Be sociable on social media
Where you should focus your efforts to get the most out of your online marketing P12
Keeping tracks
How to keep tabs on the results of your efforts to maximise income and cut costs P23
Giving it away Ways of minimising tax when passing on your wealth to loved ones P40
by Robin Stride
Private doctors have been warned their business plans are at risk from a huge backlog in police Disclosure Barring Service (DBS) checks.
Some applications can take over twice the 60-day target and in London there are fears it could be mid-summer before the Metropolitan Police clears more than 68,000 applications.
Now lawyers are advising doctors and clinics to submit paperwork early to get nearer the front of the queue.
Andrew Lockhart-Mirams, of Lockharts Solicitors, told Independent Practitioner Today: ‘Do it as soon as you possibly can, even if, for instance, the employment process is still to be unravelled because you are waiting for references or tests. Get on and make the check.’
Martha Walker, independent adviser on Care Quality Commission (CQC) issues to the Independent Doctors Federation (IDF), said the delays could have a clinical and commercial impact on the safe and smooth running of clinics, particularly smaller ones without enough personnel to cover or shadow new staff while their DBS check was completed.
She said: ‘For members who are going through the registration procedure, this protracted delay will further extend the time it takes to gain registration and could have potentially disastrous effects on a new business.
‘Members who are registered with the CQC all follow robust recruitment processes, of which the DBS check only forms a part. Until the Metropolitan Police has cleared their backlog we have asked the CQC to allow new staff to start work while
the DBS check is being carried out and that members may take into account a previous DBS certificate.’
She added: ‘During this time, we have also asked the CQC to allow new provider and registered manager applications to be submitted without DBS details, as the certificates will be viewed at the “fit person” interview.’
The IDF was awaiting a CQC response as we went to press.
Lockharts told clients: ‘The CQC has the power to take action against providers who do not carry out these checks as and when required, or providers who cannot evidence that they have carried out the required checks.
‘If you are applying to the CQC to register as a provider or vary an existing registration and a DBS check is required, the CQC will most likely be unwilling to deal with your application until you can provide them with a copy of your DBS check.’
The Metropolitan Police said average waiting time was currently 75 days, but 15% were done within 25 days and 45% within the 60-day target.
A police spokesman said: ‘DBS checks are not simple administrative work. Staff are making decisions about the disclosure of information that may involve a number of different police forces. These decisions directly impact on children and vulnerable adults and those who seek to work with them. For this reason, staff require significant specialist training and supervision.’
The force is training more staff, has transferred others to assist and has set up an extra evening shift to increase the number of checks processed.
n See page 2 comment
You could be affected if:
n Recruiting new staff for your organisation/joining anywhere when a dbS check is required
n updating expired dbS checks for existing staff members
n Registering as a sole provider or partnership with the cQc
n Varying your organisation’s cQc registration
n applying to register or change a registered manager with the cQc
n applying for any professional development or training where a dbS check is required for registration
all SmileS: (from left) mr Robert morris, optegra eye Health care medical director, mr Richard Walsh, optometrist, and consultant ophthalmic surgeon mr alex Shortt at optegra’s newly opened flagship eye hospital in london. n See why it’s all smiles on page 4
big tax breaks for banding together the best ways to structure your group to take advantage of tax breaks on offer P10
don’t keep them hanging on the phone How you manage and answer your phone has a big impact on your bottom line P16
let your fingers do the walking an automated phone appointment service has given patients more choice P20
a help in times of trouble an anaesthetist who became a medicolegal adviser explains her new career P26
Path to peaceful, prompt payment our billing expert outlines the path that ensures you prompt payment P34
apps and traps a lawyer explains the regulations on medical software on mobile devices P36
Doctor savers have been warned they now face a lower limit to the amount of money which will be protected if their bank or building society fails.
From now on, cash in bank accounts will only be guaranteed by the Financial Services Compensation Scheme (FSCS) up to a limit of £75,000 – down from the previous limit of £85,000.
This figure is per person, so the guarantee on a joint account will fall from £170,000 to £150,000.
largely due to the crisis in the Eurozone and the difficulties in Greece in particular.
‘It is easy to see why savers are frustrated by this latest blow after years of poor interest rates on their cash. Remember that the £75,000 protection limit applies to each banking licence rather than each bank and some of the main players are all owned by the same group.
Our sympathies go to any doctors or private hospital caught up in the current Dis closure Barring Service (DBS) saga.
Lengthy delays experienced by many applicants are threatening doctors’ businesses in a variety of ways: from being unable to start up as planned in private practice to being prevented from expanding services.
After hearing of mounting problems, we notified the Independent Doctors Federation to see what could be done to find a quicker solution to the problem.
The federation, fearful that the holdups could have ‘potentially disastrous effects on a new busi
Phone: 07909 997340 @robinstride
ness’, was quick to appeal to the CQC to allow some leeway to reduce the impact.
By the time you read this, we hope the quality watchdog has listened, understood and intervened. Check our website for the latest position.
Private doctors have had to bow to new regulation after regulation – DBS and CQC demands included – and they should not be left in limbo.
Meanwhile, at least The Metropolitan Police is able to recruit more staff – and second others – to work on all the black cab driver applications that are holding up the doctor traffic.
Tell us your news Editorial director Robin Stride at robin@ip-today.co.uk
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This level of protection is fixed across the EU at ¤100,000 by a Euro pean directive and is reviewed every five years. When the former level was agreed in 2010, that figure translated to £85,000, but as the Euro has fallen against the pound, it now equates to just £75,000.
Patrick Convey, technical director of specialist financial planners Cavendish Medical, said: ‘In reality, British depositors will now face less protection than before,
‘Doctors who have created considerable nest eggs will want to ensure they can split their funds across several separate institutions as soon as possible.’
But one positive change announced by the Prudential Regulation Authority (PRA), part of the Bank of England which governs banks, is that savers who deposit high balances temporarily – such as funds from property sales or inheritance – will be covered for up to £1m for six months after the funds reach the account.
Don’t miss our exclusive pay and pensions seminar on Monday 22 February in London.
Independent Practitioner Today is joining with the Royal Society of Medicine (RSM) to present: ‘Your fees, your pension – your future: how doing nothing is not an option’.
The speakers are Ray Stanbridge, of Stanbridge Associates specialist medical accountants, and Simon Bruce of Cavendish Medical.
The free event at the RSM in Wimpole Street, begins with 7pm
registration for a 7.30pm start and ends with a question time and at 8.30pm a one hour drinks reception.
Private doctors face a host of regulatory and pension changes which could impact on their finances. This seminar aims to help you protect your position. This exclusive event is for Independent Practitioner Today readers, RSM members and invited guests.
Register now: www.rsm.ac.uk/ feespensions2016
by a staff reporter
Bupa has launched a new ‘qualitybased’ prostate centre network for recognised units, which it says will give patients access to best practice in managing the condition.
The network, developed after a year of consultation with the British Association of Urological Surgeons (BAUS), uses quality criteria and standards in line with latest evidence based guidance from NICE and the European Association of Urology (EAU).
Bupa UK medical director Dr Steve Iley called the collaboration a great example of what could be achieved for patients’ interests by working together with medical bodies.
He said: ‘We’re committed to
Potential private patients can now access free help and support from experts on a wide range of health and well being topics, including insurance policy terms and conditions, making a claim and how to obtain a quote.
The new online resource, also used by insurers and brokers, is available on The Association of Medical Insurance Intermediaries (AMII) website.
AMII said it was ‘developed to act as a valuable and independent
ensuring our customers have access to highquality, goodvalue treatment. We’re always looking for ways to innovate and develop better treatment and care options for our customers and working with our industry colleagues is a key part of this.’
The network includes facilities from the major private hospital groups and has grown as more centres join.
A spokesman said: ‘When a customer calls us to pre authorise prostate treatment, we will let them know about our qualityassured network and explain the benefits of being treated by a Buparecognised consultant urologist at a network facility.’
The network follows last October’s launch of the insurer’s new
resource, educating consumers on the positive role of medical insurance in today’s changing healthcare environment and providing them with an easytouse industry guide’.
AMII chairman Stuart Scullion said a free ‘Ask an Expert’ facility allowed users to access independent advice on a range of health and well being services – either for themselves, their family or their business.
‘Our ultimate aim was to build a site which could act as a central point for members, insurance providers and consumers to access all the information they may require in one place and we are pleased to have achieved this.’
www.amii.co.uk
nurseled bowel and breast cancer self referral service. Customers concerned about a breast or bowel symptom can discuss these with a Bupa adviser by phone. If necessary, they will be booked into a recognised diagnostic breast or bowel clinic for investigation straight away.
Dr Iley added: ‘The goal is to build awareness of cancer symptoms among our customers to help drive earlier diagnosis and ultimately lead to better patient outcomes.
‘We’ve already seen multiple examples of the success of this new service – with some customers being diagnosed and treated within just a couple of weeks of calling in with symptoms.’
BAUS president Mr Mark Speak
man said it was likely some centres will be accredited as diagnostic centres, others as diagnostic and treatment centres and that many centres will not fulfil all the criteria.
BAUS was assured that nonnetwork urologists would not be prevented from seeing patients with prostate cancer, but schemerecognised hospitals would be able to advertise their accolade on the local hospital and Bupa websites.
Mr Speakman said: ‘BAUS were keen to ensure that the standards in the Bupa network mirrored those in the NHS – for example, multidisciplinary team discussion and availability of specialist nurses –and that they were consistent with NICE and European guidelines. Ultimately, these standards should ensure better care for patients.’
The Medical Defence Union (MDU) has tried to reassure doctors who are worried over new GMC powers to appeal Medical Practitioner Tribunal Service (MPTS) decisions.
Deputy head of advisory services Dr Catherine Wills said what doctors most feared was a GMC investigation, so news that the regulator could now appeal tribunal decisions might be a shock.
But she said MDU inhouse lawyers had a high success rate of
defending members and most cases closed at the GMC investigation stage.
Few cases were referred to the MPTS in the last six years and, in more than half, there was no finding of impairment against a member.
Dr Wills expected appeals to be rare, but said the MDU would continue to protect doctors’ interests by liaising with the GMC about how it intends to exercise its new powers.
Business leaders have been asked to back the campaign for health insurance products to be exempt from insurance premium tax. UK healthcare cash plan provider Medicash wants it to be treated in the same way as policies for life, permanent health and all other ‘long term’ products and
has asked the Confederation of British Industry, Federation of Small Businesses and Institute of Directors for their support.
Medicash chief executive Sue Weir also wrote to Chancellor George Osborne outlining why the tax will seriously impact on the NHS and businesses.
Medicash says the insurance premium tax rate rise from 6% to 9.5% last November could drive many businesses from making healthcare arrangements for staff due to rising and uncertain tax levels with the result of significantly greater demand on the already cashstrapped NHS.
It argues business productivity will fall as absenteeism increases due to health issues and there will be a negative impact on the nation’s longterm economic wellbeing.
The head of the Agggssociation of Medical Insurers and Intermediaries has branded the tax rise ‘illconceived and illthoughtthrough’.
HCA has opened its new medical outpatient centre in The Shard, London, offering quick, convenient and flexible access to worldclass healthcare in one of the capital’s main transport hubs at London Bridge.
It includes 78 consulting rooms plus 12 treatment rooms, with the ability to accommodate up to 600 patients a day, and rehabilitation gym including an anti-gravity treadmill, gait trainer treadmill, watt bike and video motion analysis.
Specialties include orthopaedics,
physiotherapy, spinal rehabilitation, women’s health and paediatrics.
HCA at The Shard chief executive John Reay said: ‘The Shard is an iconic London landmark and moving a medical facility into the building has been a new and interesting challenge.’
In nine months, HCA has transformed the first three floors of the building into a state-of-the-art outpatient centre. Alongside the world-class clinical staff and the latest medical technology medical
By Robin Stride
Surgeons are enjoying the ‘wow’ factor at the new Optegra Eye Hospital, London, which opened to patients in December.
There was much talk among them about the £13m venture before its launch and, now it is a reality, medical director Mr Robert Morris told Independent Practitioner Today surgeons are welcome to come and have a look and see if it is a place they would like to work.
He said he thought they would be impressed: ‘You have every bit of diagnostic equipment you could possibly want. It’s a onestop shop, both from a diagnostic point of view and for treatment –so patients only need to come to one location.’
He added: ‘For any surgeon not familiar with the equipment we’ve got, we will facilitate training for free.’
On offer is a full laser suite, medical ophthalmology rooms, ophthalmic theatres, an 11-bed ward and top-of-the-range equipment including ReLEx SmILE, a bladeless, flapless, minimally invasive alternative to laser surgery.
Baba Awopetu, group strategy and marketing director, said the
hospital in Queen Anne Street, W1, had been engaging with the optician and GP referral channel to show what the hospital could offer them and their patients.
