Be patient-focused and also save money
Adopting value-based healthcare brings advantages P14
Keeping children safe is a top priority
What you need to know when dealing with a child protection case P22
n See page 16
Stick with your investing plan
Don’t check your portfolio too often, warns financial expert George Uglow P32
By Robin Stride
A new initiative just launched to attract thousands of patients for treatment at five of the capital’s NHS private patient units (PPUs) has raised questions over the future of Healthcare London, a similar scheme announced last year.
The new London Specialist Hospitals (LSH) partnership brings together Royal Brompton and Harefield hospitals, Royal Marsden Private Care, Moorfields Private Eye Hospital, Royal National Orthopaedic Hospital and Great Ormond Street Hospital for Children.
They aim to be ‘the gateway for international patients looking for the latest cutting-edge care in a world-leading city’ and will market their first-rate treatments for orthopaedics, spinal neurosurgery, nerve injuries, cardiology and respiratory conditions, cancer, ophthalmology and paediatrics.
Independent Practitioner Today's PPU Watch columnist, Philip Housden, called the LSH project ‘the engine of future growth’ for the NHS PPU sector.
He said: ‘Although initially five specialist hospitals, future membership could be extended to others not in the first group; for example, Queen Square’s National Hospital for Neurology and Neurosurgery, part of University College London Hospital’s NHS Trust.
‘The group is understood to be already contributing to a central budget to build a new brand and share marketing costs, but also now has the opportunity to consider the future sharing of backoffice functions and costs.’
Ted Townsend, author of annual London private healthcare status reports, told this journal that the NHS PPU-only LSH consortium launch called into question the wider-based Healthcare London group, which includes both private and NHS hospitals.
‘This problem is solved with the NHS-only initiative, where the hospital specialties do not overlap. Although each hospital is strong in their specialty, they may collectively benefit from some NHS branding, and perhaps some favourable treatment from the Department of Health.’
Mr Townsend said questions remained about how the latest consortium would be staffed and paid for, and how it could attract patients.
‘Whether HCA and the Cleveland Clinic, plus the Cromwell and London Clinic, will continue to work together without the PPUs must be in doubt. And the question of whether the Home Office chooses to support either consortium with access to healthcare visitor visas remains.’
Healthcare London however gave a thumbs-up to LSH. Spokesman Michael Barker said his group was ‘excited’ about it. ‘There is space for everyone and every effort to promote London as a centre of excellence, and create a larger medical tourism economy for London, is welcomed.’
Colleague Elizabeth Boultbee, a healthcare consultant, responded: ‘Anything that expands London and its reach is a good thing… there’s room for us all.
doctors as well. Anything that will increase work is good for everyone.’
An LSH spokesperson said private care services supported the financial stability of hospitals and generated invaluable income that enabled any surplus to be reinvested back into the NHS for patients’ benefit.
‘The partnership members will collectively leverage their expertise and reputations to further drive international referrals, making LSH the healthcare providers of choice in London.’
Partnership benefits included sharing knowledge and best practice, pooling resources, being able to offer more comprehensive services to international patients and support a drive to attract patients from different countries.
‘This partnership should benefit all involved by providing the chance to share best practice and give the best possible support to patients and their families.’
LSH said that with each of its hospitals housing some of the world’s leading researchers, it could ensure patients were offered the latest drug treatments, surgical techniques and care supported with state-of-the-art equipment.
He said: ‘It appears that the inherent conflict of interests might be too great – not the ownership of the hospitals per se, but the overlapping of specialties within the grouping. For example, if a cardiac patient is identified, which hospital do they go to? ➱ See page three
‘If we can take work from Germany, US and the Far East, that’s all for the good – it’s good for
Bosses of the five NHS private providers expressed excitement at the development and its expected opportunities.
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Contact editorial director Robin Stride (right)
Email: robin@ip-today.co.uk
Robots can’t usurp the surgeon’s role
Urology surgeon Mr Hasan Qazi sets out why he believes robotic surgery is the future and why artificial intelligence should not be feared P12
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By Edie Bourne
Doctors have been urged to check that they have plans in place to address inheritance tax following a ‘record year’ for HM Revenue and Customs (HMRC).
The warning comes from specialist financial planners Cavendish Medical after it was announced that the tax paid on ‘gifts’ from loved ones has increased by more than 153% since 2011.
A total of £256m was taken by the taxman in inheritance payments on gifts in the 2020-21 tax year. Individuals can gift funds to loved ones to reduce the size of their estate, but must survive for another seven years to avoid inheritance tax being due – this is known as the ‘seven-year rule’. If the person dies within seven years, the gift will be included in the estate and inheritance tax may be charged on the sum.
Inheritance tax has also been in the news recently as rumours suggest it could be a useful political tool for the Government looking to increase votes in an election year.
There was much speculation before last year’s Autumn Statement that inheritance tax would be a target for Chancellor Jeremy Hunt. However, the forecasts proved unfounded and the nil-rate band remains frozen at £325,000 until 2028, despite being in place since 2008.
George Uglow, chartered financial planner at Cavendish Medical, told Independent Practitioner Today: ‘We often meet very busy doctors who do not have a valid estate plan in place to deal with inheritance tax.
‘Sometimes they have drafted a will but have not necessarily considered how to protect their assets or considered the tax implications. This could leave their loved ones
facing potentially substantial payments in the future.
‘With high inflation, soaring property prices and a nil-rate band remaining at the same level for 16 years, more estates than ever are likely to face an inheritance tax bill.
‘While there are number of tools and solutions available to protect against inheritance tax, there are also lots of important considera-
tions, such as affordability and sustainability, before taking action.’
He said gifting could be a simple and effective tool to reduce estates, but advice should be sought before restricting access to or giving away funds that might be required in the future.
The official figures also showed that general inheritance tax receipts reached £4.6bn for April to October in 2023, a significant increase of £0.5bn compared to the same period the year before.
Mr Uglow warned: ‘Inheritance tax is an important topic to discuss for any senior doctor – having worked hard to accrue assets, most want to ensure this can be passed to the next generation and beyond.
‘Assets subject to inheritance tax are charged at 40% – a staggering amount for family members to settle when there could be options to mitigate this. Please do arrange an estate plan with an expert rather than pay more tax unnecessarily.’
Bosses of the five NHS private providers who are collaborating under the London Specialist Hospitals banner have spoken of their hopes and opportunities for the group.
David Shrimpton, managing director, Guy’s and St Thomas’ Specialist Care , said: ‘As world leaders in heart and lung care, Royal Brompton and Harefield hospitals are excited to be a part of this collaboration with other great London specialist hospitals, working together to promote our private care services internationally and generating income to be reinvested back into the NHS.’
Mark Hawken, managing director of The Royal Marsden Private Care, said: ‘This partnership is an exciting development for all of the participating hospitals and an opportunity for all of us to bring even more patients the best-quality of care available.
‘Our private patients choose their own consultant who will personally oversee every aspect of their treatment plan, to ensure they receive the continuity and reassurance of one-to-one care.
Andrew Robertson, director for Private Care at Moorfields Eye Hospital, said: ‘This collaboration demonstrates the value of NHS pri-
vate patient units working together to deliver the highest-quality healthcare to patients from the UK and internationally, with all the financial surplus generated reinvested into NHS services for the benefit of all patients.
‘Moorfields is a world leader in ophthalmology and partnering with another four NHS centres of excellence, who are also worldleaders in their specialties, delivers an unbeatable service for international patients looking to travel to London for their healthcare.’
Chris Rockenbach, managing director, international and commercial, Great Ormond Street
Hospital for Children, said: ‘This collaboration will ensure patients from around the world can access the best and most trusted hospitals in London, meaning they can receive the most advanced clinical care in line with the highest international standards.’
Caroline Owusu-Bennoah, deputy CEO of the Royal National Orthopaedic Hospital , said: ‘London is home to world-leading specialist hospitals and this consortium of hospitals couldn’t be a better place for private patients in the UK and internationally seeking exceptional and expert care.’
See ‘PPU Watch’ on page 6
The London Clinic has launched a new 24/7 private GP service alongside new on-site GP services at its Harley Street hospital.
It said it is the only private hospital to offer the public 24/7, sameday access to a GP, 365 days a year.
Consultations are being offered through Doctorcall , the longeststanding provider of private patient home-visiting services in the country, and MyHealthcare Clinic, a doctor-led private GP service.
GPs are available for both faceto-face or virtual appointments, with all services bookable at www.
thelondonclinic.co.uk/private-gp.
Face-to-face appointments are available for walk-ins or directly via the website. The initial service is available from 2-6pm Monday to Friday.
Virtual appointments are over the phone or by video, 24 hours a day, as are home visits within one hour of central London.
Patients are charged £95 to see a GP at the hospital’s walk-in clinic 2-6pm Monday to Friday; from £65 to speak to a GP over the phone or via video call within an hour of booking, anytime of day and night; and from £195 for a
home visit within London zones 1-7.
Doctorcall founder and medical director Dr Charles Levinson said: ‘This one-of-a-kind facility is a unique way of revolutionising urgent care in the capital.
‘Three of the key leading innovators within the private healthcare sector have come together in an unprecedented way to deliver state-of-the-art urgent assistance to the growing number of patients embracing private medicine.’
MyHealthcare Clinic medical director Dr Akash Patel added: ‘Collaborating with The London
Clinic and Doctorcall is a testament to our commitment to delivering cutting-edge healthcare solutions.’
The London Clinic chief executive Al Russell said: ‘We know that there are obstacles to accessing primary care in the current market, and we’re pleased to be able to go further to help meet that challenge by delivering personalised care to more patients across London, whether in person, on the phone or in their homes.’
