining parts of the training involve teaching the employees how to always be present to the patient, in ways that vary from their approach to the patient to their approach to their colleagues.
‘Explicit measures such as looking and sounding the part also were taught and implemented, involving grooming, body language and use of language in the hospital.
‘These were discussed and rehearsed during interactive, roleplay exercises and were designed to cater individually to each department – from the nursing department to the catering department to the pharmacy.
‘The Lister Hospital’s standards were divided into two categories: the Detailed Standards of care, which include black and white options on how to behave, with specific time-frames for each department, and the Core Standards of care, encompassing the pillars of standards for the hospital to acknowledge and follow at all times.’
After the official training ended, there was ongoing training and updates to maintain the momentum and keep the project alive.
It is expected that the programme will not only give the hospital the opportunity to learn how to do what it already does better but also to help it to recognise how the staff can add special touches by adjusting their behaviour in the way they deliver services and helping them to learn how to create memorable experiences for everyone they interact with.
‘Our aim is not only to attract new patients, but also to acknowledge and empower the excep -
Our goal is to create memorable experiences in every interaction for the patient
tional colleagues that we have here.
‘We can’t afford to stand still in such a competitive market –although we’re all doing a fantastic job already, there is always scope to raise the levels of service offered by the hospital, mirroring the levels of hospitality offered by any international five-star hotel.’
Ms Jones says: ‘Our goal is to create memorable experiences in every interaction for the patient; going the extra mile, being proactive in all dealings with patients so we anticipate their individual needs. We can also get the basics right just by being polite, well mannered and showing respectful behaviour – that is the service we need to be constantly applying.
‘We want to give our patients the best experience we possibly can, both with the consultants’ level of expertise from London’s top teaching hospitals, our stateof-the-art clinical setting and equipment and truly individual care, attention and service.
‘When new staff or temporary staff do not act or meet the standards we have created, we guide them to these standards, as we do not want to see the standard drop.
‘These core standards are now set and are in a format that allows teaching and rationale at meetings or staff review sessions. Once we begin to embed the programme, our aim is for patients to insist that their GP send them to The Lister Hospital and staff members are queuing to work here – that’s the dream.’
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Watch your language! Communication – in a word – is the key for independent practitioners when marketing, says surgeon Dev Lall
ONE OF the most difficult things for an expert in any field to learn is how to communicate.
Not how to communicate to other experts in the same field, because that is very easy. That is what technical language – jargon – is for, and it fulfils that role very well.
No, the problem is how to communicate to other people not in your field, particularly the general public.
And when the subject in question is healthcare, that skill is, of course, very important indeed, because it really does matter that the person we are talking to understands the information we are trying to impart to them. It matters because we need
It really does matter that the person we are talking to understands the information we are trying to impart to them
them to understand what is happening so they can give – or withhold – consent for investigation and treatment of their condition, as well as take an active role in decision-making and managing their conditions in the future.
Not only that, we have to communicate in a sensitive and empathic way information that is sometimes very bad news.
Yes, it can be hard for experts and professionals like doctors to communicate with people who are not medically qualified. Because people have differing levels of intelligence, differing levels of education and also differing expectations.
Even the best of us will occasionally make a mess of it and fail
to get our meaning across to patients.
The obvious question, of course, is what relevance has any of this to marketing and promoting your private practice? The answer is: everything.
Why communication matters
Now, I’m not going to talk about good communication to avoid complaints, allow informed consent and all those other things that make communication so important in medicine.
You know these things already and there’s nothing I can add that you don’t already know and don’t hear repeatedly from the medical defence organisations.
But why communication matters in the context of marketing your practice is that communicating effectively what you do through the printed or spoken word is the only way you have of getting patients to come to your practice.
Because all marketing is the presenting of information from the provider of the product or service to someone who might be interested in the product or service in such a way as to persuade them to buy it. In short, marketing is about persuasion.
The three-legged stool of marketing
Dan Kennedy talks about the three-legged stool of marketing to illustrate the point that if you don’t get the correct message out to the right market via the correct media, then the stool falls over. And so, too, does your business in short order.
So, for an ophthalmologist looking for patients with cataracts, the approach might be:
Message – ‘I treat cataracts quickly and painlessly’;
Market – ‘Men and women 65+ years old’;
Media – magazines for older people, for example.
Furthermore, there has to be a message-to-market match. There’s no point trying to sell pork sausages to vegetarians, even if they are free-range, organic, awardwinning and the tastiest sausages ever created – because you’re not going to sell any.
So, that aside, what I want to focus on here is the message or communication leg of the stool.
Vocabulary and structure
The pre-requisite of good communication, of course, is to be able to get our message out in a way that is understandable and this is often where people fall down immediately.
Depending upon whom you believe, the average reading age of an adult in the UK is said to be between seven and 11 years old.
The exact age is irrelevant, of course, but this is extremely useful as a guide. You need to be quite sure that your content is accessible and understandable to an educated intelligent 9- to 11-year-old child.
The three-legged stool of marketing illustrates that you will fall over if you only manage to tackle two legs successfully
Another useful rule of thumb is that the word and sentence complexity should be what you might find written in the pages of The Sun newspaper – it’s written that way for a reason.
With that in mind, it is easy to see why so many of us struggle to effectively convey information to our patients, both in person as well as in writing on the pages of our websites, patient information leaflets and so on.
Even if the patient is highly educated and intelligent, they are unlikely to be as knowledgeable about medical matters.
style
The next hurdle is how we write. Too many of us have been conditioned through writing scientific papers and research in journals to write in the third person singular.
And while this is both traditional and adds clarity in academia, no one ever speaks like that in the real world. And to Joe and Julie public, it is and sounds completely alien and dispassionate, both of which are real killers when it comes to persuading people to take action.
The solution, though, is very easy – almost childishly simple. The solution is to write like you speak.
But writing like you speak takes effort. And because we’re not used to writing that way, it feels ‘unprofessional’ and too ‘chummy’ or ‘familiar’ to us. And while it CAN
be these things, it usually isn’t at all. It’s just that we’re uncomfortable with it. The best way of overcoming this internal resistance is with practice.
Writing persuasively – the AIDA formula
A – Attention; I – Interest; D – Desire; A – Action.
This acronym is one wellknown to marketers and copywriters as a useful, practical way to write persuasively. It’s not arbitrary, but a logical progression of interaction which has been proven repeatedly to work.
You should use the AIDA formula to help structure the content of your website, adverts and other marketing material.
Attention
Clearly, this is important as you want to catch the reader’s interest or they won’t read the rest of what you have to say. And if they don’t read what you have to say, then they won’t do what you want them to do – to book an appointment to see you.
Interest
You need to build on and support the proposition you made to grab their attention so you keep them reading what you have to say and start to see how it could be relevant to them and help them with their problems.
Communicating effectively what you do through the printed or spoken word is the only way you have of getting patients to come to your practice
Desire
Your aim here is to get the reader thinking about what you’ve had to say, mentally put themselves in the position you describe and to want the treatment that you are offering.
This is critical. You have to tell them how to get the result they now desire. Without this, the rest has all been a waste of time. So a refractive eye surgeon might talk about how you could: ‘Finally throw away your old glasses’ (Attention); About being ‘more self-confident and attractive to members of the opposite sex’ (Interest); ‘Here at Smith Eye Surgery we’ve done more of these procedures than anybody else and have thousands of delighted patients’ (Desire);
‘Pick up the phone and call us on 01230 456789 right away to book an appointment’ (Action) Yes, it looks crude and in need of polishing, but I hope this illustrates how it all works.
