February 2021 by Healthcare Today

INDEPENDENT PRACTITIONER

TODAY

In this issue

Beauty treatments are still cutting it

Latest research examines the cosmetic procedures market P12

The business journal for doctors in private practice

How to find the best computer system

We show you the dos and don’ts of gettting the best from a practice mangement system P28

Deadline to a big tax saving?

By Robin Stride

A rare possibility to save thousands of pounds in tax is beckoning as independent practitioners consider the future for themselves and their businesses.

Those who use a limited company for private work and have built up cash in the bank may have a very short window of opportunity to extract this at a 10% capital gains tax rate before being prevented by Chancellor Rishi Sunak.

With the Budget fast approaching – on 3 March – some accountants fear that the tax rate could then rise from 10% to up to a whacking 38.1% dividend tax rate.

The way out could be through a type of liquidation and is likely to prove an attractive option for fastacting consultants and GPs with a private practice who have recently retired from their independent work or are considering doing so.

Savings for some could amount to well over £100,000, accountants say.

There is always speculation that capital gains tax (CGT) rates will rise in the lead-up to almost every Budget, so what is new?

James Gransby, a partner at RSM Tax and Accounting Ltd in London,

told Independent Practitioner Today: ‘Well, this time, it looks more likely, given the need to raise taxes and, in fact, Mr Sunak commissioned a report in July 2020 from the Office of Tax Simplification to see whether current CGT rules were fit for purpose.

‘When released in November 2020, the report said that “more closely aligning capital gains tax rates with income tax rates has the potential to raise a substantial amount of tax for the Exchequer”.’

He believes this would be an easy win for the Chancellor, considering that less than 1% of the population pay CGT. But, for those that do, the figures can be large.

Access to the 10% rate of tax would mean dissolving your company via what is known as a Members Voluntary Liquidation (MVL).

Mr Gransby said: ‘This may sound scary – because of the word liquidation – but it is a routine way of closing down a company at the end of its life.

‘When using the MVL route, the money is extracted as “capital” rather than “income”, which can then give access to the 10% tax rate if certain criteria are met.’

Rules around dissolving one

In this issue

Jane

shows what’s needed to manage a remote team and reap the benefits of a flexible working policy n p20

Starting out is a balancing act

What you need to know to stay within the law when setting up a business P34

Accountant James Gransby

company and starting up a new one, known as ‘phoenixing’, were tightened up only a few years ago.

But Mr Gransby said those who had recently ceased private work or were planning to retire in the near future or who have built up six-figure sums of cash may wish to about this now before tax rates rise.

Xxxxx

He stressed: ‘MVLs are not the right option for everyone, but

there will be people reading this for whom it is the right option and, if this is you, then there may only be a few weeks to act.

‘To ensure you meet the criteria, you need to speak to an accountant and appoint a liquidator.

‘If somebody has £700k in their company and wants to get it at 10%, they might decide to accelerate retirement plans to make sure they aren’t caught by a tax trap. The worst case scenario could be to decide not to retire yet, wait six months and then get caught.’

He said the Covid crisis might make people think about their work life balance and accelerate retirement plans in some cases. n See calculations on page 5

Braithwaite

TELL US YOUR NEWS. Contact editorial director Robin Stride

‘R’ is for remuneration

In our ‘Building Block of Accountancy’ series, Julia Burn gives tips on making your income, investments and pensions tax-efficient P16

Email: robin@ip-today.co.uk Phone: 07909 997340 @robinstride

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EDITORIAL COMMENT

A better trained watchdog

There’s nothing like a Care Quality Commission (CQC) inspection to send blood pressure rising.

Visits – or news of an imminent swoop from the watchdog – can induce more immediate stress than a practice’s disappointing balance sheet.

But now some changes are on the way which could add up to some good news for consultants and GPs in private practice, their staff and the places they work.

For all its horrific devouring of the normality we took for granted this time last year, the pandemic has at least sparked a rethink about the way we all do things, what is necessary, what isn’t and what can be transformed.

Now there may be some good news in the offing from the CQC, which says it too is thinking differently about how it operates in future.

It has launched a Strategy Consultation 2021 and a Regulatory Changes consultation

paper which are now available for private doctors and their managers to comment on.

You can read some details in Martha Walker’s News Focus on page four. As a valued adviser to hundreds of doctors, clinics and providers striving to reach and maintain CQC targets, she views the proposals for improvement in inspection and regulation as ambitious.

But she considers they do have the potential to reduce much of the stress experienced by many doctors and their staff when the watchdog approaches.

The strategy would appear to give private doctors some welcome movement on aspects they have been asking for – a switch from scheduled broad ranging inspections, faster updating of ratings and assistance towards achieving best practice rather than just condemnation.

Check out www.cqc.org.uk/ regulatorychanges and tell them and us what you think.

Stop home working being a pain

Working from home is convenient, but it also has its downsides. We advise doctor employers and employees on what to watch out for P18

Don’t buy your own hype! If you are after publicity, then be sure to keep your feet on the ground and get prepared by reading what media guru Tingy Simoes reveals P24

Consent is not just a one-off

In the second part of our series on the GMC’s new guidance consent, medicolegal expert Dr Kathryn Leask discusses issues important to private doctors P26

Cash crisis control

Simon Brignall discusses some of the key billing and collection issues every doctor’s private practice can learn from the pandemic P30

Gazing ahead means looking back

With a financial spring clean in the offing, Dr Benjamin Holdsworth explains why your investment would have fared better if left alone P32

PLUS OUR REGULAR COLUMNS

Start a private practice: Get financially fit for the months ahead

Accountant Ian Tongue looks at the areas you should consider to prepare for a surge in private care P40

Doctor on the Road: Fast off the grid

Dr Tony Rimmer finds that the Honda ‘e’ is a perfect partner in the city P42

Profits Focus: Fruits of their labours

Gynaecologists exceeded accountants’ expectations for their latest earnings figures P47

Pensions’ red tape confusing doctors

By Edie Bourne

Independent practitioners who are asking the Government to pay large tax bills caused by breaching annual pension savings limits in 2019 20 are being advised to ensure they apply for ‘Scheme Pays’ before the deadline as well as completing the other criteria.

The Government announced in the winter of 2019 that it would cover clinicians’ tax charges for one year only to ease the workforce crisis in the health care system at the time.

Doctors would be compensated by the NHS upon their retirement in a legally binding agreement.

But financial advisers have told Independent Practitioner Today that doctors are confused over how to claim the tax rebate.

They are notifying doctors that to make the claim against ‘annual allowance’ charges, they must

ensure they have applied for Scheme Pays before the 31 July deadline this year.

And they also need to formally apply for the compensation scheme. Both applications use different forms and require full calculations.

Patrick Convey, technical director at specialist financial planners Cavendish Medical, explained: ‘This tax charge repayment scheme was an unprecedented yet welcome move by the Government. Many of our clients are pleased to have their tax charges covered, even if for just one year, but, as with everything concerning NHS Pensions, there are no easy options.

‘You must ensure you have the correct annual allowance figures before starting your claim and then ensure you follow the correct procedure for the applications. In many cases, you will need to have your Scheme Pays application signed off

by your NHS employers too.

‘Many doctors will have faced their toughest working challenges in the last year and may not have the time to tackle difficult calculations. We would urge all eligible clinicians to seek expert help to ensure they are in possession of the right figures and follow the correct procedure.’

The outcome of the consultation into the 2015 NHS Pension Scheme age discrimination remedy has not yet been confirmed, but is expected to be announced in the next few months.

Mr Convey continued: ‘It is imperative doctors do not wait to consider the outcome of this consultation before applying for Scheme Pays – even if they believe their 2019 20 tax charge will be removed. Better to submit the applications needed in time and correct any calculations later if necessary.’

The compensation policy applications deadline is March 2022.

PLEA TO EXTEND

An extension of the Government’s one-year scheme to fund doctors’ pension tax charges would be ‘a welcome gesture’ now to prevent senior doctors being penalised for working harder than ever before.

Patrick Convey, of Cavendish Medical, said many doctors had faced their toughest challenges in the last year and their tax bills could rise with the extra shifts worked to fight the pandemic.

He said: ‘The compensation scheme set up in 2019 meant the Government agreed to pay the tax charges of clinicians for one year only to ease the workforce crisis at the time. Things are certainly no easier for clinicians now – in fact they are far worse.

‘Many doctors are unable to work as they are unwell or isolating, so the burden falls on colleagues to do extra shifts.

‘The Annual Allowance is deemed unfair because it penalises those in defined benefit pension schemes such as the NHS. Some senior doctors will have an allowance of just £4,000 per year, which is easily breached by the growth in their pension savings.’

Covid insurance pay-outs a step closer

Insurance settlements should be a step closer for independent practitioners awaiting pay outs for claims under business interruption policies caused by Covid19. Following a UK Supreme Court test case, insurers expect to pay over £1.8bn in Covid 19 related claims across a range of products, including business interruption policies.

The Association of British Insur

ers said customers who had made claims affected by the test case will be contacted by their insurer to discuss what the judgment means for their claim.

Its director general, Huw Evans, said: ‘All valid claims will be settled as soon as possible and, in many cases, the process of settling claims has begun.’

He added: ‘We recognise this has been a particularly difficult time

for many small businesses and naturally regret the Covid19 restrictions have led to disputes with some customers.

‘We will continue to work together as an industry to ensure customers have the clarity they need when it comes to what they can expect from their business insurance policies.’

The Supreme Court substantially allowed the Financial Con duct

Authority’s (FCA) appeal on behalf of policyholders. It said many thousands of policyholders will now have their claims for coronavirusrelated business interruption losses paid.

A spokesman said the FCA will work with insurers to ensure they now move quickly to pay claims that the judgment says should be paid, making interim payments wherever possible.

Private GPs suffer Covid swab and jab bureacracy

President Dr Neil Haughton said:

‘The paperwork involved is prohibitive and almost impossible to fulfil and many practices are struggling to comply.

Private GPs complain of an administrative headache around regulation of Covid19 PCR swabtaking. This was under the Care Quality Commission’s scope, but has become the Independent Doctors Federation’s main issue after its transfer to the United Kingdom Accreditation Service.

‘This is an ongoing current issue and we are still in the process of lobbying the Department of Health to reduce the onerous bureaucracy involved, but at present this is unchanged.’

Private GPs lobbied ‘at the high

est level’ to give Covid vaccinations but their patients have had to register with the NHS for this. He said considerable effort was made to allow private practitioners and their staff access to the vaccine in line with guidelines.

Watchdog probes will be targeted

NEWS FOCUS

Care Quality Commission inspections often bring huge stress to independent practitioners and their staff. But new plans could change all that. Martha Walker reports

The Covid pandemic has accelerated change, with new and innovative types of services starting up using digital channels. And new restrictions have recreated how services can deliver care. In this new world, we must also transform.

That’s a key message from the Care Quality Commission (CQC) in its Strategy Consultation 2021, now available for comment.

During the pandemic, many doctors will have experienced the Emergency Support Framework (ESF) and Transitional Regulatory Approach (TRA), where they have uploaded evidence to demonstrate the quality of their service followed by a virtual monitoring conversation with their inspector.

Building on that experience and provider feedback, the CQC now intends to focus on continuously assessing quality with information received in real time.

And where it has cause for concern or cannot obtain suitable information any other way, it will carry out a visit. This means the watchdog is moving away from scheduled broad-ranging inspections to more in-depth targeted ones.

ESF and TRF monitoring conversations cannot be rated. However, as the CQC moves from just monitoring to conducting its inspections digitally, ratings will also be awarded as a result of non-site location visit inspections.

Many independent doctors have voiced concerns about the lack of speed in updating a rating. The CQC has recognised this and, as part of its proposed regulatory changes, intends to address outof-date ratings through real-time information-gathering, allowing it to give the public a more relevant assessment of a service.

How this change will come about is explained in the CQC’s Regulatory Changes consultation paper that is also available to comment on.

Independent doctors have often remarked that the CQC should assist and guide them towards examples and suggestions for best practice rather than just tell them they are not good enough.

This Strategy explains that if a

service wants to improve, it should get the support it needs. And, as such, the regulator wants to develop collaborative relationships with services and help them improve by pointing them to sources of guidance, best practice and other providers and organisations to offer advice and support.

Improvement can also come from innovation in medicine and that often starts in the independent sector, but the CQC has often appeared to stifle innovation in smaller clinics.

This is frequently because the CQC has not kept pace with changes. In future, it intends to work with providers to understand how innovation can help patients and create an environment where services can try new ways to deliver high-quality care.

The proposals for improvement in inspection and regulation appear quite ambitious, but have the potential to reduce the concentrated stress that many doctors and their staff experience when an inspection is announced.

Both consultation papers are on the CQC website and independent doctors should be encouraged to respond to them.

 Martha Walker runs www. CQCConsultancy.co.uk

HAVE YOUR SAY

The full reports can be read and commented on at www.cqc.org. uk/Strategy2021 and www.cqc. org.uk/regulatorychanges

Tell us what you think too: robin@ip-today.co.uk

Clinic and gym link to offer Covid therapy

A sports medicine and rehabilitation group is working together with a personal training gym to deliver a holistic programme for patients physically affected by Covid-19.

Isokinetic, i n the Harley Street Medical Area, and AMP Athletic have teamed up to ensure exercise is controlled and monitored by medical professionals in a safe way.

They say this replicates the integrated model used in professional sport, where open communication channels between trainers and clinicians form a crucial part of athletes’ rehabilitation.

Clinic gets top cardiac quality award

Same-day medical facility OneWelbeck, in the Harley Street enclave, has become one of the few private facilities to achieve BSE (British Society of Echocardiography) accreditation.

One Welbeck Heart Health centre director Graham Clark said: ‘This is no small undertaking and as an organisation we should be very proud of this. We are one of the very few private providers to achieve this quality standard.’

‘When we started developing the OneWelbeck model, we were keen to make the department a centre of excellence and I’m really pleased that we were able to recruit a high-calibre team of clinical people who have realised this.’

He said the award was not just an evidence-gathering and box ticking exercise but the reward for excellent work produced daily ‘and a particularly wonderful assurance for referrers, that their patients are receiving the best possible service and clinical care’.

HEAD OF WOMEN’S SERVICE APPOINTED

Independent charitable hospital King Edward VII’s Hospital has appointed gynaecologist Prof Christina Fotopoulou as clinical director of women’s health. The service brings together specialist centres for gynaecology, with a focus on diagnostics, gynaecological oncology and treatment of severe endometriosis and breast health including triple assessment breast screening, reconstructive and oncoplastic breast surgery, and fertility.

Use of Bupa’s web directory surges

Consultants in private practice are being urged by Bupa to update their availability on its online directory, Finder ( finder.bupa. co.uk).

Weekly visits to the website have shot up almost 60% from 70,000 before the Covid-19 pandemic to 110,000 now.

To help them manage patients’ expectations, Bupa’s Finder enables consultants to let visitors know whether they are accepting new patients and if so, whether they can offer face-to-face, phone or video consultations.

All consultants need to do is log in to their Bupa Providers Online account (www.bupa.co.uk/providers-online) and select ‘Update my Finder profile’ on the left hand side

of the screen and then they can tick to confirm their availability.

Consultants can log in to update the information whenever anything changes.

Bupa will then use this data to update Finder immediately so that everyone can see availability when they are searching for consultants.

The insurer will also use it to update its systems so that its member services advisers can let patients know when they call to pre-authorise their care.

Finder is Bupa’s online directory of healthcare professionals and services, which is used by Bupa patients and the wider public.

COULD AN MVL SAVE YOU MONEY? – £100K EXAMPLE

(SEE STORY ON FRONT PAGE)

Assumptions:

Remaining retained profits in company of £100,000

Two shareholders, one additional rate tax band and one higher rate in 2020-21 tax year

All money extracted in one tax year

Gain qualifies for Business Asset Disposal Relief

CGT annual exemption intact, no CGT losses brought forward

Excludes cost of undertaking the MVL

payable without a liquidation

Tax

Compiled by Philip Housden

Royal Marsden satellite moving forward

Royal Marsden Private Care remains on track to open its Cavend ish Square facility in the spring of this year.