There had been press coverage, roadshows for GPs and opticians, webinars, training and educational events. ‘People are saying “wow”.’
He predicted self-pay patients would account for 40% of the work, private medical insurance 30%, embassy and other work 30%.
Even the bird pictures on the hospital’s wall have ‘eyes’. These detect passing movement and come alive using computer animation when people stop to look.
Digital artist Dominic Harris’s ‘The Ruffled’ series is a virtual aviary of animated birds, including the dodo, which spring to life when disturbed by movement.
Innovative services include a telemedicine service for community optometrists wanting advice on OCT images, and a Low Vision Clinic giving a vision-loss counselling service to support those whose conditions are untreatable and ensure they maximise their remaining vision with innovative, practical solutions.
See Optegra survey on page 32
equipment, HCA at The Shard said it also offers patients a personalised approach.
Chief operating officer Miranda Dodd added: ‘We want our patients to receive the highest standard of care and have the best possible patient experience, which is why we offer convenient appointments and an approach that suits all.
‘No two patients have the same needs and, as such, we offer the best options for each individual. Furthermore, patients can book same-day appointments and
receive results within 48 hours for many services too.’
There is a dedicated entrance on St Thomas’ Street and two lifts for HCA patients and employees to use.
The facility offers an extensive range of outpatient specialties, with rapid access to diagnostic imaging services, including X-ray, ultrasound, digital mammo graphy, bone densitometry, CT and MRI scanning. There is also a Women’s Health Centre with a one-stop breast clinic and a dedicated paediatric outpatient department.
The entrance to the West Malling Diagnostic and Treatment Centre, near Maidstone, Kent
Genesis Care, the new name of Cancer Partners UK following acquisition by Australia’s largest provider of radiotherapy services, has officially opened its ninth UK facility.
West Malling Diagnostic and Treatment Centre at Kings Hill, near Maidstone, Kent, follows a similar model to those in Milton Keynes and Oxford, providing fast access to outpatient consultation and screening services, diagnostic and chemotherapy suites and the latest generation linear accelerator (Linac).
It aims to complement NHS and private services and will focus on delivering early diagnosis and rapid access to treatment for patients with breast, urological and gynaecological conditions.
Dr Russell Burcombe, consultant clinical oncologist (breast), said: ‘The facilities it will provide us with are very impressive and an extremely exciting proposition for the area.’
Paul McPartlan, the company’s new UK general manager, said two more centres were planned for 2016.
Work has begun on the UK’s first proton beam therapy cancer treatment centre, at the Celtic Springs Business Park, Newport, Wales. Edwina Hart, Minister for Economy, Science and Transport for the Welsh Government (centre), visited the site to mark the start of construction, due to open next year. Proton Partners also plans to build centres in Northumberland and London, each able to treat up to 700 patients annually. Company chief executive Mike Moran (second left) said: ‘Our centres will offer proton beam therapy, imaging, radiotherapy and chemotherapy – delivering a fully comprehensive level of cancer care, tailored to fit the different needs of each patient. Later this year in our Newport centre, we will be able to start treating patients with traditional radiotherapy, and proton beam therapy will be available in 2017.’
The BMA’s annual private practice conference from 9.30am on 6 April at BMA House, London, is targeting full- and part-time independent practitioners – both consultants and GPs – for talks on some big issues affecting them.
Topics include taxation issues, CQC regulation for private GPs, and setting up and developing the business.
Spire’s medical director Dr JeanJacques de Gorter will talk on private hospitals’ financial viability and whether they are too dependent on the NHS.
Dr Paul Mackin, Medical Protection Society medico-legal adviser, will highlight the problems, barriers and risks in indem-
Subs never sink
nifying for private practice, while Private Healthcare Information Network chairman Dr Andrew Vallance-Owen will advise on how private practitioners can best engage with the body and the workload implications for them.
Mr Julian Stainton, chief executive of Western Provident Association, will focus on how private medical insurance companies have impacted the healthcare landscape and affected patient choice and access.
A drinks reception will end the day with informal networking opportunities. Details and booking available at www.bma.org.uk/ events/2016/april/private-practice-conference.
By Edie Bourne
High-achieving doctors may soon see the size of their annual allowance – the amount they can pay annually into their pension and still qualify for tax relief – cut from £40,000 to a possible £10,000.
From April 2016, the new ‘tapered’ annual allowance will be reduced by £1 for every £2 of income for individuals with ‘adjusted income’ of over £150,000. The maximum reduction will be £30,000 for those earning £210,000 or more.
Adjusted income includes not only salary but bonuses, benefits in kind and pension contributions –adding to calculation complexity.
This means a doctor with £150,000 total earnings may be able to contribute £40,000 into their pension each year tax-free but those earning £210,000 can only save £10,000 for their future.
Simon Bruce, managing director of specialist financial planners Cavendish Medical, warned: ‘This new move will make the annual allowance calculations even more challenging for the busy consult-
ant with several income streams.
‘The very nature of doctors’ fixed pension arrangements mean it will be all too simple to fall foul of the revised limit. Small increases in pensionable pay may result in hefty tax charges – be mindful of contract increments or bonus payments of any kind.’
At the same time, the Government will cut the lifetime allowance – the total amount you can put into your pension free-of-tax – to just £1m. Those breaching this limit will face tax charges of up to 55% if they fail to protect the size of their pot.
As a rough guide, those with pensions worth £50,000 a year or more will easily reach the £1m ceiling, before taking into account any private pension benefits.
Mr Bruce said: ‘With the annual allowance reduction and rumours of a cut to higher-rate tax relief on pensions to be announced in the Budget, many high-achievers might wish to increase pension contributions before the changes come into play. But you must be careful to avoid triggering a lifetime allowance charge.’
A two-day medical management course aimed at final year specialist registrars and new consultants runs for the third time on 22-23 March at Balliol College, Oxford.
The focus is on skills required as a new consultant which are not usually taught. These include a leadership and negotiation workshop, led by Prof Richard Canter, Nuffield Department of Surgical Sciences, Oxford, and a medicolegal session.
Oxford urologist Mr Ben Turney will show how to write a business
case for your NHS or private practice and Cambridge consultant urologist Mr Oliver Wiseman will run a private practice session.
Other talks are by Stanbridge Associates accountant Vanessa Sanders, Gary Nials of Medical Billing and Collection, and Kingsley Hollis from DGL Practice Manager.
The £250 course, initially run for urologists, now also caters for gynaecologists, radiologists and cardiologists. For details, email ojwiseman@gmail.com.
In THe DecemberJanuary edition of Independent Practitioner Today, Peter Goddard wrote an excellent article on what makes a good private unit.
He refers to the six ‘C’s or ‘criteria’: care, compassion, competence, communication, courage and commitment – all vital components to drive patient care.
I would like to add another ‘Cword’ to this important list –and that is ‘culture’.
Many years ago on a visit to the BMI London Independent Hospital, I noticed that all the signage was in both english and Greek.
I asked why and was told that so many of the patients were Greek and signage in their own language was important – after all, they would not want the patients and visitors going in the wrong direction.
In the central London hospitals, much is done to help the Middle
By EvELyN DIAMOND Managing director of doctors’ education provider
Essentially Medical (pictured right)
eastern patients to ‘feel at home’ – appropriate food menus, newspapers and interpreters.
I worked in a hospital in northwest London where many of the patients, consultants and visitors were Jewish and, as part of my marketing remit, I arranged for kosher food to be available on both the snack and regular menu. The Jewish Chronicle and Jewish News were offered to inpatients and outpatients and the hospital
staff were aware of the timings of the Sabbath and holidays. I will always remember arranging for the primaryaged children of both the local Church of england and Jewish schools to come and sing Christmas carols or Chanukah songs in the outpatients department and on the wards. The gratitude was overwhelming. Making patients feel ‘at home’ as much as possible is greatly appreciated.
Claremont Private Hospital, Sheffield, has unveiled the first refurbished private inpatient bedroom, as part of ongoing investment and improvement plans.
Over £5m has been invested since it was taken over by the Aspen Healthcare Group in 2012. Other completed projects include a new main reception, refurbished theatres and a new restaurant. A new sixbay daycase suite opens soon.
Aspen said the kind of hotelstyle luxury private patients can expect when they come to Clare mont
included White Company toiletries, inroom entertainment system, free WiFi, an à la carte menu and comfortable wet room ensuite bathrooms. Hospital director Andy
Davey said: ‘We’ll refurbish all private rooms to this exceptional standard, one at a time, to minimise disruption to patients, consultants and staff alike.’
The Medical Defence Union (MDU) has appointed a new head of legal services to oversee its solicitors’ team.
Joanne Bateman succeeds Charles Dewhurst, who stepped down from the role at the end of last year, after over 20 years. He
will continue part time. From a team of two solicitors, there are now 30 lawyers and 12 support staff.
A new organisation for cosmetic practitioners will help drive out the ‘cowboys’ and lead to better health outcomes, according to the industry’s quality mark body Treatments You Can Trust (TYCT).
The Joint Council for Cosmetic Practitioners (JCCP) will be led by the British Association of Cosmetic nurses and the British College of Aesthetic Medicine.
TYCT director Sally Taber said: ‘We firmly believe it is essential for future patient safety that clinical audit must be a part of the activities for JCCP.’
She believed new recommendations into cosmetic training from Health education england were ‘a step in the right direction’ to clean up the industry, but did not go far enough to protect the public.
‘It is doctors, dentists and nurses who hold the key to raising the standards of the industry. Training and accreditation for practitioners needs to be mandatory, not a recommendation.
‘If you’re working in this field –if you’re changing the way people look, and literally have their lives in your hands – then you need training from suitably qualified people in medically suitable environs. Accredited training courses must be the future.’
Save £20 in our leap year
There will be a small increase in the annual subscription rate for Independent Practitioner Today from next month. But new doctor and manager subscribers can save £20 by taking out a direct debit before 29 February (£70 instead of £90).
From March, the doctors’ and managers’ personal subscription rate will be £90 – reduced by £15 to £75 if you pay by direct debit. The rate for organisations will be £210 (£180 direct debit). Make sure you don’t miss an issue. See page 22 for subscription details.
The London Lupus Centre has celebrated its 10th anniversary at London Bridge Hospital. Rheumatologist Prof Graham Hughes (right) reflects on the disease’s rise in the last decade and takes a look at the future
In 1972, when I set up the UK’s first dedicated lupus clinic, firstly at Hammersmith Hospital and subsequently at St Thomas’ Hospital, lupus was considered a rare, ‘small-print’ disease – usually fatal.
n owadays, it is recognised
throughout the world as being common, in some countries affecting one in 100 females.
In some countries in the Far East, such as China, Taiwan and Korea, the prevalence of lupus has overtaken rheumatoid arthritis, and many thousands of cases are
regularly published in the international research journal LUPUS (www.sagepub.com).
The reasons for this dramatic rise in numbers is unknown, though better recognition clearly plays a part.
better outlook
The survival figures for lupus have improved beyond all recognition; the majority of patients now live a full life span.
There are many reasons for this:
Better recognition of the disease;
The training of doctors – a major role of the London Lupus Centre;
Increased regulation of medication – less high-dose steroids;
The improved treatment of related medical problems such as heart disease and stroke;
The emergence in recent years of new drugs such as rituximab and belimumab.
In 1983, my team and I described a condition in which blood ‘stickiness’ contributed to problems such as clots, angina, migraine and stroke.
The tendency was found to be due to a blood protein – an antibody which adversely affected blood clotting.
This antibody, directed at cell
membranes (phospholipids), led to the naming of the syndrome ‘APS’ (anti-phospholipid syndrome) also known as ‘Hughes Syndrome’.
The ‘sticky blood’ can also affect the placenta and blood flow to the foetus, leading to miscarriage – in some women as many as 12 or 14 miscarriages. So important is this discovery that the syndrome is now recognised as the commonest, treatable cause of recurrent miscarriage.
The link with lupus? One in five lupus patients have the antibody linked to Hughes Syndrome. Diagnosis involves a relatively simple blood test and treatment can be as simple as one ‘baby aspirin’ a day.
The London Lupus Centre
Ten years ago, my team and I opened a specialist referral centre at London Bridge Hospital.
The centre has built up an international reputation with patients referred worldwide – 57 countries to date.
It deals mainly on an outpatient basis, with new referrals usually having two consultations, four days apart – in order to complete all the necessary screening tests –and, depending on disease activity and travel commitments, a follow-up protocol is planned.
Further details at www. thelondonlupuscentre.co.uk
By Leslie Berry
The British Association of Aesthetic Plastic Surgeons (BAAPS) has hit out at n HS clinical commissioning groups (CCGs) for ignoring official guidance by not funding potentially life-saving surgery.
Following obesity treatment such as gastric bands, bypasses or sleeves, post-bariatric patients can be left with almost two people’s worth of skin, resulting in functional problems – such as reduced mobility, hygiene issues and infections.