Practical application of our new-found knowledge OK, so it all sounds very basic, but having gone on this whistle-stop tour, I want to tie this together and explain how and where all this should be practically applied. In short, everywhere. Wherever and however you communicate, the approach
above is extremely useful and powerful. It allows you to convey information in an effective, persuasive manner that makes you look like a human being, not like an out-of-touch academic.
I suggest that once you’ve read and re-read this piece you re-evaluate all your communication and content – on your website, patient information leaflets, video scripts, interviews and so on – through this prism.
When you do this, you will see obvious areas where accessibility and understanding can be improved enormously.
And it’s not hard to see how doing this will make a significant difference to the number of patients who engage with what you have to say on your website and in your adverts – and so go on to become paying private patients.
If you are not full-time in private practice, then it will also positively impact your NHS work and the levels of patient compliance with treatment that you offer them.
Conclusion
I hope I have demonstrated the implications of this approach and its practical value too, both in your ordinary day-to-day communication with patients as well as in terms of your private practice.
But although simple, it’s not easy, because we’ve been trapped in a very artificial way of communicating until now.
Remember, there are four stages of learning:
1 Unconscious incompetence. You are rubbish at it, but you don’t even know you are rubbish at it.
2 Conscious incompetence. You are rubbish at it, but recognise you are rubbish at it.
3 Conscious competence. You are good at it, but it is still hard work and you have to think about it.
4 Unconscious competence. You are good at it, but now it comes naturally to you.
And the only way to progress through these stages is practice.
Dev Lall (left) is an upper-GI surgeon and runs a specialist private practice consultancy www.PrivatePractice Expert.co.uk
Business success for private clinics calls for appropriate financial support.
Mike Nolan (left) considers the funding options available to help drive practice growth and expansion
THE PRIVATE healthcare sector is diverse and vibrant and independent practice can be extremely rewarding professionally and monetarily. But there needs to be prudent financial management to back it up.
Revenues are offset by significant overheads, from staff remuneration and premises to IT, insurance and medical equipment costs. Tough decisions are often needed about how to best establish and expand operations.
Medical equipment is invariably highly specialised and frequently expensive, whether investment is needed for state-ofthe-art diagnostics or radiosurgical equipment, CT scanners or laser treatment machines.
While there is improved liquidity in the banking sector, the fallout from the recession has made it more challenging to raise buying finance for many practices.
leasing solution
For many, an upfront capital outlay may not be a viable option. Despite the strengthening economic recovery, reports suggest bank lending is still anaemic.
But alternative options are available and, invariably, equipment finance can be secured, allowing money to be retained in the practice’s cash flow.
Leasing, rather than buying and paying upfront, will often prove the most affordable option, spreading equipment costs over a
three- or five-year period through regular monthly payments.
What’s more, a cash flow analysis will highlight potential returns on investment (ROI) – and these can prove substantial. A lender with good knowledge of the market will be acutely aware of any potential ROI that new equipment may generate and will therefore be more likely to provide approval.
In certain cases, the equipment will be in place before the borrower has even been required to make a payment, allowing them to immediately reap the rewards from greater revenue streams.
And making timely, regular payments can also help to build a strong credit history.
Operating leases, regularly arranged for NHS organisations, can also be taken by private clinics – enabling equipment to be financed without being reported on the practice’s balance sheet. Instead, they are treated as expense items in the profit and loss account and so are not regarded as liabilities that might affect future borrowing.
Operating leases are also useful if a practice needs equipment to be frequently updated or replaced, with the lessee having use but not ownership of the equipment – the residual value belongs to the lessor.
A practice’s hard assets, such as advanced diagnostics or aesthetic
medical equipment, have a clear value that can be exploited to release working capital.
If an asset finance specialist believes an organisation’s business plan is sound and the debt can be adequately serviced, it will lend money against existing equipment without the need for further securities.
Typically, lending will be arranged based on a fair valuation of the equipment and the amount of debt serviceable.
In the event this debt cannot be serviced, the practice will be given the chance to sell the equipment itself, ensuring a fair and adequate price is received.
This kind of arrangement can even apply to equipment which is not unencumbered and still subject to existing finance terms.
In this case, the financier can lend money to spread the payments over a longer term, reducing monthly outgoings and providing more financial flexibility.
This might also be a viable option when attempting to fund equipment which has limited resale value, such as an office phone system.
In these cases, it may prove difficult to borrow money for the equipment itself, but the finan -
cier may decide the potential ROI from implementing such equipment makes it a safe investment.
As a result, finance may be offered with a charge on the company’s hard assets, allowing cash to be freed for the purchase of the new equipment. By using cash, it may even be possible to negotiate a further discount with the supplier.
In certain cases, acquisition – from a retiring specialist, for example –may represent the best option to achieve expansion plans and increase market share swiftly.
This would include buying a property’s lease or freehold in addition to equipment and facilities. It may also include a practice’s goodwill, although restrictions apply to the sale of goodwill for those GP readers of Independent Practitioner Today who hold NHS contracts.
There is no shortage of opportunities here either and the necessary funding can be raised against the acquiring practice’s book debts, hard assets or, occasionally, even the soft assets.
Such funding is two-fold. First, the acquiring practice must find the necessary finance for the deal itself and then secure sufficient working capital to ensure the move does not end up putting both operations at risk.
This extra working capital could be used to cover relocation costs, bringing the two practices under one roof to benefit from greater economies of scale.
Usually, such expenses would be drawn from cash flow, but, by borrowing against assets, this situation can be avoided, providing the financial flexibility to cope with any issues arising from the new venture.
Mike Nolan is managing director of Academy Leasing
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Free ‘walk-in’ clinics at a private hospital are bringing patients and consultants together. James Smith (right) reports
WE STARTED a series of free specialty evenings as a way of promoting our new outpatient suite last year.
These have been held on Fridays and are open to the general public for free and informed advice.
Spire St Anthony’s Hospital, in Cheam, Surrey, opened the suite as part of the newly built Raynes Park Health Centre in south-west London.
This means that residents from surrounding neighbourhoods such as Wimbledon and Kingston can have access to our services.
The evenings run as a two-hour walk-in clinic at which patients have the opportunity for a one-toone, 15-minute consultation with a consultant. Each evening has a theme.
We have run evenings on hip and knee problems, weight loss and blood pressure, as well as stomach and gastric problems.
Patients are asked to ring in advance to book their place, as numbers are limited. At the evening focusing on blood pressure, a nurse took patients’ blood pressure in the waiting room ahead of their consultation.
The evenings are well attended and embraced by consultants, who provide their services free of charge.
Feedback has been so positive from patients that we are now planning to continue these evenings during 2015.
So what do consultants think of them?
Dr Pritash Patel, a consultant gastroenterologist, describes a recent
evening on stomach issues as ‘a great chance to help out in a stress-free environment’.
He says: ‘No GP referral was needed; patients I mightn’t have otherwise met could discuss whatever they wanted. It was definitely worth doing. Anyone asked to do it should go in with an open mind.’
Similar sentiments were echoed by consultant gastroenterologists Dr Asif Mahmood and Dr Anton Bungay.
Dr Mahmood felt that the exercise was beneficial, finding that virtually all of the patients had obviously thought about this carefully and had written down several questions to ask. ‘It was a pleasure to be able to reassure many patients, but also advise on appropriate tests where needed.’
Dr Bungay was surprised by the high level of turnout.