A new private GP clinic from Spire Healthcare’s London Doctors Clinic has opened at the Business Design Centre on Upper Street in Islington, providing people with access to same-day appointments and online booking.
Patients can collect medication prescribed during their appointment directly from their GP.
This clinic joins London Doctors Clinic’s 19 other London locations. With up to 84 GP appointments available weekly between 9am and 5.30pm on Mondays,
Wednesdays and Fridays, patients have the choice of booking either 15-, 30-, 45- or 60-minute GP appointments.
Prices for 15 minutes start from £89 for a weekday appointment (£105 weekends/bank holidays) and from £280 for 60 minutes in the weekday (£310 weekends).
Private GP services include blood tests, sexual health, men’s and women’s health, mental health and ECGs. Referrals for diagnostic investigations provide access to MRI, CT scans, X-ray and
ultrasound facilities for orthopaedic, urology, cardiac disease and chronic and acute pain conditions.
Private GPs can consult in a variety of languages either in-person, or through a video appointment.
GP Dr Daniel Fenton, medical director at London Doctors Clinic, said: ‘We are pleased to be offering easy access to fast, high-quality GP services to families and corporate clients in Islington. Our clinic is fully operational and has already cared for hundreds of people since opening our doors.’
New private GP services are now being offered at the Cleveland Clinic London’s new outpatient centre at 55 Moorgate.
The clinic said the location gave patients greater access to its ‘unique model of care and services with same-day and next-day appointments’.
As well as GP services, the centre
offers health screenings, sports medicine and services for women’s health, cardiology, dermatology, digestive diseases, gynae cology, urology, neurology, ophthalmology and orthopaedics.
Dr Robert Lorenz, Cleveland Clinic London president, said.
‘The Moorgate site will provide the highest-quality care and rapid
access to patients in this thriving area of London.
‘Patients in the City will be able to access our world-leading specialists and integrated care, enabled by technology, all within the Square Mile.’
Cleveland Clinic Portland Place Outpatient Centre opened in September 2021.
By Leslie Berry
Hopes are high for successful returns from a major marketing initiative aimed at bringing overseas patients for treatment in London.
This follows an initiative by The Harley Street Medical Area (HSMA) to showcase ‘London’s Healthcare Excellence’ last month at Arab Health 2024.
Long-term landlord and HSMA curator The Howard de Walden Estate returned to the show for the seventh year, accompanied by 13 of the area’s world-class clinics, medtech and hospital groups.
The Arab Health Exhibition & Congress took place at the Dubai World Trade Centre.
Based in the UK Pavilion, the HSMA collective demonstrated the very best of London’s healthcare excellence and the quality and diversity of services on offer to patients from the Middle East and worldwide.
This year’s distinguished group of clinics and hospitals included: The Royal Marsden Private Care, The London Clinic, Re:Cognition Health, Fortius Clinic, All Points North (APN), Phoenix Hospital Group, Welbeck Health Partners, Pharmacierge, Guy’s and St
A new mental health and wellbeing service for Independent Doctors Federation members is being offered through a partnership with Priory Private Healthcare.
The private consultants’ and GPs’ group said the confidential service would be offered at no cost
Thomas’ Specialist Care, John Bell & Croyden Pharmaceutical, Marris Medical, HCA Healthcare UK and Harley Street BID, a notfor-profit organisation.
The message was that together they offer world-leading expertise across key areas such as cancer care, diagnostics, mental health, surgical and digital health.
Julian Best, executive property director at Howard de Walden, said: ‘The Middle East is an important market with many patients seeking first class consultation and treatment in London.
‘We were proud to once again participate in the flagship UK
to members and give support including:
Critical incident support;
Information services, including citizens advice-based guidance;
Structured mental health support for a range of issues including bereavement, stress, anxiety, depression, low mood and relationships.
The IDF said it recognised that clinicians often face the same or similar stresses and pressures as their own patients and was committed to supporting its membership. Details on how to access the help are expected soon.
‘Our ongoing strategy is to enrich the healthcare cluster by attracting new world-class operators, technological innovation and research activity to this unique eco-system.
‘Carefully identifying unrepresented specialisms that add and complement the dynamic mix, while lifting the broader level of expertise is key to ensuring our real estate remains sustainable for the long term.’
Julian Best, executive property director at Howard de Walden
lective strengths of its diverse healthcare facilities and enjoyed clinicians’ presentations about their pioneering work.
These included:
Pavilion at the region’s premier healthcare conference, to shine a spotlight on the strengths and expertise of our community of healthcare professionals, many of which are renowned worldwide for providing outstanding patient care in the UK and globally.’
The HSMA said it has more than 5,000 healthcare specialists and 250 clinics working within 95 acres of Marylebone.
In recent years, it has attracted more healthcare providers of global repute, including Mayo Clinic and the Cleveland Clinic.
Conference attendees explored the HSMA stand to witness the col-
Pharmacierge taking to the stage to present ‘From e-Prescription to robotic dispensing, launching London’s largest digital pharmacy’;
Dr Emer MacSweeney, head of Re:Cognition Health, discussing Alzheimer’s and chronic traumatic encephalopathy – from new diagnostic biomarkers to innovative new-generation treatments;
Dr Mihaela Bucur from All Points North on ‘Re-imagining health – embracing the new era of lifestyle psychiatry for optimal mental well-being’;
Dr Angela George from the Royal Marsden discussing ‘Optimising patient outcomes –harnessing the power of genomics’.
Spire Healthcare is helping tackle the nurse shortage by taking on a dozen more nursing apprentices in ten of its English hospitals.
Their four-year nurse degree apprenticeship programme, run in conjunction with The University of Sunderland, leads to a BSc in adult nursing.
The latest students are at Spire’s centres in Cheshire, Clare Park in Surrey, Harpenden, Leeds, Wirral, Leicester, Liverpool, Manchester,
Nottingham and Clare mont in Sheffield.
Spire said the benefit of the apprenticeship route was the ability to earn while learning, with a starting salary of around £21,000 depending on experience.
Some of Spire’s 160 nursing apprentices graduated in November and it currently trains 500 apprentices across a range of specialties – 5% of its total permanent workforce.
Compiled by Philip Housden
The launch of the LSH will have a significant impact on the future shape and development of the London and perhaps the wider NHS private patient unit (PPU) sector, as the participants’ income is so significant in the regional and whole NHS context.
The estimated private patient incomes in 2022-23 from the specialist hospitals in the five member trusts was £305m – recognising that Royal Brompton and Harefield are part of Guy’s and St Thomas’.
This is a 71.4% majority share of the £427m total income reported by all London trusts and 47.2% of the £645.7m reported total private patient income of all England NHS trusts.
See story on front page
Delegates from 25 NHS trusts and providers attended the NHS Private Patient Service Summit to share best practice, network and enjoy collegial working.
Attendees heard from a range of industry experts and took part in some useful breakout sessions.
Mark Riley-Pitt, director and head of healthcare risk consulting at business service company AON, warned of the need to ensure sufficient indemnity for NHS PPUs.
He also addressed the issue of reducing risk and the changing options that trusts have to work with consultants to ensure appropriate, affordable cover for private practice.
I had the privilege of chairing the conference again and opened with my annual update on NHS trusts’ private patient performance in 2022-23 and post-pandemic.
David Powell, of the Aneurin Bevan University Health Board, south Wales, shared his experience of understanding nuances and spotting negotiation opportunities relating to contracts. These were interspersed by an interactive session on benchmarking NHS PPUs’ activity.
AXA, Bupa and Aviva private medical insurers took part in a panel question-and-answer session where trusts raised key concerns relating to the insurers’ relationship with the NHS and the challenges of achieving tariffs for the often-increased complexity of private cases that are managed within PPUs.
We also had directors of private
OCL Vision celebrated its first halfdecade in business by revealing it held 12,000 patient appointments in the past 12 months and has invested £5m in ophthalmic technology
Since launching in December 2018, the independent eye surgery brand has grown from one clinic to three and increased staff numbers from 11 to 80.
Operating at three venues in London and Hertfordshire, the company is eyeing expansion in 2024 in the Home Counties and the Midlands
OCL Vision reports demand for private surgery has surged 128% over the past five years at a time when it says many private hospitals have pared back their ophthalmology departments.
Surgeon-owned, the group has ten consultant ophthalmic surgeons and 12 optometrists. Chief executive Paresh Patel said the group was poised for national expansion.
care Marcus Taylor (Buckinghamshire Private Healthcare) and Andrew Robertson (Moorfields Eye Hospital) sharing personal case studies on the challenges they faced in 2023 and opportunities they were looking forward to developing in 2024.
I’m pleased to report that although the conference was held online again, organisers SBK Healthcare plan to return to a faceto-face event in 2024. The event was sponsored by Streets Heaver Healthcare Computing.
New eye care partnership between Moorfields Private and Cleveland Clinic London
Moorfields Private Eye Hospital has partnered with the Cleveland Clinic London to deliver ophthalmology services at 55 Moorgate, the latter’s new outpatient centre (see story page 4).
The collaboration is a first-ever partnership between Cleveland Clinic London and Moorfields Private Eye Hospital, two worldleaders in healthcare.
The partnership was launched with a rapid access and urgent care clinic offering same- and next-day appointments for adult patients experiencing urgent eye symptoms such as an unexplained sud-
den change in vision, trauma, suspected infection or eye discomfort such as dry eye, pain, redness or swelling.
Andrew Robertson, director of private care at Moorfields, said: ‘We are delighted to be a part of Cleveland Clinic London’s new development, which gives us the chance to offer our world-leading eye care to patients closer to where they work.’
