A self-pay boom
Tactics to use to tap into the growing self-pay market and boost patient numbers P20
Why a well-structured portfolio allows you to ignore the gloom when investing P38
Don’t rush to punish Advice to help navigate the minefield of managing misconduct among your employees P40
By Robin Stride
Practice management experts are warning independent practitioners to ensure they are geared up for new EU data laws which threaten huge penalties for non-compliance.
The General Data Protection Regulation (GDPR) is set to force changes in the way doctors run their businesses.
But with just three months to go until the existing Data Protection Directive is updated, there is concern that many practices are far from ready, while others are ignorant of what is required.
Samantha Mulligan, director of a company providing practice management services to independent specialists, told Independent Practitioner Today: ‘It is feared that consultants do not realise or haven’t taken on board how much this change can affect them.
‘And even more worrying, the impression is that some haven’t even heard of it. We want to bring GDPR to the attention of all consultants, as the repercussions could be so dauntingly large with a potential fine totalling up to 4% of their global turnover.’
The data regulation update aims to reflect modern-day data usage. It comes in to force on 25 May 2018 and will impact everyone handling personal information.
She explained: ‘The GDPR update
aims to bring uniformity to data protection laws by making them like those already in force throughout the EU.
‘Brexit doesn’t change anything, as the Government has confirmed that GDPR changes will be implemented, despite the UK’s impending exit from the EU.’
Her firm, KMS Professionals, offered to help our readers by producing the following advice on some key steps to take and what should be done to ensure practices are compliant.
1. The main GDPR changes independent practitioners should be aware of are:
Time to report a breach of data has been reduced to 72 hours;
Significantly tougher fines for non-compliance and breaches;
New obligations and controls over processing and storing patient data, including encryption;
Explicit patient consent must be gained to cover storage and how you use that patient’s data. If you are going to share it with other practitioners or the patient’s GP, you will need consent. Implicit consent is no longer acceptable.
2. If you or your practice manager are doing any of the following, these must stop by May 2018:
Sending personal data via unencrypted email – not only can the patient be identified, the email address may be incorrect;
Sending voice files via email;
Using mobile phone apps to transfer patient photos or details to other practitioners; for instance, WhatsApp, Snapchat and text message;
Leaving messages on patient answerphones that include personal information;
Personally transporting labelled samples to labs.
3. What you should/can do:
Send voice files via a secure method, such as a Cloud server;
Only send emails that include personal data if they are encrypted or password protected.
Only the true recipient can open the email, so if the email address is incorrect, the recipient will be unable to open the email and there will be no breach of data; When leaving a voicemail, think about what you are saying. You cannot guarantee who else will listen to that message;
If using a fax, be aware of who could pick the document up the other end. You need to check the recipient has received the fax; Ensure you are up to date with the new legislation.
On yOuR maRkS! Orthopaedic surgeon mr Ian mcDermott gets to grips with the latest technology to improve diagnosis of knee injuries and assessment of patients pre- and post-operatively at the launch of London Sports Orthopaedics’ Research & Outcome Centre. See story on p5 ➱ continued on page 2
the magic of the entrepreneur a look at what support there is for doctors who become business innovators P10
getting on top of stress at work advice for managing stress on the job –without trying to eradicate it P16
Starting up in the aesthetics world a young entrepreneur outlines the steps he took to get into aesthetic medicine P25
Plans get uprooted this month’s ‘diary of a clinic build’ looks at how you tackle the planning issues P30
errors of judgement can haunt you three scenarios in which one-off mistakes had serious medico-legal consequences P32
Plan to boost private patient units philip Housden shows how we could share best practice nationally to grow ppus P34
comment
Moves to make private healthcare more of a see-through service are intensifying by the day.
New CQC ratings (see story opposite) are on the way for private doctors, patients will soon know more about how their data is meant to be handled (see page 1), and now the Private Healthcare Information Net work has published an extended range of measures.
In this age when so many providers are driven to stressing the blindingly obvious – ‘the patient is at the centre of everything we do’ – there’s no hiding place. Transparency is set to shine its light into every dark orifice.
PHIN’s latest development (see our story at www.independent-practitioner-today. co.uk) outlines patient experience and satisfaction with private hospitals. This includes an expansion of its patient satisfaction measure from the NHS Friends and Family Test.
Six patient satisfaction scores, called ‘Needs Met,’ have been be added, including how involved people felt in treatment decisions and whether they thought they were treated with respect and dignity.
Every step to make things clearer for patients must also be good news for private doctors.
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By edie Bourne
Independent practitioners who have recently received a Clinical Excellence Award (CEA) could discover the reward proves to be a substantial tax burden.
Some senior doctors have been frustrated recently to find their work ‘above and beyond’ to gain their CEA has had a costly sting in the tail.
This is because there is a restriction on the amount taxpayers can contribute to their pension every year while still receiving tax relief, known as the ‘annual allowance’.
Dr Benjamin Holdsworth, business development director with specialist financial planners Caven dish Medical, warned: ‘As the CEA boosts your pensionable pay, you could breach your annual allowance currently set at £40,000.’
There is also a new ‘tapered’
annual allowance for high-earners which reduces the limit down further – to as low as £10,000 a year for most senior doctors.
Dr Holdsworth said: ‘Pension contributions above the annual allowance – at whatever rate is relevant to you – will be taxed at your marginal rate of income tax.
‘To make matters worse, your new CEA will be backdated to April 2017. This means you may only find out if you are liable for a tax charge long after the current tax year is finished, as the Pensions Agency will not write to those breaching the annual allowance cap until autumn – and, sadly, little can be done retrospectively.’
He warned doctors to also check the NHS sums carefully when they finally arrive because his firm had discovered many of the calculations were wrong, as they were sent automatically.
Mrs Mulligan reminded independent practitioners they should have their own Information Commissioner’s Office (ICO) registration.
‘If you are not registered with the ICO already, visit the ICO website to register online. It’s easy to do and is a legal requirement. You’ll also be able to find out more about your data protection obligations,’ Mrs Mulligan stressed.
Independent Doctors Federation members were warned of the implications of GDPR at a seminar last month and are being offered support to ensure they are compliant.
See https://ico.org.uk/for-organisations/health/health-gdpr-faqs.
The ICO also has an advice line for small organisations https://ico. org.uk/global/contact-us/adviceservice-for-small-organisations. Its health pages contain a range of more general data protection and freedom of information advice, guidance and resources for the health sector https://ico.org. uk/for-organisations/health/ Next month: Don’t miss advice from Chris Alderson of Hempsons Solicitors: GDPR – is your private medical practice ready?
Independent Practitioner Today doctor readers can call Hempsons on 020 7839 0278 9am-5pm Monday to Friday for ten minutes’ free legal advice (see page 40)
By a staff reporter
Independent doctors are to be rated by the Care Quality Commission (CQC) in line with NHS primary and secondary care, and private hospitals.
The Department of Health has extended the regulator’s power to rate private doctors and clinics, including online GPs, substance abuse clinics and termination of pregnancy clinics.
Currently independent providers undergoing inspection are being recorded as either being Safe, Effective, Caring, Responsive and Well led – or not.
But, in future, independent practitioners and clinics will be rated as Outstanding, Good, Requires Improvement or Inadequate in each of the five areas.
Dr Neil Haughton, chairman of the Independent Doctors Federation’s (IDF’s) GP committee, said he believed the majority of doctors would embrace the opportunity to show the public the quality of the services they provide and that this can only help raise standards further.
He welcomed an invitation for the IDF to work with the CQC to develop the ratings criteria. The CQC will launch the ratings consultation paper early in the spring.
care services that offer medical advice and prescriptions from GPs online would also be included in the change.
As we went to press, no date has been given for when the ratings will start. The current compliance inspection programme will see all independent doctors having been inspected by March 2019.
A CQC spokesman said health-
The watchdog already rates NHS and independent hospitals, general practices and adult social care services as Outstanding, Good, Requires Improvement and Inadequate.
CQC chief executive Sir David Behan said: ‘CQC’s ratings of health and care services are helping people to make informed choices about their care as well as supporting providers to improve.
‘Never before has the public had such clear information about the quality and safety of their health and care services.’
The GMC needs greater flexibility to be more efficient and responsive to the changing regulatory environment, according to the Medical Defence Union (MDU).
Responding to a Department of Health consultation, it said regulatory reform had been talked of for far too long and action was needed now to reduce the time, stress and cost of regulatory procedures.
The MDU’s Dr Catherine Wills said: ‘We have responded on our members’ behalf to point out that regulators such as the GMC urgently need to be freed from outdated legal structures that impede reform and modernisation. ‘
She said the regulator could not influence the number of complaints received, but it knew it could do a lot to investigate cases more swiftly and fairly. See page 4
Independent practitioners’ opportunities in private practice – and threats to their business – are coming under the microscope at this year’s BMA private practice committee conference.
The meeting, on 11 April at BMA House, London, will examine the ‘ins and outs’ of private practice from the logistics of first setting up to ensuring established practitioners are reaching their maximum potential.
With doctors in independent healthcare continually having to adapt their practices to an everchanging landscape, the conference will look at the pros and cons of going private and give new and established independent consultants and GPs lots of tips. Attenders have a choice of sessions to go to in the afternoon with parallel meetings for specialists and GPs on setting up and developing their private practice.
A third session will cater for established practitioners.
The private practice committee said the conference would end with a chance to network over drinks with colleagues who are at all stages of practice. New entrants have found this is particularly valuable.
Conference highlights include:
Mr Geoffrey Glazer, chairman of the Federation of Independent Practitioner Organisations (FIPO),
highlighting the current issues facing secondary care clinicians;
An update on the changing face of mandatory indemnity for doctors in private practice. The panel of speakers includes Dr Mike Devlin, MDU; Mr Andy Foley, Bespoke Medical Indemnity; Dr John Holden, MDDUS; Prof Carol Seymour, MPS.
Ms Clare Barton, the GMC’s assistant director of registration
this year’s independent doctors Federation london Healthcare conference will be on 18 June at the royal Society of medicine. organisers promise a ‘multispecialty world-class programme’ with leading doctors and clinicians discussing the latest innovations in patient care across a range of disciplines.
the conference aims to offer an outstanding opportunity to network with medical colleagues as well as receive high-quality education and professional development, including earning cPd points. details are available from the website www.londonhealthcareconference.org.
and revalidation, on revalidation of primary and secondary care private clinicians;
Dr Sarah Jordan, a GP at The Portobello Clinic, on how to set up as an independent GP.
BMA private practice committee chairman Mr Derek Machin told Independent Practitioner Today: ‘I would encourage doctors, particularly if they have never attended, to consider coming to our private practice conference. The theme of the conference is “Setting up and Developing Your Private Practice”. We will explore the threats and opportunities.’
Accreditation for continuing professional development has been applied for. The cost for BMA members is £150 and for nonmembers it is £200 including VAT.
To register, visit the BMA’s website at www.bma.org.uk/ events/2018/april/private-practice-conference.
By Leslie Berry
A medical defence body is urging the GMC to beef up its complaints triage process as a priority to avoid doctors suffering unnecessary investigations.
Its plea came after a GMC report showed the vast majority of its investigations are closed without further action.
Dr Pallavi Bradshaw, senior medico-legal adviser at the Medical Protection Society, said this meant more than 1,000 doctors annually went through a needless, stressful and slow process, while many complainants also ended up disappointed with the outcome.
She added: ‘While some improvements have been made in
this area, the GMC must continue to improve the complaints triage process as a priority to avoid unnecessary investigations.
‘More fundamentally, the Medical Act needs to be reformed so the GMC is given more discretion to not take forward investigations in cases where the allegations clearly do not require action.
‘Its current powers were framed over 30 years ago – when a very small number of complaints were received and the GMC could investigate each and every one.
The GMC now receives over 8,000 complaints a year, but very few of these come close to the threshold of serious concern that the GMC was set up to address.’
She said the Government’s cur-
rent consultation on health regulation reform offered the perfect opportunity to address the issue of why so many cases were able to proceed to a full investigation.
‘We hope it results in reforms that create a fairer and more proportionate system that patients, healthcare professionals and the Government can have confidence in,’ Dr Bradshaw added.
The GMC says the number of reported complaints that reached a full-scale investigation have dropped by more than 35% in five years. Its report, State of Medical Education and Practice 2017, found that, in 2011, 2,265 cases reached a full investigation, whereas in 2016, this number dropped to 1,436.
The Medical Defence Union
The UK’s medical profession is at ‘a crunch point’ and will suffer increasing pressure over the next 20 years unless action is taken, the GMC’s State of Medical Education and Practice 2017 report warns.
It identifies a raft of challenges facing the medical profession today against a backdrop of an increasing and older population, and highlights four priorities for the UK’s governments and agencies responsible for medical training and workforce planning.
The report follows the launch of a consultation by Health Education England on future workforce provision for the health service.
Four ‘warning signs’ stand out:
1 Supply of new doctors into the UK’s medical workforce has failed to keep pace with changes in demand. The number of doctors on the Medical Register has grown by 2% since 2012, while, in contrast, A&E attendances and GP appointments have risen sharply. In England there has been a 27% increase in A&E attendances
in that time, while Northern Ireland saw a 10% rise.
2
Dependence on non-UK qualified doctors has increased, ranging from 18% in the South-west to 43% in the east of England.
3 The UK risks becoming a less attractive place for overseas doctors to work in.
4
need them to have so they can work as flexibly as possible, and where they should be located, given the changes and movement in population expected.’
He said the underlying challenge for all in healthcare was how to retain good doctors.
welcomed the GMC’s improvements to its fitness-to-practise procedures that have reduced the number of doctors who have to face an investigation.
Spokeswoman Dr Catherine Wills said it was pleased at the success of measures to reduce the need for investigations at an early stage. These included provisional inquiries to identify cases that would not reach the GMC’s threshold, even if the facts were proven.
Massey, GMC chief executive
Continuing pressure on doctors involved in training and a greater desire for more flexibility in how they work and train.
GMC chief executive Charlie Massey said: ‘We have reached a crucial moment – a crunch point –in the development of the UK’s medical workforce. The decisions that we make over the next five years will determine whether it can meet these extra demands.
‘Each country needs to think carefully about how many doctors are needed, what expertise we
‘Everything we hear from the profession tells us that we need to value them more; to nurture cultures that are safe and supportive, and do what we can to help staff achieve the right balance between their professional and personal lives through more flexible working arrangements.
‘The pressure on our health services shows no signs of letting up. It’s on all of us to understand why doctors are making different choices about their lives and careers.’
State of Medical Education and Practice: https://goo.gl/SbTYJY
Over four in five (85%) of people would be concerned about staffing levels if a loved one needed NHS hospital treatment, according to research from a doctors’ organisation. A similar figure believe patient safety is at risk due to funding cuts.
Mr Ben Itsuokor, consultant surgeon and president of the Independent Health Professionals’ Association (IHPA) – which fights for locum doctors – said: ‘Medical staff are leaving the NHS in droves, citing intense workload pressures and an inability to provide appropriate patient care as key reasons for departure.
‘It’s time for the Government to take this seriously and plug the funding gap before even more damage is done.’
By Robin Stride
Consultants at London Sports Orthopaedics are celebrating new levels of business fitness after a major transformation exercise.
They have signed up more team members, refurbished their premises, and unveiled a new Research & Outcomes Centre equipped with the latest high-tech orthopaedic kit.
And they have set up the Sports Orthopaedics Research Foundation (SORF) as an independent body. As a charity, it will aim to generate funding to support projects, training and educational initiatives.
It is hoped this will help the centre in the City of London at 31 Old Broad Street become a busy focal point for innovation and excellence.
Mr Ian McDermott, consultant orthopaedic surgeon at HCA’s London Bridge Hospital and managing partner of the London Sports Orthopaedics practice, said the Research and Outcomes Centre was dedicated to measuring pat-
ients’ results and gathering the most detailed and comprehensive dataset possible.
This would facilitate clinical audit and prospective clinical research.
He said: ‘Our research team will be undertaking a range of projects, which will ultimately help improve patient care and ensure that we provide the very best and most effective cutting-edge treatments for our patients.
‘Patients seen at 31 Old Broad Street will benefit from an enhanced package of care, including detailed data-driven pre-op performance assessments and post-operative reviews following major procedures such as anterior cruciate ligament reconstruction in the knee, knee replacements and hip replacements.’