He says: ‘It was refreshing to see how grateful these patients were for just a 15-minute chat and some of them had questions that had been bothering them for a long while.
‘We were able to answer them easily and quickly. I got the feeling there is a big unmet need out there for this sort of interaction where patients can ask a specialist questions they may not be able to take to their GP.
‘It is something I have not tried before, but would be happy to try again.’
For several years, we have run regular free awareness evenings for the general public at our con-
ference centre based at the main hospital.
These feature a guest speaker, a consultant who speaks on a specific topic and, most importantly, people can ask questions after the talk.
For example, consultant ophthalmic surgeon Mr Sanjay Shah gave a talk on the prevention and early detection of eye disease to mark National Eye Health Week.
Roger Walker, a consultant urologist, spoke on prostate cancer to mark the Movember campaign during the month of November. These are always well attended with an average audience of 80.
Our reason for holding these events is not just to promote our services, but to improve patient services and reduce GP waiting times – in other words, to work in conjunction with the NHS.
We must put aside our own political views on private/public sector balance and place our collective efforts towards the effective management of patients.
Most private providers are great supporters of the NHS and see the private sector as a crutch for the public sector to support itself.
We must recognise that neither the NHS nor private health sector can survive without one another: the relationship is symbiotic.
We in the private sector must seek out initiatives to support the future of the NHS and put aside self-interest to achieve a sustainable common goal.
James Smith is marketing manager at Spire St Anthony’s Hospital, Cheam, Surrey
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The demand for financial forecasts continues, but Simon Bruce explains why senior doctors should simply ignore the noise
THIS TIME of the year always brings the seasonal ritual of economic predictions for what may lie ahead, but few of the forecasters admit that their calculations for the year before turned out to be little more than educated guesswork.
As we see year in, year out, the one certainty is that many predictions will be wrong.
How many times did you hear that interest rates would ‘definitely’ rise in 2014? Or 2013, for that matter?
While these economic forecasts can make entertaining reading, acting upon the information can
be a more serious issue. Investors who try to beat the market by moving stocks ahead of a perceived negative or positive event can fare far worse than if they had simply ignored the noise.
This time last year, Citigroup predicted the FTSE100 would reach 8,000 in 2014. Although it did nearly achieve its 6,930 dotcom record from 1999, such large-scale forecasts were typically wide of the mark.
Despite these previous overoptimistic claims, the same strategists are now predicting that
the index will rise to 7,700 this year.
In September last year, the FTSE100 hit a peak of 6,904.86 points, its highest level since 2000. By October, however, the financial press was gloomily reporting substantial falls of around 10%.
The largest one-day rise (9.8%) for the FTSE100 came on 24 November 2008 – incidentally this came after the US government rescued ailing Citigroup. Yet this was also the year the index suffered its biggest annual fall – some 31%. Seasoned investors are all too familiar with these roller-coasters.
Predicting how markets and economies might react at any given time is impossible – despite those New Year articles you, no doubt, saw last month. There is some truth in the joke: ‘economists have successfully predicted nine out of the last five recessions’.
The main concern is that the forecasts are often overly optimistic or pessimistic, which can lead investors to cause more harm to their own investments than the market itself.
Rash decisions can mean selling at the bottom – the opposite of best investment practice – and then missing the subsequent rebound.
In all three of Britain’s recessions since the Second World War, the markets have rallied strongly the following year, rising by 142% cent in 1975, 29% in 1982 and 20.7% in 1991.
Research material which charts the rise and fall of the stock market every year between 1986 and 2013 reveals the maximum losses investors could have made by buying at the year’s highest point and selling at its lowest.
In 21 of the 28 years, buying and selling at the wrong times would have accounted for doubledigit losses. Interestingly, in only seven years did the market end lower than it began.
We have seen time and again that, at the exact moment investors decide to take flight from a market, the stocks flourish. But holding your nerve during such significant fluctuations can be easier said than done.
There is much evidence to suggest that our own reaction to the flux of the economy could be our worst enemy. Nobel Prize winners
We have seen time and again that, at the exact moment investors decide to take flight from a market, the stocks flourish
fearful and fearful when others are greedy’.
Financial fire drill
Rather than trying to anticipate what might happen tomorrow, the prudent option is to look at what might transpire over the course of your investment plan. Are your finances well organised and in a secure environment that can handle the ebb and flow of the markets?
Good financial advisers will ensure their clients have the right expectations before any market decline, but encourage discipline throughout the downturn. They may conduct an investor’s fire drill. This means they make sure clients are in the safest position over the long term and that they know not to panic when the next piece of negative economic news hits the media, because their portfolio has been designed to account for challenging times.
After all, global markets have always recovered and, over time, markets will take a middle course – but that does not create such strong headlines.
Simon Bruce (right) is managing director of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Daniel Kahneman and Amos Tversky reported that investors feel the fear of losses twice as much as the pleasure of the same amount of gains.
They also tend to analyse investments too frequently and over too short time-frames. The combination of these two factors has been named ‘myopic loss aversion’ and can make it difficult for investors to stay focused in the face of volatility.
As John Bogle, founder of mutual funds company Vanguard, said: ‘If I have learned anything from my 52 years in this marvellous field, it is that, for a given individual or institution, the emotions of investing have destroyed far more potential investment returns than the economics of investing have ever dreamed of destroying.’
Has Buffett got it wrong too?
Even the ubiquitous Warren Buffett has failed to follow his own philosophy. Last year, in the midst of Tesco’s annus horribilis, the investor offloaded 245m shares in the company when the share price was down by more than 50% in the year.
In doing so, he turned his paper losses into millions of pounds of real losses – he who advised investors to ‘get greedy when others are
Need some help getting into gear for revalidation? Beverley Boon (right) gives some useful advice in her top ten tips for Independent Practitioner Today readers
EVERY REGISTERED doctor has to go through the same appraisal and revalidation process even if the NHS and private sector differ in their approach.
For private doctors without a designated body, this can be complex and difficult, as they do not have a Responsible Officer (RO) and therefore have to search for a suitable person.
1 Familiarise yourself with your revalidation solution software
For appraisal purposes, you are required to submit supporting information and an appraisal portfolio to your appraiser.
In the past, this was all done with hard paper copies, but it is now conducted electronically via appraisal software.
There are many appraisal and revalidation solutions and platforms out there and the one you are expected to use may change from year to year, depending on the organisation you are currently working with.
This means it is really important to ensure you are familiar with your particular appraisal e-portfolio for the coming year.
Although similar and all designed with the same goal in mind, knowing how to navigate through your appraisal software will save you a great deal of time when uploading all your information.
The doctors I have worked with have found their biggest level of frustration comes from the IT elements: either not being able to log onto the personal e-portfolio or not being able to easily navigate
around it once in. So it really helps to find your way around these long before deadline.
2
Jot down your log-in details. Keep them safe It sounds simple and obvious, but as the process is now conducted electronically via appraisal software, both you and your appraiser need access to your electronic portfolio or e-portfolio.
With the average person having 26 online accounts, revalidation adds number 27.
Even the sharpest of minds would struggle to remember login details and passwords for every one of these accounts.
For my clients, I find creating an Excel file containing all log-in criteria really helps, especially as revalidation is such a long and ongoing process where you may not need your log-in details for months at a time.
Wherever you choose to store your passwords, always ensure they are kept securely and are password-protected.
3 Learn the four domains of Good Medical Practice – and use them
I am often asked what supporting information to provide during the appraisal and revalidation process.