Lindsey Condron, chief of operations for Cleveland Clinic London, added that the partnership would enable patients to have seamless access to world-class care in a stateof-the-art outpatient centre.
In 2022-23 Moorfields reported growth of £3.65m and 9.8%, with total private patient revenues of £40.8m; 15.4% of total trust income.
Moorfields Private reports that all financial surpluses generated in their partnership with Cleveland Clinic London will be reinvested into Moorfields Eye Hospital NHS Foundation Trust.
Philip Housden (right) is director of Housden Group commercial health care consultancy
Doctors in private practice have good reasons to be cheerful this year if the outlook being painted by independent providers proves to be correct.
Despite broader pessimism about the UK economy, with high interest rates and the cost-of-living crisis combining to depress consumer demand, independent healthcare providers are demonstrating increasing positivity.
An Independent Healthcare Providers Network (IHPN) report Industry Barometer: State of the Sector 2023 surveyed 49 independent healthcare providers on their views about their key markets and the issues affecting their business.
Despite clear challenges, the picture painted is positive across the independent healthcare market, in particular domestic self-pay markets and private medical insurance (PMI) funded care.
Nearly nine-in-ten companies across the sector felt the market environment for PMI-funded services was ‘very positive’ or ‘positive’.
This is followed by domestic selfpay services, with 86% describing the environment as ‘positive’ or ‘very positive’.
For NHS services, the numbers describing the environment as ‘positive’ or ‘very positive’ stood at 54%, a significant rise on the previous year when under a third (30%) of respondents reported that level of positivity.
It marks the continuation of a general trend of upward positivity year on year across the industry since IHPN launched the barometer four years ago.
Workforce remains the greatest challenge and area of concern, with nearly seven in ten identifying it as a key challenge, which mirrors findings from previous years.
Respondents highlighted four main ways to combat these challenges: growing their own through apprenticeships, training and development; creating new innovative roles or changing skillsets; increase training; and changes to contract/benefit packages.
Nine-in-ten providers expect training to increase over the next five years, with just under half planning to increase the number of clinical apprenticeships in their organisation.
The relationship and partnership with the NHS remains key and the report highlighted providers’ desire to continue to reduce the waiting lists in elective, diagnostic and community care through the delivery of NHS-funded services, although there is still a view that the NHS is not fully utilising the capacity and capability of the sector.
NHS policy towards the sector was highlighted as one of the big-
Independent healthcare providers are confident despite economic downturn and workforce challenges
90% of organisations feel ‘positive’ about PMI and self pay markets
The report’s findings marks the continuation of a general trend of upward positivity year on year across the industry since IHPN launched the barometer four years ago
‘Looking at this year’s barometer results, it’s clear that independent providers are positive about the prospects in all their key markets, with strong growth expected particularly in domestic self-pay and PMI but also in NHS-funded work as well.
‘This is despite the economic challenges, such as a cost-ofliving crisis, which is impacting all healthcare providers’ ability to run their organisations and recruit and retain staff.
gest challenges – 65% of respondents identified that this year, compared with 40% last year.
Drivers of NHS commissioner behaviour have been perceived to have changed, with ‘the pressure to achieve savings’ overtaking ‘the need to tackle NHS backlogs’, at 47% and 42% of respondents respectively. In 2022, almost twothirds of respondents viewed the need to tackle NHS backlogs as the key driver for commissioners.
Despite this, respondents believe that their relationships with the NHS are improving. 25% believe that the impact of Integrated Care Systems (ICS) have improved their business, up from 7% last year. Nearly six in ten believe that they feel involved in their local system, up from four in ten in 2022, and 43% feel that their relationship with NHS organisations in their local area have improved, up from 20% on last year.
Looking in the quality and safety space, other key concerns were the Care Quality Commission’s new assessment and inspection framework at 55%, and the data agenda (Digital Records, Outcomes Registry Platform and so on) at 40%.
There is widespread positivity about market environment – across self-pay, private medical insurance-funded and NHS-funded care
The quality of relationships with the NHS is improving and confidence is rising
‘While healthcare workforce is an issue for the entire healthcare system across the globe, it’s heartening that respondents are actively taking steps within their organisations to manage it.
‘Almost nine out of ten providers expect to increase their levels of training over the next five years and half plan to increase their number of clinical apprenticeships in the next year.
‘This illustrates the commitment that the independent sector has to training and developing the current workforce. IHPN will be doing more work on this in 2024 to illustrate the length and breadth of the sector’s contribution to workforce development.
‘We know that the health system works best when it utilises the efficiency and capacity of the independent sector and it’s heartening to see that private healthcare providers are still motivated to increase the volume and quality of their NHS-funded care, reducing NHS wait times and providing highquality care.
‘To see that providers feel that their relationship with local NHS organisations is improving bodes well for patients. It means that providers should have the opportunity to contribute even further to getting the healthcare system back on track.’
By Olive Carterton
Two doctors who founded a downloadable app to help people find qualified cosmetic practitioners are warning that the cost-of-living crisis may cause a business boom for unsafe aesthetic providers.
They shared their concerns after commissioning a survey revealing as many as nine out of ten men are worried about the effect financial stress is having on their appearance.
Men’s top five concerns were: weight/fitness (40%), skin quality (25%), teeth appearance (23%), eyebags and hair loss (19%).
The doctors found, perhaps surprisingly, the age most affected were men between 18 to 24 years, with a ‘staggering’ 40% worrying ‘a lot’.
Maxillofacial surgeon Dr Sieuming Ng, along with Dr Subha Punj, pioneered SafeAP ( https:// safeap.co.uk) to ensure non-surgical aesthetic procedures are delivered by qualified healthcare professionals in a safe environment.
Dr Ng, who has a private practice in Islington called SMNG Aesthetics, warned the physical impact of the cost-of-living crisis was prompting significant worries, and the survey responses painted a vivid picture of some of the surprising fears men were having.
She said: ‘What’s particularly worrying is the potential for a rise in the uptake of unsafe non-surgical aesthetic treatments, prompted by cost-cutting measures.
‘We’ve already seen this happen across a wide range of aesthetic procedures, with people having to live with physical and emotional consequences of cheap treatments for many years to come.
‘We want to do everything we can to ensure people seek non-surgical treatments in as safe a way as possible. In these challenging times, prioritising health and safety is paramount. While cheap, quick fixes may be tempting, they come with significant risks.
‘We encourage men to make informed choices, seeking qualified practitioners to safeguard
both their appearance and wellbeing.’
The research was conducted by independent survey company OnePoll on behalf of the downloadable app. It surveyed 1,000 UK males aged 18-50, breaking the results down by age and region.
The findings follow news reports highlighting the dangers of men seeking cut-price procedures abroad to restore hair loss, prompting plastic surgery societies to issue international warning guidelines.
Further research shows an increase in the percentage of men expressing interest in cosmetic procedures, underscoring a broader and largely unaddressed issue concerning men’s body image.
A previous study by SafeAP showed men were less fearful than women of complications as a factor preventing them from seeking procedures such as wrinkle-relaxing or filler injections and nonsurgical liposuction. Only 27% felt put off by horror stories they might see in the media.
Dr Ng and Dr Punj warned that men could be particularly vulnerable to predatory marketing tactics – especially as the same research showed that more than twice the amount of men (21%) than women (9%) admit to having already had a negative experience with a cosmetic procedure. Their ap allows clients to search and compare all qualified practitioners within a desired location. The verification process for each practitioner involves vetting of their medical/dental/nursing council registration, appropriate course certification for procedures provided, life support training, complete disclosure and barring service check and defence cover.
Nuffield Health and Icon Group, Australia’s largest specialist oncology services provider, are partnering to explore growth and investment priorities at Nuffield Health Cancer Centre London (CCL).
These include investment in technical capability, patient experience and medical leadership to support a development of services and more access to cancer care for patients.
Both organisations said the partnership would continue to see a collaboration with consultants shared between CCL and Parkside Hospital. Day-to-day patient appointments and operations at CCL continue as normal.
They are investigating how their
partnership could invest in Nuffield Health’s other cancer services at its UK hospitals.
The charity’s boss Steve Gray said: ‘Our ambition for the partnership is to meet the rising demand for cancer care by expanding our oncology services and develop leading cancer care pathways in the independent sector.
‘By combining Icon Group’s fantastic oncology research, innovation and investment expertise with our own connected healthcare experience across our hospital, fitness and well-being facilities in London, I believe both organisations can produce best-in-class cancer outcomes for more people.’
By Douglas Shepherd
Optegra Eye Health Care’s new UK managing director plans to expand the business ‘at a faster rate than ever before’ in 2024.
Mat Pickering said: ‘My role is to continue implementing the strong growth strategy and business plan which we have in place. We will launch a series of new dedicated NHS cataract clinics as we continue to provide timely access to treatment.
‘We are proud to see so many patients with a referral-to-treatment time of just four to six weeks, and our expansion into several new areas across England means we will help more people than ever before.’
Alongside the expansion and ‘lots of exciting new initiatives’, he
forecasted continued improvements in the service offered to private patients – from upgrading existing facilities and offering private treatments in new regions.
Mr Pickering said the company was one of the first UK providers to
offer an innovative new treatment for dry AMD light therapy. This launched last month as a pilot from its Manchester hospital.
‘Working alongside my excellent Optegra colleagues – both the leadership team and right across the
business – 2024 holds a great opportunity for the company, with lots of exciting new initiatives ahead.’
He has been with the business for five years as a hospital director, regional director and general manager.