London Sports Orthopaedics, a group of orthopaedic surgeons, sports physicians, rheumatologists and pain specialists, are closely linked to HCA’s London Bridge Hospital and offer a range of orthopaedic and musculoskeletal diagnostic services, including
digital X-rays, ultrasound and super-high-res 3T MRI scanning. Their centre has been equipped to allow detailed assessment of patients’ performance and outcomes measures, including preand post-op testing to assess the effectiveness of treatments.
Mr McDermott told visitors at a packed launch evening: ‘You can’t just be a jobbing surgeon’. Research, training, education and audit were crucial.
He added: ‘We’ll be way ahead of anything required by PHIN [the Private Healthcare Information Network]’.
The centre has a new Biodex Isokinometer, for accurate and reproducible testing of strength, speed and power. It is also the first in the UK to have a KneeKG unit for 3D video gait analysis.
Staff at the centre, officially opened by former patient Mr John Baron MP, include a clinical nurse and research physiotherapists.
London Bridge chief executive Janene Madden called the improved centre a major milestone
for orthopaedic care in the City of London. She said: ‘It will benefit patients significantly, and they will receive care from some of the country’s leading orthopaedic consultants as well as access to the very latest in diagnostic equipment.’
Patients will undergo datadriven pre-op performance assessments and will then be reviewed post-operatively to assess progress.
This will include ‘Return to Play’ assessments for patients who have undergone surgeries such as ACL knee reconstruction.
The centre will also monitor patient satisfaction rates, procedure success rates and reviews of individual consultants closely to deliver the best possible care. Some innovative clinical orthopaedic research projects are already underway.
SORF is committed to the study and development of excellence in modern clinical orthopaedic and sports injury practice through the promotion of training, education, audit and research.
Go to www.sorf.org.uk
By Olive Carterton
The drive to raise more tax in the UK led to 762 individuals being convicted in 2017 for their part in tax crimes.
Prison sentences totalled over 1,000 years and HM Revenue and Customs (HMRC) charged suspects in more than 1,000 new cases of tax fraud.
Convictions were secured for pocketing employees’ income tax contributions, failing to declare earnings and offering fake tax breaks to wealthy investors, as well as tax credits and fuel fraud.
In the ongoing fight against tax evasion, HMRC took a broad range of cheats and fraudsters through the courts for prosecution, including millionaires, those with offshore accounts, a wouldbe spy, accountants, data thieves and organised criminal gangs.
The most significant cases each came with large prison sentences, including:
Six men from the South-east jailed for a total of 45 years after persuading wealthy individuals to invest in largely fake environmental projects. A ten-year investigation revealed the scheme was nothing more than a £108m
fraud, using a complex series of offshore banking and paper transactions.
A pair of London fraudsters who evaded £46.5m in tax by smuggling wine into the UK were sentenced to a total of 17-and-a-half years in prison. They laundered the proceeds of the fraud using a string of bank accounts.
A millionaire businessman from Kent who failed to file a single return or pay £1.3m in tax because he wasn’t a ‘paperwork person’, jailed for four years.
A Dubai-based British businessman, who financed a major cigarette smuggling gang, stripped of prime Thames-side land to pay back £4.5m.
A former Ascot man who hijacked details of an offshore company in the British Virgin Islands to commit a £640,000 fraud, jailed for three years and seven months.
A wannabe TV presenter from south Wales who was part of a gang of four involved in a £400,000 VAT fraud, jailed for a total of seven years.
Simon York, director of HMRC’s Fraud Investigation Service, said: ‘2018 will see many hundreds more tax fraudsters tried for crimi-
nal offences, as HMRC continues to work on behalf of the honest majority to ensure tax crime doesn’t pay.’
HMRC claims success in more than 93% of the prosecutions undertaken, but accountants warned last month ( Independent Practitioner Today , December 2017-January 2018) that moves to improve tax compliance could backfire and lead to some doctors cutting their commitment to the private sector.
Tax officials are tightening up compliance issues for ‘wealthy
We reported on the tightening up on compliance in last month’s issue
individuals’ – and, in the taxman’s eyes, that includes most consultants.
Tax avoidance schemes are under additional scrutiny and new technology is also being introduced to tackle the ‘hidden economy’ – such as a few consultants who are said to accept cash.
Many doctors’ accountants were working frantically last month to help late-comers meet the 31 January self-assessment tax deadline.
For those who missed it, HM Revenue and Customs (HMRC) said help will always be provided for people with a genuine excuse for not submitting their return on time.
Recent rejected excuses include:
1 I couldn’t file my return on time, as my wife has been seeing aliens and won’t let me enter the house.
Doctors are being offered help to run a more profitable expert witness practice at a special conference run by the BMA.
It will be held at the association’s London headquarters on Friday 23 March 2018 and is designed to ensure doctors hear the latest views from medico-legal experts, have the chance to get questions answered and develop networks.
During the day:
Consultant physician and barrister Dr Michael Fertleman will
give a unique perspective on dos and don’ts in medico-legal reports;
Barrister Giles Eyre will discuss communication skills for experts;
Barrister Michael Williams will advise on giving evidence;
A coroner’s perspective will be given by Karen Harrold, assistant coroner and head of the Appeals and Review Unit at the Crown Prosecution Service;
Doctors will be advised how to market and grow their expert witness practice by Mark Solon of Bond Solon Training;
Dr Itiel Dror will explain cognitive bias in medico-legal reports.
Organisers said the conference was aimed at all levels of experience and would cover the essentials of working competently as an expert witness.
All doctors can attend regardless of whether they are BMA members.
Costs are £140.00 (incl VAT) for members and £250 (incl VAT) for others.
The conference will run from 10am to 4.45pm.
2
My ex-wife left my tax return upstairs, but I suffer from vertigo and can’t go upstairs to retrieve it.
3
My business doesn’t really do anything.
HMRC has also revealed some questionable expenses which tax payers tried to claim for, including:
A three-piece suite ‘for my partner to sit on when I’m doing my accounts’;
Vet fees for a rabbit;
Hotel room service for candles and prosecco.
Only a year after launching with the aim ‘to become London’s premier day clinic for women’, 25 Harley Street has been acquired by Phoenix Hospital Group (PHG). A spokesman said there would be no lay-offs, the business would run as before and consultants were expected to continue there. Other PHG centres include Weymouth St Hospital and 9 Harley Street. The group is boosting the Weymouth St unit with two operating theatres in a new complex.
By Robin stride
Nuada Medical Specialist Imaging has been relaunched as Otima Health following the acquisition of the medical consulting and surgical practices by a consultants’ group.
It told Independent Practitioner Today it was now looking for more specialists to be involved.
Chief executive Mark Aichroth said: ‘We are happy to look at both investors and those interested in practising privileges. We are looking at expanding the consultants in the core areas of urology, gynaecology and musculoskeletal services.’
Otima Health’s mission is to provide patients with access to a team of outstanding subspecialist consultants working collaboratively
under one roof. The company is recognised by all major insurers.
It said it expected to be an important provider of private healthcare in the Harley Street area, initially specialising in the three core areas.
Mr Aichroth, a long-term advocate of the consultant ownership model, said he believed a close alignment between management and healthcare deliverers helped focus on delivering excellence.
‘Working with experts within a narrow range of specialties and subspecialties facilitates the ongoing establishment of a highquality business,’ he said.
Otima Health at 19 Harley Street has two purpose-built general anaesthetic day-case theatres, full gynaecology and urology diagnostics, CT, X-ray, ultrasound, fluor-
Consultants from the Fortius Clinic have partnered with Bupa Cromwell Hospital, London, to provide hip and knee replacements using MAKO robotic technology.
The Fortius Joint Replacement Centre (FJRC) at the hospital officially opened last month, announcing a range of benefits to patients.
However, the group was keeping tight-lipped about details of the deal and declined to share information around the ‘commercially sensitive’ agreement.
Founded seven years ago in London by a group of orthopaedic surgeons and radiologists, it has over 80 specialists with two outpatient and diagnostic clinics and a surgical centre.
Speaking at a launch event, consultant orthopaedic surgeon Mr Andy Williams, a Fortius Clinic founder, said the future of joint replacement surgery had to focus on ensuring consistent outcomes
in recovery, performance and longevity:
‘There is a wide variability of surgery outcomes and complication rates in current orthopaedic practice. This is why we need to shift our focus to further training on using new technologies within the field to improve patient outcomes.
‘The use of robotic technology is changing the face of joint replacements. The MAKO robot drives up the benchmark across the sector and ensures all patients have a consistent, high standard of care.
‘Treatment with modern knee replacements are reliable, and carry little variability, when implanted correctly, but the performance does not compare to that of a patient’s normal knee.
‘The future in joint replacement treatment is in the accuracy of implant alignment with the latest robotic technology to enhance accuracy. This is beneficial not just for patients but for improving
oscopy and EOS scanners. It hosts 14 consulting suites alongside a procedural treatment room.
Mr Angus McIndoe, medical director and consultant gynaecol-
At the launch: Mr Jonathan Webb, Mr Jonathon Lavelle, Mr Andy Williams and Prof John timperley
opportunities for clinicians in furthering their capabilities.’
Fortius Clinic chief executive Jim McAvoy said: ‘In joining forces with Bupa Cromwell Hospital, we believe that the Fortius Joint Replacement Centre will become the centre of choice for patients.’
Bupa Cromwell Hospital director Philip Luce said: ‘We always strive to offer the best in orthopaedic treatment and this partnership with the Fortius Clinic gives our patients access to the best facilities and latest technology, while benefiting from the highest quality patient care and outcomes.’
ogist, said the company would represent ‘excellence in patient experience, excellence in clinical governance and excellence in outcome reporting and performance’.
Over a third of Britons (38%) would prefer innovative stem cell treatments over a traditional joint replacement, according to a study by Harley Street’s The Regenerative Clinic and YouGov.
The figure rose to 42% in the over-55 age group.
Nearly half believe stem cell procedures are the future of medicine, with 48% wanting to learn more.
Some 2,086 UK adults were asked to imagine they needed joint replacement surgery. They were also given the option of a non-surgical procedure called ‘Lipogems’ which takes adipose pre-cursor stem cells from the patient’s fat and injects them into their joints to regrow cartilage.
Global knee and sports injury specialist Prof Adrian Wilson, a joint owner of The Regenerative Clinic, said it was an exciting time for new procedures.
Doctors in aesthetics were out in force at the Aesthetic Awards where the SkinCeuticals Award for Medical Aesthetic Practitioner of the Year was won by former GP Dr Beatriz Molina.
The founder and medical director of Medikas Ltd, which has two clinics in Somerset, she worked as a GP for ten years before training in medical aesthetics.
She is the former vice-president and director of conferences of the British College of Aesthetic Medicine and a key opinion leader for Galderma, teaching and lecturing around the world.
Dr Molina recently established the International Association for Prevention of Complications in Aesthetic Medicine (IAPCAM), which aims to educate practitioners in the safe administration of treatment and management of aesthetic complications.
She was chosen from aesthetic doctors, dentists, dermatologists and surgeons deemed to have contributed most to the profession or provided the most outstanding care and treatment to their patients in the previous 12 months.
Finalists were judged on their clinical expertise, continuous professional development, commitment to patient safety and the difference they make to their patients, clinic and the profession.
Dr Molina said: ‘I’m really excited. I never expected to win, as it was such high competition and everyone is so good. We need to raise the standards in aesthetics, as it is a highly specialised medical field, to deliver the best treatments for our patients.’
Winners across 26 categories were presented with trophies in front of more than 800 guests at the Park Plaza Westminster Bridge hotel, London.
With 11 finalists, the category for The SkinCeuticals Award for Medical Aesthetic Practitioner of the Year was one of the most competitive.
Medical professionals from across the UK were also celebrated for their clinics, including: The Profhilo Award for Best Clinic Group, UK and Ireland (three clinics or more): La Belle Forme, led by Mr Taimur Shoaib, consultant plastic surgeon
Organisers of the Future Healthcare 2018 Exhibition and Conference on 13-14 March at Olympia, London, say they are on track to host over 4,000 attendees from 45 countries and exhibitors from 25 nations.
Speakers will address the challenges facing 21st century healthcare and explain how advances in innovation will offer greater integration and collaboration to better serve future generations in both the private and public sector.
Best Clinic Scotland: Clinetix, led by Dr Simon Ravichandran and Dr Emma Ravichandran, ENT surgeon and dentist, respectively
Cosmedic Pharmacy Award for Best Clinic Midlands & Wales: Cellite Clinic Ltd, led by Dr Harryono Judodihardjo, dermatologist
The John Bannon Award for Best Clinic Ireland: Ailesbury Clinic, led by Dr Patrick Treacey, aesthetic doctor
Med-fx Award for Best Clinic North England: Discover Laser, led by Dr Miguel Montero, previous GP and aesthetic doctor
The iS Clinical Award for Best Clinic South England: S-Thetics, led by Miss Sherina Balaratnam, surgeon and cosmetic doctor
The Dermalux Award for Best Clinic London: The Cadogan Clinic, led by Mr Bryan Mayou, consultant plastic and reconstructive surgeon.
➲ The Aesthetics Awards is run in association with Aesthetics Media Ltd
Aspen’s Claremont Hospital, Sheffield, has appointed Andrew Thornton as new hospital director.
He has held various director posts within the public and private sector including Nuffield Health and Bolton NHS Foundation Trust.
Mr Thornton said it was ‘a dream job’, adding: ‘I look for -
ward to making Claremont even more successful in the coming years and am looking forward to working with such well respected consultants and staff.’
The hospital is one of only three private units in the North of England to achieve an ‘outstanding’ rating by the Care Quality Commission.
The event will also feature an Invest in Health Theatre. Event director Dawn Barclay-Ross said: ‘There has been huge interest in this initiative. We already have 30 young companies ready to participate in front of host companies willing to consider offering investment to develop inspiring and life-saving projects both in the UK and internationally who will be listening.’
Hopefuls will have ten minutes to tell the audience why their innovations are shaping the future of healthcare worldwide. Young companies pitching to potential investors interested in forward-thinking developments include Our Mobile Health and Medisante.
The CPD event, organised in association with the United Kingdom International Healthcare Management Association, aims to showcase products and services.
The conference includes sessions on the General Data Protection Regulation (see story on page 1) and governance and regulation.
It is free to doctors who do NHS work. They are asked to use their NHS email address as verification and fill in the form at www.eventbooking.uk.com/future_healthcare/ before the event or they can register on the day.
The fee for those fully in private practice is £495 and they can register on the same link. Details at http://futurehealthcareuk.com.
Come and see us on the Independent Practitioner Today stand
London will be paperless. Head of business operations Ian Lilley reports
Hospitals often lag behind in efforts to become paperless but setting up a new hospital, as Schoen Clinic London is doing, makes it possible to choose the technology and develop the systems that enable this from the start.
Set to open in June 2018 in the Harley Street Medical Area, we have invested in an electronic patient record (EPR) system which will digitally store and analyse that information to help manage many everyday tasks, such as patient flow, and support decision-making by providing insights into efficiencies.
For consultants – we have appointed ten so far – the system gives immediate access to a patient’s record whenever they need it; for example, the ability to record and access patient allergy and alert information electronically at appropriate points in the patient journey.
Consultants will have remote access to their patient’s vital signs and test results and in real time, improving patient safety. This is one of the first times in the private setting the practitioner’s notes will be together with the nursing/ inpatient record.
The system also reduces the need to ask patients the same questions multiple times and, by capturing information in real
time, eliminates the need to create paper records.
Patients will be able to complete their medical history remotely on their PC, tablet or hand-held device at their convenience before their appointment.
Once validated, their medical information will be sent directly into their electronic patient record, giving the clinician access to richer information and streamlining the admission process. Clinicians will be able to use hand-held devices with camera technology to upload reports and clinic letters directly into the EPR.
Our system chosen is widely used in Europe and has been developed in conjunction with our consultants here. We worked with them to create our own specifications for what the software needed to look like and do.
Limited space was certainly a driving factor. To maximise revenue-generating space, we simply had no room for an onsite medical records office in our specialist spine and orthopaedic hospital.
But there are many other benefits for patients and practitioners including improved efficiencies, reduced costs, less environmental impact, a reduction in errors and duplication, increased data to support clinical decision-making, and improved reporting.
We are also digitising patient
management processes. Appointment letters and correspondence will be sent electronically or via secure SMS messaging, and all patients will have access to a custom-designed patient portal. Via this portal, they will book and change their appointments online and access information such as registration forms, patient guides and procedure-specific information.