There are six types of supporting information doctors are expected to provide and discuss at their appraisal at least once in each fiveyear cycle. They are continuing professional development, quality improvement activity, significant events, feedback from colleagues,
feedback from patients, review of complaints and compliments.
Within each of these areas, the key to success is to match your evidence to the four domains set out by the GMC.
These are:
1) Knowledge, skills and performance;
2) Safety and quality;
3) Communication, partnership and teamwork;
4) Maintaining trust.
Print them out. Stick them next to your computer as you go through the process.
This means you can keep your supporting information relevant and ensure you get it right first time. To learn what is expected in each of these four domains, the GMC has prepared guidance. It is on its website at www.gmcuk.org/guidance/good_medical_ practice.asp and I recommend every doctor familiarises themselves with it before starting collating their information.
4
Talk to your appraiser about the type and amount of supporting info they are looking for
No two appraisals are the same and the supporting information requirements may differ from individual to individual or from organisation to organisation. Talk with your appraiser prior to the appraisal. Ask about their expectations from the appraisal and whether there are any focal points you need to pay extra attention to.
Make sure they understand the process and software being utilised for your particular appraisal. They will be able to direct you on any organisation-specific criteria you are expected to provide during the appraisal or individual appraisal needs they want to see addressed.
Understand from them what they are looking for and gauge their supporting information expectations.
5
Think quality, not quantity
I am often asked how much supporting information to provide during the appraisal process. As every appraisal differs, it is difficult to recommend how much information is a good
amount. A good rule of thumb is to focus on quality not quantity.
It is tempting to submit as much information as possible to your appraiser. However, this may oversaturate them with unnecessary amounts of information which they will need to read through and reflect on.
If they are constrained on time, they will not be able to read everything, which may delay the appraisal process for you.
Similarly, too little information may result in your appraisal or revalidation recommendation being deferred.
So think about how relevant the information will be to your appraiser, put quality of information and evidence over quantity and concentrate on key pieces of supporting information from each category that best demonstrate your fitness to practise.
Remember to upload and correctly label information, as this will save the RO lots of time when reviewing your portfolio.
6 Learn to love your scanner
One of the most common questions I am asked is how do I prepare my supporting information for my appraisal?
Most appraisals require you to submit your supporting information for appraisal purposes using an e-portfolio.
I would recommend that any information you may wish to use during the appraisal process is scanned and stored as an electronic document as you go along throughout the year.
Before scanning, ensure that any documentation is signed off and any patient identifiable content is removed or blacked out from the document.
As you file each document, tag them with which of the six areas it will support and which of the four domains it fits into. This will save you hours of time when coming to submit.
7
Complete your parts, then let your Responsible Officer take over Revalidation occurs every five years and will encompass all the information you have provided during your annual appraisals within this time.
You do not need to submit a recommendation yourself, you will receive a revalidation recommendation letter from your RO once they have reviewed your supporting information and the content of your past five appraisals.
If you have conducted five annual appraisals in line with the guidance provided by the GMC and your RO is pleased with the information provided, you should be granted a recommendation.
If the RO feels you have not provided enough information in order to receive a revalidation recommendation, you will be given the opportunity to submit further information.
8 Find out early on who can help you in this process
Your designated body is the organisation you are connected to that provides you with your annual appraisal and revalidation recommendation.
It is your responsibility to notify the GMC of your current designated body. If you are not sure who your designated body is, the GMC has a useful tool that you can use on its website at www. gmc-uk.org/doctors/revalidation/ 12387.asp.
Each designated body has its own RO who will review the doctors that fall under the designated body’s appraisal information in order to make revalidation recommendations.
For those not connected to any organisation, you are still required to revalidate, so you must ensure you contact the GMC, who will be able to assist you in finding
an RO to provide you with a revalidation recommendation.
9
Get additional help
Not everybody is a computer whiz or has the time to spend uploading information to websites.
If you require administrative support, do not be afraid to ask for it. The appraisal software providers often allow you to nominate an administrator who can upload information on your behalf.
Many of the doctors I have worked with on revalidation valued being able to hand over the administrative side of revalidation so they could continue to spend time with their patients.
10
Do not forget about revalidation as soon as you have submitted your information
Do not simply breathe a huge sigh of relief and forget about revalidation for the next five years after submitting your information. Not only does the next one come around quickly, but each annual appraisal contributes towards your overall recommendation. So get into a habit of scanning and filing any supporting information as you go along. By preparing for your appraisal each year in good time and supplying adequate supporting information, your revalidation recommendation will be a much less stressful process next time round.
Beverley Boon is chief executive at Fitness to Practise, a company providing support, guidance and training in all aspects of revalidation
Consultants at a private clinic have teamed up with an art gallery for a new marketing venture. Olivia Cummins
explains THE LONDON Orthopaedic Clinic in Wimpole Street recently opened its doors to members of the public to invite them to a special preview of the modern art works that we have recently installed in partnership with Eames Fine Art Gallery.
We see it as a mutually advantageous business venture.
Fine art and orthopaedic medicine may not seem a likely combination, but with several bare walls to embellish, Vincent and Rebecca Eames saw an opportunity in our clinic to display some of the artists that they work with.
The duo’s Bermondsey-based gallery represents established modern masters from the 20th and 21st century alongside emerging contemporary artists with a particular specialism in original etchings and lithographs.
But Vincent and Rebecca saw the opportunity to expand their clientele to West London and our clinic also affords the opportunity to display works over a longer period than their gallery programme would usually allow.
Typically, a show runs for three weeks to a month in the
gallery, but they are conscious that some art collectors need longer – and many repeat viewings – before ‘taking the plunge’ and buying an artwork.
The minimum six-month showcase at the clinic and the nature of the clinic/patient relationship with repeated visits over that time will allow patients to build a relationship with the artworks that will hopefully lead to future sales.
Similarly, we recognised the benefit of making the clinic more aesthetically pleasing for our patients.
To expand the longevity of this
project, we introduced the idea of changing the artworks every half year and accompanying this with a gallery opening event to launch the new pieces.
At the launch, we were able to invite referring healthcare professionals from the area for a drink, enabling some networking and the hope they might like to buy a print while they were there.
The artwork is meticulously displayed around the clinic over six floors with an artist on every floor. As you travel up from the basement, you will see images from Sophie Layton, including her original photo-etching series of TV screens. Thematically, we
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• Initial data capture of archived patient files, including ongoing processing of live files/data
• Reduction in labour costs and time associated with manual paper filing
• Consultants have remote access to patient data when and wherever they need it
• Complies with the national initiatives
felt that these etchings worked well with the X-ray facility in the clinic.
Amanda Danicic’s large screen prints are displayed on the ground floor in the main reception area, as well as two of Danicic’s monoprints in green and blue colours, which also correspond to our theme colours. These pieces are very eyecatching and brighten the clinical setting enormously.
The first floor features art from Edward Twohig and, in a change from the ground floor, is a totally monochrome affair. Twohig’s etchings create a calm atmosphere for patients in the waiting area of surgeons Mr Lloyd Williams and Mr Sean Curry.
Intense pieces
Travel up to the second floor to see a repertoire from Nigel Swift featuring his oil paintings and landscapes. These are small but intense pieces, which patients can enjoy before their appointments.
The third floor contains Anita Klein’s linocuts and prints providing friendly faces for anxious patients. These sensitive and lifeaffirming works are a refreshing change for patients undergoing treatment.
If you make it all the way to the fourth floor, you will see Malcolm Franklin’s monochrome prints that show an uncertain relationship between the organic and the mechanical, which we felt was fitting for an orthopaedic clinic.