This can also have a heavy impact on their psychological wellbeing as well as impede their ability to work. In some cases, being left in these ‘molten bodies’ has even lead to depression and suicide.
BAAPS says removing the overhanging skin would help these patients re-join society and restore their lives to normality – and has issued figures to try and prove this treatment is cost-effective.
A study by association member consultant plastic surgeon Mr Mark Soldin revealed that nICEaccredited national commissioning guidelines specific to the removal of overhanging, excess skin is being ignored by over 92% (100 out of 108) of CCGs and that 40% funded no surgery at all.
He said: ‘We are only half-treating these patients, who have previously been severely obese. They have successfully shed, in many cases, half their body weight or more, and we know around 70% of them will require body contouring due to the excess skin folds.
‘Yet under a short-sighted – and rather convenient – misunderstanding of the term “cosmetic”, they are left in a cruel limbo where they can’t yet quite feel whole. Many of the patients I see tell me that they feel “disabled” and incomplete.
‘Almost like a mythical zombie: neither dead or alive, but stuck in a gruesome transitional state – slim now, yet dragging two people’s worth of skin which impede their movement or they’re forced to roll up and “tuck” into their clothes.
‘The removal of these folds cannot be classified as simply aesthetic – it is life-changing and in some cases life -saving.’
BAAPS calculated the economic burden of not treating these patients correctly – according to guidelines – is over £53m a year, based on the costs of treating stress, depression and unemployment.
But if patients had access to this important surgical intervention, the potential net benefit – savings – to the economy could be as high as an annual £73m; a combination of removing the healthcare costs and increasing the tax paying ability and productivity of this ‘lost’ workforce.
Consultant plastic surgeon and BAAPS president Mr Michael Cadier said: ‘ n ot only can this type of procedure help these patients who feel “incomplete” –but by eliminating their functional problems, increasing their self-esteem and removing the cost of treating co-morbidities such as poor mobility, skin infections, anxiety and depression, it can in fact be an active contributor to the growth of the economy and the overall wellness – or “happiness” – indices of our country.’
He added that, according to the Office of national Statistics, these metrics should be at the centre of many social and political measures.
‘This is not about making people “beautiful” but restoring normality and function, so they can lead healthy and productive lives. Moreover, studies have shown that the higher your self-esteem,
the higher your earnings – therefore, more tax injected straight back into the economy.’
Consultant plastic surgeon and BAAPS president-elect Mr Simon Withey said: ‘With target reduction in health spending of £12bn, the onus is rightly on the surgical profession to prove that funding in this area will produce savings.
‘Can we now afford to ignore evidence-based guidelines, which demonstrate that these procedures do result in both long-term savings and a more productive and happier group of patients?’
This is not about making people “beautiful” but restoring normality and function, so they can lead healthy and productive lives
MR MICHAEL CADIER, BAAPS president
Susan Hutter (right) discusses the business ideas coming to the fore in the medical profession and the best way to structure the practice to take advantage of what is on offer
‘Centres of e xcellence’ have been ‘trending’ in the medical profession for a few years now.
t hese are where a number of consultants in the same or complementary disciplines form a group, either formally or informally, in one location to provide a ‘Centre of excellence’ in a particular specialty.
the individual consultants do not have to form a joint legal structure. If they wish, they can remain separate, either trading as limited companies or sole traders.
However, in many cases, the consultants have formed partnerships and/or limited companies in which they are shareholders and directors.
now there are some trends that are growing out of the ‘Centre of excellence’ model.
one of the main ones is to ‘insource’ as opposed to ‘outsource’. for example, if there are a number of consultants all requiring one particular third-party service frequently, then instead of sending their patients to a third party, and losing revenue in the process, they are keeping the work inhouse.
the type of areas could include imaging and physiotherapy. this often means that there is some capital expenditure required. But if there are a number of consultants who are willing to group together over this, then it becomes less expensive in individual terms and the risk is spread.
Another trend that is emerging
is the development/invention of products to assist with a consultant’s specialty; for example, health drinks, vitamin supplements and aids to independent living.
In all cases, funding will be required. However, there are certain tax advantages of setting up and investing in such a business. Both of the above business models can be catered for via a limited company in which the interested parties have a shareholding.
the tax breaks available are enterprise Investment s cheme ( e I s ) relief and seed enterprise Investment scheme (seIs) relief. these can be used by shareholders with less than 30%, including shares owned by connected parties.
If the company is a qualifying trading company and the ideas above would qualify, then any capital investment into new shares would achieve 30% tax relief for eIs and 50% for seIs
If you invested £20,000, the tax relief would therefore be £6,000 and £10,000 respectively. t he maximum investment in a tax year is £1m for eIs and £300,000 for seIs
seIs is more generous: the tax relief is at 50% as opposed to 30%. But the rules are stricter and it is basically only for new businesses not those that have been going for some time and wish to raise more capital.
for these businesses, eIs is relevant. Providing all conditions are met and the shares are held for three years, there is no capital gains tax (CGt) liability on sale of the shares and also there would not be a clawback of the original income tax relief.
t here are also potential CG t savings when making the initial investment. t his is by way of deferment of CGt in the case of eIs or cancellation of CGt in an seIs
Participants in the business can include current partners in the
practice, current shareholders, employees and colleagues. It is possible to keep the model flexible to cater for different profit shares and also link profit shares to performance. the world of independent practice is becoming more entrepreneurial by the day. However, as in all of these situations, it is vital to take professional advice before proceeding.
Susan Hutter is a partner at specialist medical accountants Shelley Stock Hutter
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Social media is confusing and daunting for most business owners. Pam
Underdown (right) suggests where you should focus your effort for success
Are you fed up about not getting many sales from social media and you don’t know why?
Perhaps you’re posting on Facebook and Twitter several times daily but you’re frustrated because, no matter how much time and effort you put into social media marketing, getting new patients is just not happening for you.
Maybe you’ve even considered quitting because it simply isn’t working. Well, you are not the only one. For most business own ers, social media for business is confusing and daunting.
Success on social media is about understanding your target audi ence, engaging with them and finding out what makes them tick.
Without this, you end up just broadcasting messages and hop ing some of it sticks. But it won’t – you will be lost in a sea of enter tainment, ‘voyeurism’ and pro crastination.
Many well-meaning posts on social media are put there without much thought and without a strategy. But with no strategy, you don’t know whether what you are doing is working and why. And you don’t know how long to do things for, what to change or what is successful. you are throwing mud at the walls and hoping it sticks. And that is not a good use of your time.
➱ p14
Before you spend any time on social media, you have to have a very strong idea of what you are doing it for. What is your goal? What would you like to see achieved weekly and monthly?
Your plan will need to be broken down into several subsections: Who is going to do it/who is responsible?
This is pretty obvious, but if you are slowly starting to dabble with social media, I am sure you have realised it needs daily focus, effort and attention to really get it moving. If you don’t have the time and are unable to commit to this on a daily basis, then you will need to find the right person to delegate the daily actions to. a word of warning though: make sure you keep control over it and make sure your agent really understands you, your business, your target audience and your brand personality. It can be a complete waste of time to abdicate this to someone who doesn’t understand aesthetics. Give them specific instructions and keep a daily eye on everything they do. What platforms will you focus on? I wouldn’t encourage going gungho on all of the platforms, as you will be spreading yourself too thinly and getting nowhere.
Focus on one or two to begin with, get up to speed and master them and if you achieve your goal, then you may not need any more. In reality, it’s all about where your patients and prospective patients are spending time.
If you are not sure, you will need to ask them. Then you will need to create an overall plan detailing what you want to achieve and a smaller plan of action for each platform.
What content will you post? What will the updates consist of? What will be of interest to your prospective patients? remember, it’s all about what will interest them and not what interests you. When will you post and how often will you post? What are the sweet spots to get the biggest bang for your spend?
Most people use social media as a platform for their own self-serving megaphone announcements – ‘shouting’ at people and then wondering why it doesn’t work. you don’t need to stand out from the crowd by shouting as loud as possible.
you need to cut through the noise on social media in a way that is congruent with what people are doing on social media –and, on the whole, they are there to be social. you can still sell on social media, but it needs to be weighted in the other direction, otherwise you will turn people off. you need to put great content out there on a regular basis to build ‘know, like and trust’. This is basically common-sense marketing. No one is going to spend any money with any business if they don’t know them, if they don’t
You can still sell on social media, but it needs to be weighted in the other direction, otherwise you will turn people off
This is all about conversion. How will you take your followers and fans from social media to become a paying patient?
What needs to happen for a connection, a fan, a follower to make a phone call and arrange a booking with you?
If you are not capturing the data from your social media connections, you are wasting your time. Without capturing details through their in-built lead capture page or by taking people away from Facebook onto your own specific landing page, you are putting your faith into having permanent access to your social media accounts.
Don’t lose all of the hard work you have done already to build your audience; get them onto your list so you can start building relationships with those who aren’t ready to pick up the phone just yet.
How will you measure your success and the revenue you generate? How can you link the revenue from your social media profiles and know whether your posts and adverts are working or not?
You will need to keep a track of everything you do on social media; you will need to measure it weekly and monthly and if it’s not working, then you will need to change it.
This is all very logical, but if one element is not in place, it won’t work how you want it to.
like them and if they don’t trust them.
Imagine that you have just waved at a random person across the street and their immediate response it to thrust an order form in your hand and suggest you buy something? Would you feel inclined to seek them out and spend time with them again?
Building relationships
If you come on too strong, you’ll likely get the metaphorical door slammed in your face. To stand out from the crowd and start building relationships with prospective patients, at the same time as developing continued relationships with existing patients, you need to create a brand personality. your brand personality is based upon the real, true authentic you.
To stand out from the crowd and start building relationships with prospective patients, you need to create a brand personality
you will then use your brand personality to build rapport, build relations and build a connection with prospective patients. you need to build an engaging personality that isn’t boring or overly corporate. you need to be ‘you’ and to enable your personality to shine across, but in a way that matters to your audience.
Key personality traits
The four key personality traits to exhibit are: engaging, sociable, open and honest. Social media is very transparent and people will see through you and ignore you if they feel you are not being authentic.
Start by observing your competitors and really study those who are doing it well. What are they doing? What are they saying? What content are they post-
ing? What engagement are they getting?
Study them all, make some notes and keep tabs on it. Also look for those companies you have a personal connection with – the ones that you follow outside of your work. What do you like, what don’t you like and why are you engaging with them? What can you learn and emulate on your own profiles?
Avoid negativity
Be positive – anything negative will turn people away from you. So if you are getting others to post for you and they have a bad day, ask them not to post, in case their mood comes across in your name. you are responsible for what goes out there and if anyone leaves a negative comment, the chances are people will bite and it will look really bad for you, your business and your reputation. Be mindful, as this does happen
when someone else posts on your behalf. Make sure you have a plan to deal with any negative comments professionally and take it offline quickly.
When people start connecting with you, the chances are they won’t have a clue who you are. So how can you expect them to engage with you or even start spending money with you, if they don’t know, like or trust you?
It’s a bit like asking someone to marry you on a first date; you just wouldn’t do it. you need to build the ‘know, like and trust’ with the content that you post, and it must be content that adds value. you need to maintain a healthy ratio of six to eight content, educational and relationship-building posts to one promotional post. you need to create something of yourself that your target market will engage with. Showcase your expertise by teaching, educating and providing useful information.
If you are using your normal business page to post promotions, they won’t get much exposure at all these days – as you probably know. Facebook has restricted all the free tactics we used to be able to use in the last few years to get us to spend money with them.
Test, measure, monitor Facebook advertising is still the most reasonably priced advertising that directly can target your ideal patients, but there are ways of getting the best results and the best engagement.
It is well worth learning how to use the tool properly. To really maximise your results, you will need to test, measure and monitor. Spend small, fail small and continuously improve.
use Facebook’s own split-testing tool, where you can upload six images at a time. Videos tend to work better and really help build relationships when it is you in front
of the camera. you can also upload your patient database and use the ‘lookalike audience’ function to find prospective patients with the same interests and demographics. While it’s very cost-effective when compared to different forms of advertising, the hardest part is optimising the advert once you set it up. There are many adverts to choose from that will either help you to grow your fan page or get direct leads and sales. Don’t boost posts from your page, as the targeting is very weak; do it from the ad’s manager instead. Make sure you play on scarcity and urgency with a timelimited reduced price or a limited number available.
Next month: How to build a business with systems and a team that works efficiently even in your absence
Pam Underdown is chief executive at Aesthetic Business Transformations
How often do you think about telephone answering in your practice? Independent Practitioner Today contributor Mr Dev Lall suggested answering the phone is one of the most important tasks driving success in private practice – but often one of the most neglected and undervalued (November 2015).