Patients will be asked to com-
plete health questionnaires online enabling us to collect clinical outcome data to send to the Private Healthcare Information Network and also to feed our Quality Empowered by Documentation system used to drive continuous improvements in patient care.
Electronic tablets in all bedrooms will give patients many entertainment options plus access to services such as catering menus and personalised information about their surgery, rehabilitation exercises and discharge.
Business administration processes are also electronic. We already use an e-invoicing system, e-pay slips for staff, online training, and e-meetings.
We will continue to keep innovating, changing behaviours and progressing plans to be completely paperless in the future.
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Royal National Orthopaedic Hospital NHS Trust has ended a planned partnership procurement to develop private patient services. The trust had previously announced HCA as preferred to develop inpatient beds, theatre and diagnostic capacity.
Instead, the Stanmore, Middle-
sex, trust is now understood to be opening an inhouse-managed private ward in the new hospital accommodation in October 2018.
PPU expert Philip Housden, director of Housden Group, said:
‘This places the trust in a strengthened position to exclusively benefit from any growth in its present estimated 5% market share of the north-central London elective orthopaedics market worth in excess of £100m a year.’
Kingston Hospital has decided not to bring management of The Coombe Wing PPU back into NHS management control when the present contract with BMI expires later this year.
Instead, the trust has named One Healthcare as preferred bidder to take over the present operation and future opening of a new private hospital within the
main Kingston Hospital campus.
One Healthcare was established in 2014 and currently has two hospitals open at Ashford, Kent, and Hatfield, Hertfordshire, but this is its first NHS PPU partnership.
In May 2017, the NHS trust began a procurement exercise to find a new partner to run Coombe Wing and then transition this to a new onsite partnership/private hospital on the main Kingston Hospital campus.
Healthcare professionals working in the UK health industry are ideally placed to identify problems experienced by patients and colleagues. Every day they see the issues that could be improved by a new way of doing things, and many are now using their medical knowledge to address these problem areas in innovative, creative ways.
Jane Braithwaite looks at some success stories, what it takes to be an entrepreneur, and what support is out there to help doctors bring their innovative ideas to market BUsinEss
What makes a doctor entrepreneur?
Some medics make the transition from medical school straight to business and do not complete specialist training. Some doctors continue their training and develop their ideas while continuing to practise.
Others are consultants or GPs who use their specialist knowledge to bring quality, problemsolving tech solutions to market. The medical backgrounds can be varied, but one thing is consistent – the entrepreneurial spirit and the ability to see a problem and fix it with a great solution.
However, insider knowledge of the healthcare industry does not mean that an idea will automatically translate into a successful business. Doctors will have been medically trained, but many will have had little to no experience in relation to building a successful business based on a new idea.
To build a business and be a successful entrepreneur, several key traits are needed, including an ability to analyse problems and the self-belief to take those solutions all the way.
Furthermore, at some point there will be a need to know how to run a business and this includes knowing how to lay its foundations, deal with administration, finance and human resources.
Knowing when to delegate and hand over tasks like this to other experts is also a skill that needs to be learnt.
This website combines patient reviews, specialist information and appointment booking to provide a one-stop shop for patients looking for a private specialist in London.
Co-founded by Stephanie Eltz
Insider knowledge of the healthcare industry does not mean that an idea will automatically translate into a successful business
and Suman Saha – along with chief executive Oliver Thomas and chief finance officer Daniel Jung – these doctors joined forces in 2015 to develop their vision of creating a service that brought doctors and patients together.
An online community focused on medical students and junior doctors, Generation Medics was formerly known as ‘Help Me, I’m A
Medic’ and is the brainchild of Dr Hinnah Rafique.
Since 2013, the website has grown to be the UK’s largest online community for medics, with a community of more than 4,000 members. Generation Medics has won two UnLtd national awards, and provides medics with online support, revision aides and access to national conferences.
Dr Lewis Potter’s GeekyMedics site focuses on supporting junior doctors by making revision ‘less painful and more productive’.
Video guides, quizzes and case studies make this Newcastle University graduate and Clinical Entrepreneur Fellow’s network hugely popular, with more than four million downloads worldwide and over 130,000 subscribers on YouTube.
Co-founded by Dr Kartik Modha, a north London GP, myHealthSpecialist is an online resource for patients and GPs to find doctorrecommended private and NHS specialists.
With more than 3,000 GPs and specialists listed, the site aims to improve care and save time by connecting patients with the right specialists.
The need to help doctors develop their business skills is recognised by several organisations, with programmes and networks in place to build these skills. These are:
A joint venture between NHS England and Health Education England, launched in 2016. This programme aims to provide guidance to junior doctors with innovative ideas, helping them to develop their product or service with the goal of bringing it to market.
Doctors will be able to develop the knowledge, skills and leadership capabilities required if they are to successfully bring their ideas to market. The initial success of this unique scheme has led to it being extended; as of last year, dentists and healthcare scientists can also apply.
Successes include Dr Suman Saha, co-founder of Doctify, and Dr Lewis Potter, founder of GeekyMedics.
Doctorpreneurs is an online community aimed at connecting doctors with similar interests in entrepreneurship and health tech.
Founded in 2011, the company originally focused on organising events, providing interested parties with a way to network. The team grew in 2014, and the company now boasts an impressive events schedule, student ambassador network and start-up school.
Supported by the office of the Mayor of London and NHS England, Digital Health London provides support to those looking to bring ground-breaking ideas to the UK healthcare industry.
Avoid wasting time and overthinking your concept. Set yourself some realistic milestones that lead to clear goals
By providing innovators with guidance in relation to intellectual property, commercialisation and finance, Digital Health London aims to generate economic growth and improve health outcomes and experiences. So the opportunities for networking, developing and expertise-sharing are available, and with the UK’s small business market growing with a record 5.5m private-sector enterprises in business at the start of 2016 – up 97,000 on the previous year –could it be time to start thinking creatively and find a solution to a problem?
➲ Do your research – With so many new and innovative healthcare services out there, doing some background research is invaluable. Check out your competition and see how you can differentiate your idea from others.
➲ Perfect your pitch – ‘If you can’t explain it simply, you don’t understand it well enough.’ You should keep in mind that not everyone will have your frame of reference and people will sometimes just want to know – very simply –what your product is and how it will help them.
➲ Set clear and achievable milestones – Avoid wasting time and overthinking your concept. Set
Creating a service or product that lowers cost will help to increase uptake of your product or service once it comes to market
yourself some realistic milestones that lead to clear goals.
➲ Recognise your weaknesses –As a doctor, business skills may not be your forte. Take advantage of online resources and communities to help build those skills and develop your understanding of what it takes to run a successful business.
➲ Call in favours – Working in healthcare means your colleagues will have experience and talent in many areas: communications, IT, and marketing. These colleagues could potentially help you develop your idea or could even be future business partners.
➲ Network – Go to conferences and industry meetings. This will help build your understanding of areas of the industry unfamiliar to you and build your network of industry connections.
➲ Don’t give up the day job –Your medical expertise and position provides you with in-depth healthcare knowledge. Remember that you are where you are today because of your interest in medicine; keep up to date on developments in healthcare and keep up your connections within the NHS and private healthcare.
➲ Save people money – Creating a service or product that lowers cost will help to increase uptake of your product or service once it comes to market.
➲ Help everyone – A product that helps one group of stakeholders but not another will not go far. Make sure that your product does not make life more difficult for a certain group of users/workers. Look at feedback from users to determine how you can go about making this happen.
➲ Be willing to take a risk – Not all business ideas are successful, but this does not mean you shouldn’t try. Even if an idea does not come to fruition, you will undoubtedly learn some valuable lessons along the way.
Check if your patients need vaccination against rabies before they go:1
PRESCRIBING INFORMATION
Rabies Vaccine BP ≥2.5 IU/ml, Powder and solvent for suspension for injection
Refer to Summary of Product Characteristics for full product information.
• Visiting an area where rabies is common and taking part in higher risk activities e.g. cycling or running?
• Working abroad in close contact with animals?
• Staying in an at-risk area for more than 1 month?
Rabies Vaccine BP from Sanofi Pasteur offers pre- and post-exposure protection against rabies.2
Order at www.vaxishop.co.uk or telephone our Customer Service team on 0800 854 430
Presentation: A single dose vial of powdered vaccine and pre-fi lled syringe of solvent for suspension for injection. After reconstitution, each 1 millilitre dose contains rabies virus (inactivated, strain PM/ WI 38 1503-3M) not less than 2.5 International Units of rabies antigen. Indications: Prophylactic immunisation against rabies and treatment of patients following suspected rabies contact. Dosage and administration: The dose of reconstituted vaccine in all cases is 1 millilitre given by intramuscular injection into the deltoid region. Reconstitute with the solvent supplied and shake carefully to ensure complete reconstitution. Following reconstitution the vaccine will be a pinkish colour and free from particles. Once reconstituted, the vaccine must be used immediately. DOSAGE FOR PROPHYLAXIS: 1 millilitre given on days 0, 7 and 28. For those at regular and continuing risk, a single reinforcing dose of vaccine should be given at 1 year after the primary course has been completed. Further doses should be given at three- to fi ve-year intervals thereafter. For travellers at intermittent risk of exposure, booster doses may be given in line with offi cial recommendations. DOSAGE FOR TREATMENT: For those known to have adequate prophylaxis - 1 millilitre should be given on day 0 and on day 3 following contact with a suspected rabid animal. For those with no, or possibly inadequate prophylaxis - the fi rst injection should be given as soon as possible after suspected contact (day 0) and followed by four further 1 millilitre doses on days 3, 7, 14 and 30 (the earliest that the 5th dose can be given is day 28 as per WHO recommendations). The use of Rabies Immunoglobulin should be considered in unimmunised or incompletely immunised subjects or those with uncertain immune status in accordance with official recommendations and/or expert advice. The treatment schedule may be stopped if the animal concerned is found conclusively to be free of rabies. Subjects with incomplete prophylaxis or unknown history of immunisation should be treated as non- immune. Contra-indications: Pre-exposure: Known systemic hypersensitivity to Rabies Vaccine BP or any of its components; febrile and/or acute disease. Post-exposure: no contra-indications. Warnings and precautions: Appropriate facilities and medicines should be readily available in case of anaphylaxis or hypersensitivity following injection. The vaccine may contain traces of neomycin and betapropiolactone which are used during the manufacturing process. If Rabies Immunoglobulin is indicated in addition to Rabies Vaccine BP, then it must be administered at a different anatomical site to the vaccination site. Rabies Vaccine BP should not be administered to patients with bleeding disorders or to persons on anticoagulant therapy unless the potential benefi t outweighs the risk of administration. The potential risk of apnoea and the need for respiratory monitoring for 48- 72 h should be considered when administering the primary immunisation series to very premature infants (born ≤ 28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. As the benefi t of vaccination is high in this group of infants, vaccination should not be withheld or delayed. Anxiety-related reactions, including vasovagal reactions (syncope), hyperventilation or stress-related reactions can occur following, or even before, any vaccination as a psychogenic response to the needle injection. This can be accompanied by several neurological signs such as transient visual disturbance and paraesthesia. It is important that procedures are in place to avoid injury from faints. Corticosteroids and immunosuppressive treatments may interfere with antibody production, check antibodies 2 to 4 weeks after course. Pregnancy: The potential risk of administration of Rabies Vaccine BP during pregnancy is unknown. Due to the severity of the disease, pregnancy is not considered to be a contra-indication to post-exposure prophylaxis. If risk of exposure is substantial, pre- exposure prophylaxis may also be indicated. Lactation: It is not known whether the vaccine is excreted in human breast milk. Due to the severity of the disease, breast-feeding is not considered a contraindication. Undesirable effects: Very common side effects include: lymphadenopathy, nausea, diarrhoea, injection site reactions (pain, erythema, pruritus, induration), chills, malaise, headache, arthralgia and myalgia. Common side effects: injection site bruising, dizziness, respiratory manifestations (dyspnoea, wheezing), angioedema, pyrexia, abdominal pain, vomiting and allergic reactions with skin disorders (urticaria, rash, pruritus). Other undesirable effects have been reported, although their frequency is not known. These include serum sickness type reactions, anaphylactic reactions, oedema, encephalitis, convulsion, Guillain-Barré Syndrome, paresis, neuropathy, paraesthesia and asthenia. For a complete list of undesirable effects please refer to the Summary of Product Characteristics. Marketing authorisation holder: Sanofi Pasteur Europe, 2 Avenue Pont Pasteur, 69007 Lyon, France. Further information is available from the Distributor: UK: Sanofi, One Onslow Street, Guildford, Surrey GU1 4YS Tel: 0845 372 7101; Ireland: sanofi -aventis Ireland T/A SANOFI, Citywest Business Campus, Dublin 24, Ireland Tel: 01 403 5600 Package quantities and basic NHS cost: One single dose vial (powder) and one pre-fi lled disposable syringe containing 1 millilitre of solvent with 2 separate needles, basic NHS cost £40.84. Legal category: POM Marketing authorisation number: UK : PL 46602/0004 Ireland: PA 2131/004/001 Date of last review: February 2017
Suspected adverse events should be reported Reporting forms and information can be found at www.mhra.gov.uk/yellowcard and www.hpra.ie
Suspected adverse events should also be reported to Sanofi Tel: 08000 902 314 (for UK) and Tel: 01 403 5600 (for Ireland).
References: 1. Department of Health. Immunisation against infectious disease. Chapter 27: Rabies. Accessed November 2017 2. Rabies Vaccine BP Summary of Product Characteristics SAGB.RABIE.17.10.1326 11/17
It’s not long before the new tax year of 2018-19, but Susan Hutter (below) says make sure you don’t miss out with some useful financial planning before the current tax year closes
From 6 April 2018, the annual allowance, which is effectively the maximum contribution payable into a pension scheme, is £40,000.
The annual allowance up to 5 April is also £40,000, including effective contributions into the NHS Superannuation Scheme.
The £40,000 will be reduced for every £1 of income over £150,000 to a minimum of £10,000 annual allowance. It is possible to increase the annual allowance for the tax year of the contribution by utilising the unused allowance from the preceding three years.
For those who operate via a limited company, whose spouses are employed, the company can make an employer’s contribution into a pension scheme for the spouse as well as for themselves. This is useful if your own annual allowance is being reduced and you wish to pay more than the maximum into a pension scheme.
Also note the lifetime allowance is currently £1m. However, the
last Budget announced that this lifetime allowance will increase to £1.03m with effect from 6 April 2018 to match the Consumer Price Index. This can have quite serious tax implications.
For those who are on or around this limit, and definitely for any doctors who have NHS superannuation schemes as well as a private pension scheme, it is worth taking advice about these changes.
Essentially, when the value of an individual’s pension pot exceeds this limit, substantial tax charges will be triggered on a ‘benefit crystallisation event’ – for example, when an individual starts drawing funds from the pension.
If you invest in Individual Savings Accounts (ISAs), you may wish to maximise the 2017-18 investment, which is £20,000. Following the last Budget, there has been no increase to the tax-free limit – so this will remain £20,000 with effect from 6 April 2018.
The maximum can be made up of cash, stocks and shares or a mixture of the two. If you do not pay up to the maximum, then you will lose the balance.
As far as Premium Bonds are concerned, the current maximum is £50,000 per person. Remember, with Premium Bonds there is a chance of winning £1m every month!
The minimum prize is £25 and the general rate of return for those on the maximum is about 1.25%. It is not fantastic, but bearing in mind that bank deposit accounts are not really better and that it is tax-free, it is quite a good deal for higher-rate taxpayers.
Also there is no risk with Premium Bonds; if you get fed up with not winning £1m, you can cash them in at no loss.
For those who are higher-rate taxpayers and who have a spouse who is not a higher-rate taxpayer, it is worth considering transferring income-earning investment assets to the spouse.
If bank interest is being received on investments, higher-rate tax will be payable via self-assessment – because bank interest no longer carries a basic-rate tax credit, the full 40% tax will be payable on interest above the £500 savings allowance.
This allowance is increased for basic-rate taxpayers, however. So, if the spouse is a basic-rate taxpayer, s/he could earn up to £1,000 of tax-free bank interest a year. No savings allowance is available to those who earn more than £150,000 a year.
There are no tax implications of transferring money between spouses.
Taxpayers can currently receive up to £5,000 of tax-free dividends in a tax year. This allowance is decreasing to £2,000 with effect from 5 April 2018 and so consideration should be given to maximising the tax-free dividends in 2017-18.