Running through the clinic are various images based on hearts from each of the artists for the ECHO charity series in honour of the charity’s 30th anniversary. As a sports and injury clinic, we appreciate the work that the Evelina Children’s Heart Organisation does and 50% of every sale will be donated to the charity. These works also tie together the artists featured throughout the clinic.
Olivia Cummins is the marketing and public relations lead at the London Orthopaedic Clinic
If you would like to visit the clinic to view the art, contact olivia.cummins@ londonorthopaedic.com. Artwork can also be viewed at www.eamesfineart.com.
These sensitive and life-affirming works are a refreshing change for patients undergoing treatment
Anita Klein: ‘Heart in Sand’, linocut, edition of 30
These pieces are very eyecatching and brighten the clinical setting enormously
l Will I outlive my money?
l Could I retire earlier or go part time?
l How can I plan to help my children and minimise Inheritance Tax?
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l Are my investments right for me?
Things that matter
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For
For increasing numbers of doctors in the UK, the best part of winter is the opportunity to exchange the rain and grey skies for a week or two of skiing.
And if you have ever considered taking it a step further and actually buying your own piece of the French Alps, then now could be a good time, says Dylan Mitchell
IMAGINE AN apartment or chalet with just the right combination between traditional and modern, made from local wood and stone, set on the edge of a piste with views of snowy slopes and pine forests, warmed with an open log fire.
Each morning starts with you stepping on to your skis and heading up the slopes on the nearest lift, returning invigorated in the evening, only to set off again for a gourmet dinner and drinks in the village.
If this sounds like heaven, then chances are that you have considered buying your own apartment or even a chalet in the French Alps.
After Paris and the Riviera, the French Alps are the most visited destination in the world.
Without the restrictions of foreign ownership imposed in neighboring alpine countries of Austria and Switzerland, French alpine property is available and always in demand. And it has proven to be a sound investment.
Mortgage interest rates are now at their lowest since World War II. Combine this with the best £ to € exchange rate since 2008 and it is no wonder there is now a resurgence in British buyers looking for their dream home in the French Alps.
T Ski-in, ski-out: Confirm exactly how close you are to the nearest lifts
T Good access to airports, train stations or motorways: Quick access is vital if you want to go for short trips or weekends
T Proximity to lifts and other resorts: Property prices in the smaller ski domains are much more affordable and can offer relatively easy access to neighbouring larger and more expensive domains
T Construction quality: Ask for details of previous properties completed by the developer
T Resort facilities: cafés, shops, bars and restaurants
T Resort altitude and snow record
T Summer activities: The Alps are increasingly becoming a year-round destination. More resorts are now offering summer activities such as hiking, mountain biking, paragliding, golf courses and festivals
T Good capital growth and rental potential: As a rule, buy property that you want to use. If you want to go there, then other people will also want to go there
This beautiful town is linked to Tignes to form the Espace Killy ski area of 300km of pistes and 94 lifts.
Set at an altitude of 1,850m with access to top slopes of 3,400m, Val d’Isere offers excellent skiing conditions and is well known for its nightlife.
Skiing
Intermediate to advanced Nightlife
TTTTT
Budget
£££££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 40 mins
Chambéry: 1hr 55mins
Grenoble: 2hrs 35mins
Geneva: 2hrs 40 mins
By train
Eurostar Ski Train: London St Pancras to Bourg-St-Maurice.
TIGNES
Connected to Val d’Isere and part of the Espace Killy ski area (300km of pistes), this high-altitude resort set between 1,500m and 2,100m, with lifts connected to slopes of 3450m, is virtually guaranteed snow.
The only drawback to Tignes is the architecture, which is awful. However, this has started to
change with new, more modern developments.
Skiing
Intermediate to advanced Nightlife
T Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 30 mins
Chambéry: 2hrs
Geneva: 3hrs
By train
Eurostar Ski Train: London St Pancras to Bourg-St-Maurice.
MERIBEL
Located in the centre of the famous Trois Vallées (Three Valley) ski domain, with more than 600km of pistes.
The villages of Meribel are set at an altitude of 1,600m to 1,700m and, thanks to a new lift system, have access to slopes of 2,700m within nine minutes.
Skiing
Ideal for intermediate Nightlife
TTTTT
Budget
£££££
Getting there
By plane (time to airport)
Chambéry: 1hr 20mins
Grenoble: 2hrs 15mins
Geneva: 2hrs 15 mins
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While not as picturesque as some of the other resorts, Val Thorens is well known for outstanding skiing and nightlife.
Set at an altitude of 2,300m, you are assured of excellent ski conditions and with easy access to the Three Valleys’ 600km of pistes.
Skiing
Beginner to advanced Nightlife
TTTTT
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 30 mins
Chambéry: 2hrs
Geneva: 3hrs
Part of the Three Valleys, the largest ski area in the world (600km of pistes).
Courchevel stretches from 1,350m to 1,800m with lifts that connect it to slopes as high as 3,200m. There are a wide range of slopes, including excellent nursery slopes for beginners.
Skiing
Beginner to advanced Nightlife
TTTTT
Budget
£££££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 15 mins
Chambéry: 1hr
Grenoble: 1hr 30mins
Geneva: 2hrs 15 mins
The resort stretches up the mountain from 1,600m to 2,000m with access to slopes as high as 3,200m. Les Arcs offers a wide range of properties, some with easy access to the slopes and views of Mont Blanc.
Together, the three resorts of Les Arcs, Peisey-Vallandry and La Plagne form the Paradiski area, which covers 425km of pistes, the second largest ski area in the world.
Skiing
Beginner to advanced Nightlife
TTT
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 15 mins
Chambéry: 1hr 35mins
Grenoble: 2hrs 15mins
Geneva: 2hrs 20 mins
By train
Eurostar Ski Train: London St Pancras to Bourg-St-Maurice.
LA PLAGNE
Made up of ten villages with the highest set at 2,000m, La Plagne is part of the Paradiski area (425km of pistes), the second largest ski area in the world, with lifts up to 3,250m.
Uncrowded compared to Les Arcs, which makes it an ideal destination for beginners.
Skiing
Beginner to Intermediate Nightlife
TTT
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 15mins
Chambéry: 1hr 30mins
Grenoble: 2hrs 10mins
Geneva: 2hrs 15mins
By train
Eurostar Ski Train: London St Pancras to Bourg-St-Maurice.
Attracting mountain lovers all year round, Chamonix, set at the base of Mont Blanc, is the most visited alpine village in the French Alps.
Although the resort is set at only 1,035m, skiers have easy access to slopes as high as 3,840m. The resort is well known for its nightlife and offers accommodation and dining to suit all budgets.
Skiing
Beginner to intermediate Nightlife
TTTTT
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 5mins
Chambéry: 1hr 25mins
Grenoble: 2hrs 5mins
Geneva: 1hr 30mins
Within the Portes du Soleil ski area (650km of pistes), Les Gets is a 12th century charming village that is ideal for family holidays and caters for young children.
Skiing
Beginner to intermediate Nightlife
TT
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs 5mins
Chambéry: 1hr 25mins
Grenoble: 2hrs 5mins
Geneva: 1hr
Often described as the ‘best kept secret in the Alps’, Sainte Foy is an ideal resort for beginners and advanced skiers. Particularly well known for its off-piste skiing. With less nightlife than other resorts nearby, such as Val d’Isere, Sainte Foy is perfect for families and those looking to escape.