So, with high patient expectations, how do you deliver a quality service while juggling daily demands? Here, Stephanie Vaughan-Jones offers her thoughts on making the right call when it comes to answering the phone
1It’s your call – don’t miss it
First things first – no practice, indeed no business, can afford to miss a call.
A missed call is a wasted opportunity, potentially a lost patient and certainly a fail in terms of customer service.
First impressions count and it’s no more acceptable to leave a phone call unanswered than to leave a patient unattended face to face in clinic. But is enough value being placed on each individual call and the way each one is answered?
How many times have you heard someone say: ‘I’m only answering the phone’ or ‘I’m just on the phone’? Well there’s no ‘only’ or ‘just’ about it.
Telephone answering differs from many other operational
functions in its immediacy and the weight of responsibility it carries at front of house, protecting your brand and helping shape your reputation.
Yet it is a widely undervalued element of the overall business function.
The way you answer your phone calls has a direct impact, not only on the image you present, but also on the overall patient experience – and, ultimately, your bottom line.
Every call matters. No caller wants to be left hanging on and we know from our own research that the vast majority strongly dislike answering machines and leaving messages.
Imagine if just five calls are missed a day. The figure soon adds up – 150 in a month, 1,800 over the course of a year.
2
Wear your patients’ shoes
If there is one ‘golden rule’ for delivering the very best in customer service, then it is this.
Experience your practice as your patients do. Customer service has to be at the heart of a thriving practice. But to fully understand the way this is delivered, look closely at every patient contact point to appreciate how it feels to be on the receiving end.
So put yourself in your patients’ shoes. Think about how you are answering the phone and how you would feel if you received the same response.
A confused patient is an uncertain and uncomfortable one, so be clear, not only in the information you are giving them, but the way you are delivering it.
Understanding your patients –their needs, expected outcomes, time-scales, circumstances and what drives and motivates them
The reality is that few practices can do it all and many now seek outsourced support to take the pressure off
– will be key to getting your communication with them just right. However busy you are, taking some time to think this way will be worth the investment and you will be amazed by the insights you’ll gain. Often it is the little things that make a big difference.
3
Is your red carpet permanently rolled out?
Gone are the days of callers expecting a real person to pick up their phone inquiry only within traditional opening hours.
Patients’ habits, indeed the habits of all consumers, have changed beyond recognition, with 56% of us apparently ‘addicted’ to our smartphones or other devices and making personal, lifestyle and buying decisions in the evenings and at weekends when we have more time to act on them.
Patients want to feel special and important. They need to be nurtured. Yet delivering a seamless
response over the phone, whatever the time of day – or sometimes night – can be a real challenge.
Meeting expectations isn’t enough. Aim to exceed them, ensuring that those getting in touch outside of regular hours are receiving the same level of customer service they would expect during the day.
There’s not only a job to be done in capturing every call, but also in engaging patients over time. A well-kept data management system will help calls flow, leading to an improved patient experience at every stage of their journey.
4
You don’t have to do everything
The reality is that few practices can do it all and many now seek outsourced support to take the pressure off.
An easy to use software system, which fully supports the clinician and office staff and makes the whole process of running a busy Practice a lot easier.
Call now for a chat and ask about a free, no obligation demonstration of our comprehensive system that has been designed to save your Practice time and money.
It can be a welcome relief knowing calls are taken care of by specialist receptionists who become extended members of the in-house resource
Crosscare is a proven clinical system used within private practices and specialist clinics in and around Harley Street and across the UK.
Alongside the standard clinical record keeping and prescribing systems, Crosscare’s appointments, reporting and integrated accounting modules make the tracking of workload, invoices and revenues simple and user friendly.
We understand that each practice works in their own unique way, so being a fully customisable system, Crosscare can be easily tailored to fit your individual needs.
For further information on how our Crosscare solution can help your practice call us now on 01233 722670 or visit www.advancedcomputersoftware.com/ahc
Staffing your reception to cover every call during a busy working day with one eye on 24/7 provision can be a logistical nightmare, especially if working across multiple locations, and is, in most cases, financially non-viable.
There are many considerations – fluctuations in incoming call volumes, busy times when staff are juggling other demands or priorities, staff absences, holidays and emergencies – all of which make providing exactly the right level of internal resource at any one time potentially problematic.
But with outsourced phone answering support, practices are boosting their capability with the flexibility of overflow capacity as and when they need it.
Some doctors fully outsource individual elements – for example, new inquiry lines – so they know each one is handled in the same professional way.
Engaging an outsourced partner has proved particularly popular with self-pay aesthetic departments, who are concerned they may be missing consultation inquiries, as well as clinics that want to extend perceived opening hours or need temporary assistance.
It can be a welcome relief knowing calls are taken care of by specialist receptionists who become extended members of the inhouse resource. Handled well by a joined-up team, phone calls offer golden opportunities for improved patient engagement.
If you’re looking to hire someone to look after your calls, interview them over the phone before you meet them. Carefully selecting individuals to answer the phone should be a bit like taking a seat on BBC TV’s talent singing show The Voice – making a decision on how a person comes across without other influences clouding your impression.
Particular styles of voices and different responses suit different situations, so making the right appointment is a skill.
Think about how you wish to be perceived – are you fluffy and friendly, conversational, clipped and to the point or does a bespoke
mix of styles work across different elements of the practice?
Getting this right can significantly build your call handling efficiency while helping to build your relationships with your patients.
6
You can hear a smile
One of the most important things you can do when answering the phone is smile. Admittedly, it may sound a bit odd when we’re speaking to people we can’t see and who can’t see us, but smiling is a crucial currency.
While it’s easy to convey your pleasantness in person, with no visual clues over the phone, body language gets lost, so what we say and the way we say it becomes all the more important when seeking to make a great impression.
However busy your day is or whatever has happened only seconds earlier, smile and your demeanour will change. Your voice will become sharper, your pitch higher and you will be surprised how much brighter your pronunciation will be. It makes the whole call a more satisfying and reassuring experience for both you and the caller. Smiling is infectious too. A happy workplace makes for a more productive one, which will positively affect the service you are delivering on every level.
7
Patients are talking… . . . and not just to their friends and family. It used to be the case that online reviews were the domain of retail consumers, holidaymakers and restaurantgoers. Not any more.
These days, pretty much every product, every service, every destination is analysed and talked about in the most public of arenas.
Like many people these days, I rarely make a significant purchase without first checking out online reviews or social media sites. You name it, I’m keen to know what others think before I commit –and this behaviour is fast becoming the norm when it comes to seeking private medical services. While many in the sector will be sceptical and somewhat nervous, these outlets should encourage practitioners to really think
It may sound a bit odd when we’re speaking to people we can’t see and who can’t see us, but smiling is a crucial currency
about the way they are delivering their service, introducing ele ments that will help to build patient satisfaction, trust and confidence.
Don’t see it as a threat. See it as a valuable opportunity to gather honest, free feedback that you can take away, act on and use to your advantage.
Managing phone calls well will stand you in good stead when it comes to this kind of new-age scrutiny.
Stephanie Vaughan-Jones (right) is channel manager at telephone answering service and outsourced switchboard provider Moneypenny
A private GP practice introduced an automated telephone appointment service to offer patients more choice when making a booking.
The island of Guernsey, as a dependent of the British Crown with its own administration, operates a largely privatised healthcare system.
in practice, this means that some health and social care-related services are funded through taxation and contributions to the s ocial s ec urity d epartment’s funds, while others are paid for by individual residents.
s ervices such as GP appointments, visits to a & e and ambulance use are all paid for privately with GPs’ surgeries operated as private practices.
Primary healthcare is administered across three GP practice
groups serving 65,000 people. each practice is responsible for its own operating and capital costs, and has its own set of charges.
a patient can expect to pay around £50-£60 for a ten-minute consultation with their doctor, although Guernsey’s s ocial s ecurity department contributes £12 towards the cost of each appointment for qualifying patients, as well as covering the full cost for those who receive social security benefits.
as a general rule, around threequarters of practice revenue is generated from GP and practice nurse appointments, with additional revenue from minor procedures –
plus activity such as renting space to other medical services.
Unlike many UK practices, none of the surgeries on Guernsey operate an online appointment booking or repeat prescription service.
But three years ago, the Queen’s Road Medical Practice decided to become the first on the island to install an automated phone appointment booking service as part of a drive to enhance patient access and communication.
The practice operates across two sites: one in the capital s t Peter Port and the other in the more rural location of st Pierre du Bois.
like all practices on the island, it offers paid-for healthcare for around 22,000 residents with services administered by 14 GP partners, five associates, nurses, administrative staff, physiotherapists, an osteopath, chiropractor and acupuncturist.
The practice decided to install an automated system as a way of offering more choice for patients, as well as reducing call congestion at key times.
On the suggestion of one partner, who already knew of such a system in use in the nhs on the mainland, the surgery went live with the service in 2012.
Known as Patient Partner and developed by unified communications firm Voice Connect, the system is a PC/server-based solution which connects to a practice’s phone system.
i t is currently installed at around 800 nhs surgeries in the UK. Operating 24/7, the system allows patients to book, cancel, check or change appointments at any time, night or day using their phone.
To use the service, callers simply dial the number – usually the surgery’s standard number –and choose the appointment booking option.
Because the service integrates with the electronic appointment book, it operates in real time, detecting spaces in the diaries of
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Be sure to track the results you get from your marketing efforts if you want to maximise your income and cut costs. Surgeon Dev Lall (right) shows how
View your website as the focal point – the ‘hub’ – of all your efforts to market your practice. obviously, all your online ‘traffic’ – potential patients who find out about you through searching online or through seeing an advert you’ve placed somewhere online – will end up on your website, but this is also true of people who find you ‘offline’.
So you might get some Pr in a local newspaper or magazine, or place a paid-for advert somewhere and people who are interested in seeking your help with a medical problem will almost always perform a search for you online too to find out more about you.
we all do this: you see or read something interesting somewhere then search online to find out more.
w hat i would suggest though, even with offline marketing, is to deliberately drive visitors to your website from the advert or P r piece or whatever. Specifically ask people reading the piece to go to your website – better yet, a specific page of your website. why?
Space to
o n your website you have as much space as you need to communicate your message. This is obviously not true when it comes to Pr, because you have no editorial control at all – the editor of the magazine or newspaper will chop and change things to suit themselves.
That’s fair enough as long as the
facts are right, because they are giving you the exposure for free. But this is also true when it comes to paid-for advertising, but for a different reason.
in paid-for advertising you can buy as much space as you choose to get your message across to the reader. But advertising costs money and, depending upon the media, it can get expensive.
And even if you are willing to throw a lot of money at a particular advert, common sense demands that you limit your spend according to your return on investment. you should always ensure you get more money back from a marketing campaign than you put in. That’s the point of advertising, after all – to make money.
The advantage of sending traffic in this way to your website is that you have as much space as you want to communicate your message. web hosting is very cheap, so whether you need to take 20 pages to communicate your message or one is irrelevant.
The other aspect, though, is that online you are not just limited to text.
online you can put up text, pictures in colour, audio, video or even interactive 3D images to illustrate what you have to say. A website is a multimedia communications platform which most of us are using way below the level we could be.
There is no point marketing yourself without being able to determine if that method of marketing is working. As John wanamaker (1838-1922) put it: ‘Half the money i spend on advertising is wasted; the trouble is, i don’t know which half.’
But tracking where people come from and how they reach your practice to become patients is now easier than it has ever been. it’s really not that difficult; it just requires some thought and application.
And it is necessary because not all your marketing efforts will work. Some will fail completely. The majority will work reasonably well and generate a decent return. And a few will produce incredible and unexpected results, sending a flood of patients your way. you need to be able to tell which is which, so you know how to close the marketing loop by
deciding which approach to bin, tweak or run again unchanged. o ne simple method of doing this is by sending visitors to specific pages of your website. in fact, i would say it is foolish to send traffic to your home page except with rare exception. w hy? Because it’s all about maximising response.
Put it this way: somebody is surfing around looking for help with pain in their hip and they see your Google ‘pay-per-click’ (PPC) advert addressing that problem. ‘Great!’ they think and click on your ad, only to find they end up at the home page of your website and are faced with a load of information they aren’t really interested in at all – about you, your expertise, your CV, the fellowship you took and the wide variety of conditions you treat. People get bored easily and, with rare exception, won’t bother to search your website to find the
information they thought they were going to get about the treatment of hip pain. So they leave and click off elsewhere in cyberspace, never to be seen again. And the opportunity to help someone and get appropriate recompense has also vanished.
The same is true of P r : i f the article about you refers to how you helped a local footballer get over a knee injury – for example – then the people who will take most notice of the piece are likely to be people who also have knee problems. So, at the end of the piece, you should invite them to go to the specific knee page of your website.