Other management changes include an expansion of the UK leadership team with four new directors, recruited externally and internally.
Optegra said: ‘These changes will allow, at international group level, a dedicated team to focus on the overall growth strategy for the company and leading on the digital innovation and footprint expansion plans across UK and Europe.’
The team includes Dr Peter Byloos, chief executive and acting as managing director for the past five years, chief financial officer Jerry George and chief technology officer Dr Ola Spencer.
Dr Byloos said: ‘As the business expands and grows – last year was our strongest year to date – we recognise the need to invest in leadership and support for our increasing employee team, and so we are splitting my position with a dedicated UK managing director.’
Consultant founders of cardiac care provider One Heart Clinic (OHC) have opened a new outpatient facility in the City of London.
The 80 Cheapside venue will service its growing customer base just 400 metres from Bank Station. It provides convenient access to consultant cardiologists and offers the full range of cardiac diagnostics and tests.
Dr Ravi Assomull, partner and consultant cardiologist, said: ‘The new City facility brings a sense of real achievement. We knew when we started One Heart Clinic we were on to something very special.
‘It became clear that the challenge would be to replicate the same high-quality, patient-centric service across a wider geography.
‘I really believe our new City site is ideally located to bring comprehensive cardiac care closer to more people. This is the first of many
more cardiac hubs both in and out of London.’
OHC has three clinics in central London in Harley Street, Marylebone and the City, and clinics in Epsom, Reading in Berkshire and Hemel Hempstead, Hertfordshire.
A clinician-led organisation, it now has over 30 cardiologists working collaboratively.
A spokesperson said: ‘One Heart Clinic will continue to deliver evidence-based cardiovascular pathways that incorporate cutting-edge technology and ensure patients can have their diagnosis reached expeditiously.
‘This approach has made us a leading provider of cardiac care for many referrers, including private doctors and insurance groups. The City branch marks the first step in a continued expansion for the team with the opening of a dedicated cardiovascular MRI service following imminently.’
A
look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Private patients were increasingly complaining they were not being given adequate pricing information about the cost of outpatient appointments.
According to the Independent Sector Complaints Adjudication Service (ISCAS), gripes included a lack of transparency over doctors’ fees and a reluctance to discuss charges with customers.
ISCAS said: ‘While it may not sit easily with the clinical focus of a consultation, this is no time to be coy about charges. Understanding how much treatments cost is of fundamental importance to patients when deciding whether to undergo independent healthcare.’
It warned doctors were wrong to think that only patients paying for healthcare directly were concerned about charges.
Those with a health insurance policy also needed full information to understand whether they were reaching their limit for cover and might need to make co-payments. Some were also wary about the implications for future premiums.
Leading independent practitioners and key figures in the private healthcare market were being called to a high-level think-tank to discuss Harley Street’s future.
They were meeting amid fears for the future ability of the enclave to attract enough business in the face of growing overseas competition.
Keith Pollard, the man behind the initiative, told Independent Practitioner Today that the topic could not be more important to the private healthcare industry.
He said: ‘The future of Harley Street is vital to the future of private healthcare in the UK, as it’s the brand everyone associates with private healthcare both in the UK and around the world.
‘That brand needs to continue to grow and strengthen in both the domestic and international marketplace to compete with emerging competitors.
‘This means continuing to offer the latest treatments, the best
surgeons and the best levels of patient care as well as marketing and promotion of Harley Street around the world.’
Specialists faced a hefty rise in their motoring costs following a far-reaching tax case judgment that prevented them claiming mileage to and from their homes to regular places of business such as private hospitals.
Revised Competition Commission plans to increase private healthcare market competition brought a mixed bag of fierce criticism and cheer within the sector.
It had proposed:
Prohibiting or restricting private hospital incentive schemes to doctors;
The collection and publication of information on the performance of private hospitals and individual consultants;
Provision of fee information to patients;
The selling of nine private hospitals including HCA’s London Bridge and Princess Grace.
HCA said the Commission misunderstood the market and
was threatening unjustified and unfair remedies.
Private healthcare in the UK had a ‘bright’ future as public sector outsourcing continued to grow, according to market analysts.
Laing Buisson’s chief executive William Laing said the better economic news of recent months would, if continued, boost private spending on healthcare again. Independent healthcare was still feeling the repercussions from the 2008 global credit and ensuing recession.
High-achieving independent practitioners were being advised to decide how best to protect their pension pot from steep tax charges due to hit them in the coming weeks.
Individual Protection 2014 allowed doctors to protect the value of their pension rights as at 5 April 2014 up to a max of £1.5m. And they would still be able to accrue benefits through both occupational and private schemes without losing the protection.
I’m an ophthalmologist and my dad is a retired consultant. We’d been out for lunch and a few drinks when we came across a badly injured motorcyclist. Despite us doing everything we could, he died.
Months later, we received coroner’s letters, asking us to give evidence at the inquest. I went cold. What would this mean for my career?
From the moment I called Medical Protection, they took away a huge burden. They assigned us a case manager who helped us prepare for the legal process. They say they’re always there for you, and they really are. They know exactly what to do and they just get on with doing it.
In the end, I received no criticism in court. The relief was indescribable. I am incredibly thankful to have had Medical Protection by my side.
Urology surgeon Mr Hasan Qazi sets out why he believes robotic surgery is the future and why artificial intelligence (AI) should not be feared
ROBOTIC SURGERY represents the biggest change I have witnessed in my career as a urologist. It’s revolutionising the way we operate.
I started my career in 2001 and I remember my first list as a urology trainee, when the patient had their prostate removed for prostate cancer. The incision on the abdomen was over six inches long, the operation took five hours and the blood loss was close to a litre.
This resulted in the patient staying in hospital for several days. They had a catheter in the bladder for three weeks and when we saw them in clinic six weeks later, they had only just about resumed normal activities in their life.
Today, the same procedure using keyhole robotic surgery takes under two hours, with less than a quarter of blood loss and just an overnight stay for most patients.
The catheter stays in for about a
week and when I see patients in clinic in three weeks, they have already resumed a full range of dayto-day activities in their lives. The outcomes are superior and repeatable thanks to the use of the robot.
From a surgeon’s perspective, compared to open or even standard keyhole surgery, it’s far less demanding and there’s little difference in my energy levels between the first and the last case of the day.
In my NHS practice at St George’s University NHS Hospital, all procedures for prostate or urinary bladder cancer are now done using the da Vinci Robot, as are the vast majority for kidney surgery and reconstructive, non-cancer surgery.
The da Vinci robotic-surgical system is a sophisticated version of keyhole surgery. Small instruments, connected to the robot, are inserted into the patient’s abdo -
men and the surgeon sits within the operation theatre, and his hand movements are replicated by the robotic instruments.
The instruments are about 20 times smaller than the human hand. This, combined with tenfold magnification for the surgeon, makes the operation extremely precise.
Any minor tremors the surgeon has are removed and the robotic hand can undertake movements not possible by the human-hand.
The robotic-surgical system has limited AI and this detects and blocks large, unsafe movements. For example, if a surgeon were to have a seizure while operating, it would detect any sudden, large and possibly damaging movements and block them.
Over the past decade, the number of robotic surgical systems in use across the UK has grown. They are being utilised across a number of different specialties, including bowel, chest, ENT, gynaecology and paediatric surgery, with an increasing number of surgeons adopting robotic surgery as the standard of care.
In the past, patients were routinely told that there is a risk of conversion to open surgery. In my practice, none of my last 1,000 patients have had to be converted because any intra-operative issues can be dealt with using the robotic surgical system.
In this era of AI, there’s much talk about robots taking over. I’m excited about using AI to our advantage.
For example, a number of companies have developed robotic surgical systems that can map cancerous growths within the organ to be removed. These are fused with the surgeon’s view in real time and they can assist the surgeon towards better outcomes. However, there is variation in every operation we undertake.
Every patient has a unique internal anatomy and the shape, size and number of tumours within any organ is unique to that patient.
With increasing experience, I have also developed a ‘feel’ for tissue I encounter during surgery which represents an unexpected finding not seen on a scan and I account for these variations.
Additionally, I take responsibility, personal and medico-legal, for all procedures I undertake.
This would be a challenge for a robotic system with advanced AI and I would find it challenging to justify a surgical complication to a
patient because of an inadequacy of the robot.
For a patient, the human connection with their surgeon is important; it’s a bond of trust and faith. The awareness that the surgeon, with all their human factors, will be fighting their corner is a hugely important part of the patient journey. Replicating that with a robot may not be easy.
At Nuffield Health Parkside Hospital in Wimbledon, London, we have invested in the da Vinci Xi robotic surgical system. With an experienced team of surgeons with several thousand operations under
our belt, we are looking forward to improving outcomes for patients and proving my belief that robotic surgery is the future.
Mr Hasan Qazi is a consultant urology surgeon at Nuffield Health Parkside Hospital and at St George’s University Hospitals NHS Trust. He was appointed consultant in Glasgow in 2012 and set up the department of robotic surgery. He is the lead for the RAPID prostate cancer diagnostic centre, one of three centres across the UK utilising advanced MRI Fusion technology for diagnosis of prostate cancer
Diagnostic Audiology Including Paediatrics • Tinnitus Rehabilitation • Vestibular Testing • PTA & Tympanometry • Speech Audiometry • Speech In Noise Testing• Specialist Tests Including OAE, VEMP & ASSR • Ear Wax Removal • Independent Hearing Aid Provider
Adopting valuebased healthcare brings numerous advantages including the ability for private practitioners to improve the financial sustainability of their practices as they optimise resource utilisation and avoid unnecessary procedures and treatments.