Skiing
Beginner to intermediate Nightlife
T
Budget
£££
Getting there
By plane (time to airport)
Lyon Saint-Exupéry: 2hrs
Chambéry: 1hr
Geneva: 2hrs
RATINGS: NIGHTLIFE
T Very quiet
TTT Selection of bars and restaurants
TTTTT Wide selection of bars and restaurants
BUDGET
£ Cheap
£££ Moderate
£££££ Expensive
Next month: How to go about buying your dream ski home in the French Alps
Dylan Mitchell is director of French Leaseback.com property investments
An independent firm offering one to one meetings anywhere in the UK giving advice and help with:
• how to start in private practice
• how to maximise private practice income
• ways to reduce tax payments
• setting up in Chambers/Groups
• limited companies and LLP’s
• financial planning
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• computer software
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Specialist Medical Accountants
MDU medico-legal adviser Dr Nicola Lennard (right) who previously worked at the Medicines and Healthcare Products Regulatory Agency, discusses two clinical scenarios concerning the regulation of medical devices and medicines
of your private practice billing
At Medser v we specialise in providing the highest standards of private prac tice billing ser vices for hundreds of hospital consultants throughout the UK and Ireland
- Online access to all your billing information - Extremely cost- effective - Charges are based on revenue collected - Tax deductible - Comprehensive repor ting - Completely conndential
QThree years ago, I fitted an implantable cardioverter defibrillator in a 65-year-old man with heart arrhythmia.
Since then, the patient has attended my clinic for yearly check-ups to ensure the device is still functioning correctly.
However, the latest routine tests have shown up a problem with one of the defibrillator leads. Should I report this to the regulator and what should I tell the patient?
AAlthough the patient might not have come to any harm, this clearly has the potential to compromise his treatment and you should report such adverse incidents to the Medicines and Healthcare Products Regulatory Agency (MHRA), as well as the device manufacturer.
It is also possible that other clinicians have reported similar problems, which means the MHRA may be able to combine your findings and theirs to establish a clearer picture of the risk to other patients.
Report the incident as soon as
possible via the recently combined drug and device Yellow Card Scheme reporting site (https://yellowcard.mhra.gov.uk). Alternatively, you can request a report form by phone or email from the MHRA. 1 The device manufacturer is also obliged to report the matter to the regulator, but you should not discount your own responsibility.
The MHRA will record the details and triage the incident to determine the requirement for further investigation. You should receive an acknowledgement and you will be advised of the nature and outcome of any investigation.
As well as investigating possible faults, the MHRA analyses trends in reported adverse incidents to determine whether other action to protect patients is needed, such as the issuing of a device alert or amending device usage instructions.
You should inform the patient as soon as possible that you have discovered a potential problem. The patient is likely to be shocked, anxious or even angry and the best thing to do at this stage may be to listen and empathise. However, as soon as he is ready, you will need to discuss the implications for his health and the treatment options, such as more
frequent or detailed screening or device replacement, helping him weigh up the risks and benefits of each.
This patient may request replacement of the affected device –though the risks of this may be greater than leaving the device in situ – but offering more frequent and detailed device interrogation.
The MHRA will post updates on its website as more detail becomes available and the clinical advice may develop over time. It might also be appropriate to discuss a referral for specialist counselling if the patient has difficulty in coming to terms with what has happened.
QI am an endocrinologist and I have just seen a patient with polycystic ovary syndrome (PCOS).
She is currently on hormone therapy prescribed by her GP, but is distressed by her facial hirsutism and acne and has read about a diuretic that can help with this symptom.
I have some experience of this drug and think this is worth trying, but her GP says he is unhappy about issuing repeat prescriptions when the drug is not licensed for this purpose and
sure that arrangements are made for another suitable doctor to do so.
If the GP is to manage the patient’s ongoing treatment, he or she would need to be confident that they have sufficient reason to believe that it is in the patient’s best interests that they understand the medication prescribed, and could recognise any adverse effects.
You may wish to have a discussion with the patient’s GP about the drug’s safety and potential value in this case, based on your experience and the available evidence.
drug, he or she will be responsible for their own prescribing of the drug, but it may be helpful to set up a formal shared care agreement. It may also be necessary to draw up a protocol for the use of the drug and approval should be sought from the clinical commissioning group to ensure compliance with any local guidelines on prescribing.
References
the patient is already benefiting from the hormone treatment. What should I do?
AWhile you should normally prescribe licensed medications within the terms of the licence issued by the MHRA, the licensing arrangements do permit doctors to prescribe unlicensed drugs and to use drugs for unlicensed indications if they judge this to be ‘in the best interest of the patient on the basis of available evidence’.2
Doctors have legal responsibility for the drugs they prescribe and you should follow the GMC’s specific guidance on this subject.3
This states that you must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy and that a licensed alternative would not suit the patient’s needs.
You will need to explain to the patient that the drug is not licensed for treating PCOS when obtaining her consent and inform her of the risks, including possible sideeffects and contraindications.
This discussion, the patient’s consent and your reasons for prescribing an unlicensed medicine should be clearly recorded.
As the prescribing doctor, the GMC expects you to take responsibility for prescribing the medicine and for overseeing the patient’s care, monitoring and any followup treatment or make
It may be helpful if you provide the GP with appropriate references for the effectiveness of the medication, and make yourself available to answer any questions they may have. If satisfied, the GP may then be happy to prescribe the drug, but the decision is ultimately theirs.
If the GP agrees to prescribe the
1. Medical device adverse incident reporting forms, MHRA website. www.mhra. gov.uk/Safetyinformation/Reportingsafety problems/Devices/Medicaldeviceadverse incidentreportingforms/index.htm
2. Off-label or unlicensed use of medicines: prescribers’ responsibilities, MHRA, April 2009. www.mhra.gov.uk/ Safetyinformation/DrugSafetyUpdate/ CON087990
3. Paragraphs 67-74, Good Practice in Prescribing and Managing Medicines and Devices, GMC, 2013. www.gmc-uk.org/ guidance/ethical_guidance/ 14327.asp
Keeping good patient records should go without saying. But a lot of doctors could do much more to improve their business records and hence their profits, warns Ian Tongue (right)
WHEN CARRYING out a business of any sort, robust financial records must be kept. These can be wide-ranging, but they must all have the common theme of being complete and accurate.
It is important that you know what needs to done from the start, as it can often be difficult to implement changes later on.
Her Majesty’s Revenue and Customs (HMRC) has powers to fine businesses that they do not feel are keeping adequate records.
Key requirements
Completeness and accuracy are the key words in any accounting system and these provide a robust system of record-keeping. Also, keeping records up to date is a vital part of running any business.
The accounting system should be geared towards both your current and future plans and you should be looking at least a year or two ahead.
In the early years, simple spread sheets usually suffice, but for those with larger practices, bespoke practice management or accounting software will be more appropriate.
For those doctors who are VATregistered, the requirements are more stringent, primarily because you are acting as a collector of tax for the Government, as the system is more complex.
Records of income can vary significantly. It is important that your system records all work performed and allows you to trace
through to the date of payment from the patient or insurance company.
It is always surprising to hear from independent practitioners that they had to write off monies due when their systems went wrong. They were effectively working for free in those cases.
The key data required is:
Date work was performed;
Patient details;
Invoice number (where applicable);
Amount charged;
VAT (where applicable);
Date received;
Date chased, if not received;
Date considered irrecoverable, if debt is bad.
A spreadsheet can be set up for the above, but most software packages should have the above functionality built in.