Any unused dividend allowance will be lost as it cannot be carried forward.
If an individual makes a gain on a disposal of a capital asset – for example: shares, land and property – he will be subject to capital gains tax on the taxable gain.
In most cases, to arrive at a taxable gain, we calculate an increase between the acquisition cost and disposal proceeds reduced by certain incidental expenses of acquisition and disposal – for example, legal fees or commission.
Most individuals can then reduce their gain by an annual exemption – as long as it has not already been used elsewhere – to arrive at the taxable gain. This tax-free allowance is not available to non-UK domiciled individuals who claim the remittance basis.
The annual exemption is currently set at £11,300 and it will
increase to £11,700 with effect from 6 April 2018.
Any capital gain must be reported on a self-assessment tax return for the tax year of a disposal and the tax paid by 31 January following that tax year – unless the disposal is by a non-UK resident and the assets being disposed of is UK residential property, in which case the disposal must be notified to HM Revenue and Customs and the tax paid within 30 days of conveyance. However, the tax due date is still 31 January for those individuals who already are within self-assessment and complete UK tax returns.
From April 2019, the Government intends to require a payment on account of any capital gains tax due on a disposal of residential property within 30 days of a sale.
In the case of a disposal of land and property, the base cost can be increased by any expenditure that
enhanced the property’s value –for example, improvements to the building, construction of conservatory, extensions and so on. To be in a position to accurately calculate a capital gain (or a loss), it is important to ensure that your records are up to date, showing: The original cost of the property; Legal and agent’s fees on the purchase of the property; Capital costs of work done to the property; for example, new kitchen/bathrooms or an extension.
If you do not have the relevant information to hand, it is worth looking for it now so that you will be able to comply with the 30 day rule in a few years’ time.
As in all cases with financial planning, it is worth taking advice sooner rather than later.
Susan Hutter is a partner at Blick Rothenberg and part of the team that advises medical practitioners
In the last of his series of four articles for Independent Practitioner Today, consultant psychologist Dr Michael Sinclair (right) gives five more tips for managing stress on the job – without trying to eradicate it
I can recommend some strategies that might be useful alternatives to the usual ways you have attempted to feel less stressed in and around your work.
If you find that trying to control, suppress or eradicate your stress has made your experience of stress worse and possibly moved you further away from being the kind of doctor you’d prefer to be – or living the life that you would prefer to have – then I hope these alternatives can help in some way.
Try these out:
Take leisure and recovery time seriously – be playful
It is important to ensure that work doesn’t encroach on your leisure time.
Use a different phone for work emails and don’t look at it when you’re not working. do something different in your leisure time than you would do at work. For example, don’t be a ‘doctor’ offering medical advice to all your friends or family members when it’s your free time. don’t stare at a computer screen on your days off, if that’s what you do when you are at work. r ecognise how you might be engaging in a similar behaviour during your leisure time as you might engage in at work, because if you are, then effectively, you’re still working.
This is important so you don’t deplete the resources you need for work.
as a specialist consultant or private GP, it is likely that you get invited to work ‘social’ and networking events.
Think carefully about the social demands of your work. If your job requires you to socialise a lot of the time, requiring you to have your ‘game face’ on, it’s important that in your leisure time you socialise with people you feel completely relaxed and comfortable with, so you can let your guard down.
Studies have shown that bringing playfulness in to our lives and acting like a big kid can also have a profound impact on our wellbeing and stress levels. Try it for yourself.
n ext time you see a tall tree, what about giving it a climb? or rolling down a big hill until you get dizzy?
It might feel a bit odd at first, but if you really surrender yourself to having fun, you may find that feeling good starts to wash over you.
otherwise, especially when we are having a tough day, remind yourself how to play and ensure to put some time into your day to do whatever you find good fun and pleasurable.
Be selfcompassionate
You might be reluctant to stop beating yourself up when things go wrong, thinking it will mean you are likely to make the same mistake again, that you won’t be as ➱ p18
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‘Here to help. Not to judge.’
successful as you are or could become, that you won’t be as good a doctor as you can be.
That’s understandable because it’s likely that self-criticism has helped you to be where you are today to some extent.
But it doesn’t bode well for your stress levels, well-being, confidence and achieving all that you might want to in life. This selfcriticism often leaves us feeling on edge, anxious, angry and exhausted.
When this happens, we aren’t in the best psychological state to get things done and be the best doctor we can be.
research shows there is, in fact, an alternative to this harsh critical self that can help motivate, support and protect you, helping you to get things done and effectively manage the stress of your job.
What’s more, this alternative has all the benefits of self-criticism yet doesn’t come with any of the negative drawbacks.
It’s called self-compassion, and here’s how you can practise it in any given stressful moment:
Stop to acknowledge that this is a moment of suffering (mindfulness). You might say: ‘This is stress’, ‘This hurts’;
acknowledge common humanity and that suffering is part of life. You might say: ‘I’m not alone in suffering’, ‘We all struggle in life’;
express kindness to yourself as you might to a friend who is suffering. You might say: ‘may I be strong’, ‘may I forgive myself’.
It may be that spending time with others socialising is a personal value of yours. (For more on values, look at last month’s article again).
The truth is that we are social beings and if we deny ourselves meaningful human contact when we can be open and honest about how we feel and what’s troubling us, then our well-being suffers.
In fact, the absence and poor quality of social relationships has been shown to be a stronger predictor of mortality than cigarette smoking, obesity, alcoholism, physical activity and hypertension and is a significant contributing factor in most mental illnesses.
a good network of close colleagues, friends and family who support you and you can open up to, and also have a laugh and some fun with, can ease your work troubles. and they can help you to take a different perspective on any problems you have, or simply help you to feel more supported, and less isolated and alone.
Be kind e vidence shows that helping others –through volunteering or charity work, for example – can promote our well-being and resilience.
This ‘helping’ behaviour needs to be authentic, however, and not function as a way to avoid feelings of letting others down or not being good enough. The more genuine acts of kindness you do,
the more fulfilled and stronger you are likely to feel.
You don’t have to commit to grand acts of kindness or devote much of your time to help others; you could do simple and small favours throughout your day.
By committing to random acts of kindness, even for small moments in our day, you can increase your sense of well-being and reduce your stress.
Here’s some ideas: Water the plants, feed the cat, play with the kids, phone great-auntie Hilda, give to charity, send someone a cheery text message, buy a gift for someone else, tidy up, let someone take a break, help an old lady across the road, go on a coffee run for your team, say ‘thank you’, smile at a passer-by on the street.
Be grateful research suggests that practising gratitude is one of the most reliable ways of increasing happiness. This can be enhanced by keeping a daily record, perhaps in a diary or on your phone or tablet, of things which you feel grateful for and perhaps that went well for you each day.
This can include absolutely anything you like – from being thankful for having clean water to drink to recalling the kindness of the person making your coffee – that might be yourself – or all the good work you’ve done and what a difference to patients’ lives you’ve made that day.
If you are having a grumpy moment, it might be handy to look at a previous list to inspire you, and then you can add your gratitude now for having done this task – and maybe for even waking up to your grumpiness.
Don’t suffer in silence
Please remember that there is no panacea for stress; it’s an inevitable part of work as a medical consultant. r ecognising stress and the way you respond to it is key is managing it well.
If you are finding it difficult to manage your stress alone, do consider getting some professional help.
If you are self-prescribing, if your stress is affecting your family
I’ve seen many doctors bury their head in the sand for far too long, caught up in a downward spiral of unhelpful coping behaviours making their situation a whole lot worse.
Above all, please remember that when you screw up, or make a mistake, don’t berate yourself. You are human after al; we can all make mistakes, we can all hurt people we care about, we are all in the same boat.
I hope this series of articles has been helpful for you. Perhaps you could also share them with a colleague who you think might find them useful too
life, relationships and your job performance, be wise, recognise that doctors, just like you, are human too and can benefit from psychological therapy and support.
Dr Michael Sinclair is a consultant counselling psychologist. He is the clinical director of City Psychology Group in London, with clinics in Liverpool Street, Harley Street and Canary Wharf. He is the author of a range of self-help books, including Mindfulness for Busy People, Working with Mindfulness, The Little ACT Workbook, The Little CBT Workbook, and Fear and SelfLoathing in the City
He provides effective, evidencebased psychological interventions to individuals of all ages, couples and families experiencing a range of psychological problems such as stress, anxiety and depression and adjustment to physical health conditions. He provides training to medical and other health practitioners, consultation to a growing number of corporate occupational health departments and delivers psychological interventions to large firms to improve employees’ health and performance
why Visit? Future Healthcare 2018 is a unique gathering of global healthcare leaders, VIP buyers, and suppliers
and
eVent theMe “The Future of Healthcare – what will healthcare look like in the year 2030?”
In addition to the exhibition, there is also a great two day conference programme, with an impressive speaker line up.
Dawn Barclay-Ross, Event Director +44 (0) 203 740 4666 | dawn@futurehealthcareuk.com
pREpARE yoUR pRAcTicE FoR . . .
The continued growth of the self-pay market has been widely reported. How do you ensure your practice gets its fair share of these additional private patients?
Dawn Cremin (below) sets out the tactics you should consider when planning to increase the number of patients choosing to pay for their own treatment
DocTorS Are very familiar with the private medical insurance route: put very simply, you sign up to a fee structure, provide your profile and wait for patients to arrive.
An insured patient is still likely to go online to research their chosen consultant, check out reviews and where you practise. However, their choices will ultimately be governed by their medical insurer. For self-pay patients, no such constraints apply. They have carte blanche on whom to see and
where, so you need to apply yourself to building up your own reputation both on and offline. This is, first, so patients find you and, second, that everything they read or hear about you points to you being their preferred specialist.
Making yourself known
Having your own website seems the most obvious thing to do to drive your profile, but maintaining a website is something that needs ongoing effort and maintenance.
To rank well on Google, a site needs to regularly publish new content, so it is only worth committing to the time and effort involved in building a site in the first place if you have a plan for developing it over time.
A simpler route, if you don’t have the time to commit to your own website, is to actively manage your profile on private hospital websites.
They invest heavily in online marketing to drive patients to their sites, but, as this is a highly
competitive marketplace, you need to make yourself stand out.
Update your website regularly, highlighting any new or innovative work in the first paragraph –that’s the bit that usually appears in the search box – and keep your photo up to date and list any new treatment options. The same applies for your profile on Bupa’s website https://finder.bupa.co.uk.
positive recommendations
Gaining and publicising positive recommendations from patients, both online and offline is one of the best ways to promote yourself.
You can set up a simple review page on Google, where patients can enter feedback, or use one of the slick and effective doctor review sites such as www.Doctify. com or www.myhealthspecialist. com, which will manage and publicise reviews for you in return for a monthly fee.
In either case, cherry-pick those patients you ask to review you and ask them personally for a recommendation. While patients will write what they want to write, better to know in advance they are 100% happy than find out to the contrary when you read their review.
In terms of encouraging positive word-of-mouth reputation, give all patients a business card. You will be amazed how quickly they forget your name a few months after treatment. You want something to prompt them when they are telling a friend months or years down the line about how good you are.
When you carry out a new or innovative treatment or treat a patient with a real emotional story – for example, ‘Surgeon gets bride-to-be back on her feet in time for the altar’ – contact the patient’s local media, get it written up as a story for your website, or approach your private hospital partners to see if they will help to promote the story as a case study. Social media is a great way to raise your profile, but, just like your website, you will need to keep it updated if you want it to gain any traction.
Tying in posts to the national awareness days, such as prostate awareness week if you’re a urologist, will be more likely to be read and shared.
setting outpatient fees is an important consideration, so benchmark your charges with local colleagues
Be aware of your local competitors’ offerings and distinguish your professional service from theirs in a way that brings you the type of business that suits you best
Bear in mind where you practise will be more relevant for a patient paying for their own treatment.
An upmarket town-centre consulting room may have a perceived higher value, and you may be able to charge more than a local private hospital outpatients consulting room
But, equally, outpatient appointments drive your practice, so you may want to be competitive to attract more patients through your door. As in any market, supply and demand is the key, so you may need to flex your pricing if you have more capacity than patients
When it comes to prices for a procedure or treatment, patients want a clear and transparent price, hence the private hospitals moving to ‘fixed-price’ packages for the most popular operations
Whether you decide to opt to participate in these or not, a patient paying for their own treatment will be likely to ask you at the consultation stage how much the operation they need may cost
you and your practice team need to be able to give patients a clear price breakdown for their operation and outline where the various bills will come from if you’re not going down the fixed-price route with your private hospital
remember, the self-pay market represents a huge opportunity, but you potentially need to work harder to attract those patients to your practice
Make it simpler for patients
Patients seeking to self-pay, particularly at the initial outpatient stage, may simply be looking for a second opinion or to allay a niggling worry.
So, if you remove the barrier of requiring a GP referral letter, you will save the patient time and money. GPs typically charge private patients £30 for a private referral letter.
If you do have a website, make sure it has all the practical detail a patient may need – prices, locations, contact details, directions –and it is kept up to date. This may sound obvious, but an out-of-date consultant website is all too common and could potentially mean you losing a patient.
Dawn Cremin is a co-founder of Fruition Marketing, set up to help consultants with all aspects of promoting their private practice, including web development, branding, media relations and social media
our splash in september (left) reported that a £1bn market in selfpay is set to arrive within four years
New EU data protection laws are about to supercede the Data Protection Act of 1995 and you are mostly likely to get fall foul of it when outsourcing your secretarial work, says practice manager Stephanie Carmichael-Drage (right)
The Applic AT ion of the e U’s Gen eral Data p rotection Regulation (GD p R) on 25 May represents the most significant shift in data security standards in decades.
Yet many businesses across the country remain largely unaware of its implications and how the new rules will differ from the existing UK Data protection Act.
The medical industry has always been highly aware of data security and the serious implications of a breach. h owever, can the same be said of companies that now partner that industry?
As an example, consider outsourced typing agencies, a phenomenon not around in 1995, but one that can save companies 30% in typing costs, while also increasing internal efficiencies.
The growth of the outsourced typing industry has blossomed alongside the spread of the broadband map.
But there has been no legislation as to who can set up a typing company and, with the ‘shop front’ being a website, it is difficult to choose which provider to choose from the pick ’n’ mix market.
i n addition, with all smartphones having a recording facility, a simple app download will enable immediate login to such a service and away you go.
if you use a patient management system – such as DG l’s p rac tice Manager or appropriate content management system – typists can process directly into the database, ensuring streamlined integration.
With most outsourced firms providing a ‘pay as you go’ service and free trials, it has never been easier to start outsourcing today.
alarm bells
i have been familiarising myself with some of the competitors
within the market and it was with surprise that i discovered the issues outlined below which can arise by dipping your toes in the water with an unknown provider.
The experience starts well, and continues well, until there is an iT issue. Without an iT specialist on hand to guide you through the inevitable problems, the onus is on you to work out what the problem is and to fix it ... yourself.
The promised deadlines are not met – with the excuse being that ‘there is a flu epidemic’ and, since there is no contract, you are left with a recording and no transcript and, ultimately, with the task of resourcing an alternative agent or typing it yourself.
The wrong patient name is on the wrong letter and again there is no comeback. The implications of this are, of course, immeasurable. The ‘oh dear, never mind’ attitude of some companies is not what we all envisage; ownership is.
The ‘medical’ secretaries/transcriptionists are, in fact, not medically experienced at all. They sit with their medical dictionaries and ‘Dr Google’ and work through your documents with no natural intuition, knowledge or experience gained from years of working within the field.
Once bitten, twice shy
So it is vital that you seriously consider the ‘promises’ made by some remote companies before you choose to outsource your work, particularly in light of the GD p R legislation coming into effect in May 2018.
The amount of clinicians i have spoken to who have had bad experiences is worrying and so i feel it is important to share with you my tips below on how to choose the right provider.
number-one ruling it is imperative for doctors to partner with an outsourced typing provider who can prove that members of their medical team have worked within the industry and, consequently, are familiar with the peculiarities and characteristics that make up the complexities of the industry.
The seriousness of a breach and the ensuing potential litigation is critical to the medical industry, and benchmarks need to be identified before considering partnering with any outsourced provider. outSec complies with the current GD p R legislation. But doctors, when looking to oursource, should ensure that:
There is an i T manager in the company with whom you can talk;
The medical account manager has worked within the industry;
All remote or inhouse typists have had at least five years’ experience in nhS, private healthcare or Gp environments;
They can offer you an encrypted email system;
You have written confirmation from any potential third party that they fully comply with the written eU requirements, not just for GD p R, but for information governance, patient identifiable data and patient confidentiality.