Pamela Poku (below) reports
(VBHC) has gained traction across health systems globally since it was first introduced by Michael Porter and Elizabeth Olmstead Teisberg in 2006.1
It focuses on achieving the best possible health outcomes for patients while optimising the use of resources.
This approach demonstrates a shift from the more traditional fee-for-service and general taxation models, which focus more on the quantity of services provided than the quality of care.
The model in particular aims to empower patients on their healthcare journey by taking into account their values and wellbeing preferences.
In England, around one million
people are listed on more than one waiting list to receive treatment. 2 To help manage this backlog, the NHS has made agreements with the private sector to help deliver patient care.3
Additionally, recent research has shown that one-in-eight people have chosen private health services in the last year due to frustrations over procedure delays.4 This presents an opportunity to incorporate the principles of VHBC, which emphasise quality, efficiency and patient-centred care in a timely manner.
Elsevier Health’s Clinician of the Future 2023 Report revealed that doctors and nurses already hold a positive view of VBHC, with most expecting it to reduce the burden on secondary care and improve the
patient experience while saving costs.5
In light of this context, an even greater emphasis has been placed on the potential role that valuebased healthcare could play and the importance of the private sector in delivering the best possible outcomes for patients.
The private sector’s top priority has always been to improve patient outcomes and, with practitioners actively supporting the NHS with health services, delivering highquality care is even more important.
With the NHS under intense pressure from rising waiting lists for treatment and persistent workforce shortages, the private
sector plays a crucial role in providing patient care.
An example of a private healthcare provider that has implemented some of the VBHC in practice is Spire Healthcare. In 2021, this UK provider launched The Quality Improvement Strategy to enhance its quality improvement culture.6
To date, it has managed more than 120 projects, where it not only improved patient outcomes and experiences, but also improved efficiencies and reduced waste.
The implementation of VBHC has several potential benefits for private practices and their patients:
➤ Enhancing patient-centred care: This delivery model emphasises the provision of patient-centred care, focusing on the overall well-being of patients rather than solely treating their diseases.7
Through this approach, the private sector can improve patient satisfaction and engagement, which can ultimately lead to better health outcomes and financial stability. Further to this, such providers can better support the NHS, reducing the current burden of the rising waiting lists.
➤ Facilitating easier standardisation of care: VBHC involves tailoring services to meet the needs of the target patient population.
The private sector often has more autonomy on budget allocation, which enables a more patient-centric approach and facilitates the standardisation of care practices to align with the defined patient needs, contributing to the value-based model.
➤ Creating sustainable health systems: With the adoption of VBHC, private practitioners can improve the financial sustainability of their practices, as they optimise resource utilisation and avoid unnecessary procedures and treatments.
For private healthcare providers to benefit from this delivery
model, practitioners need data to make informed decisions about treatment plans and patient care.
However, as the private sector supports the NHS in some health services, there remains a gap in the quality of data available in patient health records.
To bridge this gap, NHS Digital and the Private Healthcare Information Network (PHIN), formed the Acute Data Alignment Programme (ADAPt) in 2021, to create a single repository of healthcare information.8
This programme combines data from the NHS and private healthcare to help facilitate better insights and lead to improvements in care and treatment for all patients across both sectors.
Given these benefits and the availability of the ADAPt, it can be seen as a natural shift for the private sector to show interest in adopting value-based healthcare principles, as this would align with their top priority in delivering high-quality care.
Although health systems can benefit from VBHC, there are still several barriers associated with implementing this approach:
Lack of interest in promoting a value-based healthcare culture: At the board level, there tends to be a reluctance to change and the language around value is not socialised as ‘normal’.9
Limited data-driven insights: Fragmented data prevents the generation of meaningful insights and analyses that can guide evidence-based decision-making.9
Lack of measurement: If effective clinical data collection is not in place, reporting patient information and accurate co-ordination of care become a challenge.9
Limited transparency: A lack of transparency in the decisionmaking process can result in a major structural barrier that limits adoption.10
As the healthcare landscape continues to evolve, the acceptance of value-based healthcare in private health systems continues to grow.
The implementation of VBHC should not be seen as a necessity but rather an opportunity to rebalance healthcare delivery and introduce a system where quality, standardisation of care, efficiency and patient experience and satisfaction takes centre stage.
Implementing tools like clinical decision-support solutions can aid the introduction of VBHC in private practice.
Such solutions have the potential to empower clinicians with trusted evidence-based information to make well informed clinical decisions, ultimately leading to improved patient outcomes, effective use of resources and enhanced patient experience.
By embracing value-based healthcare, health systems can contribute to a transformative shift in healthcare delivery, benefiting both patients and their organisations in the process.
At the heart of Elsevier’s Clinical Best Practice Council lies five compelling narratives rooted in key industry trends that impact healthcare organisations, patients, and clinicians worldwide. To learn more, visit www.elsevier.com/en-gb/health/clinical-best-practice-council.
Pamela Poku is a registered nurse, healthcare value specialist and member of the Clinical Best Practice Council at Elsevier
References
1. Porter M.E, Teisberg E.O. Redefining Health Care: Creating Value-Based Competition on Results. Boston, US: Harvard Business Press. (2006).
2. Triggle, N. (2023) One million people on more than one waiting list as NHS backlog grows, BBC News. Available at: www.bbc.co.uk/news/health-67367311.
3. Waiting for NHS Hospital Care: The role of the independent sector. The Health Foundation. Available at: www. health.org.uk/publications/long-reads/ waiting-for-nhs-hospital-care-the-roleof-the-independent-sector.
4. One in eight Britons pay for private health services, survey shows (2023) The Guardian. www.theguardian.com/ politics/2023/apr/17/one-in-eightbritons-pay-for-private-health-servicessurvey-shows.
5. Clinician of the future 2023 – assets. ctfassets.net. https://assets.ctfassets.net/ zlnfaxb2lcqx/3CKQYVWKqoF75jKTMmb WkY/ e67283ff092a738ca149cb9844530421/ CLINICIAN-OF-THE-FUTURE_ REPORT-2023.pdf.
6. Spire Healthcare Quality Account 2022-23. www.spirehealthcare.com/ media/29007/spire-healthcare-qualityaccount-2022-23.pdf.
7. Allied Health Framework for ValueBased Health Care 2022. www.health. qld.gov.au/__data/assets/pdf_ file/0026/1190267/Framework.pdf.
8. NHS choices. Available at: https:// digital.nhs.uk/services/acute-dataalignment-programme#:~:text= About%20ADAPt,-The%20aim%20 of&text=The%20purpose%20 is%20to%20protect,place%20at%20 the%20right%20time.
9. Hurst L, Mahtani K, Pluddemann A, Lewis S, Harvey K, Briggs A, Boyle A, Bajwa R, Haire K, Entwistle A, Handa A and Heneghan C. Defining Value-based Healthcare in the NHS: CEBM report.
10. Value-based healthcare in Spain: Regional experimentation in a shared governance setting. The Economist https://impact.economist.com/ perspectives/health/value-basedhealthcare-spain-regionalexperimentation-shared-governancesetting/white-paper/value-basedhealthcare-spain-regionalexperimentation-shared-governancesetting
The big question for many solo independent practitioners is whether they should stay that way – or work through a group. Sue O’Gorman has some smart advice for those considering their options
MANY CONSULTANTS will reach a point in their private practice journey where they will start to consider the advantages of remaining a solo practitioner versus becoming part of a group practice.
While both options may present challenges and opportunities, these can vary depending upon where they are in their ‘life cycle’.
Increasing financial pressures, the demands of a young family and the operational and overheads costs of setting up in private practice all factor into the decision-making process.
Here are some points to consider if you have reached that stage that may help you clarify your decision a little further:
Collaboration
Knowledge sharing : There has been a seismic shift in the evolution of groups over recent years. Not least because in a group practice doctors can collaborate and share their knowledge and expertise in an increasingly governed industry.
This forms a supportive environment where clinicians can share best practice with each other. Groups also provide opportunities for clinicians to discuss complex cases together, leading to enhanced patient care and reputation.
Expertise and subspecialisation
Diversity of specialty: Group practices lend themselves to diversity, allowing for a holistic approach to patient care for certain cases.
This may lead to greater patient satisfaction and increased trust in their clinician, whom they are more likely to recommend onto friends and family.
Operational economies
Overhead sharing: Financial savings can be gained by group practices by the sharing of costs such as consulting room rental, administrative staff, marketing, billing, software systems and equipment.
Some hospital groups may also offer commercial models to support groups, assuming responsibility for the operational over➱ continued on page 18
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heads in exchange for an agreed fee.
This takes away the day-to-day burdens of running a private practice from the clinicians, who are then able to focus on treating patients rather than dealing with any operational issues when they arise.
Absence cover: When you are away from the clinic, you will have the peace of mind that your patient is cared for by a trusted colleague, especially important for emergency situations or when your patient has ongoing health issues.
Patients often become frustrated if they cannot reach your office when you are away, so having a cover arrangement within the group is a great ‘value add’ to your brand and reputation.
Increased hours and coverage : Group practices are able to offer a greater choice of hours, availability and expertise. This offers patients access to the best healthcare services when they need them. Surely the very ethos of private care.
Multidisciplinary approach: The availability of colleagues who can review cases contributes to improved quality of care for the patient and allows feedback between clinicians to ensure best practice is continually adhered to.
Cross referral opportunities: A group practice will facilitate opportunities for clinicians to cross-refer within the same practice, streamlining co-ordination of care without the need for the patient to seek treatment outside of the group.