Private Care at Cavendish Square, in the heart of London’s healthcare district, will be a convenient location for patients from the UK and, when Covid travel restrictions ease, international patients too.

Cavendish Square will be a comprehensive diagnostic and treatment cancer centre covering all of the main cancer pathways, offering private patients fast and direct access to world-leading research-led experts in cancer and state-of-theart diagnostic technology in modern and peaceful environments.

A full feature will appear in a future edition.

Consultants reminder on complaints management

Consultants in NHS trusts treating private patients through the PPU will have agreed as part of their practising privileges to co-operate with the trust’s complaints policy. Consultants are also responsible for ensuring that information is available to their patients about the complaints process.

For NHS trusts in England, it has been the case for some time that these patients are unable to escalate complaints to the Parliamentary and Health Service Ombudsman, which is a course of action open to NHS patients.

The complaints process will involve a registered manager being responsible for Stage 1, while Stage 2 is conducted by the chairman of the board or appointed non-executive director.

In trusts that subscribe as members of the Independent Sector Complaints Adjudication Service, this is a three-stage process, with Stage 3 being managed by ISCAS.

Sally Taber, director of ISCAS, says: ‘As patient complaints are an inevitable aspect of a consultant’s professional career, the ISCAS Code of Practice can provide an invaluable framework for you when working in your trust.’

 Philip Housden is a director of Housden Group (see page 44)

Private sector shown to be a caring master

Staff have revealed the upside of working in the independent health sector in a new report aimed at aiding recruitment.

The Independent Healthcare Providers Network (IHPN) publication mirrors a recent NHS People Plan’s focus on making the state service the ‘best place to work’.

Reflections from staff working in the private sector include:

 Significant value and importance is placed on individual employees’ careers and their personal development, with substantial funding for learning and development in the sector and organisations offer a variety of training opportunities to encourage employees to progress professionally.

 The independent health sector is a place where you can simply ‘get on with the job’ with staff feeling they have real ownership over their work and the ability to make a difference and influence what goes on in their own organisations. This sense of control also

In return for flexible working capabilities, staff members may be asked to be agile and to take on extra shifts or be able to swap with colleagues. Overtime is always paid for or re-imbursed through additional leave.

This influenced many of our staff to join the independent sector, in light of 58.7% of NHS staff working unpaid hours on a weekly basis

From the IHPN report

enables staff to have a positive work-life balance, with flexibility in how they work.

 Independent healthcare organisation have a ‘family feel’. Whatever their size, independent providers place a strong emphasis on team-working, with visible leadership and the absence of any culture of blame.

INDEPENDENT HEALTHCARE SECTOR KEY DEMOGRAPHICS

85,000 – number of employees

6+ years – time the average staff member stays at an organisation

45 years – average age of employee

35% of employees work part-time

19-10,000+ average range of employees in member organisations

79% of employees are female

The report from IHPN, the representative body for independent providers of both NHS and privately funded care, also looks at how Covid-19 has impacted on working in the independent health sector.

In particular, the report looks at the recent partnership between the NHS and independent hospitals, which has seen teams from both the NHS and independent working side by side to enable the delivery of vital NHS treatment throughout the pandemic.

 See David Hare’s feature: ‘A nice place to work’, page 15

Rutherford Cancer Centres has a two-year agreement with NHS England to provide cancer treatment and diagnostic imaging services to NHS trusts and clinical care groups at a pre-agreed set of prices.

There is an option to extend for two more years on the agreement of both parties.

By a staff reporter

Private hospitals and clinics have welcomed Government plans for setting up an independent patient safety commissioner to promote safety issues in the private sector and NHS.

The move follows Baroness Cumberlege’s recommendations in her Independent Medicines and Medical Devices Safety (IMMDS) Review last July.

Dawn Hodgkins, director of regulation at the Independent Healthcare Providers Network, said: ‘Patient safety is the number-one

priority for all independent sector providers and we look forward to working with the patient safety commissioner to ensure a joinedup approach to safety issues across the whole healthcare system so that all patients can access the safest possible care, regardless of where they are treated.’

The commissioner’s statutory responsibility will include championing the value of listening to patients and promoting users’ views to improve patient safety around the use of medicines and medical devices.

Announcing Government sup -

port for Baroness Cumberlege’s recommendation, patient safety minister Nadine Dorries said: ‘I often hear from and meet with people who have been affected by issues of patient safety. Their stories have common themes – of suffering avoidable harm, of not being listened to and of a system that is then difficult to navigate when things go wrong’.

She said the commissioner will act as an independent advocate for patients ‘and strengthen the ability of health services to listen to the voice of patients’.

The commissioner’s core duties

Chief executive Mike Moran (right) said: ‘We have been supplying radiotherapy and systemic anticancer therapy to NHS patients in England and Wales. This agreement streamlines the procurement process and enables NHS organisations in England to commission a range of services directly from us. It means we will provide our services more widely.

‘I am particularly pleased to be supporting the fantastic work that the NHS is doing at this extremely challenging time. Providing these much-needed cancer treatments and diagnostic services in dedicated cancer treatment facilities will help relieve pressure on NHS hospitals.’

Centres are in Wales, Reading, Northumberland and Liverpool.

Private cancer centres agree deal with NHS Welcome for ‘Safety Tsar’

will be to promote the safety of patients and the importance of the views of patients in relation to medicines and medical devices. He or she will be able make reports and recommendations to the NHS and independent sector, and to request and share information with them.

The Government said it looked forward to working with members of both Houses of Parliement to ensure this new post acts as ‘a beacon for listening’ and reflecting patients’ safety concerns so that it can drive positive culture change in healthcare systems.

PRACTICAL TIPS FOR DOCTORS APPEARING AT VIRTUAL HEARINGS

By Douglas Shepherd

Doctors should be given the chance to continue with face-to-face disciplinary hearings in cases where a significant amount of evidence is contested, according to the Medical Defence Union (MDU).

It made its views clear in a response to a review of what lessons healthcare professional regulators can learn from the pandemic. The report was written by the Professional Standards Authority for Health and Social Care.

Dr Matthew Lee, MDU professional services director, said the defence body backed the continued use of virtual Medical Practitioners Tribunal Service (MPTS) regulatory hearings in some cases. Virtual interim orders hearings and fitness-to-practise hearings where there is uncontested evidence can be more convenient

Hearings ‘should not all be virtual’ Acquisition boosts PPM Software

A leading practice management software provider to doctors’ private practices and independent hospitals, PPM Software, has been acquired by technology group ClearCourse.

PPM’s managing director Tom Hunt called it ‘an exciting step’ for the company he founded in 1998 and hinted the move would reap benefits for customers.

PPM Software has been developed in collaboration with consultants and practice managers to ensure it adds significant value to its customers and is continually improved to meet their evolving demands.

Mr Hunt, who is still running and managing PPM Software, said ClearCourse had an impressive reputation with a proven record of enabling growth:

‘We see great opportunities to

and less stressful for those taking part.

But the MDU has ‘considerable concerns’ about virtual hearings in cases where there is a significant amount of contested evidence.

Dr Lee explained: ‘Depending on how the next few months develop with controlling this pandemic and the deployment of vaccines, we can foresee the MPTS moving to schedule such cases for virtual hearings.

‘The MPTS does not consider the nature of the allegation or the type of hearing to be a relevant consideration when deciding whether a virtual hearing is appropriate, according to its guidance.

‘However, in complex cases, where the facts are contested or where it is necessary to call a number of witnesses, in-person hearings may be fairer for all parties and should continue. We have

stances faced by front-line workers. ‘We are continuing to work with the regulators and others to ensure our members are not disadvantaged by the current arrangements.’

deliver our product to a broad range of new customers as part of the group, and it will allow us to capitalise on synergies with other complementary businesses. I’m looking forward to seeing what the future holds for us as part of the group.’

ClearCourse chief executive Gerry Gualtieri said: ‘We are delighted to bring PPM Software into the ClearCourse group of companies. The addition of its platform is an important step in the expansion of our healthcare offering and brings a new set of

 Make sure you have all the documentation about the case to hand and have downloaded the app necessary to take part Log on in plenty of time and ensure you are familiar with the technology, such as how to mute and unmute your microphone

Use a work device to take part, rather than a personal one, and make sure it is fully charged

Ensure there is a suitable background and preferably choose somewhere quiet where you won’t be interrupted Dress smartly – and not just your top half – in case you need to stand up

Be aware of your posture and body language. Behave in the same way as if you were appearing in a courtroom in person

Have a glass of water handy and have a comfort break before you start  Speak clearly while looking at the camera. If you have to look away to your notes, explain that is what you are doing

expertise and products to bolster our customer relationship management (CRM) capabilities in the sector.

‘We see great potential for growth in PPM and we’re very much looking forward to having them on board.’

It provides a single platform from which users can manage their practices, automating tasks and workflows such as patient bookings, automated reminders via text or email, and the production of clinic and theatre lists, allowing consultants to focus on delivering better patient care.

The companies said the acquisition will allow both to benefit from sharing technology and best practice.

Hospital group clients include Nuffield Health, Spire Healthcare and BMI Healthcare.

Tom Hunt, PPM’s managing director Gerry Gualtieri, ClearCourse boss

Dr Matthew Lee

Big change in GP practice due to Covid

Remote working is here to stay, according to a huge majority of GPs.

As many as 77% of GPs, including those in private practice, told the Medical Defence Union (MDU) they will continue to use remote working practices frequently after the pandemic.

Key findings from 172 GPs were:

 90% feel that working practices have significantly changed since the beginning of the pandemic;

 75% and 55% ran more video consultations and online triage systems respectively;

 97% increased their use of phone consultations;

 63% are concerned about facing a complaint or claim related to the pandemic;

 82% would feel reassured if they could provide treatment during the pandemic without the risk of being sued for negligence.

GPs felt there were advantages to new working practices including protecting staff by minimising the spread of infection (88%), increased convenience for patients (70%) and fewer missed appointments (48%).

Disadvantages included technical difficulties which hindered remote consultations (70%).

Dr Caroline Fryar, head of advisory services at the MDU, advised doctors to get defence support early if they were aware of a potential complaint or adverse event.

 See cures for the pains of remote working, page 18

Prof Dame Jane Dacre said it was shocking there was a gender pay gap ten years after Equality Act

Poll reveals wide gender pay gap for doctors

The BMA is calling for immediate action after a Government review showed female doctors are still being paid less than males for the work they do in the NHS.

Based on full-time equivalent pay, women doctors in hospitals

Ease stress in pandemic

By Douglas Shepherd

Searches for symptoms of occupational burn-out on Google have risen by over 2,500% since 2015, and the Covid-19 pandemic is fuelling a faster rise in workrelated mental health issues.

So what can those doctors who employ staff do to reduce excessive stress and burn-out – especially if they are working from home?

Angela Knox, director of workplace employee well-being program Keep Fit Eat Fit, says: ‘Recognising burn-out or excessive stress in employees is a vital part of the HR manager’s work and one which sadly often gets overlooked. ‘If employers have systems in

Survey shows Covid’s effect on clinicians

Thousands of doctors in the UK have revealed the impact that working during the pandemic has had on their mental health and well-being.

Figures from the latest BMA tracker survey of doctors in England, Wales and Northern Ireland show that 58% of doctors are now suffering from some form of anxiety or depression, with 46% saying their condition has worsened since last March.

As they tackled a mounting second wave, nearly seven in ten doctors said fatigue and exhaustion were higher than normal.

The doctors’ union fears that the current level of strain being placed on doctors could have a lasting impact on workforce numbers in the wake of the pandemic.

As many as 47% of doctors told the BMA they are now more likely to work fewer hours in the future.

A further 27% of doctors said they were now more likely to take early retirement.

Consultant shortages in the NHS have topped 8,000.

place that are designed for regular monitoring of each employee, then problems can be identified and dealt with before they escalate.’

She recommends employers and their managers proactively promote these steps among their employees:

Step 1: Encourage regular exercise. Even the shortest ten-minute brisk walk can have a real impact on mood and motivation. Getting away from the desk to exercise in the fresh air has a direct link to increased productivity.

Step 2: Ensure employees don’t sit at their desks for too long. A five-minute desk break every hour reduces the risk of injury, refo -

cuses the mind and helps break the monotony of both home and office working – even if it’s just a walk to the kitchen for a cup of tea.

Step 3: Encourage quitting unhealthy habits.

Step 4: Make sure people talk to their line manager. Communication is what prevents those initial feelings of pressure, anxiety or demotivation from becoming mental health problems like burnout. The sooner an employer is aware of the problem, the sooner they can do something about it.

Step 5: Set up routine catch-ups with the team. With a large number of employees now working from home, it’s important to keep lines of communication open to

keep the social aspect of work. This reduces the feeling of isolation and has a positive impact on wellbeing.

Step 6: Promote mental health days. Fostering a workplace culture where people don’t feel guilty for occasionally taking the day off sick – even if they’ve not got a physical illness – will help alleviate longer-term stress and maintain morale.

Step 7: Push annual leave. Employees should be encouraged to use all of their holiday allowance each year, even if they’re not going away anywhere. This fosters a healthier work environment and creates a better work-life balance that benefits everybody.

Self-employed hit hardest by money worry

Financial distress is more damaging to the well-being of the self-employed than those in employment, according to research from Trinity Business School.

A negative impact on mental health and quality of life was most pronounced in the self-employed who themselves had employees.

Martha O’Hagan-Luff, assistant professor in finance at Trinity, said: ‘The findings of our study are particularly relevant during crisis periods such as during the Covid pandemic, demonstrating the importance of providing adequate financial support for the selfemployed, given that we find that financial distress has a more pronounced negative effect on their well-being than the wageemployed.’

A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new

A trawl through the archives: what made the news in 2011

the right amount of money in, and from the doctors’ perspective, their indemnity may be invalidated by underpayment – so it’s a serious issue for all concerned.’

Accountants said the doctors most likely to be caught out were those with a general accountant who would not necessarily realise that professional indemnity rose in line with profits.

Specialist medical accountants would remind their doctor clients of this fact.

Doctors at risk by not paying subs

Private doctors were being warned they could risk professional disaster if they failed to increase defence body subscriptions to match rising incomes.

The alert came after consultant surgeons were shocked to receive letters asking for thousands of pounds to make good alleged subs shortfalls going back years.

One was asked for more than £30,000, while another was required to give financial details stretching back nearly a decade.

One defence fees expert told Independent Practitioner Today: ‘The problem appears to be that consultants have not notified their medical defence organisation when their private practice income has gone up.

‘From the defence body’s perspective, they are not getting

One said: ‘It is vital for any consultant in private practice with rising profits to inform their professional indemnity provider. This ensures they have an adequate level of cover in place at all times.

‘If insufficient and a claim is made against them, there is a possibility that their policy will be invalidated. Potentially, that would be disastrous. You could be talking of claims running into seven figures.’

Debts cured by card

Independent practitioners were being advised by the chairman of the London Consultants Association to get a credit card machine if they wanted to improve their cash flow.

Cardiologist Dr Duncan Dymond told established and aspiring private doctors at a conference that his late payers ‘plummeted down’ when his practice invested in one.

Later he told Independent Practitioner Today: ‘It has done

incredible things to our cash flow. It has probably knocked 70% off standing debt.’

A year previously, this journal ran a headline ‘Credit card to cure crunch’ in which experts advised independent practitioners to start taking credit cards, as the recession meant patients would inevitably take longer to pay or default on payments.

Partnership accord vital for groups

Consultant groups were being warned of the dangers of not having legal agreements in place before entering partnerships.

The damaging consequences of skimping on agreements were highlighted by a lawyer specialising in the healthcare sector.

He warned that dozens of groups were risking a damaging conflict and costly dispute by not getting agreements right from the outset.

Chris Inson, of Capital Law LLP, said consultants’ groups would be

more common as they formed to negotiate with newly formed GP consortia.

He said: ‘As in any other area of business, it is folly to enter into any arrangement without a robust and well-drafted partnership agreement in place.

‘And it is crucial for partner to consider what points of potential conflict should be addressed at the outset or such agreements will be virtually worthless.’

Doctors risk new income tax inquiry

Hundreds of doctors with a private practice were on the verge of risking a new round of tax investigations by HM Revenue and Customs (HMRC). They had either forgotten or been too busy to submit their tax returns and end of January tax payments.