They hold appropriate professional indemnity insurance.
Check, check and check again o utSec is proud of the very fact that it is ready, ahead of time, with compliance of all the regulations governing GDpR and information governance.
At any point in time, outsec is able to demonstrate the following:
All outSec transcriptionists sign a confidentiality agreement with outSec;
All outSec transcriptionists sign a data protection agreement with outSec;
All outSec transcriptionists sign a client confidentiality agreement; o utSec’s FileManager system leverages the Amazon/AWS cloud to provide the resilience and availability demanded by modernday businesses;
Data security is very important to outsec. Data transfer between a mobile device and the o utsec servers is secured using the latest encryption protocols;
The medical department operates a data security platform for all emails, outside of those automated notifications via the secure FileManager system which may contain patient identifiable data; All medical o utSec transcriptionists complete the on line training module for information governance on a yearly basis; All signed agreements and information governance training certificates are held by o utSec head office, and copies are available on request.
So, can you and/or your transcription provider be as confident in your compliance and capabilities as outSec is?
Your reply should, of course, be ‘yes’. But if you hesitated, then perhaps you should consider calling me for an informal chat on 01366 348088 or email me at stephanie. carmichael@outsec.co.uk.
Moneypenny client since 2015
Moneypenny will support your existing team by looking after overflow calls whenever you need – sending detailed messages back to your practice.
moneypenny.co.uk 0333 202 1005
• 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
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AEsThETic mEdicinE
Thinking of entering aesthetic medicine? Then follow our top ten tips from an entrepreneur who has just done it – Dr Rajveer S. Thethi (right)
After recently shifting from a pure nHS background to working in aesthetic medicine, I found it to be both a steep and stimulating incline for my learning.
I have stumbled along, had tremendous self-doubt and found some success and some failures.
Independent Practitioner Today asked me to share some of my thoughts to save you time, energy and money if you are thinking of going into this area – and to make the right decisions at the start.
Here are my top ten tips. I have confidence you will enjoy them and they may be useful if you are purely considering aesthetics, have just started or even if you are more established.
Starting out in aesthetic medicine, you will soon discover the amount of choice you have can become overwhelming. there are course providers up and down the country delivering a vast range of workshops and training.
t here are the standard combined Botox and dermal filler training days, the separated days for toxin and filler training, the one-to-one courses and everything in-between.
One thing you must understand is that in aesthetics, although you are still answerable to the GMc, there are no formal regulations, no overarching body and no one to uphold any professional conduct in the field.
Given these facts, there are many ‘training schools’ popping up with minimal experience and normally no formal teaching or training accreditation. So be alert! Do your research thoroughly and pick the course that is right for you. look at:
the student to trainer ratio;
How many models are injected in one day?
Are there live models? Some just inject dummy heads.
Do you get a manual?
Do you need to bring your own model?
Will the organisers provide any take-home kit?
can you take ‘before and after’ pictures of your models?
Of course, price is also an important issue that should not
be ignored. Just because a course is expensive does not mean you are going to necessarily get superior training.
Some large providers of training treat their students like cattle, herding you between rooms with exceptionally large student-totrainer ratios. the syringes of Botox get passed around and you all share one to two injection points each –overall a rather underwhelming educational experience.
2choose your working environment carefully there is no right or wrong answer here. Doctors, nurses, dentists, dental therapists, dental hygienists, paramedics and soon beauty therapists are all in this game and want a slice of the cake just as much as you.
Patients want discretion, privacy and so a lot of my colleagues have opted to go mobile. t his means they work from various locations including salons, hairdressers and even people’s homes. this is very common practice.
As a healthcare practitioner who is used to scrubbing up to remove a skin tag, I found the concept of strolling into a patient’s home to fill their lip a bit distasteful. But it happens and it happens a lot. Make sure you know where you are going and tell someone the address if you decide to make this part of your practice.
Put simply – you can be either clinical or not. there is not really any middle ground. Opening a dressing pack onto a cat fur-ridden sofa, is not ‘clinical’, so make sure you have the right kit on board.
Salons can range from being high-end boutiques to complete wastelands, so make sure you know what you are signing up for before you agree to anything.
I hire a clinical premise for all my procedures, therefore it is clean, reputable and clinical and just being in that environment gives me an edge over my competitor.
3
Get your first patients sorted early I mention this from my own experience. I spent so much time contemplating what my course was going to be like and the techniques I need to understand that I completely forgot about the reason I wanted to do it: the patient.
I walked away from the course raring to go. Sadly, I had not planned for the next step – finding a patient and getting my kit ready. I needed to find someone quickly who was willing to let me stick needles in their face for free or cost price.
t his task is easier said than done, as most people want some assurance of your experience before you approach them with a 27-gauge needle.
I am fortunate in that my training provider, for a completely reasonable price, provided me with a suitcase containing all my essential kit ready for collection on the day of my training course. So many quirky items that I would never have associated with aesthetic medicine, including a small pair of plyers.
finding these items separately would not only have been expensive but extremely time-consuming. Hence, I would opt for the lazy doctor’s route and buy a kitted suitcase. then your only job is to organise the actual toxin, filler, insurance, premises and find a victim.
Do not leave it too long or your skills will fizzle out and there are too many stories of people doing these courses and never getting started.
4 do not underestimate the time you need c oming from the n HS into the world of aesthetics, there is some naivety in us all. you see these big corporate clinics turning over millions and see these happy patients
and you can quickly think: ‘I could do that.
Unfortunately, it just is not that simple. t he clinics that you see doing so well and the people flaunting all their ‘before and afters’ on social media have had to work at it. Piece by piece, chipping away, day and night. And, unfortunately, all that hard work is quickly overlooked by those joining the industry.
expect it to be tough, expect to have to work hard and expect yourself not to be stable and content for at least the first two years.
looking back with hindsight, I struggle to comprehend the amount of challenges I have had to overcome along the way.
5 stay medical; don’t get lazy
I am a true supporter of the camp that my nHS training has paved for my good practices that I wish to carry through to my aesthetic career. this means stick to things you know work.
With more unexpected entrants into the aesthetic community daily, you need to stand out. Becoming a doctor was not easy – we all know that and working as a doctor to strict ethical code, regulation, guidelines and clinical governance becomes a part of your practice. Do not forget that when you enter aesthetic medicine.
I too frequently observe people just jabbing faces like it is a slab of meat. Anatomy is only one of the bugbears. Know your anatomy inside out. t here is no excuse. even cannula work can do a lot of damage if you do not know the locations of the branches and facial nerve.
Other areas such as documentation, audit, teaching, keeping up to date and patient feedback are important to consider. It is fundamentally about self-improvement and that needs emphasising in this industry.
In the nHS, if you are struggling to manage a patient, you would refer to a specialist in that field. you would not try to fix a neck of femur fracture in the GP clinic with matches and yarn, and I strongly believe the same ethical principles apply within aesthetic medicine.
Dr Thethi’s coach, Pam Underdown, chief executive at Aesthetic Business Transformations, says:
‘i have loved every moment coaching and mentoring Dr Raj and seeing how much he has grown in just a few months.
‘From the moment we first spoke, not only could i tell how determined he was – and is – to make a success of his new business, but how coachable, open and willing to learn he is.
‘in addition to having the right attitude, it is critical for me to know that Raj was going to take action and implement everything he learns. His burning desire to learn the business and marketing side of private practice will ensure that he doesn’t make the expensive mistakes that others can and do make.
‘Raj has fitted into our private coaching group extremely well and, due to this, he has had a huge range of help and support not only from me, but from the whole group of experienced aesthetic practitioners. i am really looking forward to seeing this rising star continue to grow and shine.’
6Find support wherever you can
I underestimated the power of having support and how it improved my practice in the beginning. Support can be gained through so many channels and, trust me, you are going to need them all.
your aesthetic medicine journey is a marathon and you are going to struggle working alone for such a great length of time. Hence, make sure you have someone there with you: a business partner, close colleague or a spouse.
Have someone you can trust to give the right advice, because the wrong decisions initially can become costly mistakes to rectify later.
Another powerful support system are the online social media forums.
On f acebook, there are multiple, national, UK-specific aesthetic forums where the big names in the industry are all within messaging distance.
frequently, if there is a complication or a question, leaving a ➱ p28
query on the forum will mean you get floods of positive, useful information back from people with a lot more experience, who have been where you are and made the same mistakes.
However, be aware that, nowadays, everybody is an expert if they write ‘in my opinion’ at the end of a statement. Do not follow blind advice and make sure you are getting it from a reputable source.
Some of the training providers have secret online forums with a closed aesthetic community. t hese can be amazing places to absorb knowledge and I advise you to find training providers with a forum already live and running, as you can join a community.
t hey not only help with your clinical work, but these forums can also tackle all aspects of the job, including the business side too.
7
Re-invest and do not stop learning
So, you have done your foundation course and treated your first patient. now what?
It seems many practitioners feel now they have achieved the goal they can take their foot off the accelerator.
Unfortunately, this is the perfect time to quickly realise how little you actually know from a foundation course. you need to take any funds generated from your handfuls of patients, suffer the losses and re-invest that money – plus a lot more – into more courses.
A patient is not going to come to you if all you do is fill a nasolabial fold. you need to start to think pan-facially and these concepts of advanced facial analysis only come with further training and experience.
you need to get to the point I am approaching now, that when I sit on a train and look across at
another commuter I can make a lengthy aesthetic plan of all the things I can improve with their face.
As a medical student, I used to look at their hand veins and guess who I would be able cannulate.
n ow I am tracking the route of their facial artery and trying des-
perately not to mentally cannulate it.
8
SPECIALIST MEDICAL ACCOUNTANTS
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
• Setting up in Private Practice
• Setting up in Private Practice
• Setting up in Private Practice
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• Developing your Private Practice
• Developing your Private Practice
• Tapering of the Annual Allowance
• Tapering of the Annual Allowance
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• Expenses that you can claim and those you cannot
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Get a business coach you’ve only just started, you do not have the capital or the patient flow and a coach is quite costly. But, coming from an nHS background, I know I do not have T
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the slightest idea how to run a business.
t his is where you need to become savvy and start switching your subconscious to a business mode. When I first started, I was basically handing out discounts, making everyone’s third aunt twice removed my best friend and giving them ‘mate’s rates’.
After acquiring one of the best aesthetic business coaches in the UK – Pam Under down, head of Aesthetic Business transformations – I have quickly discovered the error of my ways and, more importantly, how to correct them.
Another good tip from my coach is to spend all car journeys listening to business and selfgrowth audiobooks. t his has meant I have developed so much in so little time.
I am learning concepts in business I did not even know existed and have started actioning these changes in my own business. My coach has opened so many doors for me in the aesthetic world that I would not have even fathomed sat alone at my desk by myself. My network within the aesthetic community has grown tenfold with her introductions of past colleagues. My business aside, I have also grown significantly as a person while having her support and guidance.
9 do not pay attention to the competition
I did this a lot at the start. I would spend my days looking at competitors’ websites, looking at their flyers, their prices and treatments. Another thing I learned from my business coach is that this is your race and your race alone.
Diverting your time and energy spent looking at the competition towards something constructive for yourself and your business will make you feel less anxious, stay in more control and it will further your own business and your drive. f ocus on gaining experience more than anything. If you are not getting complications, it means you are not doing enough procedures. no race is won looking sideways at the competition. look onwards and upwards…
Regulation is coming this is a sore topic to end on but one that will carry a lot of weight in the next few years.
If you are not already aware, after Sir Bruce Keogh’s 2013 report Review of the Regulation of Cosmetic Interventions , key recommendations have been flagged which will shape the way the industry evolves.
With rumours of level 7 supervision and GM c -approved specialist registers, there is currently a lot of smoke in the arena which will take a while to clear before we see the beast before us.
With acceptance of beauty therapists into the aesthetic circle from the Government and creation of the Joint c ouncil for cosmetic Practitioners, there is a paradigm shift ahead. It will change the way we view our roles and the way in the public views us.
you will be warned that regulation is coming from all angles, but no one really knows yet what that means. Who will regulate what and how these pieces of a complex jigsaw from three different boxes are even going to come together – no one knows.
Do not look at the beauty therapists as your competition or something to get worked up over. concentrate on your business and your self-growth.
you are a medical professional and no one can take that away from you. Work hard, keep your head down, focus on your goals and good luck. It is an amazing journey you are embarking on. enjoy the ride!
Dr Rajveer S. Thethi is medical director of Skin Radiance Clinics, Leeds. Email: info@skinradianceclinics.co.uk
Using a psychiatrist’s new premises as a case study, over a series of four articles, Maurice Citron (right) presents a diary of a clinic build. He sketches out some of the important issues and processes you will need to consider if you decide to acquire, develop and trade from your own clinical property
My first article last month considered some of the issues practitioners could expect to encounter when they acquire a property for development. Now let’s look at the planning and preliminary stages of a project.
The planning system your development is likely to require one or more planning consents. this may involve a change of use, consent to extend, refurbish or convert.
the planning system in the UK can be contentious and there are, at any one time, a plethora of vested interests in each planning application.
f rom national to local level, there are collections of planning
documents which will be relevant to your specific site. these inform the ambitions of national, regional and local authorities for the built environment. independent interests, such as Heritage England, also play a role in the system.
t he National Planning Policy f ramework (NPP f ) is a national plan relevant to all planning authorities with a very broad vision, arguably a political vision, of planning in the UK.
An ability to convert office space to residential under permitted development rights is an NPP f policy driving current residential development activity in many cities. At the other end of the spectrum, a local authority may produce local area plans for each
of its town and rural areas designed to address local concerns and issues.
Any planning application seeking consent needs to put forward a coherent argument showing how the proposed design complies with the various relevant planning documents.
i n theory, this plan-based approach gives the system a measure of objectivity. Every planning decision, either a consent or refusal, must be supported by reference to existing national, regional and local plans. ideally, subjective opinion does not determine planning decisions. But planning documents are
invariably ambiguous, or have the potential for ambiguity, which allows for a degree of interpretation and dispute.
instructing an architect will be the first port of call when assembling the planning application, although there are usually several other professional inputs that are required. Various supporting surveys and reports will accompany the application, including the likes of archeological, heritage, ecological and transport reports. this supporting documentation will assess the impact your design has on the surrounding area and the people already working and living there.
t hey can also have financial and timing implications on your
plans. for example, if the ecological survey finds the presence of bats in your property, you may be required to preserve their habitat or provide an alternative one for them.
Our study site is consultant psychiatrist Dr ian Drever’s new psychiatric day clinic, Esher Groves in Esher, surrey. Planning application was initially refused.
i ts submission requested a change of use from office to clinical space (D1 Non-residential institutions) with a substantial extension at the rear of the property providing around 750 square feet of clinical consulting rooms with additional ancillary space.
Concerns were raised as to the bulk of the new extension, its proximity to the adjacent grade ii listed church and neighbours’ issues relating to the location of bins and pedestrian access.
the council’s refusal was challenged by Esher Groves, who ultimately achieved consent when the council’s decision was overturned by the planning inspectorate.
Estate management
the planning process takes time and while the process unfolds, it is important to practise good estate management. t his may include ensuring your property is adequately secure when vacant before work begins.
it is very important to have the correct buildings insurance in place. this became self-evident to Esher Groves in Easter 2016, after a horrendous storm uprooted a large tree situated in the church grounds. t he tree collided with Esher Groves property, causing substantial damage to the roof and side elevation wall. t he insurance company sent out a loss adjustor to assess the damage to the property. fortunately, given the circumstances, this case was not contentious and insurance monies were made available to completely replace the entire existing roof and repair the damaged wall. that storm cloud certainly had a silver lining. But the owners had another surprise in store. During the roof works, it became apparent there was no firewall separation in the loft void running the length of the terrace. this could have been catastrophic.
A fire in one of the properties could have affected all the properties in the terrace. t his was quickly rectified, and a firewall put in place between Esher Groves and its adjacent neighbour.
Development appraisal there is a lot of creativity at this stage of the project, which, in the majority of cases, will need to be tempered by budgetary restraints. it is sensible to start working and continuously update a schedule of costs as the design takes shape. if you decide to raise development or refurbishment finance, lenders will want to see a detailed schedule of works with an accompanying schedule of costs. they will also very likely want to assess the track-record of the developer, which, in the case of healthcare practitioners, is not always available.