Shared costs: Depending upon the specific commercial framework, a group set-up can reduce loss in income when clinicians are away; for instance, ensuring there is always cover if your secretary is absent, as most groups will employ more than one medical secretary or administrator.
Patients are less likely to divert to your competitor when you offer
Patients are less likely to divert to your competitor when you offer consistency of care provided for by your colleagues in the group
consistency of care provided for by your colleagues in the group.
P osition as authorities in your specialist area: Marketing efforts are often more effective when done collectively.
A combined brand presence can lead to increased visibility in the community and a broader reach, attracting a larger patient base than individual practitioners might achieve on their own.
Enhanced reputation: By collaborating with groups, private hospitals can offer a broader range of specialised services, attracting a more diverse patient population.
In addition, a collaboration with a well-regarded group of doctors can enhance the hospital’s reputation. The collective expertise and established reputation of the clinicians can attract patients seeking high-quality healthcare services, thereby boosting the hospital’s credibility.
Shared workload: With a group practice set-up, clinicians can share the clinical and operational workload which often leads to a better work-life balance.
This can help prevent burnout and contribute to an increased job satisfaction, particularly when clinicians may also have a busy NHS practice too.
Values and strategic goals
It is also important to ensure that the individuals within the group have aligned values, goals and drive to achieve long-term success. Coming together as a group is not without its challenges, but it should be conducive to an environment where all pull together in the same direction and one of support and collaboration.
Groups may become fragmented if one partner feels they are carrying the group by doing the lion’s share of the operational workload.
SOLO PRACTICE BENEFITS
Remaining as a sole practitioner also has some distinct advantages.
Retaining autonomy
As a sole practitioner, you continue to have full control over the running of your practice. There is no requirement to consult and compromise with partners.
There are now a variety of commercial models available to some clinicians over recent years, such as employment models by the hospital groups, which may also appeal to those who seek an alternative way of working while remaining as a sole practitioner.
Direct patient relationships
Sole practitioners often have longstanding relationships with their patients and the families of their patients they have courted over many years. This may foster a greater trust among patients, as there is a consistency in approach to their treatment.
Some patients may have a preference for a particular style of ‘bedside manner’ and choose their clinician over and above others for this reason.
Financial benefits
In some instances, remaining as a sole practitioner can lead to higher earning potential, as there is no requirement to share profits with partners.
You have direct control over your practice’s financial decisions and potentially reduced overhead costs that are associated with running a group.
Commercial agility
Sole practitioners can be more nimble and adaptable to changes in the healthcare industry.
They are able to implement new technologies, adopt to various practice models or make adjustments to their services without the need for extensive consultations or personal differing agendas of partners within the group.
Without the need for consultation or consensus from partners, the
Without the need for consultation or consensus from partners, the decision-making process is more streamlined
decision-making process is more streamlined. This allows for adaptation in a more timely manner when changes arise within the healthcare landscape or within the practice.
As a sole practitioner, you can tailor your practice to your preferred style and delivery. You may wish to implement personalised care plans and treatment options based on your own expectations and patient preferences.
While there are clear advantages to both, it is essential to note that individual preferences and the nature of the specialty, commercial or political climate of the sector can influence whether a doctor chooses to work in a group or remain in a solo practice. Ultimately, the choice depends on the practitioner’s goals, work and lifestyle, and the requirements to best service their patient population.
Sue O’Gorman (below) of Medici Healthcare Consultancy provides services to help healthcare professionals think and act commercially. For further information, she can be reached at www.medicihealthcareconsultancy.co.uk or by phone on 07985 456487.
The self-pay patient is a significant component of any successful private practice. Simon Brignall (right) discusses how to manage them effectively so that you can reap the benefits
SELF-PAY PATIENTS have led the expansion in activity in the independent healthcare sector since the height of the Covid pandemic in 2020.
In 2023, while the predominant story was the increase in demand from insured patients accessing private healthcare, the levels of self-pay activity continued to remain at historical highs.
At Civica Medical Billing and Collection, we are raising 50% more self-pay invoices as a percentage of the invoices we raise annually than we did in 2019. This has been despite the headwinds created by the cost-of-living crisis, and we expect this trend to continue due to the following factors.
☛ Waiting lists
Issues around NHS access, with waiting lists at record levels, are the main reason patients cite for choosing to go private.
With a General Election at some point in 2024, there is political consensus that the private sector will have to be part of the solution in what is likely to be a decadelong problem.
Many of these patients may be choosing private healthcare for the first time and, with satisfaction and service metrics high, are likely to make recommendations to friends and family.
☛ Wealthier elderly patients
As a demographic, the older generation are getting wealthier. Many have benefited from rising house prices and have been protected from the impact of many aspects of government policy and, as such, are in a better position to
➱ continued on page 20
access private healthcare than ever before.
Combine this with increased aspirations for their retirement, often based around greater quality-of-life expectations, and it means they are more likely to access the independent sector than previous generations.
We have seen the growth of selfpay impact all specialties and client types whom we partner, from clinicians to clinics and hospitals.
Some specialties such as dermatology can have practices that comprise of 50% or more self-pay patients and are even making decisions about whether they want to treat all insured patients.
Other sectors such as mental health and private GPs can be predominantly all self-pay. It is important to note that due to the ongoing relationship these clinicians have with their patients that necessitates the need to raise many invoices to the same person, it is vital that the payment pathway is simple and effective.
We have also seen a growth in private GPs, with many hospitals adding them as a gateway to the services they offer. Walk-in clinics, which offer a range of services from same-day GP access, sexual health screening and vaccinations are now common in most city centres.
Self-pay patients are a vital component of private healthcare; both because the demand is increasing and, unlike insured activity, you have complete control over the fees that are charged.
Consultants can set their fees based on a range of factors such as their experience, the demand for their services and their competition.
If you have not updated your fees in a while this could be a good time to conduct a review of your fee structure and we suggest that this is something you should seek to do on a regular basis.
Having shown the value of selfpay patients to your practice, we can see that it’s important to make sure that these patients are managed effectively both from a billing and collection perspective.
In our experience, this is often
Self-pay patients are a vital component of private healthcare; both because the demand is increasing and, unlike insured activity, you have complete control over the fees that are charged
As a result of the increasing cost of healthcare and a desire to keep premiums to a minimum, many private medical insurance companies have amended their policies to include clauses which outline thresholds/outpatient limits or require co-payments or excesses.
Whatever the rationale for these patient liabilities, it still falls on the practice to administer this task.
not the case. Practices rarely offer a range of payment options to allow for simple invoicing and secure payment collection and the chasing of outstanding debts is often sporadic.
The result is that the practice accumulates a large amount of outstanding debt leading to cash flow difficulties or, even worse, the loss of income.
It is important to consider the types of self-pay patient that comprise your private practice. Here are some of the main types we manage for our clients.
For self-pay patients, it is important you have a published price list or to have notified the patient of their fee in advance. It is best practice to also confirm the payment options that are available as well as when payment is due.
Our company offers a variety of payment pathways available to our clients tailored to the needs of their practice:
Most commonly, we invoice patients after their treatment, offering a range of payment options which includes a link to our payment portal for 24/7 payment collection as well as via our payments team;
Invoicing and collection of payment in advance, when required;
Money can also be collected on the day or by the practice team via our Client Self-pay platform.
Remember that when you are invoicing patients post treatment date, you will need to put in place a robust chase process for any outstanding invoices and ensure that this is followed regularly until payment is collected.
Failure to implement this effectively is the most common reason we see practices with spiralling debt levels and issues around cash flow.
This is always the area that even the most efficient practices find challenging and often makes up a significant amount of their aged debt. This is why it is important to have a robust process in place and ensure that it is routinely followed.
Remember, most patients do not review the terms of their insurance policy; they assume that all costs are going to be met by their insurer, so when they receive an invoice for an outstanding balance not covered by their insurance company, this can come as quite a shock.
From our experience, a lot of patients will ignore the invoice, thinking that it is either a copy of what has been sent to the insurer or that their insurance company is liable.
This is why it is important to follow up with the patient directly and clearly explain what is owed and why.
Some patients may choose to contest this with their insurer, as they may believe that their private medical insurer is liable, which is why it is important that any issues are highlighted as soon as possible to minimise delays.
Once the patient accepts that the money is owed by them, then steps need to be put in place to take payment.
➲ Collection by the facility
It is increasingly common for hospitals and clinics to collect monies on behalf of their clinicians. This can be for a consultation or as part of a fixed-price package (FPP) for a procedure.
The FPP is where the consultants, anaesthetist and facility fees are combined to show one price to the patient.
It is very important not to overlook this area of self-pay even though the facility concerned raises the invoice.
Make sure that these patients are recorded, that all payments in
relation to these fees are reconciled and, most importantly, any that are outstanding are chased. Hospital administration can vary dramatically between different units and can suffer from the impact of personnel changes. In our experience, it is very common for payments to be delayed or more often to get missed entirely.
We raise an invoice to the hospital for your fee on our system, reconcile the payments received and chase the relevant finance department to obtain any outstanding fees.
Some practices regularly treat the same patients or patients’ family. Mental health practitioners can treat patients for a period of time and a private GP practice may look after an extended family for decades.
The fact that these patients will require repeated invoicing makes it even more important that the process is as frictionless as possible. We offer our clients the ability to settle multiple outstanding invoices at the same time as well as the option to add a payment link to their website.
The growth in self-pay activity has been the major trend in private healthcare for more than a decade and the impact of the pandemic has only caused this to accelerate. It is important that you review how you manage these patients to ensure you offer them the pay -
It is increasingly common for hospitals and clinics to collect monies on behalf of their clinicians. This can be for a consultation or as part of a fixedprice package for a procedure
If you are going to see a patient who is not a resident of the UK, it is even more important to make sure that your fees, method of payment and payment date are made clear, because once they leave the country, it is extremely difficult to collect any fees owed.