One accountant said: ‘NHS GPs have managers to remind them about deadlines, but most consultants with a private practice don’t.’

TELL US YOUR NEWS

Share your experience of what has and has not worked in your private practice. Even if it’s bad news, let us know and we can spread the word to prevent other independent practitioners falling into the same pitfalls. Contact editorial director Robin Stride at robin@ip-today.co.uk

Chris Inson of Capital Law LLP

COSMETIC

MARKET

Beauty treatments are still cutting it

LaingBuisson’s second major study into the UK cosmetic surgery market covers 2019 through to late 2020, including a look at how Covid-19 impacted the scene. In this commentary, its author key findings

THE PATTERN and contrast in market values and growth between the surgical and non-surgical markets continues to be stark.

Little appreciable growth has been shown by the surgical market and it is currently valued at circa £270m+.

But the non-surgical market continues to grow and, although value is difficult to verify, is around £3bn in the UK. It has greatly benefited from continued demand for facial aesthetics and growing demand for non- or minimally invasive enhancements such as body contouring.

Overall demand for surgical procedures has softened since the 2008 financial crisis and the PIP breast implant scandal of 2012, and the figures indicate only a marginal growth in recent years. Some surgical procedures appear to drift in and out of fashion, but demand for breast augmentation remains consistently high.

Market data is more difficult to analyse for the highly fragmented non-surgical market, which is still considered a ‘wild west’ by many. But information provided by Save Face, a national register of accredited practitioners who provide non-surgical cosmetic treatments, indicate that the industry was worth £2.3bn in 2010, so the estimated value of circa £3bn appears reasonably accurate.

What is clear is that the nonsurgical and minimally invasive market is growing at an astonishing pace.

Social media has played a large part in driving growth in procedures alongside the acceptance that cosmetic enhancement is now viewed as a normal part of a beauty and wellness regime. Younger consumers are more likely to seek advice and treatment, particularly for non-surgical procedures.

It is important to remember, however, that social media itself can promote unachievable images and representations of face and body, which the younger age group is likely to be particularly influenced by.

This has resulted in numerous well-documented issues relating to the quest for perfection. Not least is the immediacy of access for non-surgical enhancement, which is rarely subject to a ‘cool-

A key finding from the report is that interest in cosmetic interventions has remained high during the pandemic even if accessing treatment has been difficult

ing off’ period as with surgery. This can lead to rushed decisionmaking, poor assessment of options and lack of acknowledgement of risk.

Reasons to be optimistic?

The good news is that there is much more balanced coverage in all forms of media about the positives and negatives associated with surgery and non-surgical enhancement.

Of note is the heightened social media presence of professional organisations such as British Association of Aesthetic Plastic Surgeons and British Association of Plastic, Reconstructive and Aesthetic Surgeons.

This, coupled with a much more aligned approach to the need for regulation within the industry and renewed attempts to pass primary legislation relating to injectables, does offer optimism for the future.

And it appears that the Covid-19 pandemic and the transition to home working could be a key driver of demand as we are confronted by our own image on screen daily.

A key finding from LaingBuisson’s Cosmetic Surgery Market Report,

Second Edition is that interest in cosmetic interventions has remained high during the pandemic even if accessing treatment has been difficult.

Apart from a dip in April 2020, research showed that online searches for cosmetic surgery have been consistent throughout the year in the UK. Many providers and clinics confirmed a surge in interest.

The pandemic also led to many providers reviewing and updating the way they conducted their digital processes – whether just offering virtual and online consultations or taking the opportunity to digitise the whole patient pathway, including payment and consent processes via encrypted services.

There was a clear difference between smaller clinics and specialist providers, who moved swiftly to digitally enable their services, and larger, multispecialty providers who have been slower to react.

In the latter case, they were also managing the relationship with the NHS to provide capacity, so cosmetic surgery, understandably, has been low on their list of priorities.

The ability of small providers to respond swiftly and be flexible and very consumer-focused is an important lesson for the future and will help support their growth within the market.

Good progress, but still some way to go

In the cosmetic surgery market, there is already a clear regulatory framework and accountability for individual surgeons. The framework and processes are also overseen by the Care Quality Commission (CQC), and cosmetic surgery providers themselves have a responsibility to promote themselves in an ethical fashion and not breach guidelines of the Advertising Standards Agency (ASA) or Committee in Advertising Practice.

Clinics and ‘medi spas’ that provide a range of non-surgical or minimally invasive treatments may also fall under the remit of the CQC, depending on the treatments they offer.

There is still a way to go, however, before this industry as a whole is seen as wholly reputable. Many cosmetic surgery providers

are building strong reputations based on positive customer experiences and now promote surgery in a more balanced way; however, some continue to push the boundaries of social and regulatory acceptability.

Organisations such as the Joint Council for Cosmetic Practitioners (JCCP) is pushing hard to effect change, working in collaboration with organisations such as the Medicines and Healthcare products Regulatory Authority, the Chart ered Institute of Environmental Health, the ASA, the AllParty Parliamentary Group for Beauty, Aesthetics and Wellbeing and the professional and system regulators.

Thus, there is light at the end of the tunnel, but the goal of ensuring consumers can always be assured of safe treatment in regulated premises overseen by a clear regulatory framework that has accompanying sanctions for poor practice is still some way off.

Wake-up call

A wake-up call was perhaps the CQC review of providers in 2019 and the subsequent comments by Prof Ted Baker: ‘Patients should be able to expect safe, high-quality care from all providers of cosmetic surgery.

‘Staff must be appropriately trained and supported to carry out their role, effective processes should be in place to monitor patients during and after procedures and emergency equipment on hand to ensure patient safety.

‘We know there are some independent cosmetic surgery providers doing all these things and providing a very good standard of care. Unfortunately, our initial inspections suggest that this is not always the case.

‘Where we have found concerns, we have held those providers to account and have been clear where improvements must be made. We expect providers to deliver on their commitment to provide safe, high-quality care. And we will do everything within our powers to ensure this happens.’

Sadly, there are still providers that fall outwith the remit of the CQC and other existing frameworks. This part of the market, ➱ p14

often available through beauty practitioners and ‘spa’ services, has little regulation, patchy oversight and little sanction or redress for consumers.

This market is fragmented and opaque, with many different types of providers, lack of licensing or regulatory framework and frequent evidence of poor training and little or no acceptable clinical practice.

Unfortunately, the persuasive nature of – usually – online and social media promotion of these services is clearly successful and has driven increase in demand. Cosmetic treatments including injections and lasers can be provided in almost any setting with minimal training and oversight, and the attraction of buying cheap treatments from high street beauty salons is clearly influencing consumer choice.

However, the growth of clinic chains such as Sk:n and Destination Skin is a positive development in terms of offering all the latest treatments in properly regulated settings. Sk:n continues to expand and is proving popular with clinicians as a base to grow their non-surgical or minimally invasive practices.

Buyer beware

The report suggests that the consumer, too, must have some responsibility to seek out practitioners of good reputation and ask questions about risk and aftercare.

There is evidence that those seeking cosmetic surgery are more likely to be guided by information they have sought and by personal recommendation and are thus perhaps more likely to make balanced judgements.

But consumers for non-surgical treatment see cosmetic intervention as simply an extension of a beauty and wellness regime. In practice, research into the options in this market rarely happens.

There is no requirement for practitioners to undertake an assessment of the motivations for treatment, which would quickly identify those clients coping with the increasingly common issue of body dysmorphia.

Equally, the provision of informed consent, recognition of the potential for medical complications and the ability to respond

The provision of informed consent, recognition of the potential for medical complications and the ability to respond to unexpected events is still inadequate in many settings

to unexpected events is still inadequate in many settings.

During the initial lockdown in 2020, there were reports by Save Face and others of ‘pop-up’ services promoted via Facebook offering cash only, home visits for dermal fillers. These services disappeared as rapidly as they appeared, offering no redress or follow-up.

Social media, the ‘Instagram’ generation and pressures within society to achieve a ‘look’ are frequently cited as influencing factors, particularly among the younger demographic. This group is looking for instant improvement, not long-term rejuvenation.

The reverse is true of the older demographic, who take a longerterm view of cosmetic surgery as part of a wider well-being mindset.

This demographic is also likely to be a repeat client for hospitals and surgeons and is more likely to want to develop a longer-term clinical relationship, with perhaps more invasive surgical interventions interspersed with non-surgical enhancements. This demographic is also less likely to be driven by treatment price.

Increasingly, information on all forms of cosmetic surgery and cosmetic enhancement is being sought online – with the younger generation using mobile phones as the main search tool.

Older consumers are likely to use tablets, too, to support their search information. Providers, surgeons and clinicians need to be aware of this shift in consumer behaviour and ensure they are tailoring their digital offer and engagement to achieve optimum results.

For the first time in the Second Edition Report , LaingBuisson looked at the hair restoration market. This is a market that has seen rapid growth in the UK and Europe over recent years, but, like the non-surgical market, is divided between accredited surgeons and clinics and other providers that currently fall outside any regulatory framework.

Given the rise in demand, this is a cause for concern.

Treatment abroad: the big change in 2020

One of the main features of lockdown was an inability to travel, which had a clear impact on outbound cosmetic surgery tourism.

However, numerous providers, particularly those in Turkey, were quick to re-open and many had continued promotional activity and online engagement with prospective clients during lockdown.

The most noticeable difference in treatment abroad in 2019 and 2020 compared with previous years has been the decline in ‘brokers’ or facilitators who put together travel packages for clients.

There has been a big shift to direct-to-consumer engagement by providers abroad who now offer to provide the ‘whole package’ themselves.

For Turkey, being outside the EU, there will be little change in the existing arrangements, but for other providers within the EU it remains to be seen how post-Brexit arrangements will impact their ability to attract and service UK clients.

Future view

Looking ahead, the overall surgical market is expected to remain fairly static, although the picture may vary for different procedures according to fashion and a shift from surgery to non-surgical treatments such as those designed to provide a non-surgical option to blepharoplasty.

In terms of geography, demand continues to be strong in London

and the South-east, although growth has not been so strong in the latter as previously.

However, other traditional ‘hot spots’ such as the Midlands and the North-west remain strong and are likely to be so for the foreseeable future.

Given the perhaps unexpected surge in demand during 2020, it is difficult to predict how economic uncertainty may impact the market. It may be that there is some down-trading from big-ticket surgical procedures to non-surgical, more temporary interventions. What is clear is that consumers are happy to invest in polishing their appearance as part of a regular routine rather than it being seen as only discretionary spending.

Prospects for cosmetic surgery are generally dependent on consumer economic confidence and confidence in cosmetic treatments, and currently there are vulnerabilities to both these factors. Future economic prosperity in the UK remains uncertain. And while confidence in cosmetic surgery treatments has been improving since demand took a knock from the PIP scandal several years ago, this market is undoubtedly being impacted by the popularity of non-surgical options.

 About the LaingBuisson Cosmetic Surgery UK Market Report, Second Edition

In addition to providing consumer buying insight in the cosmetic surgery and non-cosmetic treatment markets, the report analyses prices, key market providers and investor activity. It also provides a detailed assessment of the UK’s cosmetic dentistry market.

Visit www.laingbuisson.com/ shop/cosmetic-surgery-uk-market-report/ to see the report’s contents pages.

Liz Heath (below) is a consultant with LaingBuisson and author of the cosmetic report

A nice place to work

A new report shines a positive light on working in the independent health sector. David Hare (right) reports

THE INDEPENDENT Healthcare Providers Network (IHPN) wants to raise awareness of the private sector as a place for doctors, nurses and other front-line staff to develop and enjoy their career –and ultimately to make a difference to millions of patients’ lives every year.

The UK independent health sector is home to world-renowned doctors, nurses and other healthcare professionals whose expertise plays a key role in attracting millions of domestic and international patients every year.

But with the NHS as the largest employer of healthcare staff in the UK – and indeed in Europe as a whole – there is often very little focus on the experiences of the sector’s 100,000 strong workforce.

At the end of 2020, the IHPN was therefore delighted to publish our first ever report looking at this issue.

It shines a light on what the sector has to offer to both current and prospective healthcare employees in terms of careers, control and culture and sharing the stories of many of those working in independent healthcare.

Undertaking focus groups with staff at all levels working on the front line, as well as leading human resources directors in the sector, our report found that the sector can be summed up as a place where:

 People can develop their career;

 Have control over their work;

 Enjoy an inclusive, compassionate working culture.

Staff working on the front line emphasised the value and importance that is placed on individual employees’ careers and reported that there is significant funding for learning and development.

Rather than a one-size-fits-all

model, those working in the sector can benefit from a bespoke training pathway.

These range from entry level clinical and non-clinical roles –HCA apprenticeships, trainee nurse associate prog ramme, nursing preceptorship programmes –up to clinical leadership training and Level 7 post- graduate courses.

Ownership of work

Independent healthcare providers are also seen as a place where you can simply ‘get on with the job’, with staff feeling they have real ownership over their work and the ability to make a difference and influence what goes on it their own organisations.

This independence helps drive through the innovative practices the sector is known for around the world.

Doctors, nurses and other frontline professionals see themselves in control of their work, with positive work-life balance and flexibility being encouraged in how they work.

This is particularly beneficial to those with young children and

likely a key factor in the 35% of the sector’s employees who work parttime – indicating how work can successfully be tailored to family needs.

The independent healthcare sector is undoubtedly a diverse place, ranging from large international hospital chains to small local charitable organisations. But an overarching theme among all the staff we spoke to was of the positive and inclusive culture in their organisations –whether it is the ‘family feel’, visible leadership or strong commitment to the health and wellbeing of their staff.

Developing staff

Of course, it is impossible to look at working in healthcare without viewing it through the prism of the current coronavirus pandemic.

In addition to the excellent partnership working that has taken place between staff in the NHS and independent sector since last March, enabling over 2.3m NHS patients to access the care they need, the sector has also played a

Doctors, nurses and other front-line professionals see themselves in control of their work, with positive work-life balance and flexibility being encouraged in how they work

role in supporting the development of NHS staff.

Last autumn, it was announced that NHS junior doctors will now be able to benefit from new training opportunities in the independent provider sector and, in the long term, we hope this will encourage many more thousands of doctors to explore careers in the sector and what they can enjoy in terms of careers, control and culture.

The health service, of course, remains under intense pressure and, indeed, the ability to attract, recruit and retain the healthcare workforce has never been more vital.

In demonstrating the diversity of the healthcare system, we want to raise awareness of the independent healthcare sector as a place for doctors, nurses and other frontline staff to develop and enjoy their career and ultimately to make a difference to millions of patients’ lives every year. 

David Hare is chief executive of the Independent Healthcare Providers Network

ACCOUNTANT’S CLINIC: THE BUILDING BLOCKS OF ACCOUNTANCY

to of top tips

is for remuneration

Our A–Z of top tips continues this month as Julia Burn turns to the letter R

AS WE approach the end of the tax year, it is a good opportunity to review remuneration packages to ensure you are being paid in the most tax-efficient way.

As a business owner or as an employee, there are various methods of remuneration, whether by salary, dividend or pension contributions.

Salary v dividends

If you are a business owner, owning shares in a limited company, and also an employee, it is worth reviewing how you are remunerated to ensure this is done in the most tax efficient way.

While you will be earning a commercial salary, any bonuses may be better to be drawn as dividends from the business rather than bonuses paid via salary.

This is a point that you should discuss with your accountant, who will be able to tailor advice to your individual circumstances.

It is worth considering your personal tax allowance and the tapering of this when a salary exceeds £100,000, as the marginal rate of tax between £100,000 and £150,000 can be very expensive.

The pandemic is affecting doctors’ businesses in many ways, the most notable being the reduction

in profits and squeezed cash flows due to forced closures.

If profits in a company are lower than usual, but director drawings have stayed at a similar level, it may result in overdrawn directors’ current accounts.

This can prove very costly to a business and where an overdrawn director’s account is not repaid within nine months of the accounting year end, what is known as S455 tax is payable on

the balance at the same time that the company’s corporation tax liability is due.

S455 tax is charged at 32.5% on the balance of the overdrawn director’s account at the end of an accounting year.