Assembling your professional project team early on is one way of solving this problem. t heir experience and track-record can be leveraged in the funding proposal to reassure the lender and help secure development funding.
Next month: Issues raised by the CQC and what to expect when work begins on site during the construction stage.
Construction is the transformation of two dimensional ideas into three dimensional physical objects and sometimes things get lost in translation…
Maurice Citron is director of Citron Singer Property Finance, a commercial property finance broker specialising in the healthcare sector
With the pressures of modern practice, it is easy to make a misjudgement in your professional or even your personal life which raise questions about your integrity. Following our first feature last month, Dr Kathryn Leask (right) looks at three more scenarios in which one-off mistakes had serious consequences
A consultant gynaecologist who had recently moved to another part of the country set up a Facebook account to keep in touch with her old friends and neighbours.
Soon afterwards, she received a friend request from a previous patient and, without giving the matter much thought, she accepted. A little later, she received a message from the patient asking for advice about
menopausal symptoms which she answered in general terms.
Over the next few weeks, the patient contacted her with further questions on the same subject until she lost patience and unfriended her.
A little later, the GMC contacted the consultant telling her it had received a complaint from the patient. It was concerned the consultant had blurred professional boundaries and failed to advise the patient to consult her own GP.
MDU advice:
If you are new to social media, a friend request can seem harmless
enough and you may feel obliged to accept friend requests out of politeness.
However, when it comes to patients, you need to maintain the same professional distance as you would in person.
Even with former patients, the GMC says a personal relationship may be inappropriate, depending on the length of time that has elapsed, the nature of the relationship and the patient’s vulnerability.1
If a patient contacts you on social media about their care or other professional matters, the GMC advises you to explain that you cannot mix social and professional relationships.2 If appropriate, direct them to your professional profile or – in this case – their own GP.
Don’t accept any new friend requests from patients and consider changing your privacy settings. It is possible to restrict who can send friend requests and restrict who can see your posts.
An orthopaedic surgeon with practising privileges at a private hospital was asked for a reference by one of the resident registrars who had applied for a surgical post at a nearby NHS trust.
The consultant had previously supervised the registrar during several knee arthroscopy operations and had no concerns about his ability to carry out the basic procedure, although he had to step in on one or two occasions to prevent the registrar trimming too much cartilage.
He duly wrote a reference, recommending him for the post. A year later, the consultant discovered the registrar was under investigation by his new employer after concerns were raised about him by theatre staff.
During the investigation, the trust reviewed the registrar’s references and referred the consultant to the GMC for failing to disclose concerns about his competence.
MDU advice:
You may want to help a younger colleague by writing a positive reference, but you have an overriding duty to include ‘all information you are aware of that is relevant to a candidate’s professional competence’ 3 and the GMC expects you to ensure any documents you sign are ‘not false or misleading’.4
Equally, you will be doing the doctor and their patients a disservice if you overestimate their abilities.
It would be better to speak to the doctor about their ambitions and explain your concern about their readiness, which you would have to mention in your reference. If you wish, you could also offer to mentor the doctor and help them improve their skills.
A general physician had decided to scale back his practice before retirement, but decided to supplement his income by acting as an expert witness.
While his main area of interest was cardiology, he accepted instructions in the case of a young patient who had suffered from a post-thrombotic syndrome fol -
lowing a DVT which left her with debilitating venous ulceration.
The physician reviewed the records and carried out a literature search, concluding that the treating doctor’s standard of care was reasonable. However, another expert instructed by the claimant’s solicitors disputed this, pointing out that the doctor had not complied with his hospital’s protocol at the time.
Recognising that he had failed to check the hospital procedures, the physician told the defence side he had changed his view and the claim was settled. But the expert instructed by the claimant’s solicitors complained to the GMC about the unbalanced report.
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MDU advice:
Expert witnesses should have sufficient experience in their field to be able to give a reliable and informed opinion about specific issues in a case.
If the matter is outside your professional competence or you do not have enough relevant knowledge, you should have the insight to recognise this and turn down the case, in line with GMC guidance.5
If you are interested in being an expert witness, you could consider attending a specialist training course, which covers areas such as report writing, the legal process generally and court appearances.
Bear in mind that experts can also be sued, either for negligence or breach of contract in relation to the production of their report or their conduct at an expert’s meeting.
References
1. Paragraph 8, Maintaining a professional boundary between you and your patient; GMC, 2013.
2. Paragraph 11, Doctors’ use of social media; GMC, 2013.
3. Paragraph 8, Writing References; GMC, 2012.
4. Paragraph 71, Good Medical Practice; GMC, 2013.
5. Paragraph 12, Acting as a witness in legal proceedings; GMC, 2013.
Dr Katherine Leask is a medico-legal adviser with the MDU
Now is a great time to connect local best practice and national leadership together to re-energise and invest in the Private Patient Unit sector – and snatch the £1bn-a-year opportunity these units are for the NHS. Philip Housden (right) explains more in the second of a series of articles
My review of the 2016-17 annual accounts for out of London NHS trusts last month in this journal showed the massive opportunity that should not be ignored. The NHS PPU sector needs stimulatation!
Optimising the use of present PPU capacity and services, and targeted investment in expansion, could make a serious dent in that £1bn.
New PPUs can and should mean new extra capacity – not the rebadging of NHS capacity – more beds to enable more patients to be treated and more intensive use to be made of the expensive estate and infrastructure that trust’s already have.
So, what needs to be done?
Here is my high-level strategic five-point action plan, based on what the NHS is best at, designed to target that £1bn for the NHS PPU sector outside of London. i t is a co-ordinated approach. Although it would require some local adaption due to the differing starting points and markets across the country, it builds on current best practice across the NHS.
NHS leaders need to state again that private patients are ‘just something the NHS does’ and are ‘business as usual’.
Leaders of trusts expect their staff to treat patients regardless of whether they are in catchment or without, and whether they are eligible for the NHS or not.
But some make a practical distinction when it comes to private medical health insurance. i t is time for the NHS leadership community to set a climate for NHS trusts to operate in that is at least benign for private patients – or even better, one that is open and positive.
This is a pre-requisite to the rest of the action plan to end this subsidy of insurance: leadership from the top sets the tone.
Create a central fund to invest in targeted small, fast-track schemes to open more private patient beds, perhaps funded from the capital receipts of sales of surplus NHS land.
Private patient wards, even small ones, can produce a surplus over and above their own staffing and internally re-imbursing theatres, imaging and other departments.
There are models where the PPU takes private patients first but ‘pulls in’ agreed NHS elective priorities into unused capacity, thereby keeping the beds at a high level of occupancy.
e xamples of such priorities include out-of-area patients, cancer surgery and specialist regional procedures. Such an approach to the flow of patients has been shown to maximise the capacity for both private patients and NHS; capacity that is essentially extra and ‘free’ to the trust.
There are trusts across the NHS that have ideas for the expansion
of beds but cannot fund these schemes. These might be the bringing back of unused capacity – older wards that need updating and are used for ‘back-office’ functions – or the potential to graft on additional space into other future building schemes.
These trusts could be first in the queue for central resource, paying back from immediate increased earnings into the fund for subsequent schemes.
This ‘paid-for’ new capacity might also help to repatriate some of the presently outsourced activity going, ironically, to the local private hospital now.
The BBC’s Panorama programme recently stated the safest place to be is an NHS hospital. As patient safety is enhanced with the 24/7 infrastructure that, out-
side London, only the NHS can provide – with some exceptions in largest cities – a failure to provide PPU capacity will only lead to more private patients defaulting to the NHS.
So trusts can engage on this issue and be open with their consultants and with their local private hospital to set the expectation that the most complex patients are treated in the right place, and when the insured are identified and appropriately charged for.
Consultants already know this, as evidenced by multiple-site surveys in recent months (see bar chart above) and are increasingly telling their private patients so.
There is no need to outcompete private hospitals on hotelstyle services, so set a modest and fit-for-purpose NHS PPU brand.
Private patients choosing or being advised to be in a PPU are there because they understand the patient safety advantages.
The offer to private patients is the ‘best of both’, firmly based on NHS core values of high-quality patient care, but with an added hotel feel and consultant choice.
Many trusts are now multi-site and so have private patients on two or more campuses.
This has created the opportunity for the development of subbrands, examples being:
Spencer Hospitals in east Kent,
Lindsay Private Patients in Lincolnshire;
The recent Nash Private Healthcare in essex.
These new brands and ‘PPU chains’ could be supported to grow to be regional, or perhaps even support a national NHS brand-raising awareness campaign to demonstrate the win-win of private patients for all.
Last month’s article analysed the annual accounts of PPUs
A new NHS PPU development initiative should foster the sharing of best practice between trusts.
The South west NHS Trusts PPU group has met for some time and does this, and a London group meets from time to time, but there is still no single place
for trusts to go to for best practice. with only a little encouragement, the learning from a number of exemplar sites could be collected and made available to all.
On a linked issue, there is the potential to share back-office and administration expertise and the potential to engage with more negotiating power with the established insurers.
Close analysis of 2016-17 PPUs’ performance casts light on the size of the financial and service prize that the NHS has. This opportunity is dissipated across more than 100 acute hospital campuses outside London.
it has therefore a largely unrecognised collective value because so many local components each seem small when looked at individually. But when considered together, these form a significant collective opportunity.
Now is a good time! As recent news coverage testifies, NHS
capacity is under increasing pressure and trust estate is being scrutinised and asked to work harder. This is a way for the NHS to help itself and reduce the inadvertent cross-subsidy of insurers.
A vision for the future for PPUs is one of an increasingly networked approach where the NHS shares best practice, invests in fast-payback new capacity and thereby delivers increased financial and other service benefits.
Along this service-led path the NHS will also provide something back to insurers, increased competition and choice, a meaningful benefit for their patients and their consultants.
This is a billion-pound PPU opportunity and it should start to be grasped.
Next month: What’s been going on in PPUs in London
Philip Housden is a director of Housden Group
A
big difficulty for many new and established consultants in private practice are billing and collection issues – whether they work as an individual or a group. Findlay Fyfe (left) examines the scale of the problem
C O nsu LTan T s en T er I n G private practice quite often start on their own, so have a steep learning curve when setting up and running the business on top of nHs responsibilities.
Doctors’ check-list includes:
➤ Deciding whether to engage a medical secretary. Due to start-up costs, consultants often begin by carrying out some of this role themselves;
➤ Finding a location to practice;
➤ arranging medical indemnity or insurance;
➤ registering with private medical insurance companies and hospitals;
➤ Marketing themselves to find their first patients.
Once this is all sorted, you have to decide what you are going to charge.
n ow this might seem quite straightforward, but many doctors quickly find there are more issues to consider than they initially realised.
For example, do you want to simply match a colleague’s fees, which is an obvious option, or differentiate yourself at the start, based on factors around your experience, location and speciality?
Avoid undercharging
What you do not want to find out later is that you have been undercharging, or worse still, not charging at all for work carried out.
a mistake we found in the past was a consultant’s secretary had charged all insurers at one insurer’s rates, not realising different insurers will accept different fees for similar work and procedures.
In some cases, there was up to a
100% differential, costing the practice tens of thousands of pounds over several years.
a nother common mistake we find is the incorrect billing of multiple procedure codes because each insurer has their own specific rules about how the invoice total is derived. If these are misunderstood, you could be missing out or billing incorrectly – and that can cause you problems with the insurers.
Increasingly, private medical insurance companies are wanting billing information sent through online portals, so either you or your secretary need to understand how to do this and set aside time to manage this process.
This method is known as electronic data interchange (eDI) and there are many reasons why you get eDI failures, such as incorrect information.
These e DI failures need to be managed. You might be surprised how many patients give wrong details. a common mistake is wrong insurance membership details or not realising their policy has expired.
We have also had many practices where these eDI errors were ignored – which means the insurance company never received the invoice.
There is also an increasing amount of excesses and co-share policies built into medical insurance cover, meaning that even if patients are insured and payments – known as a benefit – are made, there will still often be invoices which need to be sent to the patient and chased.
Billing and collection can prove to be an onerous task for your secretary
This requires robust procedures to be in place and is generally something that gets put off when a practice is busy.
Quite often, the patient is not aware of their liability and it is extremely common for us to find that shortfalls make up a large proportion of a practice’s aged debt and can go back years.
Of course, you may decide to do embassy and/or medico-legal work. But these invoices tend to be paid much later than insured and self-pay invoices and that will require your secretary to diarise to follow-up on these.
Once payments are made, they need to be reconciled against invoices – especially if a payment is made for multiple invoices.
I suspect you have gathered that this is plenty of work for consultants working in one location and with one secretary to oversee, outside the day-to-day managing of the most important person in all this: the patient.
However, if you decide to work at multiple locations, if your secretary is not engaged exclusively by you, you could have multiple secretaries, meaning multiple versions of the above process to be managed or data coming from various systems.
It is also important to remember that, come your tax year-end, you will need to amalgamate all your invoicing and collection information into one.
If one of your secretaries is better at the billing and collection than another, that can make doing your accounts – well, let’s just say – time-consuming.
Group practices are becoming increasingly common and for many good reasons. These include specialty coverage, holiday coverage, economies of scale and basic strength in numbers.
They come in all shapes and sizes. In virtual groups, consultants still act as independent practices and the group may have a website to channel patient flow to more organised structures such as a chambers or limited liability partnerships, with the cost of administration and marketing being shared by the group members.
Many secretaries either find they struggle to find the time to do the billing and especially the chasing of invoices or, like the consultant, do not like mixing the medical with the financial side
With clinics and hospitals, you will more likely have account departments who manage the billing and collection, but, in our experience, the same problems exist.
There is the additional concern of staff turnover and continuity planning, holiday and sickness and, again, general key person dependency problems.
There is also the issue in areas of high property value around the opportunity cost, in that the space dedicated to this function could be better employed as a revenuegenerating area for the clinic.
Outsourcing this key billing function can provide a solution to these problems, providing on-tap capacity to allow consultants to grow and evolve their private practice with a simple cost structure that is based on received income. at MBC, we specialise in man-
aging the billing and collection side of private practice – becoming a seamless extension of the practice. Increasingly, practices are realising the benefits of separating the medical from the financial side – leaving them free to concentrate on treating the patient and keeping discussions on a purely medical basis.
Many secretaries either find they struggle to find the time to do the billing and especially the chasing of invoices or, like the consultant, do not like mixing the medical with the financial side as well as having the awkward discussions if invoices are disputed.
If you are interested in learning more, email us at info@medbc. co.uk for a free consultation.
Learn about the medico-legal issues you need to know when starting out: see page 46
Findlay Fyfe is managing director of Medical Billing and Collection
But with no obvious group format, groups can fail to evolve due to variations in opinion as well as different expectations and perceptions of what each party is ‘bringing to the table’ from the start.
If in a group, you will still have many of the same issues of being on your own to contest with. The added dynamic will be the increase in volume of business, so you will need to be keeping a closer eye on your billing and collection – what might be monthly becomes weekly or even daily.
There will also be the need to distribute money to each consultant based around the format the group has decided.
It is normal practice to have one of the consultants to be responsible for either doing this or making sure it is done.
Like any business, groups can expand or contract depending on circumstances. Decisions around administration can result in binary decisions about staffing which can impact the fixed costs of the group, especially when you factor in the risks of key person dependency.
Whoever is undertaking this task will need to manage each consultant’s insurance provider numbers and their various pricing structures and billing rules.
Bad news hitting the headlines? Simon Bruce on why a wellstructured portfolio allows you to ignore the doom and gloom when investing
Futurologists have one thing in common: they are nearly always wrong in their predictions and are rarely held to account for their poor forecasts
GaininG perspective is sometimes not that easy. Modern life provides us – some would say swamps us – with so much news, information and punditry, which focuses on the here and now, that it is easy to be overwhelmed.
the list of things to concern us is long and worrisome:
Donald trump leading the free world;
a nuclear-armed north Korea; an increasingly fractious Brexit process and looming cliff edge. if we do not worry for ourselves, we do so on behalf of our children and their children in turn. that is only natural, but it can feel a little unsettling at times.
the natural extension of this is to worry about what the impact of all this doom, gloom and uncertainty will have on your portfolio and, in turn, on your future wealth and expenditure goals.
t he first mistake is to believe that the world is falling apart around our ears. it most certainly is not.
Donald trump is being contained by the sensible constraints put in place by the founding fathers of the United s tates of america. islamic state had been severely constrained. according to the iMF, growth in the eU and other advanced econ-
omies is estimated at 2.2% and that in the developed and emerging economies is estimated at 4.6%, giving a global rise in real output of 3.6 %.