Specific phone numbers
it is now cheap, easy and simple to get extra phone numbers both personal and business. By having different phone numbers that people can ring depending upon where they saw your advert, this
would tell you where they came from automatically. So you could run an advert with a particular phone number to ring for an appointment which is different to the one patients would normally ring. By having different numbers on adverts in different magazines, you would know which adverts were working and which were not, so which to run again and which not to bother with.
we’ve probably all seen these before, particularly in newspaper ads – ‘ring (012) 345 678 and quote code 21’. By having different codes to quote for adverts in different magazines and papers, this similarly allows you to see which ads get the best response.
free gift/special offer we don’t tend to use these much, although some in cosmetic sur -
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gery do so. The idea is the same –you have different offers in different ads and, depending upon the gift or offer that the patient asks for when they phone, this tells you where the patient found out about you in the first place.
free report
offering a free report to visitors is really powerful, for all sorts of reasons and i highly recommend it. Two big reasons for doing so include:
❶ For a patient, ringing up for a free report about a given condition is far less threatening than having to ring up to book an appointment. They don’t have to ‘decide’ to see you yet and they get something of value to them for free;
❷ From the consultant’s point of view, you too get something of value when someone rings up for a free report: you get their contact details.
in effect, the person making the
there is no excuse for not tracking the results you get from your marketing efforts. it really is mandatory
call is saying ‘yes, i have this problem and i ’m interested in being treated by you. Please tell me more’. They are, in a very real sense, asking you to convince them why they should see you.
And you should take the opportunity to do so.
There are three ways of doing this. Firstly, make your free report on the condition concerned genuinely useful to the patient – i’m talking about a non-clinician’s guide to diabetes or whatever, not a just brochure for your practice.
Secondly, clearly explain in your report the benefit to patients of coming to see you in particular.
And, finally, follow up the contact. w hen someone requests a report like this, you should be sure to have someone in your practice write to them and/or phone them up, say, a week later asking whether they received it oK, whether they found it useful and to invite them to book an appointment.
benefits of email email is underutilised, but it is a devastatingly effective way of growing your private practice. it is both a free and instant way of communicating, which we should be using more than we do. So one very simple thing you could do is to set up multiple email addresses and publish them in different adverts, inviting people to contact you for further information. This will allow both tracking as well as follow-up at a later date.
There is no excuse for not tracking the results you get from your marketing efforts. it really is mandatory. i t maximises your income while minimising your costs, and that’s something we can all see the benefit of doing.
Mr Dev Lall is an upper-GI surgeon and runs specialist private practice consultancy www.PrivatePracticeExpert.co.uk
After almost eight years as a consultant anaesthetist, Dr Helen Hartley (below) joined defence body Medical Protection as a medico-legal adviser in 2010. Here she describes the work in her changed career
I wanted to have a change of career due to a number of factors – my growing interest in law and ethics, professionalism, the regulation of medicine and the potential benefit of risk management initiatives on patient safety.
t he world of a medico-legal adviser (MLa) is a mystery to the majority of doctors, who probably also hope it stays that way as they aim to avoid the requirement for medico-legal assistance.
a s the interface between doctors and the legal process, MLas oversee the management and progress of a wide variety of cases. t his can range from general advice on, for example, confidentiality or report writing, to advice to help minimise risks that may develop from challenging ethical and professional scenarios, through to claims, complaints, regulatory and disciplinary issues, inquests and criminal investigations. each case has its history, symptoms, diagnosis and, of course, ‘treatment’ options. we advise and support the doctors involved and, with their consent, liaise with those investigating their practice, instructing solicitors, barristers and expert witnesses along the way, where necessary.
From a practical perspective, the role is highly varied and as project managers we have to be highly organised.
there is no typical day: I could be office-bound one day then travelling cross-country the next to attend a meeting, represent a doctor at a disciplinary hearing, support a defendant doctor in court or give a lecture.
a s some doctors can find the investigation process difficult, MLas need to be patient, empathetic and listen to their concerns to try and help them understand the situation they may find themselves in.
you use them, and always in easyto-understand language.
✍ Verbs should generally be transitive and in the active voice. By using a transitive verb, you have to specify who does what to whom – the subject and the direct object.
The passive voice introduces an element of uncertainty into your meaning by not clearly telling the reader who is the subject of the sentence, phrase or clause.
People often use the passive voice when they are not sure of their facts or when they are being disingenuous. You may, however, choose to use the passive voice sparingly to vary the pace of your narrative, which in turn helps to retain the reader’s attention.
The tense of the verbs should always be correct. Obviously all liability and causation reports are referring to things that happened in the past, but which past?
✍ Things that happened continuously in the past are best expressed in the past progressive /continuous (or imperfect) tense. For instance, ‘he/she was suffering’. This tense conveys a sense of continuing or repeated past actions. Alternatively, use ‘used to’; for instance, ‘he/she used to suffer’.
✍ Things that happened in the past and which were completed, even if the event occurred more than once, are best described using the simple past tense. F or instance, he/she suffered. Alternatively, the present perfect tense can be used; for instance, ‘he/she has suffered in the past’.
✍ Things that happened before another event in the past should be expressed using the past perfect (pluperfect) tense. For instance, ‘he/she had suffered for three years before he/she visited a dentist’.
✍ Use the present only if something is still ongoing. For instance, ‘he/she is still suffering’. Take care not to mix these up, as to do so can mislead the reader about when something took place.
The two tenses you should use in a current condition and prognosis report are the present, when referring to the current condition, and the future, for the prognosis.
So when you are describing the current condition you will say ‘he/she has…’, and when talking about the prognosis, ‘he/she will/ shall…’
Another verb form that you should be familiar with is the ➱ p30
• Completely open scanner that is well tolerated by claustrophobic patients
• Weight-bearing scans for spine and joints enable a more precise diagnosis
• Patients who are large or cannot lie down can be accommodated
modal auxiliary – a form of very that is used to indicate likelihood, ability and permission. This is a favourite of defendants and is often used by them to make statements that are contrary to the facts.
For example, potential harmful treatment had been carried out on a medically compromised patient, with no evidence that their medical history had ever been checked.
The defence responded, claiming that the doctor ‘would have’ checked the medical history before carrying out the treatment. This verb form is best avoided.
Ambiguity is the sign of poor writing and is caused by placing words in the wrong order (poor syntax), the incorrect use or overuse of punctuation, and the overuse of pronouns.
To avoid ambiguity, make sure that every clause and sentence is syntactically correct. do not use punctuation unless it is absolutely necessary. It is much better to make the subject of a sentence clear by using the subject’s name rather than repeatedly using pronouns, which assumes that the reader knows to whom you are referring.
Remembering your duty as an expert, you should avoid using loaded words, as they will prejudice the reader. Clichés, figures of speech, metaphors and similes should also be avoided.
Avoid superfluous words and phrases. They serve no other purpose than to waste time. Why use several words when a single word will do? For example, the phrase ‘in view of this fact’ means ‘so, ‘at the present time’ means ‘now’, and ‘in order to’ means ‘to’.
‘no’ to double negatives double negatives can cause confusion. e xpressing an affirmative using the negative of its contrary is an acceptable method of emphasising a negative if used carefully – for example, ‘it is not inconceivable’. But unless you are very confident with your writing, this form of expressing is best avoided. Saying the same thing twice with different words in the same sentence should also be avoided. Anything littered with punctuation is difficult to read. As a gen-
there is no reason why any report should contain any spelling mistakes. however, electronic spell-checkers can only identify incorrectly spelt words. they will not pick out an incorrectly spelt word that is, in fact, another word spelt correctly; for example, ‘form’ and ‘from’.
spell-checkers are not infallible, so mistakes will occasionally creep in. It is probably acceptable to have one spelling mistake every ten pages. any more than that is a sign that the report has not been properly proof-read. take extra care when spelling names, addresses and specialist terms.
the lexicon of medicine is full of abbreviations and acronyms. the rule for using abbreviations in reports is simple. Write the word or phrase out in full the first time you use it and place the abbreviation in brackets immediately after.
You are then free to use the abbreviation from then on. for example, the General Medical Council (GMC). the same rule applies to the use of acronyms – for example, the National Institute of health and Care excellence (NICe).
Italics are used to emphasise words and phrases or when writing foreign words used in an english sentence. You can use italics for emphasis, but don’t overdo it or it begins to be meaningless.
I have a thing about dates: I always write them out in full – for example, 12 september 2014. I would never abbreviate the month to ‘sept’ and I always include the year. Writing the date this way, especially in reports, means that the solicitor does not have to think. I’m all for making the solicitor’s life easy.
eral rule leave out all punctuation except full stops in the first draft of your reports and only insert commas, semicolons, colons and so forth later where they are absolutely necessary to the meaning and sense.
If you want to avoid having to decide which punctuation mark to use, write shorter sentences –then you won’t need anything other than a full stop. I am sure that solicitors are trained to write sentences devoid of punctuation, except for a full stop at the end.
This is for the simple reason that adding a comma sometimes alters the meaning. You should make a point of carefully studying all letters sent to you from solicitors, and see how clear and unambiguous is their writing.
Consistency in the use of punctuation in a report is important. For example, if you have decided that a colon should precede lists and that each item is to be separated by a semicolon, do not introduce other devices later on. A colon says to the reader: ‘I am going to tell you something: here it is.’
If you want to avoid having to decide which punctuation mark to use, write shorter sentences –then you won’t need anything other than a full stop
Quotation marks should only ever be used when you are directly quoting what someone has written or said. e xclamation marks should never be used in formal business writing.
And the rule for using capital letters is straightforward: they are used at the beginning of sentences, for proper names or titles and for adjectives such as ‘english’. Some people use capital letters in a random fashion, often capitalising every noun. next issue: sources of evidence
Adapted from The Effective and Efficient Clinical Negligence Expert Witness , by Michael R. Young, price £60 from Otmoor Publishing
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A major campaign has been launched to alert GPs and the public about eye care and what consultant ophthalmologists can now do for them. Leslie Berry reports
Ophthalm O l O gists’ skills are vastly under-used in the private sector due to a worrying lack of knowledge among doctors and patients about what they can do.
New research from Optegra Eye health Care has revealed what the company calls ‘an alarming, selfacknowledged gap’ in gps’ abilities when it comes to diagnosing and treating eye conditions.
medical director mr Rob morris, a refractive expert, says: ‘it is clear from our research that both the British public and many gps are unclear about the current treatments available for eye conditions.
‘For example, we learnt that one-
in-five gp s is unaware that patients can have their long or short sight corrected at the same time a cataract is being removed, freeing them of glasses or contact lenses. this is despite the fact that one-in-three British adults will be affected by cataracts in their lifetime.’
Share best practice
he says the company is committed to continuing professional development for the ophthalmic and healthcare community and will work with both gp s and optometrists to share best practice and grow understanding of new
an overwhelming 98% of GPs agree that optometrists and opticians are best placed – over GPs – to diagnose eye conditions
The main reasons for this are because optometrists have more time (according to 70% of GPs and optometrists), they can dilate eyes for thorough examination (69% agree) and because optometrists are more up to date on symptoms (68%)
90% of optometrists say that they are seeing an increase in eye health problems compared to just five years ago
99% of GPs and optometrists agree a rise in obesity and diabetes is likely to cause more eye problems in the future
More than three-in-five optometrists (63%) feel there is a serious absence of public knowledge around regular eye health
65% of optometrists think the Government and nhs could do more to promote eye health and regular eye tests
technology and the range of treatments available.
m
r m orris’s comments came after Optegra commissioned The Vision of Britain report, which shows that more than a quarter of British adults (26%) turn to their gp rather than an optometrist for help if they have an eye problem. But 32% of gps surveyed admitted they felt ‘de-skilled’ in diagnosing eye conditions, some reflecting the immense pressures and workload on these doctors. and as many as 44% say they feel less confident in identifying eye conditions than other parts of the body, such as ears, heart and lungs.
two-in-five gps surveyed believe they need more or refresher training on all eye conditions. a further 40% say they would refer eye problems to a specialist more quickly than other parts of the body.
t he Optegra Eye h ealth Care report is based on wide-ranging research among British adults, gps and optometrists.
Fewer eye tests it reveals that the most common eye problems presented by patients to optometrists are infection, presbyopia or hyperopia, diabetes-related issues and agerelated macular degeneration.
Both optometrists and GPs cite the lack of regular eye tests as one of the biggest causes of rising eye health problems, along with smoking, diet, genetics and UV rays
it is also producing information booklets to assist with referral pathways and where to direct patients in an emergency. as part of its professional development programme, it is providing a number of continuing education and training (CEt) and continuing professional development (C p D) courses through healthcare trade media.
But although four in five British adults worry about protecting their eyesight, nearly half do not attend regular eye tests every two years as recommended by the College of Optometrists.
Both optometrists and gps cite the lack of regular eye tests as one of the biggest causes of rising eye health problems, along with smoking, diet, genetics and UV rays.