It is repayable to the company when the overdrawn director’s account has been settled, but it obviously creates a cash flow issue, so much better for a company to avoid if possible.

Government support for businesses

As mentioned in previous issues of Independent Practitioner Today, the Government has provided various measures to support businesses during the pandemic, including the furlough scheme which has evolved during this time. It is important to keep up to date with any changes in these schemes, if they are being utilised, to ensure the business is abiding by current regulations and obtaining the best support available. It would be a good idea to keep in regular contact with your accountant, who will be up to date on all of the changes.

Pensions

To encourage taxpayers to save for the future, tax relief is available for contributions you make to your pension. This includes superannuation contributions. The relief is usually claimed via your selfassessment tax return, but, in some cases, it is obtained at source; for example, when you are an employee.

There is a limit – annual allowance – on how much you can save each year without incurring a tax charge. The maximum you can save annually is equal to the

annual allowance for the year plus any unused annual allowances from the previous three years.

The standard allowance is £40,000, but it may reduce to £4,000 if you earn in excess of £200,000.

If you incur a tax charge, you may request that your pension scheme pays it, thereby reducing the value of your pension pot. The NHS has declared that it will compensate medical practitioners for such reductions on their retirement.

This has been confirmed by the NHS – see www.england.nhs.uk/ pensions/ for more information.

The rules are complex and you should speak to your accountant or pension adviser if you think they may affect you.

When you draw from your pension, you pay tax at source, just like on your employment income. When you first take money out of your pension pot, you should be

If your pensions are valued at more than £1,073,100 in 2020-21 and you start taking money out, substantial tax charges may arise

Personal tax

Due to the Coronavirus pandemic, the Government allowed taxpayers to defer their 31 July 2020 payments on account for the 2019-20 tax year to 31 January 2021 without incurring interest charges.

Where individuals have taken advantage of this deferral, they may find that they have cash flow issues in this month (February 2021), as they will have had a much larger payment than usual to pay in January 2021.

ment means that the January 2022 tax bill may be higher than usual. If you have funds available to pay any deferred payments by 31 January 2021, you may wish to consider doing so to help your January 2022 cash flow.

The future

able to draw 25% of its value taxfree.

If your pensions are valued at more than £1,073,100 in 2020-21 and you start taking money out, substantial tax charges may arise. Taxation of pensions is complex and you should obtain professional advice.

It may be possible to obtain a further deferral from HM Revenue and Customs where you are unable to pay the taxes due, but any further extensions would incur interest charges.

Where the tax liability was below £30,000, the Government extended the above deferral further and the 31 January 2021 tax bill was able to be paid over 12 months, by 31 January 2022.

However, deferring this pay -

We will all have to wait for the Chancellor’s delayed budget to be announced, which is currently scheduled for March 2021, to find out what the changes to tax will be and how that will affect businesses and individuals.

The most important thing is to ensure that all finances are up to date so that decisions which need to be made within businesses and personally can be reviewed and actioned as quickly as possible. 

Julia Burn, is a director at Blick Rothenberg and part of the team that advises medical practitioners

CHECK OUT OUR BUSINESS DIRECTORY

Independent Practitioner Today now features an online advertising directory to complement our journal and website. Split into ‘business’ and ‘lifestyle’ directories, they list the services independent practitioners need to run their practices or spend their well-earned money on.

Stop home working becoming a pain

While many are enjoying the benefits of avoiding tedious commutes, a better work-life balance and more autonomy over their working day, it hasn’t been without its downsides. Remote working poses dangers to employees’ physical health that may be unexpected or go unnoticed.

Beth Husted offers some tips for doctor employers and employees to consider while working from home

SINCE LAST March, millions more employees have experienced the highs and lows of working at home. While many are enjoying the benefits of avoiding tedious commutes, a better work/life balance and more autonomy over their working day, there are some downsides too.

The strain on employees’ mental health following the sudden switch to working from home is already high on the radar.

In fact, of the mental health appointments provided by Unum’s Help@hand service over the summer, 76% related to stress, anxiety or depression. These are conditions that can benefit signifi-

cantly from early support and intervention.

However, it is not just mental health that businesses need to keep a close eye on. Remote working poses dangers to employees’ physical health that may be unexpected or go unnoticed.

With the Prime Minister announcing again last month that all those employees who can work at home should do so for the foreseeable future, large-scale remote working is here to stay until the jabs stop the spread of Covid.

Employers need to inform their employees of the risks and take steps to keep them comfortable and healthy.

‘Tech neck’ ‘Tech neck’ is the stress caused to muscles in the neck, back and shoulders by leaning forward to look at smartphones, tablets, or computers for long periods of time.

Common symptoms are headaches, neck stiffness and muscle spasms. The following are good preventive solutions:

❑ When sitting at your workstation, position the neck so if you were to nod or fall asleep, your head would tip backwards, not forwards.

❑ Have good lumber support for your back.

❑ Ensure your body weight is sup-

ported by your chair and that all your weight is not going through the spine.

❑ Move the neck and shoulders regularly to get the blood flowing.

Musculo-skeletal issues

While laptops allow for remote working, what makes a laptop useful also causes problems.

The low screen and the small keyboard encourage the body to hunch forward and does not provide the proper support for your wrists.

Using a laptop for long periods can wreak havoc on posture and cause repetitive strain injuries (RSI) in the fingers and hands.

A laptop also encourages people to opt for makeshift workstations rather than a proper desk. These can cause huge postural and muscles problems, with hours spent in unsupported and unsuitable positions that put the spine in particular under huge strain.

To avoid problems:

 Always sit at a desk or table.

 Use a separate keyboard and mouse. This will help you keep the forearms roughly horizontal, with the wrists in a neutral position.

 Position the screen so that the top of it is level with your eyes. This may mean using a laptop stand or a separate monitor.

 Sit on a chair that can be adjusted to the right height and position and provides effective support to the back.

 If needed, use a footrest so that feet aren’t dangling off the floor. Having something to rest your feet on will help prevent pains in the legs, provide extra support and reduce strain on the back.

Sitting still for too long Even before lockdown, employees who worked at a desk were spending 75% of their time sitting down. 1 This sedentary existence causes a whole number of health issues, including increased risk of diabetes and heart disease.

Sitting for long periods is also associated with poor mental health. People feel their minds work better when they are moving.2 With research showing that employees are working for an extra 48 minutes a day on average since lockdown, it is likely they will be sitting still for an even bigger part of the day.3

Using a laptop for long periods can wreak havoc on posture and cause repetitive strain injuries in the fingers and hands

For this reason:

➤ Encourage employees to take a proper lunch break away from their desks, including getting outside and doing some form of exercise if possible.

➤ Promote team-building activities that require employees to leave their desks, such as a walking challenge or taking the most creative picture of their surroundings.

➤ Provide employees with simple exercise guides and stretches that can be done anywhere.

➤ Encourage them to follow the 40-20 rule. Employees should sit for a maximum of 40 minutes and stand and move around for the other 20.

➤ Lead by example – show senior leaders being active away from their desks to encourage others to do the same and reinforce the message that activity is necessary and important.

➤ Don’t make every call a video call – encourage a mix of audio and visual calls so that employees can walk around when on the phone, helping them to build more exercise into their day. 

Beth Husted (below) is rehabilitation and well-being manager at employee benefits provider Unum

References

1.http://hrnews.co.uk/office-workersspend-75-of-their-waking-hours-sitting/ 2. www.bhf.org.uk/informationsupport/ heart-matters-magazine/activity/sittingdown

3. https://workplaceinsight.net/peoplework-longer-and-different-hours-underlockdown/

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GUIDE TO DELIVERING SUPERIOR PATIENT EXPERIENCE IN PRIVATE PRACTICE

How to be a flexible working

Jane Braithwaite (right) explores the topic of flexible working and how we can use it to our benefit within the healthcare sector, focusing on what it means for employers and employees.

She covers how to manage a remote team, the technology that enables efficient remote working, and how to ensure you reap the benefits of a flexible working policy

CARING FOR and treating sick patients requires face-to-face contact and, clearly, our healthcare organisations must be built around this capability. But 2020 taught us there are many aspects of healthcare that can be managed without the need for us to be together in the same location.

We have learned these lessons in a crisis-type situation having to adapt incredibly quickly, with no clarity on the time-scales involved and huge uncertainty as to what the next challenge might be.

The principles of flexible working have been accepted by organisations for some time, but the Covid19 crisis has accelerated its adoption hugely and it has been an absolute necessity in many situations.

Adoption of these new working practices has been sudden and dramatic and a terrible upheaval for many, who have found their work-

ing and professional circumstances altered drastically.

But we have learned that flexible working, in the right environment, managed in the right way, can offer benefits.

Great benefits

Benefits such as greater efficiencies and productivity, the ability to provide a service across increased geography, the potential to reduce costs and, possibly most importantly, it really benefits many people, allowing them to do their job more productively and improves their well-being.

We have also seen how embracing flexible working has impacted communications with patients, with the wider use of phone triage and video consultations.

While these solutions clearly cannot replace the need for treatment provided in person in a hos-

pital environment, they clearly can add some value in terms of patient care and potentially productivity for healthcare providers.

Many of you will have concerns about how to ensure people work well together, particularly in terms of the ability to collaborate and how to recruit new team members and ensure they feel part of the existing team.

This is a topic very dear to my heart, as everyone in my company has been based at home, working flexibly, since I started the business back in 2013.

I am a big fan of flexible working, but I will talk openly and honestly about the pros and cons and how to avoid some of the pitfalls and I will also address the question I am asked most by those who are sceptical about home working, which is ‘How do I know my team is working when they are at home?’

What is flexible working?

The term flexible working is selfexplanatory on initial consideration, but it does cover a whole range of options, so it is worth breaking it down and considering all the possibilities.

Flexible working encompasses flexible hours and/or flexible locations. So, it also covers part-time working with flexible working hours, and remote working, which can mean home working or it could also mean working from several different locations.

Many of the consultants we support at Designated Medical work flexibly, managing clinics at a few different hospitals and clinic locations. It is also fair to say they work flexibly in terms of hours, as they rarely keep to the standard nine-tofive schedule, holding evening and weekend clinics.

Over the last few months, many

working winner!

19 and it will be interesting to see results going forward, but there are some points made here that we should consider – in particular, the point that younger people are less likely to work from home.

What do employees want?

There are countless surveys, reports and press articles attempting to answer this question and the claims are often contradictory.

Some say how home working is the answer to work-life balance and the solution we have all been searching for, stating vast improve ments in productivity and employee well-being.

Others focus on the lack of company culture that results in feelings of isolation and a decline in productivity.

Any regular LinkedIn users will have seen ad hoc surveys over the last few months and the results seem to imply that people want a mix of both home and office working, but a strong negative reaction to being totally office-based. A blended approach with flexibility seems to be the preference for most.

Chatting with friends and family, we find this is a Marmite topic – you either love it or you hate it. Many of us absolutely love the flexibility, the ability to focus and concentrate and to take control of our schedules.

of our consultants have also been offering video consultations for their patients, which can be done anywhere including at home.

Many doctors work from one permanent consulting room with a permanent team of staff also based in an adjoining office. But this model is becoming less common over time, largely due to the cost of consulting and office space especially in central London and other urban locations.

Homeworking is also used by most people to some degree. The ability to ‘log on’ from a home computer, laptop, tablet or phone makes home working very accessible.

Technology is most definitely a key factor in flexible working and we will discuss this in more detail later.

When you consider home working and working from different locations, it is fair to say that most

people are working flexibly to some degree these days and our response to Covid-19 has driven far greater take-up of these options.

At the end of March 2020, the Office for National Statistics launched the online Labour Market Survey. The survey takes place each quarter, involves approximately 18,000 households and asks questions regarding employment in general, but also includes specific questions regarding home working which are relevant to our topic.

Survey results

These are the main points from the survey:

➲ In April 2020, 46.6% of people in employment did some work at home;

➲ Of those who did some work from home, 86.0% did so because of the Covid-19 pandemic;

➲ Of those who did some work from home, around one-third worked fewer hours than usual (34.4%), and around one-third worked more hours than usual (30.3%);

➲ Women were slightly more likely to do some work at home than men, 47.5% and 45.7% respectively;

➲ People aged 16 to 24 years were less likely to do some work from home than those in older age groups;

➲ More than half of people living in London (57.2%) did some work at home;

➲ Occupations requiring higher qualifications and more experience were more likely to provide home working opportunities than elementary and manual occupations.

Clearly, the results from the survey are hugely affected by Covid-

Others hate the constant demand to attend Zoom meetings and miss the spontaneous discussions over a coffee and the creativity of working together in an office.

And for many households, home working created a pressure cooker with two adults trying to find space in the home to work, often sharing an inadequate broadband signal and many facing the prospect of home-schooling.

Over the summer months, the Government published guidance on ‘Making your workplace Covid secure during the coronavirus pandemic’ and employers have been challenged with Covid risk assessments to ensure a safe environment for their employees.

In a recent poll of UK employers by Peninsula, one-in-seven employers admitted that they were not confident their workplace was COVID-secure. ➱ p22

And a further one in four said they were only ‘fairly confident’, which is incredibly worrying given that there is a risk of fines for employers who do not provide a Covid-safe working environment

I have already admitted to being a huge advocate of flexible working and, personally, I believe that all employers should have a flexible working policy. But I also believe that there is a requirement for a very well thought-through policy.

The introduction of home working because of Covid was immediate and dramatic. This is not an ideal way to introduce huge change to how an organisation works and it is no surprise that many people, both employers and employees, have found the situation less than ideal.

There was no time to plan, to introduce supportive technology to enable home working or to change how teams communicate and collaborate to ensure that flexible working was successful. There was no time to create a policy.

But, to move forward successfully, it is important to take the time to create a well-considered policy that enables businesses and organisations to reap the benefits of flexible working and enables employees to succeed and prosper. Before creating your flexible working policy, it is important to be clear on the benefits for both your organisation and the employees the policy will affect.

Benefits to employers

The number-one benefit to employers will be happier employees.

Most people do want more flexibility, and offering a flexible working policy will be positive for your current team and will also appeal to potential candidates when you are recruiting.

The other main benefit is potential cost savings, particularly in office accommodation.

By implementing a flexible working policy, you may be able to reduce the amount of office space needed overall.

Some roles are suited to home working for 100% of the time and implementing such a policy could reduce the need for office space considerably.

For roles where a blended approach of home working and office working is best suited, savings in space may also be made by implementing a hot-desking policy.

And for hospitals and clinics with offices dedicated to admin support, there is an opportunity to reclaim that space and turn it into consulting space and therefore make it profit-generating.

Administrative support is suited to remote working and an important area that everyone should consider.

The systems are in place to allow most administrative jobs to be managed remotely and, for many

Flexible work aspects you must master

There are key areas to consider when implementing a flexible working policy

people working in these roles, remote working is preferred.

The cost savings in office space could be considerable and the improvement in employee morale could be great.

For growing clinics where space is at a premium, a flexible working policy may allow you to continue to grow without increasing your accommodation costs by reassessing how space is currently used, moving some employees to a flexible working policy and reallocating office space.

Benefits to employees

Most employees value a flexible working policy, as it helps them gain a better work-life balance; many workers save a couple of hours each day previously spent commuting, not to mention the cost of their season ticket.

For others, the ability to choose to work some days in the office and other days from home is appealing. The ability to work from home to focus, without disruptions, on a particular activity, project or research activity is hugely beneficial.

These are the key benefits, but many others may be relevant to your organisation and your employees. For example, for those of us who are concerned about the environment and climate change, the impact of less commuting is considerable.

Benefits to patients

Lockdown situations mean many patients are offered medical care via phone and video consultations and obviously the GP, consultant or healthcare professional could be making these calls from any

Communication

There is absolutely no doubt that communication is harder when teams are working flexibly, and considerable effort should be put into providing easy and effective ways for individuals and teams to communicate.

To a certain extent, this requires a culture shift and new rules of engagement to avoid everyone relying totally on email for communication.

Everyone needs to be encouraged to pick up the phone and speak to others, ideally using video

location, including their own home.

At the time, this was often the only care that patients could be offered, but we also saw the positive effects of offering certain levels of care in this manner.

These consultations will never replace the need for treating people in person, but they can be part of the overall approach to patient care.