Focusing only on the downside exacerbates the level of stress and worry and may tempt some into repositioning their portfolio based on what might – or might not – happen in the world.
at worst, some might retreat to ‘safe’ cash, something it most certainly is not, having lost more than 15% of its purchasing power since the credit crisis.
there are a number of reasons why portfolio tinkering is unlikely to be a sensible course of action and i outline them below.
Reason 1: Today’s ‘unprecedented’ turmoil is no different to how it has always been today’s worries dominate our thinking, but can you remember what you were worrying about a year ago or two years ago?
Most investors do not own 100% risky assets, such as equities. Holding short-dated highquality bonds is an insurance policy that dampens portfolio return volatility and provides resilience at times of true equity market trauma, like the technol-
ogy stock crash of the early 2000s and the credit crisis in 2007-08. t he overwhelming take-away message is to acknowledge the relentless upward trajectory of purchasing power for those patient enough, and disciplined enough, to stay the course.
Reason 2: Bad news sells –do not ignore the underreported good news We are all aware that bad news sells. For example, the Office for Budget responsibility (OBr) – set up in 2010 to monitor and forecast the progress of the UK economy – has a ‘gloomy’ forecast for growth of ‘only’ 1.4% for 2018.
sky news, for example, led with the depressing headline ‘Gloomy Budget as UK slashes growth outlook’. this needs to be balanced out by the good news that one rarely hears.
the UK economy is still growing. r emember that this slowdown comes after a period of growth that has outstripped much of the developed world –particularly the rest of the eU – for the past few years.
We seldom hear about the fact that the UK GDp regained its previous high of 2008 in 2013. Why are we still so depressed about the UK economy today, when every-
one was pretty cheery with its size in 2008?
Unemployment is now at a 40-year low at 4.3%; 32 million people are in employment compared to 30 million in the 2008 boom times of the Gordon Brown era.
Reason 3: The danger of conflation of ‘what ifs’ t he human mind likes stories and, in themselves, these stories may lead to what appear to be rational outcomes on which some action or another could or should be taken.
What we often fail to realise is that the seemingly logical outcome is highly unlikely; we have failed to multiply the probabilities of each sequential outcome together.
Reason 4: The futility of futurology
Futurology is the financial markets’ version of astrology. there is a huge industry out there from the i MF and the UK’s Office for Budget r esponsibility (OB r ) to investment banks, academics and BB c reporters all peddling their own view of the future.
t hese futurologists have one thing in common: they are nearly always wrong in their predictions
and are rarely held to account for their poor forecasts.
t he OB r , for example, who recently pronounced on the state of the UK economy – which the
chancellor used as the baseline in his n ovember Budget – has a pretty poor record of forecasting the UK’s economy. the conflation of ‘what ifs’ adds to the problem.
Reason 5: The framing of data
as we all know, data is used to score points in support of the data-user’s viewpoint. Be aware that simple statements of fact can be both very influential and misleading.
it is normal to be worried about the potential impact of what is going on in the world and how this will affect markets. the reality is that you are not alone.
in fact, all active investors have some view on how trump, Brexit, Merkel’s problems in Germany or the Federal reserve in the Us – to name a few – will impact bond and equity prices.
t hese global, diversified viewpoints are already reflected in the equilibrium price of securities, agreed freely between buyers and sellers.
Your portfolio should be structured to manage uncertainty. Well-structured investment portfolios seek to ensure that any mar-
ket conditions can be weathered in the future, whatever drives these storms. if this is not the case, it is time to ask for help.
Simon Bruce (right) is chief executive of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Poor performance and misconduct issues can be a minefield for doctors who employ their own staff. Hempsons’ solicitor Lucy Miles gives some useful pointers to help you navigate the minefield
‘No maN is an island’ – this phrase is particularly pertinent in the workplace, given that many of us depend on the skills, experience, expertise or manpower of employees to succeed.
While employing staff is positive and beneficial for the most part, it also involves issues and potential liabilities which can be difficult to manage, especially for smaller employers with limited resources.
This article looks at two common employment scenarios and gives guidance on how best to manage them successfully.
ScEnARio 1: Performance issues
‘my secretary seems to be struggling to get her work done.
She has been employed for five years but only became my secretary six months ago. She rarely completes tasks on time and the letters she produces are often inaccurate and contain typos, which puts additional pressure on me and others to ensure everything is checked carefully.
She is often late to meetings, disorganised and never seems to be on top of things, but she is fun and friendly
and gets on well with everyone else.
‘We haven’t said anything to her about her work, as we don’t want to hurt her feelings, and I had hoped things would start to improve naturally as she settled into the role.
‘However, last week, she lost a patient’s file, and although it was subsequently found under a pile of miscellaneous paperwork on her desk, it has become clear that something needs to be done to avoid more serious issues arising in future. What should we do?’
AUnder-performers are an unfortunately common issue for many employers. It is often tempting, especially when you have a full workload, to avoid having difficult conversations with under-performers, but this is not advisable.
This is primarily because there is little prospect of improvement without some action being taken. meanwhile, the situation could get worse and, if a serious issue were to arise, a lack of previous action might constrain the steps you could take.
The starting point for this kind of situation is to arrange a meeting with the employee to discuss the situation.
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The meeting should be informal and designed to:
Provide constructive feedback;
Establish whether there are any underlying causes for the poor performance;
Set clear and achievable goals and standards for the employee to work towards.
If there are underlying causes for the performance issues, these will need to be considered carefully and sensitively, meaning specific support might be needed.
It may be that this meeting will allow you to identify simple steps to address the situation. For example, it may be that the training the employee received at the commencement of employment was insufficient and this can be addressed by additional training.
A further review meeting should be organised for a reasonable future date, perhaps a month later, at which you should discuss and review the employee’s performance.
At that stage, it should be apparent whether improvements have been/are being made and the concern is resolved or that further formal action is necessary.
If the performance has not improved or not improved sufficiently, a formal performance management process should be initiated.
This would involve a series of formal, minuted meetings and a documented plan being drawn up setting out specific measureable targets and objectives with deadlines. The length of the process will be determined by the number and nature of issues, but should afford the employee a reasonable opportunity to improve.
It is important to provide advanced notice of each formal meeting and allow the employee to be accompanied by a trade union representative or work colleague.
The employee must understand, from the outset, the purpose of the meetings and that failing to meet the required standards could result in warnings/ sanctions being issued and ultimately dismissal on the grounds of capability.
Capability is one of the five potentially fair statutory reasons for dismissal, but it is crucial that employers follow a fair perfor -
mance management process before dismissing an employee on the grounds of capability. This is in order to demonstrate that the dismissal is procedurally as well as substantively fair and thereby reduce the risk of Employment Tribunal claims and allow any claims to be defended robustly.
It does not seem that dismissal is the desired or likely outcome in this scenario, but managing the performance issues proactively, sensitively and in line with the process suggested above should enable the required improvements to be made and risks to be managed while maintaining good relationships.
ScEnARio 2: conduct issues
‘We have had two incidents in the last month where patients have complained that they did not receive medication upon discharge but were invoiced for it.
‘ o ur records for both occasions show that the medication was dispensed and sent home with the patient, so we are concerned that the medication has gone missing. The same nurse discharged both patients and the medication in question was Tramadol.
‘We suspect she has taken it because something similar happened in a different site a few years ago, although – unlike the nurse in that case – this nurse has nine years’ service and a clean disciplinary record.
‘We are planning to suspend the nurse first thing m onday morning and then invite her to a disciplinary meeting on Tuesday, as this needs to be dealt with urgently. Is that an appropriate way forward?’
AIt is often tempting in situations such as this to rush ahead and deal with things as a matter of urgency.
But doing so could jeopardise the process and lead to liabilities, such as claims for unfair dismissal, constructive dismissal and/or breach of contract. Taking time to ensure that proper procedures are followed is important in this context.
Conduct – or, more appropriately, misconduct – is another potentially fair statutory reason to dismiss, but a fair process including an appropriate level of investigation must be undertaken first. Without this, employers are at risk of Employment Tribunal claims and less able to defend such claims robustly.
Even when you are dealing with serious conduct concerns, suspension must never be an automatic, knee-jerk reaction. Each case should be assessed by reference to the specific circumstances.
In this scenario, it appears the employer has formed an initial judgement based on a previous unconnected incident involving a different employee, which is not advisable.
Rather, the employer should consider and weigh up the:
Nurse’s clean record and lengthy service;
Seriousness of the issue;
Impact a suspension could have on the employee – in terms of both her career and her well-being;
Risks if she remains at work for the time being and any ways those risks could be mitigated.
On assessing the situation, the employer may determine that it is sufficient to restrict the nurse’s duties temporarily to prevent her handling/administering medication or have her to work in a different role, meaning that suspension is not necessary.
Suspension should always be a last resort because it has been established by the courts that suspension is not a neutral act, and doing so without reasonable grounds and consideration of alternative options could amount to a breach of contract.
It is also essential that an investigation is carried out before the employee is invited to attend a disciplinary hearing.
The purpose of an investigation is to gather all relevant material, so, in this case, it would be necessary to consider:
The process of dispensing a prescription;
Whether any other members of staff were involved in the processes;
What the circumstances were on the two occasions in question;
What the nursing notes/discharge paperwork show and who completed these documents.
It would also be necessary to speak to the nurse under suspicion, all other staff involved and any witnesses to the events. The investigation should be carried out by a senior staff member who is unconnected to the issue.
A recent case has confirmed that it will be rare for an investigation to be viewed as too thorough. However, whether an investigation is sufficient will always be scrutinised by the Employment Tribunal in an unfair dismissal claim.
A decision on whether there is a disciplinary case to answer by the nurse should only be taken once a thorough investigation has been carried out. This decision should ideally be made by another senior manager who would then chair the disciplinary process.
If there is to be a disciplinary hearing, the employee should be invited with reasonable advanced notice and allowed to be accompanied by a trade union representative or a work colleague.
It is essential that, in advance of the hearing, the employee is informed of the specific allegations and given a copy of the investigation report.
The disciplinary decision should be taken after the hearing and confirmed in writing. The employee should be given the right to appeal the decision and told how to do so.
If there is an appeal, then ideally it should be dealt with by another manager who has not been involved in the case. If the allegations are upheld, it is likely that a referral to the Nursing and Midwifery Council would be necessary.
Lucy Miles (right) is a senior solicitor at Hempsons
So how do you proceed when an older patient refuses treatment? Dr Sally (right) answers a reader’s query
QI have an elderly patient with multiple co-morbidities who is often reluctant to engage with medical services and has, on occasion, stopped taking her medication.
Periodically, she has also stopped eating and drinking and refused admission to hospital, although she has resumed her medication and normal eating patterns within a few days. However, she drafted an advance decision to refuse treatment when she first stopped taking her medication.
I am concerned, as the patient has now developed diabetes and is once again refusing to take her medication.
Although I have not formally assessed her, I believe she does not lack capacity at present, although I am concerned that she will lose consciousness and therefore capacity.
If she does, her decision to refuse treatment may apply and I am concerned that I may be criticised if I do, or do not, treat the patient. What should I do?
AAn adult patient has the right to consent to or refuse treatment and is assumed to have capacity unless it is established otherwise.
However, the issue of capacity relates to the specific decision in question at the time that a decision needs to be made. Capacity often varies, depending on the complexity of the question as well as the individual concerned.
An advance decision enables an adult patient, who requests to refuse treatment, to ensure that their wishes will be respected in the future when they lack capacity.
But when the patient loses
capacity then the health professional involved will need to consider whether the decision is valid and applies in the current circumstances.
If the decision is to refuse lifesustaining treatment, it must be written, signed and witnessed. It must clearly state that the decision applies even if life is at risk. It must also state what treatment the patient wishes to refuse. A general statement that they do not wish to be treated is insufficient. A healthcare professional is not liable if they act in line with what they believe to be a valid and applicable advance decision. Bear in mind that an advance decision will become invalid if the person has subsequently done anything that clearly goes against it – for example, if the patient has withdrawn the decision or has subsequently created a power of attorney for that same issue.
The GMC advises doctors to engage in advance care planning with patients who have a condition likely to affect the length or quality of their life or where capacity is likely to be lost.
In the circumstances described, it would be wise to speak to your patient sensitively to clarify her wishes while she still has capacity.
This discussion should be carefully documented, along with the capacity assessment. If there is any doubt about her capacity, then it may be appropriate to seek a second opinion from a colleague.
Dr Sally Old is a MDU medico-legal adviser
QAs a private GP, I recently saw a patient who complained of severe pain in her mouth, fever and facial swelling.
I examined the patient’s mouth and found what appeared to be a severe dental abscess. I asked the patient if she had a dentist that she could make an emergency appointment with, but she explained that she hadn’t been to the dentist for a number of years.
The patient said that she also struggled to afford the cost of dental treatment and asked me if I could prescribe antibiotics and painkillers, which she felt would clear the problem up.
While I sympathise with the patient, I feel unable to prescribe these medicines. What should I do?
AGPs sometimes have a responsibility to offer to provide any emergency treatment you think is immediately necessary, even where the underlying cause might be a dental problem.
This duty is set out in paragraph 26 of the GMC’s Good Medical Practice (2013) , which adds that doctors providing assistance in emergencies should take account of their own safety, be aware of the limits of their competence and consider the availability of other options for care.
But from a legal perspective, the Dentists Act 1984 restricts the practice of dentistry to registered dental professionals and those in training.
This means that, unless dually
It would be inappropriate for a doctor to attempt to manage a condition requiring dental skills
qualified and appropriately registered with the General Dental Council, GPs are not able to treat dental conditions. But they can provide urgent and necessary medical treatment if the patient is not able to contact a dentist.
It would be inappropriate for a doctor to attempt to manage a condition requiring dental skills. But as with any consultation, it is important to keep a record of any treatment provided to the patient and the advice offered. GPs should also be aware of relevant guidance such as the NICE guidance on managing dental abscesses in primary care.
Ultimately, it would be in the best interest of the patient to be seen by a dentist and that, legally and ethically, you are unable to provide dental treatment you are not qualified to carry out.
Dr Oliver Lord is a MDU medico-legal adviser
So you want to do private work? Entering private practice for the first time can be an exciting time but there are traps if you are unprepared. Worrying about how to go about it and what you need to be aware of is natural. Dr Karen Ellison (left) answers some common questions
What do I need to know about private practice and the GMC?
The GMC requires all doctors to be registered and to hold a licence to practise, whether they work in the NHS or private practice. Independent practitioners must still have regular appraisals, be subjected to revalidation and must remain resolutely fit to practise. Obviously, your ethical, clini
cal and professional standards must withstand scrutiny by the regulator. The GMC guidance within Good Medical Practice 2013 applies to all doctors no matter where they practise in the UK.
What do I need to look out for with regards to defence cover for private practice?
The GMC in Good Medical Practice (2013) says ‘you must make sure
you have adequate indemnity or insurance cover so that your patients are not disadvantaged if they make a claim about the clinical care you have provided in the UK’.
Indemnity is provided in the NHS for claims arising out of NHS work. It will not cover you for claims arising from your private work. Nor will it cover you for assistance with referral to the regulator,
any disciplinary proceedings, complaints, inquests, criminal investigations, ethical dilemmas or general medicolegal advice. Make sure your defence cover is in place before you start seeing private patients and that it is adequate for the whole of your scope of practice, including any expert reports you may do.
Most major private hospitals employ their own staff, but you may be responsible for paying for your secretary or other specialist technicians you may need to use. Check with individual providers what your practising privileges include. You must ensure that any other healthcare professionals involved with your patients have adequate defence cover and always check their qualifications if you are involved in their recruitment.
If you become an employer, you will be bound by relevant legislation and it may be wise to seek employment law advice from a solicitor.
Can I advertise?
The short answer is ‘yes’, but care is needed. Good Medical Practice 2013, paragraph 69, states ‘when advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerabilities or lack of medical knowledge’.
Most private hospitals will arrange advertising for their doc
Private practice is a business and the GMC states that you must be open and honest in any financial dealings you have with patients
tors in a brochure of services. If choosing to advertise personally, be aware that you must comply with advertising codes enforced by the Advertising Standards Authority.
If your place of work advertises on your behalf, make sure it abides by advertising standards and that the brochure makes reference to availability of the document in Braille for the partially sighted. In areas where a particular language is in widespread use, the brochure should also be available in this language.