Reacting to the results, Optegra says it is running a series of educational events on each area of the eye to help raise awareness of latest research and treatments.
l ast month, the company launched a tour of some major Uk cities offering free eye health checks to the local community, and a free report on eye health. t he roadshow started in guildford, surrey, and as we went to press was due to be taken up in the six other Optegra Eye health Care hospitals in the Uk: london; north l ondon; Birmingham; a pperley Bridge and l eeds City Centre, Yorkshire; Whiteley, h ampshire, and Didsbury, manchester.
Optegra commissioned research with Censuswide in July 2015; online research with 2,016 adults aged 16 or over throughout the UK, 50 GPs and more than 50 optometrists. Further details on the roadshows and report are available at www.optegra.com/VOB.
Patient details
1
Coding principles
Ensure you get all the patient’s details before or straight after the consultation or procedure. As a minimum, get the patient’s name, date of birth, address, contact number and email address. It is obviously very important to get the name of the patient’s insurer, the patient’s membership details and any pre authorisation details. These will be very useful later on in the process.
3 4 bILLING AND COLLECTION
Check the coding principles applied to the procedure you are billing. There are certain codes that cannot be billed together and this is known as an unacceptable combination or unbundling. If you try to bill the codes on one invoice, then the insurer will automatically reject the invoice and this will delay the payment to you.
Billing the private medical insurers can put independent practitioners on a long journey to get to that ‘crock of gold’. Gary Nials (right) outlines the various milestones you need to navigate to ensure you get prompt payments
CCSD codes
2
Pricing rules
Next, determine the Clinical Coding and Schedule Development Group (CCSD) codes for the procedures you have carried out. This can been done by either using the CCSD website (www.cssd.org.uk) or from the insurer’s website, usually in the provider’s section.
Check the insurer’s pricing rules for multiple procedures. For example, some insurers will only pay 100% of the published fee for the first procedure, 50% of the published fee for the second and 25% or nothing for any other procedures. Remember to follow any pricing rules, otherwise you may find your invoice rejected at the first stage and delay payment.
After the consultation or procedure, invoice as quickly as possible to ensure prompt payment.
Deliver the invoice to the insurer, which can be done through some insurer’s websites or by simply posting the paper invoice. But be careful, as some insurers do insist on electronic delivery.
There are a number of ways to check whether you have been paid for the work you have billed. Some insurers allow you to check online. Otherwise you will need to wait for the remittance advice sent either by email or through the post.
Do not just assume that a payment from your insurer into your bank account is all the money for the work you have done. You must ensure you reconcile your invoices with your payments
If the insurer does not pay the invoice within 30 days, then always phone their provider helpline to find out why.
Create your invoice. As a minimum, it must have a unique identification number, invoice date, your name, address and contact information.
Also include the details of the patient you are billing for, name, date of birth, membership number and pre authorisation code, the CCSD codes and descriptions of the procedures, date of treatment and the fee you are charging.
Due to the increase in patient excesses or patient contributions to treatments, inevitably the patient may end up funding some of the fees. This is known as patient shortfall. For the paperwork, you will have to credit the insurer’s invoice with the shortfall and raise a new invoice for the patient.
Again, all the details that you put on the insurer’s invoice need to go on the patient invoice. More importantly, the invoice should explain the ways the patient can pay you.
Be prepared to accept payment in several forms such as credit or debit card, bank transfer, cheques and cash.
Chasing patient payments requires constant effort. A few days after sending the invoice, you must contact the patient to inquire whether they have received the invoice and when they are going to pay. In most cases, the patient will pay after receiving the invoice or your initial phone call. In a few cases, you may be required to do a little more chasing or employ the services of a debt collection agency.
You have finally received all the payment for the procedures and all your paperwork is in order. Of course, if this process seems a little daunting. then consider outsourcing your billing to a professional company. as it will have expertise and processes in place to ensure prompt payment.
Gary Nials is the managing director of Medical Billing and Collection
With the increasing use of mobile software applications in patient care, James Lawford Davies warns doctors of the associated legal and regulatory considerations of apps and recommends a clear policy for governing their use
Apps are regulated in essentially the same way as hospital systems and computers, attracting the same liabilities
I use my smartphone as – among other things – a spirit level, a calculator, a camera, a web browser, a dictaphone, a radio, a sat-nav device, a diary, a clock, an address book and a messaging device.
I also occasionally use it to make phone calls.
The remarkable processing power we carry in our pockets provides a wonderful variety of services and opportunities. And a significant and rapidly growing number of applications (apps) for smartphones have a healthrelated dimension.
The number and variety of health applications has risen dramatically over recent years, reflected in the fact that NHS Choices published a ‘Health Apps Library’, offering a list of ‘safe and trusted health apps to help you manage your health’.
However, the use of this type of software by practitioners for medical purposes has also increased, with many doctors using apps daily in clinical practice. This, in turn, gives rise to legal and regulatory considerations regarding liability, governance and compliance.
Let us consider some of these considerations in relation to both health apps and software more broadly.
Perhaps understandably, few people are aware that when standalone software is used in a healthcare setting, it may constitute a medical device, an in vitro diagnostic (IVD) medical device, or an accessory to an IVD. If it does qualify as such a device, then it is an offence to sell or supply it unless it conforms with relevant legal standards. The classification criteria to determine when stand-alone software attracts regulatory requirements are not, however, straightforward. So when does software become a medical device?
Although the UK has its own laws governing medical devices, in reality, the legal framework is of European origin.
The UK Medical Devices Regulations of 2002 – subsequently amended on a number of occasions – incorporated three EU directives into UK law: The 1990 Active Implantable medical Devices Directive;
The 1993 m edical Devices Directive;
The 1998 In Vitro Diagnostic medical Devices Directive.
Medical devices are defined as being: ‘… any instrument, apparatus, appliance, software, material or other article, whether used alone or in combination, together with any accessories, including the software intended by its manufacturer to be used specifically for diagnosis or therapeutic purposes or both and necessary for its proper application, which:
Ais intended by the manufacturer to be used for human beings for the purpose of:
(i) diagnosis, prevention, monitoring, treatment or alleviation of disease;
(ii) diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap;
(iii) investigation, replacement or modification of the anatomy or of a physiological process or;
(iv) control of conception and
Bdoes not achieve its principal intended action in or on the human body by pharmacological, immunological or metabolic means, even if it is assisted in its function by such means’ (my emphasis underlined).
It follows from this definition that, while the regulations specifically include software within their scope, it is also necessary to consider the intended use and purpose of the software to determine whether or not it constitutes a medical device.
Stand-alone software must have a ‘medical purpose’ to qualify as a medical device. When considering this, it is necessary to look at the purpose of the software itself: the test does not include software which is incorporated into an existing medical device.
For example, built-in software which controls a CT scanner will be treated as a part of that device, not as stand-alone software requiring its own classification. However, software which interprets CT scan results to aid diagnosis may well be a medical device.
When considering use and purpose in the context of classification, it may also help to consider the function of the software and the action it performs on data.
For example, software that ➱ p38
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merely stores electronic patient records is unlikely to be categorised as a medical device. But if it incorporates modules which provide additional analysis that contributes to diagnosis or therapy – for example, a patient medication module – then this may be classified as a medical device.
Similarly, the purpose of the software itself must be medical, not just applied in a medical context. For example, a clinical information system which records and stores data relating to patient identification and clinical observations will not usually be considered a medical device in itself.
However, if it incorporates a functionality which provides additional diagnostic or therapeutic information, then it may qualify as a device.
This distinction between medical and non-medical purposes can be nuanced, depending on the circumstances. An example given by the Medicines and Healthcare Products Regulatory Agency (MHRA) is the use of an application which uses an accelerometer in order to detect falls in epileptic patients.
This is likely to be regulated as a medical device, as its purpose is medical, whereas the use of the same application to alert a carer when an elderly person gets up out of bed would not be regulated as a medical device.
A further consideration is whether the software is used for the benefit of individual patients or for a cohort.
Stand-alone software which is used to interpret or evaluate data relating to the medical care provided to an individual may be a medical device, whereas software used to analyse population data or to create generic treatment plans will not be.
If it is decided that stand-alone software is indeed a medical device and is intended for diagnostic or therapeutic purposes, it will be a Class IIa device or, if potentially hazardous, Class IIb.
If it is used for other purposes, it will be a Class I device. The compliance of Class I devices relies on self-declaration by the manufacturer, whereas Classes IIa and IIb require the intervention of a notified body – such as the British Standards Institute – to assess compliance.
The use of and integration of such apps into day-to-day practice therefore warrants the development of a clear policy governing the use – or indeed prohibition – of apps in the workplace
As mentioned above, modern smartphones have the capacity and versatility to collect a vast array of personal data.
The advent of comparatively affordable genome sequencing and ready access to genetic data can also be fed into apps and software, creating an increasingly powerful and personalised source of what may be very valuable health information when properly processed and interpreted.
The MHRA has published useful guidance on the regulation of health apps, suggesting that there are a number of key words which are likely to contribute to the MHRA determining a health app is a medical device.
These words include:
Amplify;
Analysis; Interpret;
Alarms; Calculates; Controls; Converts; Detects; Diagnose; measures; monitors.
These, of course, reflect the provisions of the medical device regulations discussed above, and many of the same questions discussed above will arise in relation to classification.
There may be a tendency to assume that such apps – carried as they are on a personal phone or tablet – are even less likely to attract regulation than a hospital system or computer programme, but, in fact, they are regulated in essentially the same way, attracting the same liabilities.
The use of and integration of such apps into day-to-day practice therefore warrants careful consideration and the development of a clear policy governing the use – or indeed prohibition – of apps in the workplace.
The burden of medical device regulation in the context of health software and apps will most commonly fall on the shoulders of the software producers – those companies which place the device or accessory on the market for sale or supply.
However, healthcare providers should seek to ensure that the software they purchase satisfies the relevant regulatory requirements.
One particularly powerful reason for doing so is because compliant manufacturers are responsible for implementing an effective post-marketing surveillance system for their devices, which is designed to make sure that any problems or risks associated with the use of the device are identified.
Related to this, the liability that may arise as a result of the use of health apps by medical staff necessitates at the very least a clear policy governing the use of such software.
James Lawford Davies is a partner at Hempsons solicitors
Is there a better way of gifting? Hugh Davies (right) examines some useful ways of passing on wealth to loved ones throughout the year
Although many parents wish to build a nest egg for children or grandchildren, there are certain rules to be aware of if the recipient is under the age of 18
Although your money might belong to you, it often comes as a surprise when people are told they cannot give it away without tax implications either for themselves or for their loved ones.
there are a number of rules governing monetary gifts to prevent individuals from avoiding inheritance tax by off-loading their wealth before death.
the associated tax liability will depend on how much you intend to give, to whom and how often. the current rate of inheritance tax (Iht) is £325,000 or £650,000 for couples. Any assets – property,
savings, investments, possessions – above this limit will be assessed and a tax charge of 40% will apply, or 36% if you donate at least 10% of the estate to charity.
If you are married, you can pass your full estate to your spouse in the event of your death without triggering a tax charge. In doing so, you will also pass on your Iht exemption, so a full £650,000 of your combined estate would remain I ht -free upon your spouse’s subsequent passing.
But new rules announced by the Chancellor last year mean that, from April 2017, a ‘family home allowance’ will be gradually added to the existing tax-free rate – at £25,000 per tax year – until it reaches £500,000 per person by 2020.
So if you jointly own a property with your spouse or civil partner worth up to £1m, you will be able to bequeath this to your children or grandchildren, free of Iht
If you die within seven years of passing on an asset, the gift will attract a tax payment. A gift given between three to seven years before your death will be liable for tax but at a reduced rate, known as ‘taper relief’.
It is possible to give away £3,000 each year, without any tax implications. t his is the total sum rather than an amount per beneficiary. It can also be carried forward for one year if unused, so you may have up to £6,000 to spend in one year or £12,000 if your spouse also chooses to give the full sum. you can also make gifts of £250 to as many beneficiaries as you choose in one tax year but this cannot be combined with the £3,000 allowance. For example, you cannot give one beneficiary £3,250.
you are able to give as much money as you wish to certain ‘exempt’ beneficiaries either while still living or via your will. t his includes your spouse or civil partner – provided they live in the uK – and registered charities.
you may consider giving your children a regular amount each month because, unlike larger lump sums, such payments are excluded from inheritance tax. t his is provided they are taken from after-tax income, not savings, and will not affect your lifestyle – that is to say, you have to sell your home to facilitate the payments.