For many patients, the reassurance of discussing their concerns with their doctor without the need to travel while feeling unwell is a huge plus.

Another example is when a patient is preparing to come into the hospital for surgery; they are often anxious, needing reassurance and building up a list of questions they want to ask.

Offering these patients, a short phone or video consultation before attending hospital would be welcomed by many patients and it is an approach we are suggesting to many of our consultants.

We know that most patients call within 24 hours of having surgery and so a proactive approach will avoid last-minute panics.

We could consider a flexible working policy allowing GPs and consultants to work flexibly from home, providing phone and video consultations as a form of triage before face-to-face appointments being booked, allowing us to have greater control of how urgent appointments are allocated.

For GP practices where space is at a premium, this could be a good solution, and offering flexible working contracts may help to alleviate the problems of recruitment.

calls so people see one another regularly.

This does not happen naturally, as people are worried about interrupting others and shy about using video. Encourage people to book a time to talk by phone or ideally video and ensure this behaviour is led by the leaders of the organisation.

The hardest communication to encourage in a virtual working environment is friendly chats. How was your weekend? How is your son getting on at university? . . . and so on.

It is important to allow for these types of conversations to foster team spirit and develop healthy working relationships across teams.

At Designated Medical we have a weekly ‘cuppa and a chat’ that is completely optional but open for those who want to drop in for a bit of light relief.

Every quarter we hold a ‘town hall’ meeting which is a more formal event, bringing the whole company together for a business update followed by a fun activity led by someone on the team.

Technology

Technology enables flexible working and is a vital consideration. Working flexibly requires a truly paperless office environment, and those who are still relying on processes that depend on paper changing hands will need to revise these processes and most often employ technology as the enabler. This might involve the use of SharePoint for Microsoft Users or Google Drive or increased use of specialist cloud-based systems such as practice management systems and other relevant ones that encompass your marketing, finance, and human resources departments.

For example, Xero is a commonly used accounting system that enables remote working for your finance team. Cost-effective technology is widely available and, implemented correctly, can provide huge efficiencies.

Video calls, either using Zoom or Microsoft Teams, are now familiar and we have all now learned where the unmute button is! There are numerous other technologies to encourage communication and collaboration, including Slack, conference calls, shared documents.

Recruitment

One of the biggest problems with the Covid experience of home working is that everyone was forced to do it rather than choosing to do it.

A flexible working policy will generally be a big positive when you are recruiting and it also allows you to recruit from wider geography.

Instead of being limited by commuting time to the office or clinic,

you can potentially recruit from further afield and appeal to a broader group of candidates.

We currently have marketing managers working for us based in South Africa and Spain. We also have a book-keeper based in New Zealand. The time difference is a consideration, of course, but aside from that, most things are possible.

However, flexible working and especially home working does not suit everyone. The ONS Survey that I mentioned previously reported that younger people are less likely to work from home and this is for good reason.

For those who are starting in their career, the benefit of an office environment is significant, as it provides the opportunity to learn from senior team members and managers. Working in collaboration is very important in the early stages of any job.

There is also a sociable element to consider, with younger people and new joiners more likely to feel isolated working from home and valuing the opportunity to make contacts and even friends at work over a coffee or popping out for a glass of wine after work on a Thursday evening.

Anybody who saw the struggles of the news presenter last summer, being interrupted by a small child mid-broadcast, will also recognise that home working is not always well suited to those who have young children unless they have an office space to protect them from unexpected interruptions and childcare in the home.

Training

There are numerous examples of excellent training provided via online learning remotely and flexibly, including the Open University which has been doing so since 1969. Even softer skills like leadership and management can

be learned in a remote working environment.

I have absolutely no doubt that it is possible and often sensible to manage training in this way. The ability for consultants to learn new techniques by watching a video of another consultant performing it, perhaps in another country, is hugely powerful.

But, as I said earlier, we cannot underestimate the power of individuals learning from colleagues in person, especially more senior individuals within an organisation; and I would offer a slight health warning regarding the more informal training concerning graduates, younger team members and new recruits to an organisation.

Management

Managing a remote team requires a greater focus on communication when team members are working on an individual basis and there needs to be built-in plans to bring the team members together to have discussions that ensure they continue to work together as one team.

The responsibility for creating this culture will always lie with the manager leader and, ideally, we need a team manager who embraces flexible working and leads by example, using video and conference calls to encourage team discussion and collaboration.

It is at this point I will raise the thorny question that I am often asked by managers who are sceptical about flexible working, which is ‘How do I know if my employees are working at home?’

This is a good question and I could spend considerable time answering this, so I will try to summarise by saying that trust is vital. Most people come to work to do a good job and take pride in their role.

The minority of people, who are not committed to their work and are lazy in the office, will also be lazy when working from home and this is a management issue regardless of the working environment.

Most people value the opportunity to work in the most productive way for them and will deliver a greater contribution to your organisation when trusted to do a good job.

As leaders, we need to think about the work our teams are doing differently. Ultimately, it is the outcomes of the work that is done that is most important.

If a medical PA is running a busy practice, answering patients’ phone calls, booking appointments, typing dictations in a timely way and the consultant and patients are happy, we know that person is doing a good job.

We could check the medical PA is logged on to the practice management system at 9am sharp but if the outcomes of the work being done are all good, then this is unnecessary and potentially damaging to the culture of the team.

This type of checking and micromanagement should only be needed when we have doubts about the outcomes.

In many companies, there is a culture of presenteeism. Those employees at their office desk at 8am and still there at 7pm are the ones in line for a promotion. But with flexible working, we need a culture where our employees are trusted to do their job.

We must measure their performance on the quality of the work they deliver. At the end of the day, this is what benefits our patients and ultimately benefits our organisations.

Conclusion

In conclusion, I would like to reemphasise my opinion that a flexible working policy is essential for all organisations, but it requires real thought as to which roles are suited to a flexible approach, consideration given to the people who would embrace flexible working and the implementation of technologies and a working culture that supports it.

And, as business leaders, we need to pay attention to the development of the next generation of employees joining our teams, who need the support and guidance of more experienced team members and managers.

If you would like to discuss your flexible working policy with me, please do get in touch and I will be happy to share any advice and guidance from my own personal experiences. 

Jane Braithwaite is managing director at Designed Medical

PUBLIC RELATIONS

If you and your practice are after publicity, then be sure to keep your feet on the ground and get prepared by reading what media guru Tingy Simoes (right) reveals here

Don’t buy your own hype!

WHEN THE public is deluged with content, as we all are in these days of 24/7 news and ever-expanding social media platforms, they rely on outlets they trust to help them make decisions.

They simply don’t have the time or the inclination to trawl through PubMed and read your peerreviewed publications, so when they’re looking to source a medical practitioner or clinic, they will turn to their mainstream medium of choice.

People who read The Daily Telegraph, trust the Telegraph. Same with The Sun or The Mail, Radio 4 or Good Morning Britain. They become the ‘Which?’ guide for their audience: from washing machines to hip replacements.

I have lost count over the last two decades of the amount of calls I get from forlorn medics, who can’t comprehend how this or that col-

league got in some kind of ‘Top 50’ list (you won’t believe it, at no.9!) while grumbling ‘I’ve seen their work; they’re not THAT good.’

Being prominent in the media does not necessarily mean, as you well know, that this plastic/orthopaedic/ayurveda specialist is better than another.

Background checks

The press do have a duty of care, and I have found that the vast majority of reputable journalists are quite conscientious in their background checks – that is, they usually confirm the person hasn’t been struck off. But again, they’re not going to trawl PubMed either.

So whose word are they taking, that these folks really are ‘Top Ten’ material? They, too, take the word of those they trust: publicists with whom they have a long relationship, sometimes celebrities who

vouch for them, clinicians they have used for comment in the past, and others.

All they need is an assurance that you are who you say you are; that you do, in fact, have this exciting new breakthrough you claim to have; that it will help them sell issues; and you won’t kill or maim their readers.

It can be daunting for those just starting their careers to dip their delicate toes in the murky waters of media relations, when it feels infested with alligators of the ‘old guard’ – but let’s be honest: publicity just works.

However, this piece is not strictly about how to get publicity. This piece is about what happens when you do.

Over the course of my career, I have run the press offices for specialty associations, royal colleges, private practices, hospitals

and trade unions. I have publicised new healthcare technology, launched medical devices from GI to intraocular implants and even handled the media circus around the separation of conjoined twins. The vast majority of medics were new to public relations – that is, the concept of proactively seeking publicity rather than shying away from it.

Kicking and screaming

Some had to be dragged kicking and screaming in front of the cameras, others were only too delighted to leap out and land in front of the podium like a Marvel superhero. Preferably with a fog machine and cymbals.

Strange things happen when you become a ‘meedja’ darling. When you go from relative obscurity to being regularly rolled out on the BBC Breakfast sofa, it’s understand-

able for it all to go to your head a bit.

But this is the thing: it’s not peer review; it’s Tatler

Garnering favourable publicity is a complex algorithm with so many variables it could have stumped Stephen Hawking.

The media outlet has to need the content at the moment you have it; the PR agent has to know which media is correct for which announcement and, within that, the correct reporter or editor to target.

That reporter or editor has to care enough to open the email or take the call. Then, you have to hope that Boris or Trump don’t do something daft, start WWIII and ruin the news cycle.

If you do secure the coverage, you don’t necessarily know when it will run, whether they will be quoting other people who criticise your ground-breaking development or even guess the size of the article. It’s a crap shoot.

You’re just . . . how can I put this? . . . not that special.

It can be done

So to those out there who want to get on those fabled Top Ten lists, who want to achieve some positive exposure, those who have valid talents, abilities and techniques that should be unleashed upon the world – take heart. It can be done.

The fella down the hall at your posh clinic who is always on the Today programme and gets all the referrals doesn’t hold some magic wand.

They got lucky, they played a good PR game and there is absolutely no reason you can’t do the same. They might have more name recognition, but, believe me, they all started out where you are.

It’s a funny thing, though; over time, they do acquire a sheen of untouchability. They start to believe what is written about them.

Some become more sniffy about which outlets they will deign to bless with their participation. For example, I worked with a doctor who, in true Naomi Campbell supermodel form, ‘wouldn’t get out of bed for anything less than Harper’s Bazaar’.

Be thankful they believe it – that leaves more space for us!

Diva behaviour does not endear you to journalists, nor to your PR agency

If you’re just starting out in a new practice or venture, snap up those opportunities. So what if it’s just the Watford Advertiser?

The more deserving some of these media stars believe themselves to be of mainstream accolades, the more likely they are to become a pain for the press to deal with; ignoring those journalists who got them on the stage in the first place and issuing self-aggrandising stories that they believe people care about, such as their fancy new consulting rooms. No one, literally no one, cares.

You see, every marketing channel you choose has an arc, a life cycle. I had a client for many years who eventually became so enthralled by his own media exposure, he would threaten to sue newspapers whose coverage he didn’t approve of. I’ve also had clients indignant that other, lesser mortals were quoted alongside their hallowed names and so contacted newsdesks to complain.

Diva behaviour does not endear you to journalists, nor to your PR agency.

When I was very young and stubbornly ambitious, projecting an image of never needing anything from anyone, my dad always warned me: ‘Don’t buy your own hype.’

So those of you looking to enjoy the fruits of regular coverage, heed my old man’s words and stay humble. Because there are others jockeying for the position – and publicity is a helluva drug. 

Tingy Simoes is an award-winning publicist with over 20 years’ experience, founder and managing director of Wavelength Marketing Communications (www.wavelengthgroup. com) and author of the first-ever PR Manual for the plastic surgeons and aesthetic professionals entitled How to Cut it in the Media

A digital prescription platform to allow convenient prescribing from home

CloudRx is a digital prescription system that allows prescribers to create and send an electronic prescription to our fully licensed pharmacy for fast delivery direct to your patient. It can be used from home by doctors working away from their practices.

No cost to prescribers

Simple and quick prescription creation.

Legal paperless prescriptions, including repeat prescriptions and controlled drugs.

Patients receive text and email requesting secure payment. Alternatively, we can invoice the prescriber or clinic each month.

Prescriber Fees can be added if requested

Medicines are dispensed and dispatched by a variety of delivery options

Fully integrated into MidexPRO

“We have worked with CloudRX to maintain a cold chain for the medication and direct delivery to patients at home.”

Dr Charlotte Norton, Medical Director of The Slimming Clinic, the UK’s largest chain of private doctor-led weight loss clinics

Consent is not just a one-off

At the heart of medical finance

In the second part of our series on the GMC’s new guidance on ‘Decision-making and consent’, Dr Kathryn Leask continues to discuss factors of particular importance for private practitioners

The scope of decisions and planning ahead

It is important to be clear with patients about the scope of their decision in advance.

This is particularly where treatment is to be provided in stages by different healthcare professionals or there may be different ways to proceed once treatment has begun – such as where the patient is having surgery under general anaesthetic.

You must not exceed this, except in emergencies (paragraph 31).

You should try to anticipate circumstances when the patient will find decision-making more difficult and discuss these in advance to avoid a time-pressured situation where the patient could find it difficult to give informed consent (paragraphs 32, 33 and 39).

This section echoes and refer-

ences the GMC’s existing guidance on advance care planning in its guidance on Treatment and care towards the end of life: good practice in decision-making.

Involving other members of the healthcare team

In addition to the GMC’s Delegation and Referral guidance, the new consent guidance addresses a team-based approach to consent and delegation (paragraphs 40-47).

This sets out the factors to consider when delegating part of the decision-making process, such as the complexity of the procedure, and ensuring the person is suitably trained and competent.

Responsibility for ensuring informed consent is obtained remains with the treating doctor and you should make alternative arrangements if a colleague raises concerns.

Resolving disagreements

You must not assume a patient lacks capacity because they make a decision that you believe to be unwise. It may be reasonable to check their understanding if their decision seems at odds with their beliefs and values and offer more support, but you should still respect their right to decide (paragraph 48).

As has always been the case, you are not obliged to provide treatment that you do not believe to be in their clinical interests, but the guidance says you should be ready to explore their reasons.

You can still refuse to provide the treatment if, after having this discussion, you still do not think the treatment would serve the patient’s needs, but you should explain why and the other options available, such as seeking a second opinion (paragraph 49).

Recording consent decisions

The guidance reminds doctors of the importance of recording decisions in the patient’s medical records.

However, it accepts the need for a proportionate approach about the level of detail, provided it includes ‘the decisions made and actions agreed – and who is making the decisions and agreeing the actions’ (paragraphs 50 and 51) as required by Good Medical Practice

You must not assume a patient lacks capacity because they make a decision that you believe to be unwise

Reviewing

decisions

Consent is a process rather than a one-off event which means patients should be kept informed and given opportunities to reconsider; to ask questions and discuss any concerns; and to change their mind at any time.

The guidance advises you to regularly review decisions to take no action and sets out other circumstances when it is important to review decisions (paragraph 58) such as where you have reason to think the patient has changed their mind (paragraphs 56-59).

Challenging circumstances

The remainder of the guidance (paragraphs 60-96) looks at different circumstances that may affect the decision-making process.

These are listed below, although not all will be relevant to independent practitioners:

 Time and resource constraints (paragraphs 60-61);

 Treatment in emergencies (paragraphs 62-64);

 If the patient does not want to be involved in making a decision (paragraphs 65-68);

 If you are concerned that a patient cannot make a decision freely (paragraphs 69-75);

 If your patient may lack capacity to make the decision (paragraphs 76-86);

 Making a decision when the patient lacks capacity: overall benefit (paragraphs 87-93);

 Making decisions about treatment and care when a patient’s right to consent is affected by law (paragraphs 94-96).

On issues concerning mental capacity, the guidance is consistent with existing UK law: the Mental Capacity Act 2005 and its accompanying Code of Practice and the Adults with Incapacity (Scotland) Act 2000.

The legal framework is summarised in a separate GMC factsheet published alongside the new guidance.

You are advised to read this section of the guidance and refer to it when necessary, although you may also want to seek specific advice from your medical defence organisation.

The new consent guidance should not require any huge changes to your existing practice because the need to involve patients in decision-making is long-established.

However, it serves as a reminder of the importance of obtaining informed consent in the wake of the Montgomery judgment and sets out a framework for decisionmaking that will enable you to comply with your legal and ethical duties. 