As a rule, for most of the clients we have that deal with international self-pay patients, we collect the money in advance of treatment to remove any uncertainty.
ment pathways that meet their needs.
Often the simplest and most effective solution is to partner with a billing company that offers both the expertise and full range of functionality a modern private practice needs.
Simon Brignall is head of sales and accounts at Civica Medical Billing and Collection
What do independent practitioners need to know when dealing with a child protection case? Dr Sally Old explains
EVERYONE WORKING with children has a duty to safeguard and promote their welfare and should be able to recognise and act on signs that a child may be at risk of abuse or neglect.
As such, it is vital that the best interests of the child should inform your decision-making and safeguarding responsibilities, and these should take priority over the interests of the parent or carers.
The ethical and legal duty for doctors to act on safeguarding concerns have not changed and are set out in the GMC’s Protecting children and young people: The responsibilities of all doctors
However, it is important to be aware of local child protection arrangements in order to respond effectively when a child is at risk.
This GMC document highlights that all staff working in healthcare are expected to receive safeguarding training.
The Royal College of Paediatrics and Child Health has produced a competency framework which outlines the responsibilities and training required for healthcare professionals and those in contact with children.
Furthermore, it states that local authorities, police and Integrated Care Boards all have responsibility for reviewing the deaths of children in the area. Any multi-agency panel or structure in place to review
deaths should include a designated doctor for child deaths.
In addition to the GMC’s guidance, the Government has also produced Working Together to Safeguard Children, which sets out multi-agency arrangements in which a number of agencies are responsible for setting out local plans to protect children from abuse and neglect. These ‘safeguarding partners’ replace the old Local Safeguarding Children Boards.
Recognising potential signs of abuse and raising concerns Consultations are an opportunity to notice changes in behaviour such as becoming withdrawn, failure to thrive or unexplained inju-
Even if your suspicions turn out to be groundless, raising your concerns can be justified if you have done so on the basis of a reasonable belief and through the appropriate channels
if your suspicions turn out to be groundless, raising your concerns can be justified if you have done so on the basis of a reasonable belief and through the appropriate channels.
ries. It may also be a chance for a child to confide their fear or distress to someone they know and trust.
If you have concerns about a child’s welfare, you must act. Even
The GMC’s guidance also makes it clear that you must be able to justify a decision not to immediately share a concern that a child or young person may be at risk of abuse or neglect. You must record your concerns, discussions and reasons for not sharing information in these circumstances. If you are in any doubt about whether to share information, seek advice from a colleague, your local named doctor for child protection or your medico-defence organisation.
Bear in mind that medical professionals can refer a child to a local authority without consent or parental authority if it is necessary to safeguard a child.
Keep a record of your decision and the reasons for it regardless of whether you share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.
It is also important to share only necessary and relevant information and to share it in a secure manner.
Additional guidance on child protection can be found in the National Institute for Health and Care Excellence’s (NICE’s) Child maltreatment – recognition and management and its Child abuse and neglect guidance.
In conclusion, judge each case on its own merits, be aware of local procedures and relevant national guidance and that you have a duty to act on concerns that a child or young person is at risk.
Consider arranging or requesting training in child protection for yourself and your staff, if needed.
Intercollegiate guidance recommends that all – even non-clinical – staff working in healthcare should have basic child protection training (level one) and that those who have any contact with children and young people, or with adults who may pose a risk to children, should have further child protection training (level two or above).
Finally, if you have any concerns or questions, seek advice from a colleague, your local named professional for child protection or your medico-defence organisation.
Dr Sally Old (right) is a medico-legal adviser at the Medical Defence Union (MDU)
While the field of genomics is already having a significant impact on oncology – and this is only set to increase – significant innovation will affect the treatment space over the next ten years.
Dr Tim Woodman (below), medical director of policy and cancer services at Bupa UK Insurance, reports in the first of a two-part analysis
THERE ARE five key areas with the potential to have the most significant impact for us at Bupa and other healthcare providers.
In this feature, I’m going to explore the first three in more detail:
1 Liquid biopsies, including multi-cancer early detection tests;
2 Cell and gene therapies;
3 Cancer vaccines;
4 Digital oncology;
5 Artificial intelligence (AI) in cancer care.
Liquid biopsies, including cancer early detection tests
Liquid biopsies are increasingly being used in clinical practice. They are tests to diagnose or analyse tumours using fluid samples such as blood, saliva or urine rather than a solid piece of tissue.
They offer a personalised approach to cancer detection and treatment that is minimally invasive and could enhance patient outcomes and potentially reduce cancer care costs.
A subset of liquid biopsies are multicancer early detection (MCED) tests. They represent a significant potential shift in cancer care, enabling the simultaneous detection of numerous potential cancers.
This capability not only enhances early detection but also revolutionises our approach to comprehensive cancer screening. Liquid biopsies can test for a single type of cancer or a MCED test can check for many different types of cancer in a single test.
They also have the potential to play a role in the triage of cancer patients, where those who require urgent care are prioritised.
While it is challenging to refer patients with non-specific symptoms of cancer for further testing, an affordable liquid biopsy triage – ideally able to detect multiple cancers – could be used with these patients to allow for rapid early assessments and investigations. Although liquid biopsies may
Liquid biopsies can test for a single type of cancer or a MCED test can check for many different types of cancer in a single test
increase the number of patients who have abnormalities referred for further investigation, this may also contribute to increased efficiency, reducing time to diagnosis and potentially the costs associated with some late-stage therapies.
Benefits of liquid biopsies are:
☛ Offering advantages in realtime monitoring, understanding treatment response and tailoring personalised treatment plans so that ineffective therapies can be avoided.
☛ Potential ability to identify other biomarkers such as ribonucleic acid (RNA), proteins, tumour cells and extracellular vesicles.
☛ Being less invasive for patients than traditional tissue biopsies.
☛ A depth of insight through minimal residual disease (MRD) detection currently unseen within standard clinical practice and long before relapse can be picked up via traditional methods, such as imaging.
It may increase the understanding of tumour presence and changes over time, potentially offering a more sensitive and specific approach to cancer treatment.
The current drawbacks of liquid biopsies include:
➤ The risks of false-positive results in MCED tests, indicating that someone has cancer when they do not, and tests may not always accurately distinguish between benign conditions and early-stage cancer. The likelihood of a false-positive result is greatest in those who are at the lowest risk of cancer.
➤ False-negative results may occur, providing patients with a false sense of security and potentially delaying necessary treatment.
➤ Discovering cancer-related information through screening tests can lead to emotional and psychological distress for patients and their families. So there will be a need to establish well-defined onward care pathways for them.
➤ Even if the MCED test correctly detects the cancer, it may not provide precise information about the location, the extent and aggressiveness of the disease; therefore, further investigation, such as imaging studies may be necessary.
cases where there are non-specific symptoms of cancer and there is no alternative screening programme.
Currently, there are eight commercially available MCED tests, and at least another 20 in development.
At Bupa UK Insurance, we are partnering with Signatera to offer our customers tests for breast, colorectal and prostate cancer, and with Informed Genomics to give customers access to the Galeas bladder cancer test.
This urine test will help reduce the need for unnecessary cystoscopies in diagnosing bladder cancer. And The Cromwell Hospital in London is offering the TruCheck Intelli MCED test as part of a controlled pathway overseen by multidisciplinary teams.
As the technology develops and is validated, MCED tests will likely be used as a first-line tool for the early detection of cancer in tailored populations, followed by other testing, if needed – for example, to confirm the exact location of a tumour. This may improve patient outcomes and could decrease costs in future.
The use of liquid biopsies for monitoring cancer recurrence is likely to be adopted at scale earlier than its use in diagnosis.
Clinical trials are currently looking into liquid biopsies to monitor lung, breast and oesophageal cancer. It is anticipated they may be available by 2026.
They will also be a valuable tool to monitor treatment response, potentially replacing traditional blood tests and expensive imaging procedures for certain types of cancer.
In combination with AI, liquid biopsies will allow the development of an individual imaging plan for each patient, enabling less
➤ They could ultimately increase diagnostic procedures, rather than minimise the number of steps in the pathway to diagnosis. Further validation is needed to establish test accuracy, reliability and cost-effectiveness. However, in future, as liquid biopsies become more reliable and costeffective, we may lean towards using MCED tests, particularly in ➱ continued on page 26
While the initial cost of these therapies continues to be high, the potential benefits include reduced treatment frequency and the need for prolonged hospital stays
early phases, advanced programmes have been put in place by regulators such as the United States Food and Drug Adminis tration (FDA), European Medicines Agency (EMA) and Medicines and Healthcare products Regulatory Agency (MHRA) to accelerate the development of these therapies.
the distinctive characteristics of CG therapies and the need for new health technology assessment (HTA) methods.
It is expected that more CG therapies will be approved and used in an increasing number of cancers.
exposure to radiation for those with minimal risk of recurrence, which will likely decrease diagnostic waiting lists.
Cell and gene (CG) therapies have the potential to provide lasting treatment.
They can be tailored to the patient’s needs, paving the way for a more precise approach that can lead to better outcomes. These therapies could reverse or stop the progression of cancer and may significantly improve quality of life for patients.
Cell therapies involve the use of cells to treat or prevent disease by various methods, such as CAR-T therapy, stem cell therapy and tissue engineering.