If you are involved in more than one type of income source, it is important to have extra columns to separate the income.
For example, clinical work needs to recorded separately from medico-legal work, as the latter is potentially subject to VAT (see below).
For the vast majority of clinical work, VAT should not be an issue, as this service is regarded as ‘exempt’ from VAT.
However, medico-legal work or procedures carried out purely for cosmetic or aesthetic purposes are ‘standard-rated’.
You are under an obligation to keep records that allow you to determine whether you are carrying out sufficient ‘standard-rated’ work to require compulsory VAT registration.
At the time of writing, the VAT registration limit is £81,000 a year on a 12-month rolling basis and NOT aligned to your accounting year-end.
Every business should have some form of credit control. This ensures that debts are paid on a timely basis and is vital for any consultant carrying out a private practice.
Normally, it will be a secretary or perhaps spouse employed in the business that will perform this function.
In particular, issues around insured patients arise and these need to be followed up as soon as possible.
The key areas seem to be coding of procedures and charging the correct tariff. In relation to the latter, it is important that you make the patient aware of any excess from the outset if you are charging more than the insurance firm’s tariff rates.
It is just as important that expenses are recorded as income – although, clearly, HMRC is not as concerned if you miss some off, as it gets more tax!
That is the key message: record your expenses properly or pay more tax.
The key data to record within your system is:
Invoice date;
Description;
Amount;
VAT (if applicable);
Date paid.
With all of the above data, you should be in a position where all costs are recorded and tax relief obtained at the earliest opportunity.
For a self-employed consultant, it can be tempting to use your own bank account for running your private practice, but this is not recommended.
Maintain a separate bank account at all times to ensure a segregation of your personal expenditure from business expenses.
You do not need to ask for a business account, as this will come with fees and extra services that you don’t usually require. But, on occasion, the bank will insist on a business account being used if the practice is large.
Anyone trading as a company must have a separate business bank account in the name of the company.
It is generally best practice to keep all invoices, remittances and bank statements in hard copy format to support the entries within your electronic system. The general rule is to keep records for six years, but many keep them longer if they have the space.
Preparing a balance sheet is an extremely effective tool to ensure that your accounting records are complete and accurate.
This statement is prepared by your accountant, but they require you to keep the records described previously.
Preparing a balance sheet goes much further than simply looking at the income and expenses as per the invoices and remittances. It extends to the accounting procedures to reconcile the movements, in and out, on the business bank account and reconcile fees to amounts received and owed at the end of the financial year end.
Preparing a balance sheet often highlights additional income, and not declaring this can lead to penalties.
A few years ago, there was an amnesty for doctors to declare additional income, as many had missed off Bupa awards and other sundry fees.
As an accountancy firm, our standard practice is to prepare a balance sheet for all clients where we can which give them addi -
tional comfort over the work performed, which, in turn, should reduce the risk of an inquiry with HMRC.
It should be noted that limited companies are required to prepare a balance sheet each year.
It is vital that all businesses maintain robust accounting records and your private practice is no exception.
Take advice from your accountant and ask for feedback on your systems, which they should be happy to give.
As your practice grows, keep things under review and ensure the systems grow with your business and consider the use of practice management software when appropriate.
Next month: The top ten private practice pitfalls to avoid
Ian Tongue is a partner with accountants Sandison Easson and Co
If you can’t afford a Range Rover right now, then try the Nissan X-Trail instead at half the price, says Dr Tony Rimmer (right)
EVERY PRIVATE practice has to start somewhere and the early days of growth can be a real financial strain. With every profit boost comes extra investment to improve premises and equipment.
The days of surplus income to spend on luxuries arrive later than you would expect, so during the development phase, compromises have to be made. This applies to family car we drive as much as anything else.
I am sure that those of us who are attracted by large 4x4 sports utility vehicles (SUVs) would love to afford a Range Rover Sport, but if your practice is re-investing for future growth, the £65,000 cost may be an unrealistic option.
So what alternatives do we have? Is there a way of getting
most of what the Range Rover offers at half the cost?
Enter the latest Nissan X-Trail. The third generation of this well-known model has become a different type of vehicle. Previously a boxy, functional and utilitarian vehicle in the mould of a basic Land Rover, the new car has metamorphosed into a classy quality product wearing a sharplystyled suit.
Making the most of the great success of the smaller Qashqai SUV model, Nissan has styled the X-Trail to look like a bigger version. The greater size gives a boost to interior space and allows the option of seven seats.
Available in four levels of trim
and equipment – Visia, Acenta, n-tec and the flagship Tekna, my test car was the n-tec version and had 19-inch wheels, roof-rails and Nissan’s new NissanConnect multimedia system.
This would be the model to go for. Its standard equipment like the ‘around view monitor’ that aids parking with a bird’s-eye view of the car computed by cameras in the nose, tail and wing mirrors are features one would expect in a car costing twice as much.
Unusually, engine choice is limited to one. A 1.6litre 128bhp turbo-diesel unit powers all models of all trim levels.
As most competitors offer 2.0litre turbodiesels, this would seem to be a risky manouvere by Nissan. However, they counter this
this Nissan and that is a vehicle that now costs at least £40,000 before extras.
Performance, as expected, is somewhat hampered by the modest engine size. With a reasonable 320Nm of torque, the X-Trail feels agile enough with a driver only, but fill the capacious interior with a further six passengers and the Nissan starts to feel sluggish and underpowered.
To compensate for the limited power, the gearing is short and I found myself really stirring the gearbox to keep a reasonable pace.
I would not recommend the optional £1,350 automatic gearbox, as this would just compound the problem. The X-Trail is not any slower than its rivals, but you have to work quite hard as a driver to maintain your speed.
argument by claiming really excellent fuel consumption figures: up to 57.6mpg overall (for the twowheel drive model).
Although the X-Trail looks like a four-wheel drive off-roader, standard set-up is only frontwheel drive on the base models, which saves weight and improves economy further.
The interior design, like the outside, is based heavily on the Qashqai. This is not a bad thing and the dashboard looks modern and up to date.
A large seven-inch touch screen operates the sat-nav and audio system and a further five-inch screen in front of the driver displays further useful information.
Trim quality, while not up to Audi or Range Rover standards, is still a giant leap forward compared to the previous model and
gives an up-market feel, which can be enjoyed by rear-seat passengers, who have excellent best-inclass head- and leg-room.
The rear-most seats fold up from the boot floor and offer room for an extra two passengers of small adult size.
If your private practice is young, it is likely that you have young children too. An SUV makes a lot of sense and has great appeal for families with three or more youngsters.
The ability to accommodate all the paraphernalia that family trips demand in a vehicle with loads of useable space has great influence on our buying choice. This is where the X-Trail excels.
Only the Land Rover Discovery can equal the available space in
So does the private practitioner on a restricted budget have to suffer too much if they choose the X-Trail as family transport?
Well, the new model is more car-like cross-over than rugged 4x4. It has the best and most useful interior space in its class and is only hampered by a smaller than average engine with no larger option.
It is smart, economical and great value for money at under £30,000, especially when you compare it to premium rivals.
I don’t think any of us professionals would feel short-changed and the compromise needed before practice profits allow an upgrade to a premium brand are minimal.