Dr Kathryn Leask (right) is a medico-legal adviser at the MDU

How to find the best

Technology should help and not hinder your business, but unfortunately some practices struggle daily with an inefficient IT set-up that they have outgrown or which never really met their needs. So how can you ensure you are able to get the best from a practice management system? Healthcode’s Kingsley Hollis (right) shares these essential dos and don’ts.

Do start close to home Before focusing on technology, carry out an honest appraisal of your practice business and consider what aspects require improvement.

For example:

 Cash. Poor cash flow is one of the commonest causes of company insolvency. To avoid this fate, it is essential to bill promptly and accurately to avoid queries and disputes, track payments effectively and re-allocate shortfalls.

 Patient administration. Providing an efficient and responsive service throughout the patient’s

journey helps build your reputation and attract more referrals.

 Communication. Reliable, efficient and secure lines of communication are an operational necessity, from managing correspondence with patients to staying in touch with other members of the practice team and sharing clinical information when appropriate.

 Information. Accurate, relevant and up-to-date business intelligence about your financial position and current trends supports rational decision-making. Use this assessment to determine

your business priorities and focus on the technology that addresses these goals.

Do test your current IT set-up

Look at how well your current technology is aligned to your business goals. For example, the ability to generate accurate electronic invoices which include all the information required for processing and payment.

Rate the technology for how it performs in a range of routine practice tasks, paying particular attention to:

 Time. How long, on average, does it take to complete?

 Ease of use. Is the system simple and intuitive?

 Efficiency. Is there any duplication involved, how much of the work is automated?

 Failure rate. How often does something go wrong and what are the business consequences?

Consider whether glitches can be resolved with help from your existing provider or if you need to invest in something better.

Don’t exclude other members of the team

Consult those who use the system most, such as your secretary or the person responsible for registering

best computer system

patients and billing, about how the process could be more efficient.

Not only will you obtain a fresh perspective but it will encourage them to engage with any system changes.

Do set a realistic budget

If you decide that you need to invest in your IT systems, work with your accountant to decide how much you can afford to spend, as well as the tax implications of your investment.

Be sure to take account of possible costs such as technical support, upgrades, data back-up, additional data storage and adding new users.

These benefits are included in Healthcode’s subscription, but could blow a hole in your budget if they aren’t part of your financial calculations at the outset.

Don’t think short-term

Technology advances at lightening pace and even sophisticated IT software can date quickly.

The best defence against your IT systems becoming a costly white elephant is to focus on systems that are both future-proof and scalable.

Traditional self-hosted software – which you buy and install on your own machine or server –makes this more challenging, because you have to keep pace with upgrades and ensure you are not running an outdated legacy system.

The alternative is to subscribe to a software as a service (SaaS) solution, such as Healthcode’s ePractice, where the software is hosted by a specialist provider and then accessed securely online.

With this model, software is managed, upgraded and patched by the provider, ensuring you are using the latest version and can take advantage of new features as they come available, such as mobile apps or new reporting functionality.

An added advantage of this approach is that you can usually start with a basic service and then ‘trade-up’ as your practice expands, without the need to start from scratch.

Do your research

Once you have decided on your criteria and budget, take time to research the practice management solutions to find the best match.

To help whittle down the options, it’s a good idea to draw up a table to compare the functionality, features and costs. Ask for recommendations from fellow practitioners too.

Do find a provider who is on your wavelength

The first requirement of any IT provider you choose to work with is the ability to talk your language, because clear, effective communication is key to finding a solution that meets your particular business concerns and avoiding misunderstandings.

Here are some other important questions to consider:

1 How did they respond to your initial query – excellent customer service from the start?

2 Do they have expertise and a proven track record in the independent health sector?

3 Are they financially stable? Ask for business references, check with Companies House or buy a report from a reputable ratings agency.

4 Do they have the resources to respond quickly to problems and a development team to ensure the system keeps pace with new technology?

5 Can you speak to other users about their experience of system functionality, reliability and customer service?

The best defence against your IT systems becoming a costly white elephant is to focus on systems that are both future-proof and scalable

6 Can you trial the system for a limited period to ensure it meets your needs?

7 What training and technical support can they provide?

8 How will they help you safeguard patient data? See my next point.

Don’t make assumptions about data protection

Every breach of patient confidentiality risks damaging your reputation and attracting the attention of the GMC, but the loss of patient data might also incur a hefty financial penalty from the Information Commissioner’s Office.

Data controllers are legally obliged to have appropriate security measures in place to protect personal data, such as password protection, encryption and firewalls.

They must also ensure the compliance of organisations that process data on their behalf, so before hiring any IT service provider, it’s essential to check they have strict information security safeguards in place, including arrangements for storing data, back-up and recovery.

Healthcode’s IT security measures include full end-to-end encryption, an enterprise quality infrastructure, which is physically located in the UK, and user credentials.

Our Information Security Management System complies with ISO/IEC 27001:2013 and we are certified by the Governmentbacked Cyber Essentials scheme.

Do ensure everyone has relevant training

Every staff member with computer access should be properly trained on the systems they need to use, be given their own user credentials – this should not be shared – and follow the practice’s data protection policies. Training should be included in new staff inductions and refresher training is also a good idea.

Don’t ignore teething problems – feedback

For anyone used to the established way of doing things, however inefficient, adapting to a new IT system can be challenging and there is a risk of frustration if they find the new system does not live up to their expectations.

It is important to ask users about their experience and feed any difficulties back to the provider so they can be addressed quickly. If people feel their concerns are being taken seriously, they are more likely to engage with and get the best from a new system.

Do stay switched on

Return to the areas for improvement you identified at the outset and track your progress. For example, has the new system speeded up invoicing and improved cash flow? Compare before and after to ensure there has been a return on your investment.

Finally, there is a tendency to think ‘job done’ once a new IT solution has gone live, but as we have seen, things can change quickly.

Ultimately, you can only continue to benefit from your technology if it is aligned to the developing needs of your practice, so it pays to keep an eye on both if you want to succeed in the long term.

Kingsley Hollis is head of business development (ePractice) at Healthcode

BILLING ADVICE

Cash crisis control

Simon Brignall discusses some of the key billing and collection issues every doctor’s private practice can learn from the pandemic

THE IMPACT of Covid-19 was the dominant theme of 2020 for all of us working in the private healthcare sector.

We are now in our third national lockdown, but thankfully we are seeing the roll-out of vaccines and we can begin to see the light at the end of the tunnel.

I was looking back at the articles I wrote last year as we entered the first lockdown and thinking about the many inquiries I have received to determine the key areas of concern and how they could be effectively managed.

The issues that practices faced were broken down into the following key areas:

 Cash flow;

 Fluctuations in activity;

 Staffing.

I thought, with the benefit of hindsight, it would be useful to dis-

cuss each of these issues and the steps you can take to address them.

Cash flow

Private practice is like any other business, which means cash flow is king. Problems around cash flow can cause even successful practices problems with paying staff and suppliers, let alone generating necessary income for the consultant.

It is important to understand the key areas that can impact your cash flow.

Delays in invoicing

It is vital that your work is invoiced promptly, as this will ensure you have a reliable cash flow and allow you to keep debt to a minimum. Raising invoices in a timely manner enables billing issues to be picked up earlier and boosts the likelihood they can be resolved quickly.

Bear in mind that the raising of an invoice is the first link in the billing chain, therefore problems at the start can cause delays in the whole process.

This is important, as some private medical insurers have rules around time limits on sending them your invoices, which means that they can sometimes deny payment, leading to lost income for the practice.

At Medical Billing & Collection (MBC), we invoice the main insurers electronically, which ensures we have a dispatch record that can be referenced to resolve any dispute. Last year, I received many calls from concerned consultants whose secretary had fallen behind on the billing for a range of reasons, resulting in the practice either losing income or experiencing cash flow difficulties.

Reconciliation and invoicing of outstanding payments

The most common inquiry was from doctors who felt that while there was not a problem with their billing, they did have concerns around the chasing process. Quite often they did not have visibility on what was outstanding for the practice or the data they had access to was not up to date. It is important to ensure you have accurate information on what money is owed to the practice, as only then can you implement a robust chase process.

This can only be achieved if payments are allocated to the relevant invoice in a timely fashion. This will allow any outstanding balances to be identified and, where a patient is liable, an invoice to be raised accordingly.

Chasing process

Having identified which invoices are outstanding, it is important to have a chase process that is not only robust but routinely applied. This will ensure that issues around problem payers are highlighted and where there is a discrepancy with the invoice, you can seek to rectify the problem. By making the payment process as simple as possible and providing a range of payment options you minimise the delay in the invoice being settled.

At MBC, patients can pay their invoice at a time that is convenient to them via our online 24-hour payment portal, which improves our collection rate.

We average bad debts of less than 0.5%.

Our experience from last year indicates that most practices experienced fluctuations in the revenue side of the business, which is why it is important to ensure that there is a constant focus in this area to minimise the impact to the practice.

Fluctuations in activity

We partner with over 1,500 consultants and we saw a range of impacts to their practices. Some specialties which easily accommodated the move to remote consultations were less impacted, such as mental health.

Other specialties where remote consultations were also an option but relied on access to hospital

For many practices, we implemented billing solutions where the switch to remote consultations meant they then wished to invoice self-pay patients electronically who previously paid on site

 Health issues;

 Issues around managing childcare;

 Difficulties around working remotely;

 Early retirement.

They were aware that this was causing the practice to be impacted by some of the issues I have highlighted here, such as delays in invoicing and chasing and the accumulation of bad debts.

are unavailable, it is often the practice finances that suffers.

A simple yet effective solution to staffing issues may be to outsource the billing to a medical billing company who will then partner with the practice. The billing company will ensure you have service continuity around the business side of the practice.

facilities for their procedures built up waiting lists.

These patients were then accommodated as access to theatres and hospital facilities became available later in the year when we saw a return to pre-Covid volume levels.

For many practices, we implemented billing solutions where the switch to remote consultations meant they then wished to invoice self-pay patients electronically who previously paid on site.

We also had practices that were continuing to see patients face to face, but, due to social distancing requirements, preferred to not have patients congregate at the front desk while paying their bill.

We know that the pandemic has caused many patients to defer accessing healthcare for other issues and there is a pent-up demand for these services.

I have received many calls from consultants who were facing unpredictable revenues and were concerned about their cost structure. They wanted to ensure their costs were correlated against their received income, but they did not want to diminish their capacity to benefit from the recovery when it occurred.

However, our costs are calculated against received income, which means they easily adapt to changing circumstances, yet the practice still benefits from our capacity when its volumes recovers.

Staffing

As you would imagine, many calls I received in earlier lockdowns were from consultants facing problems to do with their medical secretary. They either had limited or no access to this key member of the team due to any of the following reasons:

In larger organisations, you can ensure that any key member of staff is supported through crosstraining; however, for many practices, the secretary is responsible for all aspects of the practice and often without any back-up.

The secretary is the shop window to your practice, dealing with patient engagement, diary management, medical letters and booking theatres and tests on top of the billing and chasing.

So it is easy to see that when they

Although the problems I have highlighted in this article can be addressed by the practice, it is often the simplest solution to partner with a medical billing company and see your business benefit from its experience.

This leaves you free to focus on your private practice and the delivery of care to your patients. 

Simon Brignall (right) is director of business development at Medical Billing and Collection

• Completely open scanner that is well tolerated by claustrophobic patients

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Gazing ahead also involves looking back

With a financial spring clean in the offing, Dr Benjamin Holdsworth (left) explains why your investments would have fared better if left alone

LAST YEAR will certainly go down in history as a momentous one: with the tragedy that is Covid-19, the painful global downturn that has ensued, the curbs on personal freedom and the end of one of the most divisive presidencies in the US, carrying the headlines.

What will almost certainly be forgotten as a footnote to the year is the fact that global equities actually finished the year slightly up on where they started.

Yet that is to belie the still raw memory of some of the most severe daily and weekly market falls – and subsequent rapid rises –that investors have ever experienced.

Such moments in markets can be discombobulating and, when emotions kick in, can lead to poor decision-making.

Risky behaviour

Being tempted to act on market falls – or the perceived prospect of market falls – is extremely risky and likely to harm your portfolio. This is where good advisers will act as behaviour coaches – to stop knee-jerk reactions which will have a detrimental effect on your long-term goals.

For example, in 2020, markets fell around 25% but returned to above their starting point. In 2016, which saw an awful start to the

Starting out is a balanc act

While many doctors find their businesses suffering in the lockdown, others are planning to set one up. So what do you need to know to be within the law? Kirsty Odell (right) gives guidance on the legal considerations you need to think about if you are setting up a UK healthcare business

BUSINESS STRUCTURE

There are many ways to set up a new business and you need to consider not only what is right now, but in the future, because undoing a structure to create something new while in business is very disruptive, expensive and may even not be possible.

Each option has its own advantages and disadvantages and there will also be tax considerations to take account of.

Some of the main structures are as follows:

Sole Trader: This may be appropriate for a small business where an individual is providing the services alone, like a physiotherapist.

It is simple to set up and run, but does not have a separate legal personality, so you are personally liable.

Partnership: There are different types of partnerships, but a general partnership is where people are carrying on a business in common with a view to profit.

As with a sole trader, there is no legal personality, and each partner is liable for all the partnership’s obligations – regardless of which partner created them.

Limited liability partnerships:

There are limited liability partnerships (LLPs) which are corporate entities but taxed in a similar way to general partnerships.

The members of an LLP have limited liability and the LLP has its own legal identity.

Limited liability company: Again, there are different types of companies, but limited companies are most common. They have their own legal identity and the shareholders have limited liability.

However, there are added administration costs and disclosure requirements which sole trad-

ers and general partnerships do not have.

Charity: If your business has a charitable/social aim, then a community interest company (CIC) or other social enterprise or charity may be an option.

They are still companies – as above – but have more stringent regulatory requirements. Charities enjoy several tax reliefs, and both are liked by the public sector as they are asset-locked. This means the organisation may be at an advantage in obtaining grants and some contracts.

REGULATORY REQUIREMENTS

The regulatory requirements will depend on the business you are proposing to operate and the structure that you put in place.

Some key areas of consideration for healthcare companies are registration with the Care Quality Commission (CQC) and ensuring products are passed by the Medicines and Healthcare products regulatory Agency (MHRA).

Care Quality Commission: Will your business be carrying out any regulated activities? If it will, then it will need to be CQC-registered.

There are several different types of regulated activities, but some of the main ones that may be relevant to you include: treatment of disease, disorder or injury, surgical procedures and diagnostic and screening procedures.

Medicines and Healthcare products Regulatory Agency (MHRA): If you are selling a product, you will need to consider whether or not it is a medical device.

If it is, then it will need to follow the requirements of the relevant regulations, dependent on the type of device that it is.

For example, some devices have ➱

to be registered with the MHRA, for which there are three classes, and accessories to medical devices are classified separately. They may also need to pass conformity assessments and have CE marks.

New rules apply as from 1 January 2021, although the EU regulations have been brought into British law to begin with.

However, changes in the EU legislation due to take effect in May 2021 and May 2022 will not apply unless they are implemented by the British Government.

It does mean that devices which comply with British legislation may not be compliant for sale in the EU or European Economic Area (EEA).

INSURANCE, LICENCES AND INTELLECTUAL PROPERTY

All business will want to have cover in place to protect from potential liability. The big one will be professional indemnity/insurance.

Each individual practitioner in your organisation may be covered for defence, but the organisation is likely to have some liability or, at the very least, is susceptible to being sued if something goes wrong.

So having in place the appropriate cover for the function or services the organisation is carrying out is essential. Finding the correct cover may be a long process, and costs are high.

In addition are the usual business insurances, such as employer’s liability insurance, property insurance and public liability insurance cover. Other types of insurance may also be required dependent on the business being operated: such as product liability and directors’ and officers’ insurance.

As well as insurances, the business will need licences to carry out some of its business operations. This will include, for example, software licences for all the information communication technology and waste carrier/disposal licences. It might also be TV and music licences and other intellectual property.

You may also be creating your own intellectual property: not only products, but designs for your logo and website. So you may want to consider trade marking those.