Many individuals choose to make large cash gifts as presents for wedding or civil partnership ceremonies.
the amount allowed depends on your relationship with the recipient; parents can give up to £5,000 tax-free, grandparents £2,500 and all others £1,000. If the wedding fails to take place, your gift will not be exempt from Iht
Although many parents wish to build a nest egg for children or grandchildren, there are certain rules to be aware of if the recipient is under the age of 18. there is no limit to the amount of money you can give your child but only the first £100 of interest earned is tax-free (for 2015-16). once this level is breached, all the interest will be taxed as if it is the parent’s income. Money given by grandparents and other adults does not suffer this cap.
Parents or guardians can open Junior ISAs as a tax-efficient way of helping their children build future house deposits or tuition fees.
Children must be under 18, but, once opened, any friends or family members can contribute to either a cash or stocks and shares version. t he annual limit from contributions is £4,080.
As an added advantage, the interest earned on money deposited into the Junior ISA does not count towards the £100 per parent tax-free limit, unlike a child’s bank account.
one point to note: your child will
have access to this money when they reach 18 and will be able to spend it on anything of their choosing rather than yours – one reason Junior ISAs were dubbed ‘motorbike funds’. they can also manage their accounts and investments from the age of 16.
the alternative is to pay into a pension for your offspring, meaning they are unlikely to be able to access the pot until they turn 55. the attraction is that the contributions receive the same tax relief as any other pension – despite the fact that children are not taxpayers.
they can also still take the 25% lump sum when they draw on the pension – as long as pension rules remain the same.
the pension pot could benefit from five decades of growth with an added 20% tax relief.
Since the pensions death tax was abolished, more individuals are considering leaving their private retirement pots untouched in order to pass on to the next generation.
Although pensions were exempt from Iht in the majority of cases, they were normally subject to a punitive tax charge –known as the pension death tax – at the rate of 55% if the deceased had started to take income or had taken tax-free cash.
Now when someone older than 75 dies, their heirs will pay income tax on any remaining pension at only their marginal rate. And no tax charge will apply if they were aged under 75, subject to them having available lifetime allowance remaining.
Whether you choose to pass on some of your wealth now or in the future, ensure you have the full picture of what this could mean in terms of the tax that might be applicable for you and the people you would like to protect.
Hugh Davies is a financial planner at Cavendish Medical, specialist financial planners helping senior consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Independent practitioners’ difficult ethical questions are answered this month by Dr Christine Walker (below)
QI am an orthopaedic surgeon who retired a few years ago. I continued to carry out independent expert work for a while after retirement but have not accepted any new instructions for over a year.
Despite this, I have continued to receive questions from solicitors as well as requests to appear as a witness in cases that are coming to court after considerable delay. Must I comply with these requests?
AThe responsibilities of experts in civil claims are governed by the civil procedural rules. The overriding duty of any expert witness is to the court and, by retiring, the duties of the expert witness are not extinguished.
If another expert had to be instructed by either party in a case, then significant costs would be incurred. That said, you may wish to explain your position to the solicitor. In certain cases, they may prefer to instruct a new expert who is currently practising.
If the instructing solicitor does not agree to release you from your duties and you chose not to attend court or provide adden -
dum reports, you may receive criticism from the court or even an adverse costs order.
Doctors taking on expert work should plan ahead carefully. A case may remain open for many years.
If approaching retirement and considering taking expert work, you may wish to inquire with the instructing solicitor as to timescales and make clear any limits on the commitment you can offer.
The GMC offers guidance on acting as a witness in legal proceedings and the Civil Justice Council sets out best practice in terms of experts’ duties.
Although neither document specifically addresses the effect of retirement on the duties of experts, the best practice guidance states that if experts withdraw, they must give formal and adequate written notice to those instructing them with reasons.
Doctors who continue to undertake expert work must make sure they have appropriate indemnity still in place and that they maintain their licence to practise, if required for the work they do.
QI recently retired from my role as a private physician. I do not plan to work again and was considering requesting voluntary erasure from the GMC register.
However, the online application process asks whether I am aware of any matters that might lead to an investigation or a fitness-to-practise hearing.
A couple of years ago, a claim was made against me and several other doctors. I do not yet know the outcome of this claim, but
Doctors taking on expert work should plan ahead carefully. A case may remain open for many years when I last spoke to a claims handler from my defence organisation, I was informed that the expert report was positive and she seems hopeful that the claim will not progress. Does this mean that I do not need to disclose this information?
ABy the end of their careers, most doctors will have experienced processes such as these and will be aware of just how slowly they can progress.
Some doctors will have ongoing cases at the time they retire or cases may arise after retirement and this can mean that voluntary erasure is not straightforward. It may be tempting to avoid mentioning this issue when submitting your application for voluntary erasure. But, in the interests of full disclosure, you should disclose, in factual terms, a brief summary of the case you are involved in – in the supplementary section of the application form.
QI am a GP working in independent practice. An insurance company has requested that I provide a medical report on a patient who is seeking medical insurance through their employer’s scheme.
The patient has a couple of current medical conditions that he is being treated for and has previously – five years ago – been treated for anxiety and depression.
At the time, he attempted suicide on several occasions. The patient has given permission for me to disclose information to the insurance company, but we have not specifically discussed what I will be disclosing.
I am worried about putting my patient’s mental illness in the report. What should I do?
AIn Good Medical Practice (2013), the GMC states that a doctor has a duty to ensure that information provided in a report is not false or misleading and should take reasonable steps to
insure that the information is correct and not deliberately leave out relevant information.
However, you should only disclose factual information that is relevant to the request.
The GMC advises that you should have the patient’s express consent to disclose information for such purposes (Confidentiality, 2009), so you should discuss with your patient the fact that you will have to include information regarding his mental illness in your report, the possible implications and obtain his written consent.
You should also ask the patient if he wishes to see the report before it is submitted to the insurer.
The insurer should already have advised the patient of their rights under the Access to Medical Reports Act 1988, but if you have any concern that the patient might take issue with the content of the report, then it is advisable to share your report with the patient before disclosure, even when they have not indicated a wish to see.
If the patient objects to information which you believe to be relevant being disclosed, then you should advise your patient that you will be unable to write the report.
Should the patient disagree with the content of the report, then you should consider whether an amendment can be made.
If you are unable to agree to this, you may be able to add a comment to the report highlighting that the patient does not agree with what has been written.
Dr Christine Walker is a medico-legal adviser at the MDU
The new generation Q7 is well worth a close look for independent practitioners with kids and who appreciate high quality and up-todate technology, says Dr Tony Rimmer (right)
EvEry yEar, new technological advances alter the way we practise. r adiological investigations become more accurate, blood tests become more precise and information becomes easier to access.
Surgical techniques have also become more sophisticated, often driven by new scientifically advanced equipment and knowhow.
In private practice, we are starting to engage more with social media and the benefits it can bring by attracting and communicating with our patients.
Our organisations are more efficient with computerised databases and software which, although it may not always feel like it, optimise our work patterns. We incorporate these changes in our day-to-day work almost imperceptibly.
Technology also drives change
when it comes to the vehicles we drive. Manufacturers constantly strive to improve safety, efficiency and economy and utilise the latest material and engineering sciences to achieve these goals.
Consequently, I always look forward to assessing the latest versions of our favourite cars just to see how they have been changed – and whether the alterations have been successful in a mean-
ingful way for us as potential buyers.
Why would we spend our hardearned money on the latest models if the gains are not real and significant?
Premium SUV
One such car is the new secondgeneration a udi Q7. This large seven-seat premium SU v has been a favourite with many
medical families since its launch in 2005.
It combined the practicality of a roomy people carrier with the security of permanent four-wheel drive and the quality of the audi brand. Unfortunately, it lost out in the looks department, was not particularly economical and did not excite many keen drivers. But sitting on a brand-new platform, powertrain, chassis and
with the latest infotainment system, the fresh Q7 promises to be an improvement in many areas. It is initially only available with a 3.0 litre v6 turbo-diesel engine in two states of tune producing either 215 or 268bhp.
More efficient
a lthough volvo has gone along the four-cylinder only route, this audi diesel engine is probably the brand’s most impressive unit and has been updated and made more efficient.
a udi quotes about 48mpg for both versions, so expect about 33mpg in the real world. an eightspeed automatic gearbox connects to the Quattro permanent fourwheel drive system.
a ir suspension is an option, which is highly recommended because the several different ride settings will maximise comfort whatever the load. a plug-in hybrid e-tron model will be available during 2016.
The new car is certainly an
improvement with regard to the way it looks. Sharper styling gives it a lower and less bloated and obese appearance.
you may not buy one for its head-turning capabilities, but it is subtle and smart in just the same way that the volvo XC90 cuts a dash. Like its Swedish rival, the boxy shape pays dividends when it comes to interior space.
There is plentiful room for seven and although the rearmost seats are best suited to young adults, the middle row of three can slide back and forth to suit.
as we know, audi interiors are top-notch and the Q7 is no different. The ‘floating dashboard’ virtual cockpit in front of the driver, first seen in the latest TT model, works well and having the sat-nav screen directly in the driver’s sight-line is really useful.
High-quality materials and supreme fit and finish make the inside of the audi a rather nice place to spend time on long journeys.
There is no getting away from the
The ‘floating dashboard’ virtual cockpit in front of the driver works well and having the sat-nav screen directly in the driver’s sightline is really useful
There is plentiful room for seven and although the rearmost seats are best suited to young adults, the middle row of three can slide back and forth to suit
fact that this is a big car, but the engineers have managed to shed 300kg compared to the old model. advanced material technology has allowed this and, combined with more efficient engine technology, produced a car that gives more miles per gallon and produces less CO2 than its predecessor.
The steering is accurate with more directness than the old model and the handling, although not sporty, has also improved. The 272bhp of my test car was plenty quick enough and can surprise many a hot hatch.
Its primary role, though, is of transporting the family. The quiet and refined way it goes about this will be appreciated by young and old alike.
Now, I do have to admit that the original Q7 was not one of my favourite cars. To find the latest version as agreeable as it turns out to be has been a pleasant surprise.
although not as roomy as the XC90, it is more engaging for the driver. The range rover Sport may be the ultimate keen driver’s luxury SUv, but it is a lot more expensive. a ny private practitioner with children who appreciates high quality and up-to-date technology would do well to consider the Q7 as family transport.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Seven-seat hatchback 4x4 SUV
Engine: 3.0 litre V6 twin turbodiesel Power: 272bhp
Torque: 140Nm
Top speed: 137mph
Acceleration: 0-60mph in 6.2 secs
Overall economy: 47.9mpg
CO2 emissions: 153g/km
On-the-road price: from £47,775
With the new tax year soon upon us, now is a good time to review your trading structure to ensure you are best placed for the changes that lie ahead. Ian Tongue (left) reports
The Governmen T has made several changes to the taxation around limited companies and pensions and so it is important for doctors with businesses to understand the impact.
There are two major changes coming into force from 6 April 2016:
The income tax treatment of dividends;
The reduction to an individual’s annual pension allowance for those earning over £150,000.
The taxation of dividends
Dividends are the most common way consultants extract profit when trading as a limited company.
The income tax treatment for the individual receiving dividends has been well established, with basic-rate taxpayers paying no more tax, higher-rate taxpayers paying 25% of the net dividend and additional-rate taxpayers paying 30.6%.
These are effective rates, as the tax return grossed up the dividend for notional tax suffered. The current tax rates often present a significant tax saving when compared to being a sole trader.
From 6 April 2016, the grossingup system is replaced by the introduction of a rate of income tax on the net dividend received. The new rates are:
First £5,000 – tax free; Dividends falling in the basicrate tax band – 7.5%;
Dividends falling in the higherrate tax band – 32.5%; Dividends falling in the additional-rate tax band 38.1%.
Therefore, the new rates could pose an opportunity or a threat depending on your individual tax circumstances.
The pension annual allowance is the amount you can pay into a pension each year and attract tax relief. This is presently £40,000 for everyone. Some years ago, it was as high as £200,000.
From 6 April 2016, for those earning between £150,000 and £210,000, this allowance will reduce on a tapered basis such that, at an earnings level of £210,000 or more, the limit is reduced to £10,000.
This change is very important and relevant for the nhS consultant carrying out a private practice, as the calculation of earnings will include your private practice income.
referring to one’s payslip to see how much you have paid into the nhS Pension Scheme relative to the annual allowance is incorrect, as the physical contributions are disregarded.
This is because the nhS Pension Scheme is known as a ‘defined benefit’ scheme which, in simple terms, means that what you put in does not correlate to what you get out.
What you receive as a pension is a product of earnings level, length of service and which nhS Pension scheme you belong to.
Therefore, a calculation of your increased pension benefits is made based on a formula provided by hm revenue and Cus toms. The way in which these calculations work, receiving an increment in pay, clinical excellence award or taking on an additional superannuable programmed activity, usually results in a significant spike in your calculated benefit increase.
The system allows you to look back three years and bring to your aid any unused relief to reduce or mitigate your liability. however, with the reduction from £40,000 to £10,000 for those earning more than £210,000 in the years to come, this unused relief is likely to be modest.