How should I store medical records and how long do I need keep them?
You must keep records safely and securely and the private hospital will usually have provision for this. Patient information must be protected from improper disclosure. Medical records can be destroyed after a certain period, but there is no set guidance relating to this in the private sector. We suggest you follow the same recommendations as those that apply in the NHS.
You must also comply with the Data Protection Act 1998 and you may need to consider registering with the Information Commissioner’s Office as a data controller if you intend processing patient information electronically.
What can I charge for my services?
Doctors in general find the business side of private practice initially rather daunting. Nonetheless, pri
vate practice is a business and the GMC states that you must be open and honest in any financial dealings you have with patients.
You must tell patients what your fees are before treating them and gain their consent to agree to pay. Most private medical insurance companies will have a set tariff for each ICD code (International Statistical Classification of Diseases and Related Health Problems).
You must retain financial records for inspection by HM Revenue and Customs and seek consent to disclose patient identifiable information if it requests it.
Will I need a CRB check?
You will, but it is no longer called a Criminal Records Bureau check. To protect vulnerable adults and children, all employees must agree to a check on their records in relation to criminal activity. This is now called the Disclosure and Barring Service check (DRB) and is required at each hospital in which you practise.
What if I have a complaint?
The GMC in Good Medical Practice (2013) says that if you have a complaint against you, you must put matters right if you can. You must apologise, explain what has happened and what steps have been taken to prevent a recurrence.
There is no statutory framework for dealing with complaints in the private sector, but hospitals will have their own procedures, which will generally fall in line with the NHS complaints procedure. The Care Quality Commision monitors complaints in the private sector and each hospital will be required to compile a summary of complaints yearly for inspection.
Property taxes explained for those starting a private practice, page 48
Dr Karen Ellison is a medico-legal adviser at Medical Protection
Property taxes can be complicated and catch you unawares, so it is important you take the time to understand the rules and regulations to ensure you don’t get caught out with unexpected tax to pay. Ian Tongue (right) explores the more common taxes and potential problem areas that owners face
yoUR mAin REsidEncE
For most, your ‘home’ or main residence is clear cut and it is rare that anyone would pay any capital gains tax on the disposal of their home. Stamp duty will have been paid on the purchase – more on that later.
Where complications can arise is when a property is retained after it being your main residence. It is possible to make an election for which property is your main residence, within certain time limits. MPs were extensively using this when the scandals of ‘flipping’ homes to avoid capital gains tax were revealed.
The basics
The sale of your home or ‘main residence’ attracts a tax relief against paying capital gains tax known as principal private residence relief. This usually means that no capital gains tax is payable on the disposal of your home irrespective of how much money you may have made during the period of ownership.
For most, this is very straightforward, but the application of this relief can be complex and depends on:
What buildings are on site that constitute your dwelling house;
The size of your grounds;
Periods of absence;
Ownership;
Business use of the premises;
Periods of letting.
While not exhaustive, if any of the above apply to your circumstances, it is important that you discuss matters with your accountant in advance of any disposal.
invEsTmEnT pRopERTy
Properties that have been your home or main residence previously and are retained as an investment are more complicated when it comes to capital gains tax.
There is a period of 18 months from the leaving of any property that was your main residence where it is regarded as continuous ownership, meaning that if you dispose of the property within that time, you would get private residence relief, subject to general eligibility.
Where a property has been rented out following your period of occupancy and beyond 18 months, another type of capital gains tax relief applies after claim-
ing private residence relief, which is worth up to £40,000. This is known as letting relief and is the lower of:
The private residence relief claimed;
£40,000;
The gain from letting your home.
Due to the combination of private residence relief and letting relief, it can substantially mitigate or extinguish the gain payable on a property that was previously
your home where it was retained for a period as a rental property.
Where a property was purchased as an investment and has never been your main residence, no private residence relief or letting relief is available.
So, after deducting selling costs and your annual capital gains tax exemption, you would pay 28% – at current rates – on the difference between the selling price and the original cost, including any capital expenditure.
REnTAl pRoFiTs
There have been many changes recently to how rental profits are calculated in relation to the deduction of finance costs; for example, mortgage loan interest and other repairs-type expenditure.
For finance costs, this usually relates to a mortgage, but would apply equally to an overdraft or other financing facility on which interest is paid. Changes to mortgage interest relief apply from 6 April 2017 and are a gradual phasing in of a restriction to the deduction of loan interest against your rental income.
It is being phased in over four years and, once completed, loan interest will not be deducted in arriving at your calculated rental profit. You will, however, receive a deduction of 20% of the interest suffered against rental profits.
The effect is to restrict tax relief on the interest to 20%. It could mean a taxable profit for a property with a high level of debt, low rental yield, and historically making a loss or break-even position.
When tinkering with loan interest, HM Revenue and Customs also decided to restrict the costs you can deduct against the rental property.
This is largely the historic system for unfurnished lettings, but replaces the wear and tear allowance for furnished lettings and removes the 10% of rental income as an allowance, allowing you to deduct the actual costs incurred for the replacement of furnishings.
Certain costs that you would think reasonable to deduct are capital expenditure together with many costs you incur before bringing the property to market for rental are added to the pur -
chase price rather than a deduction against rental income.
Discuss your circumstances with your accountant to ensure you understand what is an allowable deduction against your rental property.
Significant changes to the taxation of furnished holiday lettings many years ago aimed to restrict losses. Owners could offset losses against other income and that lead to some abuse. Losses arising from furnished holiday letting activities can now only be carried forward against profits from the same trade.
When compared to a normal rental property, there are several benefits to furnished holiday lettings. These are mainly in relation to capital gains tax relief and the ability to claim capital allowances.
There are strict qualifying criteria for properties falling under this definition and if you are considering such properties, it is important you understand your tax position and the rules in detail.
As part of a package of measures trying to free up houses for homes rather than investment, the Government introduced a surcharge of 3% on the headline stamp duty rates for most second homes from 1 April 2016.
Aside from it increasing the cost of second homes, this has proved to be a potential cash flow issue for many, where they have not sold their previous property at the point of buying the new one even though that is their intention.
You can claim back the extra stamp duty paid if your previous property was sold within 36 months. Your solicitor should advise you more in this area if you are buying new property.
As always, discuss your circumstances with your accountant and make sure you keep them aware of any property acquisitions or disposals.
next month: year 2 of private practice – time for a review
Ian Tongue is a partner with Sandison Easson accountants
Our motoring correspondent Dr Tony Rimmer finds the new Volvo XC60 is the right match for medical professionals who appreciate a quality product but do not want to be too flashy
There are times in every independent practice when difficult decisions need to be made.
Premises – if you have them –may be deteriorating and clinical practices may need to be updated. For recovery to happen, a significant investment of time and money is necessary.
Sometimes for some independent practitioners the financial gain after all the mounting costs mean it is just not worth it.
In the motoring world, this is what happened to Swedish carmaker S aa B which folded in 2012. Fellow Scandinavian carmaker Volvo was heading the same way, but managed to survive by the skin of its teeth.
When the Chinese corporation Geely bought Volvo in 2009, it had its work cut out. Years of minimal r&D investment had left the company soldiering on with dated models on outdated platforms. The only solution to resurrect the brand was to invest heavily to develop completely new models
using completely new chassis and drivetrains.
In the modern motor industry where cars are now hugely sophisticated compared to those of only ten years ago, it takes several years to develop a product line-up from scratch.
During that time, a manufacturer has to rely on the diminishing sales of outdated products to keep the cash flow going. Only when their brand-new models hit
the marketplace can they start to recoup its investment.
Fortunately for Volvo, its XC60 mid-sized premium SUV actually had a steady increase in sales over the last couple of years leading up to the introduction of the new model in 2017.
The Swedish brand had cleverly predicted the upsurge in popularity of this sector of the marketplace and is now ready to ride this wave if the new car is good enough.
So, the latest XC60 is a completely new car and sits on a scaled-down chassis shared with the larger seven-seater XC90 which I tested two years ago ( Independent Practitioner Today , January 2016). It is offered with a variety of four-cylinder engines, both diesel and petrol.
Three main trim levels include the Momentum, Inscription and r -design and are available with increasing specification and price.
Direct rivals in this crowded market include the audi Q5, Mercedes GLC, Jaguar F-Pace and the Land rover Discovery Sport. The latest contender, even newer than this Volvo, is BMW’s latest X3 so competition really is keen. as more of us are turning away from diesel power, there are two petrol models. The T5 has a fourcylinder 2.0litre turbo-petrol engine producing 251bhp and 380Nm of torque.
of my test car the ride was smooth, absorbent and appreciated by all passengers. although the steering could be critisised for being too light and lacking some directness, it does mean that driving in urban environments – in most XC60s will find themselves – is a piece of cake.
I was particularly impressed by the engine. Quieter than diesel variants at low speeds, it revs easily and provides enough power for swift progress. Lacking the extra torque of the diesel models, it has to work a bit harder, but it is all the more enjoyable for it.
The standard eight-speed gearbox ensures that you are always in the right gear and changes seamlessly between ratios. The overall character of the XC60 provides comfortable and relaxed progress, be it around town or cruising on a motorway.
The in-car tech is superb. It includes satnav, DAB radio, heated half-leather seats, LED lights and the tablet-style touchscreen is better than all rival systems
The range-topping T8 plug-in hybrid model adds a powerful electric motor to supplement the conventional engine, but costs a significant extra £15,000. I have been testing the T5 Momentum, the entry-level petrol model.
The new car looks fresh and modern. It manages to retain all the Volvo brand styling cues, including the ‘Thor’s h ammer’ daytime running lights.
It sits lower than the outgoing model and has a more muscular stance on the road. The interior reflects a deliberate and noticeable improvement in quality. The fascia is soft to touch and the driver’s controls work with solid precision.
The in-car tech is superb. It includes satnav, D a B radio, heated half-leather seats, L e D lights and the tablet-style touchscreen is better than all rival systems.
Interior room is perfect to
accommodate a growing family. Five adults can sit comfortably with plenty of boot space for luggage. If you need seven seats though, you will have to consider the bigger XC90.
a lthough these medium-sized SUVs are not designed as drivers’ cars, there is no doubt that ownership is a lot more enjoyable if comfort and agility are above average. This is certainly the case with the new XC60.
On the standard 18-inch wheels
The interior reflects a deliberate and noticeable improvement in quality
I really like this new Volvo. I think that it would suit many of us medical professionals who appreciate a quality product but do not want to be too flashy. Volvo, like SaaB used to be, is the thinking man’s premium brand. It may be a few thousand pounds, model for model, more expensive than the old version, but it makes significant steps forward in all areas.
I prefer it to the a udi Q5 and the Mercedes GLC. The latest BMW X3 will have to be very good indeed to challenge this latest Swedish class-leader.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Five-seat hatchback 4x4 Suv
Engine: 2.0 litre four-cylinder twin-turbo petrol
Transmission: continuously variable automatic
Power: 251bhp
Torque: 370nm
Acceleration: 0-60mph in 6.4 secs
Top speed: 137mph
claimed fuel economy: combined 38.7mpg co2 emissions: 167g/km on-the-road price: £37,900
All you need to know about accountancy for private practitioners
It
is increasingly tough out there for consultant gynaecologists, but many continue to ride above the financial storm. Ray Stanbridge reports on on the latest figures in our unique benchmarking series
In our Profits Focus a year ago, I commented that ‘an initial review of 2016 results further suggests that incomes have stabilised and, if anything, have tended to show a modest rise’.
The actual results of 2016 have confirmed this view. The average gynaecologist in private practice increased their gross income by about 7.3% from £109,000 to £115,000 between 2015 and 2016.
But costs rose by about 9% from
£55,000 to £59,000 on average. As a result, taxable profit rose by about 3% from £54,000 to £56,000.
It seems that most of the income improvement from those we surveyed was in the area of Choose and Book rather than traditional private practice.
bodies have made it increasingly difficult to practise obstetrics. We have not seen many signs of an increase in self-pay as in other specialties.
Costs in a typical private practice have increased in certain areas.
Staff costs have shown a modest increase, as we expected. There appears to be some correlation between rising staff costs and increases in the income tax personal allowance.
Consulting room hire costs have shown a modest increase, again affecting trends more nationally formalised in the Competition and Markets Authority’s rulings.
Particularly for new consultants, the new rules are financially hurting.
Indemnity/insurance costs continue to rise for the major market players. Some consultants have ceased all obstetric work and, as a result, have reduced indemnity/ insurance fees and paradoxically this may have resulted in a fall in average costs in years to come.
Also, at the same time, there are new entrants in the market who are offering competitive insur -
Private medical insurance firms continue to squeeze fees, and indemnity and defence insurance bodies have made it increasingly difficult to practise obstetrics
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is
Source: Stanbridge Associates Ltd.
ance rates for consultants with good claims records.
There has been some growth in accounting and professional costs, reflecting additional support services in relation to negotiations with the private medical insurers, defence organisations and complaints because gynaecologists/obstetricians are at fairly high risk.
Most other costs remain fairly constant with the exception of ‘others’. We have noticed a growth in IT costs for some practices, as well as additional resources being spent on marketing.
What then of the future? We are noticing a growth in the number
of female consultants who perhaps have a better work-life balance than some of their traditional colleagues.
Some consultants are also looking for a quieter life. With increasing interest in the employment model for consultants in private practice, our view is that there may be some restriction in the
number of new consultants coming into the market.
For those who are competent, our provisional figures for 2017 continue to be steady, although it is often the case of working harder for the same reward.
When examining these figures, be aware of the increase in difficulties of trying to make comparisons
year on year. There are a lot of different business structures out there.
Some consultants are incorporated, others have formed groups. Yet others have changed the nature of their practices by focusing on Choose and Book work and/or eliminating any obstetrics or high-risk gynaecology work.
our figures are a good benchmark guide, but are not statistically significant and merely represent a sample of those actively involved in private practice.
As the figures suggest, our service is restricted to those consultant gynaecologists who are not in full-time in private practice. They:
Hold either a new-style or oldstyle nHS contract;
Have at least five years’ experience in the private sector;
Are seriously interested in private practice as a business;
Earn at least £5,000 a year from private practice;
Work as a sole trader, a member of a formal or informal group or through a means of partnership on a limited liability company.
next issue: Radiologists
Ray Stanbridge is a partner with accountancy, finance and tax advisory medical specialists, Stanbridge Associates
How ARE YoU doinG?
use these benchmarks
Anaesthetists
Urologists
years ending 5 april Source: Stanbridge Associates
Make sure you don’t miss our next issue, published on 22 March. you may not receive every issue if you have not yet subscribed to the journal. Don’t risk missing out on vital topics we tackle next time, including:
With general Data Protection Regulation (gDPR) kicking in on 25 May, is your private medical practice ready? Clive alderson of Hempsons Solicitors is here to help
Can you afford your bucket list? Cavendish Medical’s Dr Benjamin Holdsworth on why you should consider now how to make your dreams a reality
If cash is king, then cash flow is queen, so it is essential you get your billing and collection in order to have a successful private practice. Findlay Fyfe of Medical Billing and Collection shows how
Reporting serious incidents and data sharing in private practice –Jane Braithwaite gives some top tips
My, how things have changed! Our series adapted from a new book, Death, Disease and Dissection, kicks off with a look at the structure of the medical profession between 1750 and 1850
The Uk is a popular destination for international patients seeking expert private healthcare and specialist treatment. Dr Rachel Birch, medico-legal adviser at Medical Protection, outlines steps to minimise the risks in treating patients whose first language is not english
The robots are coming: Dr Neil Haughton, the Independent Doctors Federation’s president-elect, on the changing face of consultations
Ten tips to help you achieve a successful CqC compliance inspection
a consultant asks for help after being asked to act as a certificate provider for a lasting power of attorney relating to money, finances and property for a patient. The MDU’s Dr katherine Leask responds
Our Business Dilemmas feature answers a consultant paediatrician who was contacted by a local authority in relation to a court hearing regarding the welfare of the child and is confused at the implications
accessing private consultants is often not as easy as you might think. Private gP Dr alix Daniel gives her thoughts on referrals
Working in a London PPU? Then don’t miss Philip Housden’s report
Creating your own premises: our series continues with points on the CqC process, the construction phase and development funding options
More details from Mr Ian McDermott on the London Sports Orthopaedics’ Research and Outcomes Centre and its research foundation
Plus all the latest news and views
aDveRTISeRS: The deadline for booking advertising for our March issue falls on 23 February
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