Each individual practitioner may be covered for defence, but the organisation is likely to have some liability or, at the very least, is susceptible to being sued if something goes wrong

DATA PROTECTION

Will your business be processing or controlling any sensitive data? For example, if it employs staff, it will be controlling personal information about its employees.

It may also receive information about its patients/customers. You need to consider if you should be registered with the Information Commissioner’s Office (ICO).

Ensuring any personal data is properly controlled and processed, and particularly if it is to be shared, is vital. The fines for breaching The General Data Protection Regulation (GDPR) are extremely high.

There should be a clear understanding of the data flows so that appropriate measures can be put in place to ensure compliance with data protection legislation. It is vital all staff are trained on keeping information confidential and secure. British Airways were fined €204m – later reduced to €22m – for failing to protect customer data in 2019.

CONTRACTS

Having set up the business, you then need to contract with people to provide your goods or services. You will need to consider what contractual arrangements you need to have in place.

Many disputes arise out of contracts which are made on a handshake and then when things get tough, each party blames the other. Without a written contract, everyone stands to lose, and it may not have happened in the first place if they had sat down and thought through how it was going to work.

Some of the general contracts to consider include:

Contracts with patients/ customers: This will cover a number of different areas and will depend on exactly how the business is being run.

For example, a website-based business will need to have different terms and conditions to a faceto-face service to comply with legislation. As well as general terms and conditions in relation to the service/product being offered, a website business may also need website terms and conditions, privacy notices and a cookies policy.

Many disputes arise out of contracts which are made on a handshake and then when things get tough, each party blames the other

If you are providing goods or services to consumers, then any terms and conditions will need to comply with consumer regulations in that jurisdiction.

Also, with a website, you will need to consider if you will be liable in other jurisdictions – for instance, every state in the US has its own regulations.

Contracts with hospitals/ other providers: If your business is to provide a product or service to a hospital or other provider, then you will need to agree terms and conditions with them.

Hospitals/NHS trusts may insist on their own terms being used and these could take a variety of forms and may be quite onerous.

Contracts with suppliers/ manufacturers: You will want to agree commercially acceptable terms with any suppliers or manufacturers. They may insist on their own terms and conditions being used, which should be reviewed carefully.

Key areas of consideration in these contracts are payment terms, delivery times, quality control, rights of termination and how liabilities are divided.

Contracts with employees/ self-employed persons: If you are engaging individuals then it may be a contract of employment or a consultancy agreement of some kind, whereby they are selfemployed.

You will need to agree the terms on which they will work. You should consider if there are any particular qualifications, registrations or insurances or perhaps practising privileges that they have to maintain to continue the engagement.

If you are clear about your objectives, have set out a clear project plan, and considered all the knowns, and identified the known unknowns you need to be ready for, and gained advice from others in the process, your healthcare business in the UK should be a great success.

 Note that this article is a guide for the legal situation in England and Wales only

Kirsty Odell is a senior solicitor at Hempsons

Sandison Easson Medical Accountants Limited (a newly formed member of the Sandison Easson Group) has provided an estimator toolkit to give hospital consultants some indication of what their deemed pension input will be for tax purposes.

Visit www.nhsannualallowance.co.uk for

and

T 01625 527 351

E info@semail.co.uk

W www.sandisoneasson.co.uk

A Rex Buildings, Wilmslow, Cheshire, SK9 1HY Also at 1 Harley Street, London, W1G 9QD

Free legal advice for Independent Practitioner Today readers

Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.

We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.

Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.

Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes’ of free legal advice.

Advice is available on:

 Business structures (including partnerships)

 Commercial contracts

 Disputes and litigation  HR/employment  Premises  Regulatory requirements and investigations

A dead person’s notes

Dr Kathryn Leask (right) explores the implications of the Access to Health Records Act 1990

Dilemma 1 Can he have his brother’s notes?

QI am a private gastroenterologist and had been involved in the care of a patient with metastatic bowel cancer. The patient has sadly died and his brother has requested a copy of his records.

I understand that the family of the deceased are making a clinical negligence claim against the NHS hospital and GP due to concerns about a delay in referral and diagnosis.

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The brother has quoted the Access to Health Records Act 1990, stating that he has a claim arising out of the death and, as such, he is entitled to a copy of the entire record.

relevant to any claim which may arise out of the patient’s death’.

It was clarified by the High Court that a personal representative of the deceased does have a right of access to all of the records, not just those relevant to any claim which may have arisen out of the death. In this case, there is no requirement to limit the disclosure, bearing in mind the exemptions below.

If a request for the records is made by someone other than the personal representative but who has a claim arising out of the death, they are only entitled to records which are relevant to the claim.

AIn-house pharmacy

Secretarial support  Billing service

We are a leading private outpatient clinic and we are inviting new applications for practising privileges for our extended opening hours on Saturdays.

Unlike a living patient, where the data protection regulations apply, the relevant statute covering requests for records of deceased patients is the Access to Health Records Act 1990.

Under section 3(1)(f) of the Act, an application for access to a deceased patient’s health records can be made by ‘the patient’s personal representative and any person who may have a claim arising out of the patient’s death’.

Whether the brother is entitled to receive a copy of the deceased’s entire record will depend on whether he is the personal representative. The Act goes on to say at section 5(4) that ‘… access shall not be given … to any part of the records which, in the opinion of the holder of the record, would disclose information which is not

So it is important to establish whether the deceased’s brother is the personal representative. A personal representative should be able to provide evidence of their status; for example, by providing a copy of a Grant of Probate or Letters of Administration. Alternatively, a certified copy of the patient’s will should make reference to who the personal representative or executor is.

There may be other reasons why records should not be disclosed, even to the personal representative, and the Act refers to this at section 4(3) and 5.

Information that is likely to cause serious harm to the physical or mental health of any individual, information relating to an individual other than the patient and information provided by the patient with the expectation that it would not be disclosed in the event of their death may be exempt from disclosure.

Dr Kathryn Leask is a medico-legal adviser at the MDU

A colleague has a drink problem

A doctor raises concerns about a colleague’s behaviour. Dr Sissy Frank (right) responds

Dilemma 2

How do I report his drink issue?

QI recently went out to dinner in a local restaurant and recognised a colleague from one of the hospitals where I have practising privileges. He was standing at the bar and seemed quite drunk. I mentioned this to one of my other colleagues. She replied she had seen him out in restaurants and bars before and he was usually drinking heavily.

The next time I had a clinic at the hospital, I heard staff talking about an emergency involving a patient who had had complications following surgery. I was shocked to learn that the patient had been intubated by the colleague I had seen at the bar and discovered that this would only have been a few hours afterwards.

I understand that the procedure was successful and the patient recovered, but I’m concerned that my colleague was working shortly after drinking so much alcohol. I think he needs help, but I wouldn’t want to make things worse by reporting this through formal channels. What should I do?

AYour colleague’s behaviour puts patients at risk as well as his own career and reputation. This overrides any personal or professional loyalties.

If this is a close colleague, you could consider talking to him about your concerns in the first instance and encourage him to seek help. Be sympathetic but

make it clear that you are concerned that patients are being put at risk and be clear that you will need to take action if the issue is not addressed.

If this approach is unsuccessful or you don’t feel it is an option to discuss this directly with your colleague, you can report your concerns in line with the hospital’s procedure for raising concerns. This would generally involve raising the matter with the doctor’s line manager or a senior manager in the department.

You would not have to have proof of the excess drinking and it should be accepted that you have acted in good faith.

If you raise this verbally, it’s also advisable to follow up in writing and keep a record of correspondence so you can document the steps you have taken to raise your concern if necessary.

Strict confidentiality

If your colleague was found to have an alcohol problem, then the hospital would likely support him by involving occupational health and ensuring that he sought appropriate treatment.

It should also treat his case as a health problem, which requires strict confidentiality. This means you should not expect a detailed report of the outcome, although it would be legitimate for you to confirm that your concerns had been acted upon.

Even if the doctor is referred to the GMC, the usual approach would be to offer health assessments, although the GMC may restrict his practice to ensure patient safety. However, the GMC would not erase a doctor solely because of health concerns.

While it may be difficult to raise concerns about a colleague’s health because of worries that it could cause problems for them or make interactions uncomfortable, patient safety is paramount and if you feel a colleague’s health may put patient safety at risk, you should take steps to protect the patients.

Be reassured that reporting health concerns about other doctors often means that the doctor is enabled to confront the issue and to access the help and support they need to practise safely in the future. 

Dr Sissy Frank is a medico-legal adviser at the MDU

A

PRIVATE

PRACTICE

– Our series for doctors embarking on the independent journey

Get financially fit for the months ahead

There is no question about the extent of demand for private medical treatment, but juggling the needs of the NHS and private sector will be a significant challenge for some time.

Most private practices have been significantly affected by the impact of Covid-19, so it is important that when the capacity to carry out private work restores, you are financially well placed to adapt to a new environment.

Ian Tongue looks at some of the areas you should be considering in order to be financially fit for the year to come

Look at your trading structure

This is often the decision that yields the greatest tax savings, but also provides a great deal of financial flexibility.

There was a significant shift in recent years to using limited companies for private practices to help mitigate pension annual allowance charges and provide other strategies if you don’t require all of the money generated by the private practice.

For those trading as selfemployed or in partnership with a financial year-end that is coterminous with the tax year end – that is to say, 5 April/31 March – there are usually few barriers to switching trading structure.

If you have a financial year-end for your private practice that is not coterminous with the financial year-end, an acceleration of tax liabilities can occur with the switch and this can be a barrier, depending on your financial circumstances.

For those who have considered switching to a company but ruled this out on the basis of accelerated tax liabilities, now is the time to reconsider matters, as the tax effect of changing structure is likely to be less due to the impact of Covid on private practices.

Consider your defence cover

It has been surprising to hear during the pandemic how many clients renewed their indemnity insurance prior to the first lockdown and how some operators were not prepared to revise the premiums during the year.

As this is usually the most significant expense of the practice, it has understandably been a significant financial issue.

Some may miss out on a refund of premiums, but it is expected that many will be able to contact the provider when the actual earnings are known and request a refund. It is therefore important that you get your information to your accountant as soon as possible to ensure that this is addressed at the earliest opportunity.

For those renewing soon, it will be difficult to assess the next 12 months, so it may be tempting to go on the lower side of things to avoid the situation experienced last year.

January 2023 will definitely be a date to hate, but, with planning, can be easily managed

Be realistic and, most importantly, contact the provider if you can see that your income figures will be higher than disclosed at the renewal. It is clearly a false economy to be under-covered, as you may not be protected against a claim.

Income tax payments

Given the downturn in most private practices, reducing income tax payments on account for the 2020-21 tax year has been common to reflect current levels of activity.

With the everchanging situation of the virus and private hospital capacity, it may be that these payments can be reduced further depending on actual earnings.

Send your tax and accounting information for 2020-21 to your accountant as soon as possible after the year-end and, if you have overpaid in January 2021, they can adjust the July 2021 payment or seek a refund.

Likewise, if the payment reductions were too high, you will know at the earliest opportunity of any additional amounts payable that may be attracting interest.

With any temporary downturn in a business’s profits, it is important to plan for the tax effect due to the delay in paying tax.

For those in a company, it is highly unlikely that you will be paying tax on account and therefore you will settle your tax on the basis of the actual amount due approximately nine months after the company’s financial year-end.

For those paying under selfassessment – the self-employed and partnerships – you are required to pay ‘on account’ within the same tax year and soon after the tax year in question.

These payments are crudely set

at 50% of the liability for the year before rather than assessing your actual position.

The effect of this is that a reduction in your income tax liability for 2020-21 will affect the payments on account for 2021-22 payable in January 2022 and July 2022.

This will result in January 2023 being a time when any shortfall is paid – because the payments on account were lower – together with payments on account for 2022-23 being based on a higher liability. January 2023 will definitely be a date to hate, but, with planning, can be easily managed.

For those with companies, you can plan the timing of taking dividends or loans to smooth out the tax position but this is always considered on a case-by-case basis.

Consider your staffing arrangements

The Coronavirus Job Retention Scheme, or furlough scheme as many refer to it, has been a welcome support to businesses during the pandemic. At the time of writing, the scheme is set to end at the end of April 2021, having been extended.

Depending on how long the scheme runs for, you may be able to use it to assist you with retaining key employees if sufficient work is not available to restore their position to normal hours.

Over time, the scheme has become more flexible and therefore you can pay for the hours that are being worked and claim the majority of the costs for the hours that are not worked.

Consider new opportunities

There are likely to be many opportunities that present themselves as the NHS and private hospitals start to return to some level of normality.

These opportunities may be available individually or perhaps for those working together, so it is important to understand what is happening with the private medical sector.

You may need to look to other private hospitals for your private practice, depending on their longer-term policies.

Within the private medical sector, there have clearly been certain specialties more affected by the

reduced capacity within the private hospitals. Plastic surgery has been particularly hard hit.

To prevent this situation arising again in the future, many specialists are considering their own facilities to trade from.

This is clearly a significant undertaking, but it does present a significant opportunity and, with the right set-up, you can access a profitable new income stream that the private hospitals would have previously earned.

It also provides you with an asset that can be sold in the future rather than reaching retirement and simply ceasing your private work.

Often, these arrangements are with colleagues to diversify the risk both financially and clinically. If you are considering this, it is important to have the right team around you, with specialist accountants and advisers essential.

When the current difficult Covid situation is overcome, there will be a new environment of private work and it is important that you consider your position in advance to adapt to the challenges ahead.

Engaging a specialist medical accountant during the times of significant change will ensure that you are in a strong position when life starts to go back to some level of normality.

 Next month: A look at software packages for your private practice

Ian Tongue (pictured right) is a partner with Sandison Easson & Co

The new year was hopefully going to see the virus under more control which would have allowed the unlocking of private hospitals to carry out more private work, but with the third wave upon us at the time of writing, this will no doubt delay matters.

On behalf of the partners and team at Sandison Easson & Co. we thank you for all that you are doing to keep us safe and well.

DOCTOR ON THE ROAD: HONDA e

Fast off the grid

Love is in the air this month and Dr Tony Rimmer (right) finds this little mover the perfect partner in the city

OUR MEDICAL world is run on an evidence-based scientific background where a logical approach to all situations and problems is the modus operandi.

But, despite this, it turns out that many great advances were only made possible by trailblazing medics and scientists thinking outside the box.

In fact, we humans often get the greatest joy and satisfaction from things that do not seem logical when looked at pragmatically. Take our choice of car, for instance.

If we had any sense, we would all drive very efficient anodyne workhorses that cost little to purchase and run. But we don’t – and thank goodness for that.

We buy over-powerful sports cars, over-priced luxury cars, two seaters, convertibles and big 4x4 monsters that could drive to Everest base camp. None of them make any real sense, but we love them and buy them in droves.

The same applies to the new breed of all-electric car. If we were sensible, we would all wait until the cost of a useful electric hatchback with a range above 300-400 miles comes down to the level of a basic Ford Fiesta.

Thankfully, because we are human and like to be individualistic, cars like the new Honda e continue to be developed. This small EV is Honda’s first all-electric car for Europe and is aimed squarely at the urban/city runabout market.

Retro styling

Its main competitor is the MINI Electric, which I reviewed in November. The styling is dramatic, retro and intended to make a statement. It does so in the flesh, especially in the brighter paint colours available.

There are only two variants. The £27,160 entry-level car has 134bhp and an excellent level of standard features, including some novel ones such as the side camera mirrors and a full-width digital dashboard.

The £29,660 Advance model boasts 152bhp and a few extra features like heated front window and steering wheel and a centre camera mirror. This is the version I have been testing. Both versions have the same 35.5kWh battery and both are claimed to have up to 137 miles of range.

Step into the little e and you are immediately blown away by the dramatic full-length dashboard screen with the external camera mirror screens at each side.

It all turns on automatically as you shut the door and it takes a few moments to take it all in.

This futuristic element will appeal to those who want their new electric car to feel as gamechanging as the technology undoubtedly is.

There is plenty of room for driver and passenger up front and although the rear seats are not spacious, access is helped by the five door bodyshell.

Instant performance

Boot space, as expected for such a small car, is not massive at 171 litres and is similar to the MINI.