The potential impact of this change is a staggering £13,500 in additional tax.
This tax can be offset against your pension benefits, but it does form an interest-baring loan, so the younger you are, the more will be deducted on retirement.
Additionally, the time-scales to apply for the nh S Pension Scheme to pay any tax due can be tight due to a lack of communication between trusts and nh S Pensions.
For a more detailed look at the annual allowance for pensions, see my article in the n ovember 2015 issue of Independent Practitioner Today
what can be done?
The trading structure adopted for your business can have a significant impact on your taxable earnings, but the effectiveness of changing will depend on your individual circumstances.
The potential impact of this change is a staggering £13,500 in additional tax
If set up correctly, the use of a company should lower your tax liability as well as providing additional flexibility.
As highlighted above, the income tax payable on dividends will increase by 7.5%, but the introduction of the £5,000 allowance can still result in the use of a firm being more tax-efficient and the added benefit of potentially providing you with a higher annual allowance for your pension.
In certain circumstances, a partnership with your spouse can be
an effective structure. A partnership acts in a similar way to selfemployment but the profits are split in a pre-determined ratio. Profits are subject to income tax and n ational Insurance, but, more often than not, it is a more tax-efficient structure than selfemployment. This structure requires your spouse to have an active role in the business, but, in my experience, the spouses of most consultants are actively involved anyway.
Whether a limited company or partnership is appropriate to your circumstances will depend on your unique position. With many changes to tax legislation announced and more in the pipeline, now is a good time to review your trading position.
Next month: Should I lease or buy medical equipment?
Ian Tongue is a partner with accountants Sandison Easson & Co
Welcome to the BVRLA – I’m delighted that you’ve decided to join the trade association that provides a face for the vehicle rental and leasing industry, communicating its messages to customers, the media and government.
So why not turn to the experts in the field to help you find the vehicle that suits your needs?
The BVRLA’s corporate identity, particularly its logo, forms part of that message.
An accountant with knowledge of the medical profession will be able to guide you through the correct set-up of alternative structures. The practical aspects can often be overlooked by some general accountants.
The BVRLA has three categories of membership, each with a logo that members are entitled to use (and, in some situations, are obliged to use). Appropriate use of our logo tells your customers, your suppliers, and the rest of the world that you adhere to the high standards that come with BVRLA membership.
anthony K associates are vehicle leasing brokers specialising in providing vehicle contracts for doctors and all associated professions in the medical sector.
testimonials from our very many happy customers are proof of our attention to customer service and our practised ability to help clients get the vehicle they want quickly and easily.
This brief guide explains how we expect our logos to be displayed – and how they should not be displayed. These are not hard-and-fast rules, and we sometimes depart from them ourselves, but we do expect our members to respect them and to gain our prior approval before using our logo in any way other than described here.
The main options to consider are that of a limited company or partnership with your spouse.
If you need a copy of our logo, for use on your printed marketing material, or to go on a page of your website, please contact our communications team, who will be happy to send you an EPS or JPEG version appropriate for your purposes.
If you have any queries about use of the BVRLA logo that are not addressed in this guide, they will also be able to help
A limited company is a separate trading entity which has shareholders who own the company and directors who run it. The shareholders and directors typically comprise of the consultant and their spouse.
Gerry Keaney Chief executive, BVRLA
A group of specialists who went into business with their staff are enjoying the experience and seeing exciting growth. Leslie Berry reports
C onsultants at the l ondon Claremont Clinic ( l CC) have reported a healthy start to their venture with nearly 7,000 appointments in their inaugural year.
now they say they are looking forward to continued growth over the coming months at their outpatient clinic, which opened in 2014 at 50 52 n ew Cavendish s treet ( Independent Practitioner Today, october 2014).
lCC offers adult and paediatric care in over 15 specialties including ophthalmology, endocrinology, dermatology, oncology, cardiology, gynaecology and rheumatology.
a range of tests and services are also available, headed by a full range of ophthalmic tests including optical coherence tomography ( o C t ) and biometry, ultrasound and complex blood and endocrine tests.
the clinic was established by a group of specialists and staff who wanted to bring together their practice experience and their work in cuttingedge research in a purpose built facility in the Harley street area.
unusually, specialists and staff jointly own the clinic – and they believe this has helped them to offer a level of excellence across all aspects of patient interaction.
lCC chairman and ophthalmic surgeon Prof lyndon da Cruz says has is very proud to have been involved with this sort of collaborative venture.
Meanwhile, many of the consultants at l CC remain at the
forefront of research breakthroughs in their respective fields.
Prof da Cruz, for example, is leading an exciting trial at Moorfields eye Hospital to see if sight can be restored to patients suffering from wet age related macular degeneration (aMD) following stem cell treatment.
t his innovative surgery uses embryonic stem cells to grow a replacement ‘patch’ of retinal pigment epithelium cells that are later transferred to a patient’s diseased eye during surgery, with the ultimate aim to restore sight.
He says: ‘ t he stem cell transplantation for macular degeneration has really given us enormous hope for people who have lost their vision and would ordinarily have no chance of treatment.’
l CC oncologist Prof Justin s tebbing continues to pioneer advances in immunotherapy for metastatic cancer patients.
More than 50 patients with melanoma, lung cancer or mis
match repairdeficient colon cancer were treated at lCC in the first year with a checkpoint inhibitor, pembrolizumab; and the results look promising for expanded use in other cancers as well.
Prof s tebbing says: ‘ t hanks to tremendous recent advances in immunotherapy, we really do stand at the beginning of a new era in the fight against cancer.’
another lCC consultant, cardiologist Dr tim lockie, is also the lead investigator in trials at the Royal Free Hospital looking at the management of critically sick patients who are suffering a heart attack, as well as the use of cuttingedge tools to assess the flow of blood inside the coronary arteries.
Reflecting on his practice at lCC, he said: ‘it is great working within such a skilled multidisciplinary team. We each bring expertise from our own area of interest and to be able to bring this altogether for the benefit of our patients is one of the key strengths of the lCC.’
as well as the consultants’ commitment to research, the clinic has a growing programme of continuing education and training events that have become popular with consultants, gPs and health care professionals in and around l ondon. Many of the evenings are oversubscribed.
one event was an ophthalmology seminar where Mr Carlos Pavesio, also director of Medical Retina service at Moorfields, gave a lecture on different presentations of the red eye.
t his was followed by Mr n ick strouthidis, also a glaucoma service training director at Moorfields, who spoke about the role of oCt imaging in glaucoma.
For more information about lCC consultants and services, see www.londonclaremontclinic. co.uk
Why not tell us the story of your clinic or business? Email robin@ip-today.co.uk
association with
Falling income and profits are hitting gynaecologists and the squeeze is set to continue as some consultants give up private practice. But that could mean more work for those left, says Ray Stanbridge
Consultant gynae C ologists have not been immune from some major market developments we have been witnessing.
t hese include the ongoing reduction in fees, following the introduction of the Bupa open referral system in 2013 and the growth in nHs Choose and Book business – now accounting for 30% market spend, according to market analysts laingBuisson.
t hen there has been the increase in room rental, secretarial and other costs following the
Competition and Markets authority (CMa) rulings, which were implemented in full from a pril 2015.
a combination of structure and organisational, as well as market changes, are hardly the best features to ensure an accurate analysis of income.
the private medical sector is in a state of great flux and, as discussed in previous articles in this series, many consultants have looked to join groups or to incorporate.
aveRage INCOMe aND eXPeNDITURe OF a CONSULTaNT gyNaeCOLOgIST WITH aN eSTaBLISHeD
Expenditure
t his has made for significant comparison difficulties. as well as these factors, readers need to be aware that this survey is restricted to those consultants who are not full time in private practice.
they include those who:
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.
e arn at least £5,000 a year in private practice.
Work as a sole trader, a member of a formal or informal group, through the means of a partnership and/or a limited liability company.
Having made all the caveats, my overall finding is that the average gross fees of a gynaecologist in private practice fell by 1.9% between 2014 and 2015.
Costs increased by about 5.9% from £51,000 to £54,000. a s a result, taxable profits have fallen by about 8.8% from £57,000 to £52,000.
gross incomes have been slipping slowly for the past two or three years. as i wrote in this col
umn last year: ‘We have seen the fall we were anticipating. the reasons for the fall seem to be firstly, the impact of insurer fee reductions for many, particularly younger consultants and, secondly, the increasing proportion of n H s related income in the practice.
‘nHs Choose and Book procedures, for example, generally are undertaken at a lower rate than insured rate, though in certain instances this is changing.’ What happened on fees between 2012 and 2013 happened again between 2013 and 2014.
indeed, we have noticed a situation that some gynaecologists with small practices are giving up completely, and relying solely on additional nHs business.
in time, this could lead to a shortage in the private sector. simple economics suggest that where there is a shortage, prices go up.
t here have been a number of cost increases over the past year or so and one cost decrease: medical supplies and assistant fees.
t his seems to be the result of the fact that consultants are tend
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)
Source: Stanbridge Associates Ltd.
ing to deal more with procedures on their own – or doing less complex procedures in the private sector.
staff costs have shown a small increase. as previously reported, there is a correlation between the growth in the tax free personal allowance and salaries paid particularly to staff members. obviously, this figure is an average and professional secretaries are paid significantly more. office costs seem to have risen
slightly. there is no particular reason here, apart from rounding adjustments. a similar observation can be made on the slight growth of accounting/legal costs.
Marketing costs
there has been further growth in ‘other costs’. these relate to marketing and business promotion. s ometimes this category includes business entertaining. i ncreasingly, those consultant
gynaecologists who are serious in developing their practices spend more on marketing than in the past.
What of the future? there seems to be a pattern of income and profit squeeze and, for the next year or so, this is likely to continue.
But i believe there is some glimmer of hope. We are seeing an increasing trend towards selfpay and this may be a new feature of the market.
continued squeeze
i n addition, the reluctance of some consultants with small practices to enter the market may lead to a shortage and a possible increase in insured prices. this phenomenon is not, however, immediately clear, as insurers continue to squeeze consultant fees.
What we do expect is a further squeeze, albeit slight, on fees and margins.
t his will vary by region, and will also be affected by the ability of private hospitals to raise fees for services under the terms of the CMa ruling.
next issue: Radiologists
years ending 5 april
Make sure you don’t miss our next issue, published on 17 March. Only subscribers to the journal are guaranteed to receive every copy and we don’t think anybody who is serious about continuing private practice in the future, when there is so much happening that will affect them, can afford to miss any issue.
Coming up next month:
Don’t miss our free Private Doctors’ Tax guide 2016
Practice Builder: in our new series, Malcolm McCoskery – who has held posts at four different private hospitals/groups – looks at different topics relevant to consultants who are aiming to build their practice. In this issue, he covers whether to work as part of a multidisciplinary team
Hempsons’ lawyer Lynne abbess examines the case for private doctors being a member of an limited liability partnership – or not
Do you feel like you own a job and not a business? Many businessowners feel trapped, they do not have the freedom they set up their business for in the first place simply because, without them, there is no business. Pam Underdown explains how to get a business with systems, leverage and a team that operates efficiently – even in your absence
Following the recent introduction of a mandatory duty to report known cases of female genital mutilation in the under 18s, Dr Karen ellison, gynaecologist and medico-legal adviser at Medical Protection, explores the issues for private doctors who are conducting female genital cosmetic surgery
eDITORIaL INqUIRIeS
Property: Dylan Mitchell suggests some of the best buys for doctors in the French alps for 2016
In Business Dilemmas, Dr Kathryn Leask of the Medical Defence Union answers your questions arising from private work as an expert witness
Doctor On The Road columnist Dr Tony Rimmer finds a car that won’t cost you a lot of hard-earned income to give you everything you need in a family car: the Renault Kadjar
get that will sorted! Considerations for medical practitioners
Could youTube help grow your practice?
Profits Focus, our unique benchmarking series, examines the income, expenses and profits of radiologists
Retirement tips
Plus all our regular features: accountant’s Clinic, Breaking Into Medico-Legal Work, Starting a Private Practice
and all the latest news and views to help you run your practice
aDveRTISeRS: The deadline for booking advertising for our March 2016 issue falls on 22 February
Robin Stride, editorial director
Email: robin@ip-today.co.uk Tel: 07909 997340
aDveRTISINg INqUIRIeS
Margaret Floate, advertising manager
Published by The Independent Practitioner Ltd. Independent Practitioner Today is editorially independent and thanks Bupa for its assistance with distribution.
Printed by Pepper Communications Ltd Material is governed by copyright. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form without permission, unless for the purposes of reference and comment. Editorial layout is the copyright of the publishers. If you wish to use it for promotional purposes on websites or for reprints, we would be happy to discuss licensing the copyright to you.
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