Dr Tony Rimmer is a GP practising in Guildford, Surrey
Body: Seven-seat hatchback SUV Engine: 1.6 litre V6 triple turbo-diesel Power: 128bhp
Torque: 320Nm
Top speed: 116mph
Acceleration: 0-60mph in 11.0 seconds
Claimed economy: (Combined) 53.3mpg
CO2 emissions: 139g/km
On-the-road price: £28,995
A fifth
4,481
The largest number of followup consultations carried out by one of our practices in a 12-month period
On average, a practice will have 20% of its billing going to other organisations such as corporates, embassies and solicitors
£400k
Largest ever ‘backlog’ for a single consultant. This is the amount of outstanding invoices which we took on, going back over many years
A quarter
£700k
The largest amount of backlog which we took on for a group practice
A practice will, on average, have 25% of its billing going to the patient either directly because they are not insured or due to excess/out-ofbenefit amounts
.05%
5-7%
If a practice does not use a billing agency, they will typically write off between 5-7% of a consultant’s turnover
Over half
On average, a practice will have 55% of its billing going to the private medical insurers
2,001
The largest number of new patients seen by one of our practices in a 12-month period
Consultants will happily share knowledge on medical matters, but discussing finances is often a taboo subject. So Garry Chapman thought he would share some surprising statistics obtained over the past 20+ years through his billing company’s client base
On average, Medical Billing and Collection writes off less than 0.05% of a consultant’s turnover – across all its clients throughout the life of the business
£235.55
Average value of an invoice raised in private practice
60% of the amount that we invoice to the insurance market comes from Bupa and AXA PPP
25%
Highest increase in revenue generated by Medical Billing and Collection for a practice when doing the same amount of work
Garry Chapman is managing director at Medical Billing and Collection
Some consultants are doing well, but many have been hit by business pressures and that has meant a 12.3% profits drop on average, finds Ray Stanbridge. Additional material from Martin Murray
OUR LATEST figures for our unique survey of specialists’ incomes suggests that consultant gynaecologists in private practice have, overall, experienced a hefty fall in gross and taxable income between 2012 and 2013.
Gross incomes dropped by 5.2% between 2012 and 2013, from £114,000 to £108,000. At the same time, expenses rose by 4.1% from £49,000 to £51,000 on average. As a result, taxable incomes fell by 12.3%, going down from £65,000 to £57,000.
We expressed some surprise that gynaecologists’ incomes had risen between 2011 and 2012 ( Independent Practitioner Today, February 2014). This year, we have seen the fall we were anticipating.
The reasons for the drop seem to be, firstly, the impact of insurer fee reductions for many, particularly younger consultants, and secondly, the increasing proportion of NHS-related income in the practice.
NHS Choose and Book procedures, for example, generally are
AVERAGE INCOME AND EXPENDITURE OF A CONSULTANT GYNAECOLOGIST WITH
undertaken at a lower rate than insured rate, though in certain instances this is changing.
We are finding that most gynaecologists are having to work harder to enjoy the same income levels that they did in previous years.
Cost trends show that there were slight falls in medical supplies/ assistant fees and use of home. There was no particular reason for these changes.
Staff costs showed a further increase from £12,000 to £13,000 on average. Again, where spouses act in a secretarial or administrative capacity, cost increases do mirror changes in personal tax allowances.
There has been a further increase in professional indemnity costs and these now average about 14% gross income.
The figures are distorted by those small numbers who undertake private obstetrics work. In real terms, we expect indemnity costs to have peaked.
A number of new providers are in the market, cherry-picking low-risk gynaecology practices. These will affect average results in due course.
Travel and conference costs increased slightly as more gynaecologists seem to enjoy more
exotic locations for their professional meetings.
There has been a further growth in ‘other costs’, primarily marketing. For many successful gynaecology practices, professional marketing is now a significant cost. The evidence is mixed as to whether such expenditure actually pays off.
We predicted in 2014 a period of uncertainty for gynaecologists in private practice, though generally felt that income would hold up.
On the whole, this prediction was correct. We do anticipate further fee pressures from insurers in coming months.
However, there are signs that the private practice market is recovering and this will understandably have a positive effect on consultant level of activity.
Obviously, ‘average’ figures do not reflect what has been experienced by individual consultants –some have enjoyed significant growth in their businesses, while others have seen a real collapse.
As with other articles in this series, we must comment on the data difficulties we are now having in compiling our survey. We
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)
Source: Stanbridge Associates Ltd. Additional information: Sandison Easson and Co
An interesting feature of the market is that an increasing number of individuals are looking to fund their treatment through direct and regular savings
wrote in February 2014: ‘Firstly, our survey is not statistically significant, but rather an overview of the movement in typical sample practice and expenditure.
‘There are increasing data consistency and comparability problems. Some consultants, for example, have incorporated and, for the purpose of this analysis, we have tried to treat them as unincorporated.
‘Others have formed groups and have had a stimulus to their incomes. Meanwhile, other consultants have become more sophisticated in taking on tax planning in their private practice.’
We are finding that most gynaecologists are having to work harder to enjoy the same income levels that they did in previous years
These caveats still remain and, if anything, need to be enhanced.
We would also remind readers of the qualifications needed to be part of our survey.
Our survey is restricted to those consultant gynaecologists who are not full-time in private practice.
They:
Hold either an old style or new style NHS contract;
Have at least five years’ experience in the private sector;
Are seriously interested in private practice as a business;
Earn at least £5,000 a year gross from private practice;
Work as a sole trader, a member of a formal or informal group through the means of a partnership or limited liability company.
An interesting feature of the market is that an increasing number of individuals are looking to fund their treatment through direct and regular savings.
The growth in the market may be primarily from self-pay rather than insurance patients. As a result, it may be that unitary fee levels for the average gynaecologist on average will rise.
Next month: Radiologists
Ray Stanbridge runs an accountancy, finance and tax advisory service specialising in the medical profession. Martin Murray is a partner at Sandison Easson & Co, specialist medical accountants
Use
ending 5 April
Make sure you don’t miss our next issue, published on 19 March. Only subscribers to the magazine are guaranteed to receive every copy and we don’t think anybody who is serious about continuing private practice in the future, when there is so much happening that will affect them, can afford to miss any issue. Coming up next month:
The top ten private practice pitfalls to avoid
How to buy your dream ski home in the French Alps
Every consultant and private GP likes to think they are an expert –but how do you create that status in the eyes of potential patients? Mr Dev Lall has some good advice
Pricing issues: in the first of two articles, Garry Chapman recommends five billing areas that consultants should look at
Independent Practitioner Today’s motoring correspondent Dr Tony Rimmer goes on and on about the Infiniti Q50 (right)
The MDU’s Dr Philip Zack answers questions around the doctor’s duty to be open and honest
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EDITORIAL INQUIRIES
Dr Richenda Tisdale of the Medical Protection Society looks at remote consulting: the pitfalls and advantages
Putting communication centre stage. Richard Matthews shows how professional actors are being used to help independent practitioners improve communication skills
Don’t cut corners with your expense claims – you could end up paying more than you thought
Profits Focus examines the income, expenses and profits of radiologists
A twin for your unit? We report on a life-saving charity with the mission to twin every British plastic surgery unit with one in a developing country
What a waste! We lift the lid on mistakes independent practitioners and their teams make when trying to manage clinical waste
Why your credit rating could be hampering your business growth
New series: we start an adaption of Michael R. Young’s new book ‘The Effective and Efficient Clinical Negligence Expert Witness’
ADVERTISERS: The deadline for booking advertising for our March issue falls on 20 February
Robin Stride, editorial director
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ADVERTISING INQUIRIES
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Publisher Gillian Nineham Tel: 07767 353897.
Email: gill@ip-today.co.uk
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