Visibility is excellent and the boxy body shape helps maneuvering in town, as does the impressive turning circle helped by being rear-wheel drive.

Out on the road, the Honda has, like all EVs, instant performance on tap. This go-cart ability is perfectly suited to urban and city use and, like the MINI Electric, makes driving around town a fun experience.

The steering is sharp and the

ride is impressive but the chassis is not as well tied down as the MINI. The smooth ride is allied to a quietness that is well suited to A-road and motorway journeys although these will be rare outings for most owners.

Restricted range

The biggest potential fly in the ointment to make you think twice about buying this new Honda e is, like the MINI, the restricted range. The quoted range of 137 miles is more like 100-110miles in the real world. If you have access to your own charger at home then this may not be a deal-breaker.

Also, the Honda has the capability to accept fast 100kW rapid

charging when available from public charge points.

That means only 30 minutes for an 80% top-up. Home charging from a 6.6kW charger takes four hours for a full charge – perfect for overnight.

I really like the Honda e. It may not be quite as much fun as the MINI Electric to drive but it’s slightly more practical and has a wonderfully futuristic interior. Even the novel camera-screen mirrors are great when you get used to them. It rides well and is comfortable. As an urban/city car it is a perfect performer. 

Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey

HONDA e ADVANCE

Body: Five-door hatchback

Its go-cart ability is perfectly suited to urban use and makes driving around town a fun experience

Engine: Single electric motor. Rear-wheel drive

Power: 152bhp

Torque: 315Nm

Top speed: 90mph

Acceleration: 0-60mph in 8.3 secs

Claimed range (WLTP): 137 miles

CO2 emissions: 0g/km

On-the-road price: £29,160

The Honda e boasts a dramatic full-length dashboard screen with external camera mirror screens at each side

NHS PRIVATE PATIENTS UNITS

London’s patchy PPU performance

In the second of the new series analysing NHS private patient units, based on their published 2019-20 annual accounts, Philip Housden (right) expands on last month’s round-up of the top ten performing trusts. All of these were in central London. Here he focuses on the capital’s other trusts

The Top Ten performing NHS trusts by private patient revenues in 2019-20 are all located in central London hospitals and have been shown to be delivering a growing proportion of overall NHS revenues, as I reported last month in Independent Practitioner Today

This month extends the analysis of London to the remaining 12 NHS trusts, analysing the four ‘next movers?’ and the eight ‘lowest earners’.

Of course, the results reported in trusts’ 2019-20 annual accounts on which this article and analysis is based were partially adversely impacted by Covid-19 and restrictions on capacity in JanuaryMarch quarter. The impact was greater during 2020 and this will be reflected in future articles.

Next movers?

➤ The Royal National Orthopaedic Hospital (RNOH) has set a steady course for growth having invested in an expansion from 18 to 28 private patient beds when moving the PPU into the new Stanmore Wing that opened in December 2018.

With a brand refresh and the new capacity, the trust was able to increase revenues by 7.4% (£525k) to £7.6m in 2019-20, the third straight year of growth. This total now represents 3.9% of all trust revenues last year, which despite the growth, was still a decline from 4.6% the year before.

The trust’s strategy is to increase complex surgery and international referrals.

Although the private patient ward has, for now, become the trust’s ward that accepts Covid patients, private patient activity in the second half of 2020 was strong with an increase in spinal work in line with this strategy. The trust also has an outpatient presence in Bolsover Street, central London.

➤ Bart’s Health’s private patient revenues fell by just over £1m (16.7%) to £5.3m in 2019-20 after recent growth.

This was achieved with four ringfenced beds and two beds that were

The interior of the new wing of the Royal National Orthopaedic Hospital in Stanmore

flexed intermittently between NHS and private patient activity, while £840k of the total private patient revenue was derived from fertility services based at the St Bartholomew’s site.

The rest of the revenue is generated from the relatively sparse activity across Royal London and Whipps Cross sites.

Planned private patient activity at the Newham Hospital site was delayed by the refurbishment programme that was needed to create the ring-fenced capacity.

The medium-term outlook is positive, as significant growth and service benefits are expected once the trust will have access to the partnership private patient facility now being built by Nuffield Health in former surgeons’ accommodation and pathology buildings.

This is due to open later in 2021 with 48 beds, four operating theatres and 28 outpatient consulting rooms.

It is expected that a significant level of diagnostic, clinical sup -

St Bartholomew’s Hospital, where Nuffield Health is building a private patient facility in the former surgeons’ accommodation and pathology buildings ➱ p46

port services and complex clinical activity and income will be derived from the services provided by Nuffield as well as regular conversion and transfer of patients between Nuffield Health and the trust.

The increased levels of such complex activity are expected by the trust to more than compensate for any potential loss of activity to the new Nuffield Hospital.

➤ London North West also experienced a decline – of 8.2% and £400,000 in 2019-20 – but it is understood that, prior to Covid19, revenues were strong.

The trust’s private patient strength is the Sainsbury Wing on the Northwick Park site, which has 19 dedicated private patient beds and in 2020 celebrated its 25th anniversary of opening working to the TrustPlus brand.

It has ambitions to support private patient growth across all their major sites aligned and the wider North West London Integrated Care System developing site and service strategy.

This strategy includes relocation of regional colorectal services to the Central Middlesex site, which can act as a stimulus to opening new private patient capacity and services on that site and then in due course on the Ealing Hospital campus also.

➤ St George’s increased revenues by £309,000 to £3.4m, a growth of 9.9% last year. However, the trust has still not yet moved forward with long-standing plans to invest in a dedicated private patient unit and this still represents only 0.48% of total trust patient-related incomes.

➤ Kingston Hospital has delivered the biggest growth in this group of trusts.

In 2019-20, private patient revenues jumped £2.27m (441%) to £2.8m and this was an increase from 0.21% to 1.02% of total trust income.

Kingston Hospital ended a longterm contract with BMI at the end of 2018-19 financial year and moved the business to in-house control and operational management to new arrangements commencing from April 2019. As was experienced most

recently by Basildon and Thurrock NHS Trust, this move is significantly financially positive for the NHS.

➤ Next, Barking, Havering and Redbridge in north-east London is keen to develop private patient services, having ended the partnership with HCA at Queen’s Hospital, Romford, early in 2018.

The trust has improved revenue capture and improved tariffs, resulting in an increase of £254,000 (96%) to a total of £518,000 in private patient earnings in 2019-20 albeit from a narrow service range and low volumes. The trust is known to be reviewing options for growth principally to support the service strengths in cancer and complex surgery.

Lowest earners

The final six trusts between them delivered revenues of only £0.9m, or an average of only £150,000 a year each.

Each of these are located further away from central London and therefore it can be argued do not enjoy the same access to the inter-

national patient market, but it is clear that they are underperforming when compared with similarly sized trusts located in most regions outside the capital.

London remains the driver of NHS private patient revenues and services. Growth is evident and there are new initiatives planned, but performance across the capital remains patchy.

The long-term adverse impact from the enforced capacity and service closures resulting from Covid-19 are not yet fully known, but my ‘NHS PPU Barometer’ report in Independent Practitioner Today (November 2020) has demonstrated how the impact of the pandemic is likely to lead to a reduction in excess of 50% of incomes in 2020-21.

Meanwhile, the ending of the NHS contract with independent hospitals in London has created capacity in the independent hospitals to continue with their private work and so there is a fundamental shift of market share taking place.

For some trusts, this may be a long-term restriction on their ambitions. On the upside, the pan-

demic has been a catalyst for improved system thinking and working and such an approach has a great deal of potential for application for joining-up private patient services between NHS trusts.

Resulting benefits could include lower back office costs, more senior commercial leadership and an improved offer to insurers and selfpay patients.

The 22 London trusts discussed in this pair of articles are spread across five Integrated Care Systems and in each ICS there is at least one Top Ten leading trust and several with significant potential for commercial income growth.

Perhaps 2021 is the right time for trusts to co-ordinate their private patient strategies?

 My analysis of regional trust PPU ‘rising stars’, scheduled to be this month’s article, has unavoidably had to be delayed and will be picked up in future articles in this series.

 Next time: The south coast

Philip Housden is managing director of Housden Group commercial healthcare consultancy

PROFITS FOCUS: GYNAECOLOGISTS

Fruits of their labours

Gynaecologists exceeded accountants’ expectations for their latest earnings figures. Ray Stanbridge reports

A COUPLE OF years ago, we were pessimistic about the future of private gynaecology given the large cost increases, particularly for those specialising in obstetrics. We were wrong and I am pleased to report that most gynaecologists enjoyed a satisfactory year in 201819.

Our headline figures show that gross incomes have risen by 8% from £138,000 to £149,000. Costs have continued to increase, going up from £64,000 to £71,000.

As a result, profits for the year have increased by 5% from £74,000 to £78,000.

AND

Expenditure

Fees have increased slightly over the year. This appears to be primarily as a result of growth in selfpay, as insurer pressure on fees reimbursed by them remains high. Costs have continued to rise as we predicted some years ago.

Hospital charges

Staff expenses have shown a small increase from £20,000 to £21,000 on average. As reported last year, this seems to reflect the growth in fees charged by private hospitals or clinics operating under the Competition and Markets Authority (CMA) rules. Spouse

Those gynaecologists with little or no obstetrics work seem to be paying lower premiums even if their total income is comparable

salaries appear to have been fairly constant.

A similar observation can be made with respect to a continuing rise in room hire fees where hospital or clinic proprietors, working under CMA guidelines, have acted to increase fees according to market trends.

Defence costs

Professional defence costs seem to have risen further. We have not undertaken any detailed analysis but much of this increase appears to be the result of obstetrics activity.

Those gynaecologists with little or no obstetrics work seem to be paying lower premiums even if their total income is comparable.

Other costs have been remarkably stable. There was some increase in office and use of home costs where consultants chose to have their main business base at home rather than at private hospitals or clinics.

Phone costs have risen slightly, presumably in line with growth of activity.

What then of the future?

The financial year 2019-20 included the first couple of months of the Covid-19 pandemic. This will have some effect

on figures, although obviously nothing like the effect expected in 2020-21.

Our initial look at 2019-20 figures, however, suggest that gynaecologists, on the whole, continued to progress well.

As we have reported before, and the same is true for other disciplines we study, our sample is not statistically significant, but rather it gives a view of an average practice performance in the UK.

Readers will be aware that the

figures are not totally consistent from year to year as a result of changes in the way private consultants conduct their businesses, the behaviour of private health insurance company and market trends.

Survey criteria

There are also some changes because our survey has increased its criteria for inclusion from only £5,000 earned in private practice to at least £10,000 a year.

Other criteria for entry to the survey are that consultants must:

 Hold either a new style or oldstyle NHS contract;

 Have at least five years’ experi ence in the private sector;

 Be seriously interested in private practice as a business;

 Work as a sole trader, a member of a formal or informal group or are members of a partnership or limited liability company, either of which has incorporated.

 Next month: Radiologists

Ray Stanbridge is a partner with accountancy, finance and tax advisory medical specialists, Stanbridge Associates Limited

Years ending 5 April

Stanbridge Associates Ltd

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Coming in our March issue, published on 9 March:

 Don’t miss the start of a major new series from the Medical Defence Union examining the learning points from claims received by independent practitioners in a variety of specialties. Over the course of the next months, the specialties covered will include radiology, ophthalmology, ENT, psychiatry, orthopaedics, ENT, cardiology, anaesthetics.

 Are you making the most of branding opportunities? Simon Marett, of medical specialists Ellerton Marketing, begins a brilliant new series showing how to close the gap between the good and the bad. In the first article, he looks at logos and recommending pitfalls to avoid

 The billing process – how technology clears the way for payment.

Healthcode’s Desné Marston explains how you can use the clearing service to bill accurately and promptly, which is one of the vital signs of a healthy practice.

 Jane Braithwaite continues her ‘power of people‘ series dedicated to helping doctors who employ their own staff build up and manage their teams successfully

 Stay strong! There are reasons to be positive this year in terms of finances and the markets. Cavendish Medical reveals why

 The subject of gender fluidity comes under the spotlight in Hempsons’ monthly ‘Keep It Legal’ column

 Improve your financial performance! Medical Billing and Collection’s Simon Brignall has some useful learning points

INDEPENDENT PRACTITIONER

TODAY The

Published by The Independent Practitioner

Ltd. Independent Practitioner Today is editorially independent and thanks Bupa for its assistance with distribution. Material is governed by copyright. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form without permission, unless for the purposes of reference and comment. Editorial layout is the copyright of the publishers. If you wish to use it for promotional purposes on websites or for reprints, we would be happy to discuss licensing the copyright to you.

 If you have been doing your private practice in private patient units in the south coast area of England, then check out Philip Housden’s analysis of how they have been doing in the income stakes

 Having spent significant resources and countless hours training, clinicians must convey their expertise to the public – it is especially vital in an overcrowded market. But ‘being on social’ is not the same as being great on social, warns medical PR guru Nikki Milovanovic

 Our Profits Focus benchmark series from medical accountant Ray Stanbridge puts radiologists’ earnings under the microscope

 We look back a decade to what was hitting the news then. Doctors in private practice were suffering from a profits freeze and private patient power was growing stronger

 Tips and advice from the latest in our Accountant’s Clinic A-Z series

 The Golf has been a favourite of doctors down the years. How does the Mark 8 fare? Our motoring correspondent Dr Tony Rimmer gives his verdict

 More of your questions are answered by MDU medico-legal advisers in our Business Dilemmas series

 Start A Private Practice – advice from specialist medical accountant

Ian Tongue

Don’t forget to catch up with more news affecting independent practitioners and their business on the home, news and feature pages of our website: www.independent-practitioner-today.co.uk

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business journal for doctors in private practice

February 2021

INDEPENDENT PRACTITIONER

TODAY

In this issue

The business journal for doctors in private practice

Deadline to a big tax saving?

EDITORIAL COMMENT

A better trained watchdog

PLUS OUR REGULAR COLUMNS

Pensions’ red tape confusing doctors

PLEA TO EXTEND

Covid insurance pay-outs a step closer

Private GPs suffer Covid swab and jab bureacracy

Watchdog probes will be targeted

NEWS FOCUS

HAVE YOUR SAY

Clinic and gym link to offer Covid therapy

Clinic gets top cardiac quality award

HEAD OF WOMEN’S SERVICE APPOINTED

Use of Bupa’s web directory surges

COULD AN MVL SAVE YOU MONEY? – £100K EXAMPLE

Private sector shown to be a caring master

INDEPENDENT HEALTHCARE SECTOR KEY DEMOGRAPHICS

Private cancer centres agree deal with NHS Welcome for ‘Safety Tsar’

PRACTICAL TIPS FOR DOCTORS APPEARING AT VIRTUAL HEARINGS

Hearings ‘should not all be virtual’ Acquisition boosts PPM Software

Big change in GP practice due to Covid

Poll reveals wide gender pay gap for doctors

Top post in genetic cancer

Ease stress in pandemic

Survey shows Covid’s effect on clinicians

Self-employed hit hardest by money worry

A trawl through the archives: what made the news in 2011

Doctors at risk by not paying subs

Debts cured by card

Partnership accord vital for groups

Doctors risk new income tax inquiry

TELL US YOUR NEWS

COSMETIC

MARKET

Beauty treatments are still cutting it

Good progress, but still some way to go

Wake-up call

Buyer beware

Treatment abroad: the big change in 2020

Future view

A nice place to work

Ownership of work

Developing staff

ACCOUNTANT’S CLINIC: THE BUILDING BLOCKS OF ACCOUNTANCY

to of top tips

is for remuneration

Salary v dividends

Pensions

Personal tax

The future

CHECK OUT OUR BUSINESS DIRECTORY

Stop home working becoming a pain

GUIDE TO DELIVERING SUPERIOR PATIENT EXPERIENCE IN PRIVATE PRACTICE

How to be a flexible working

working winner!

Survey results

Benefits to employers

Flexible work aspects you must master

Benefits to employees

Benefits to patients

Communication

Technology

Recruitment

Training

Management

PUBLIC RELATIONS

Don’t buy your own hype!

Background checks

Consent is not just a one-off

At the heart of medical finance

Resolving disagreements

Recording consent decisions

Reviewing

Challenging circumstances