While some cell therapies aim to replace or repair damaged cells with healthy ones to restore normal functioning, some such as CAR-T therapy enhance the patient’s own T-cells by genetically modifying them to target and attack specific tumour cells.
Gene therapies use genetic material such as DNA to treat a disease by permanently altering the gene known to cause the disease.
This is done by adding or modifying genes to correct genetic defects or providing cells with the ability to produce therapeutic proteins.
Gene therapies can be broadly divided into somatic gene therapy and germline gene therapy. Somatic gene therapy affects only the patient being treated, whereas germline gene therapy doesn’t only affect the person but also their descendants.
Currently there are more than 500 ongoing clinical trials for CG therapies for cancer registered with ClinicalTrials.gov.
Although the majority are in
While the initial cost of these therapies continues to be high, the potential benefits include reduced treatment frequency and the need for prolonged hospital stays.
With uptake is rapidly growing, many challenges remain to effective implementation and patient access for CG therapies. These include:
➲ The high cost of CG therapies. CAR-T therapy for cancer currently costs around £370,000 for a single patient. Expanding their use to earlier lines of treatment may expand the number of people receiving them, increasing overall costs.
Introducing more of these therapies into the market would also put pressure on healthcare systems, particularly if they are not curative and a second CAR-T therapy is needed.
Ongoing trials exploring costeffective approaches are expected to complete in the next year.
➲ Ethical concerns around the accessibility and equitable distribution of CG therapies have been raised. Their high cost and limited geographic availability have the potential to exacerbate health disparities.
➲ Regulatory approval of CAR-T therapies often stems from early access programmes which rely on lower level of evidence from earlier-phase clinical trials. This introduces uncertainty about the safety and efficacy of both current and new CAR-T therapies.
Ongoing confirmatory trials, required by their early approval, may reduce this uncertainty in the coming years. The quality of life after CAR-T treatment is still poorly investigated.
➲ Regulation for CG therapies is complex and continues to evolve across different regions, despite manufacturers and providers requesting consistency across regulatory pathways.
Much has been written about
There has been a growing interest in cancer vaccines due to recent advances in vaccine technology and the lessons learned from mRNA-based Covid-19 vaccines.
The large-scale production and distribution of RNA-based Covid19 vaccines provided valuable lessons in manufacturing, distribution and logistics, which can be applied to cancer vaccines. Other vaccine delivery methods rather than RNA – such as DNA and peptides – are also being studied and may be promising.
Cancer vaccines can be designed for both prevention and treatment of cancer.
Preventative cancer vaccines can significantly reduce the incidence of certain types of cancers, supporting a preventative care approach and helping healthcare organisations reduce the number of people becoming unwell.
These vaccines are designed to prevent the development of cancer by targeting a specific virus or other risk factors that can lead to the development of cancer. They can be used to prevent cancer from occurring in high-risk individuals or populations.
Two types of preventative cancer vaccines have been approved for many years:
The HPV vaccine protects against the human papillomavirus (HPV) which can cause some types of cancer, such as cervical cancer;
2
The hepatitis B vaccine protects against the hepatitis B virus (HBV), which can cause liver cancer.
There is a drive to boost uptake of existing preventive cancer vaccines. The NHS aims to eliminate cervical cancer in England by 2040 by increasing uptake of both cervical screening and the HPV vaccine. This will include offering the HPV vaccine in libraries and sports centres as part of a catch-up programme.
Preventive cancer vaccines for breast, colorectal and lung cancer
Therapeutic cancer vaccines may have fewer side-effects compared to traditional treatments and potentially reduce the need for more aggressive treatments, leading to improved outcomes and quality of life
are in early clinical trials that are expected to be completed between now and 2029.
If more preventive cancer vaccines become widely available, it is expected there will be a significant reduction in the incidence of certain types of cancer.
Therapeutic cancer vaccines can be customised to target a patient’s specific cancer, allowing for more personalised and effective treatment approaches.
They may have fewer side-effects compared to traditional treatments and potentially reduce the need for more aggressive treatments, leading to improved outcomes and quality of life.
Therapeutic cancer vaccines are designed to train the immune system to attack cancer cells within the body.
Some have already been approved by regulatory bodies for use in certain types of cancer, such as prostate cancer (FDA), bladder cancer (FDA and Therapeutic Goods Administration) and advanced melanoma (FDA breakthrough designation, EMA priority medicine designation).
Cancer vaccines are being used in combination with other treatments, such as chemotherapy, radiotherapy and immunotherapy, to improve efficacy and reduce toxicity. Combination approaches may be particularly useful in treating metastatic disease.
In February 2023, the FDA awarded breakthrough designation to the combination of a personalised cancer vaccine and a monoclonal antibody (immunotherapy) for the treatment of patients with advanced melanoma following surgery who are at a high-risk of relapsing.
There were 19.3m new1 cases of cancer worldwide in 2020, accounting for an estimated 9.9m deaths. This is predicted to rise to 30.2m new cases each year by 2040, with the number of deaths annually reaching 16.3m.2 Cancer remains the top condition affecting costs for health insurers globally and across all regions.
A concerning trend in cancer is an increasing incidence in young adults. Recent research showed that early-onset cancer cases among people under 50 worldwide have increased by 79% from 1990 to 2019.
Researchers estimate that the global number of new early onset cancer cases and associated deaths will rise by a further 31% per cent and 21% respectively in 2030, with those in their 40s the most at risk.3
There are over 300 therapeutic cancer vaccines in clinical trials. Early-phase studies are demonstrating promising efficacy of vaccines for colorectal, lung, gastric and pancreatic tumours. Researchers believe these vaccines will become widely available by 2030, but some believe that may happen earlier.
Future personalisation of cancer vaccines could allow them to be tailored to each individual’s specific cancer, allowing for more targeted treatment without affecting healthy cells. This theoretically will reduce side-effects and the need for longer periods of treatment, which can often be unpleasant.
Cancer vaccines will increasingly be combined with other therapies to enhance treatment success. Early-stage clinical trials are looking into using a cancer vaccine with CAR-T and other types of immunotherapy.
The UK government and BioNTech recently signed a partnership aimed at providing personalised cancer vaccines to up to 10,000 patients by 2030.
BioNTech clinical trials are targeting a variety of cancers, including melanoma, lung, prostate, and head and neck cancer.
These new technologies offer a more personalised approach to cancer prevention, minimally invasive diagnosis and more targeted treatment.
They have the potential to reverse or stop the progression of cancer significantly improving quality of life for patients and greater treat-
ment precision will potentially reduce debilitating side-effects and cancer care costs.
References
1. Cancer Tomorrow, The Global Cancer Observatory, 2020. https://gco.iarc.fr/ tomorrow/en/dataviz/ isotype?types=1&single_unit=500000
2. Cancer in the UK: Overview 2023, Cancer Research UK 2023. www. cancerresearchuk.org/sites/default/files/ cancer_in_the_uk_overview_2023.pdf
3. Cancer cases grow by 79% in young people – as ‘alarming’ study suggests key reasons. Sky News, September 2023, https://news.sky.com/story/cancer-casesgrow-by-79-in-young-people-asalarming-study-suggests-key-reasons12955418?utm_campaign=HLTH_EUR_ Newsletter&utm_medium=email&_ hsmi=76216270&_hsenc=p2ANqtz8qDo_-xmbGmRHcGD0os_ZAw0XZpG UkS2JzNBJWt9XMdBQDwiheRppWk1q mouZ-LyGfmL3I4UOL7cX6fEbTqU5PsX myDw&utm_content=76216270&utm_ source=hs_email
Further growth and record revenues from private patient units (PPUs) have been received by NHS trusts in England. Philip Housden reports
ENGLAND NHS trusts achieved significant growth with record incomes from private patients, but are still not operating at pre-Covid levels, finds Housden Group analysis of the 2022-23 Annual Accounts.
Total revenues were up £102.2m to £645.7m for NHS trusts in England (£543.5m in 2021-22), which is an increase of 18.8%.
Revenue growth was much higher at 70.8% and £267.6m, but this was the first year of the ‘Covid bounce-back’. The 2022-23 total represents a marginal increase from 0.66% to 0.73% of total trust revenues.
While this is a further increase from the Covid low of 0.52% reported in trust accounts in 202021, it remains well below the high of 1.10% achieved in 2018-19 financial year (Figure 1).
The trend for the capital to be the main engine of growth for the NHS continued, with revenues for the 22 trusts within London climbing to £427.2m, up £78m (22.3%) from £349.2m the previous year.
Out-of-London trusts also grew
The trend for the capital to be the main engine of growth for the NHS continued, with revenues for the 22 trusts within London climbing to £427.2m, up £78m (22.3%) from £349.2m the previous year
significantly, but not at the same rate, from £194.3m to £218.5m (12.5%) (Figures 2 and 3).
Again, all the top six trusts by revenue were in the capital, with Royal Marsden (at £162.2m), Guy’s and St Thomas’ (£62.6m) and Great Ormond Street Hospitals (£54.7m) earning 43.4% of all England NHS trust incomes between them, a rise from 42.4% the year before.
Indeed, the top 20 trusts increased their market share from 76.9% to 78.3% of all private patient earnings. Growth inside the top 20 was 21%, while outside was only 11.5%.
This shows that investment in private patient services capability will drive increased growth.
When revenues are illustrated by region, this shows the dominance of London and to a lesser extent that of the Home Counties in the South-east surrounding the capital (Figure 4).
A review of the top ten fastest growing trusts outside of London – those increasing by >£1m revenues – shines a light on good practice and some of the innovative steps some trusts have taken to develop private patient revenues in support of core NHS services. This has been achieved through own PPU branding, joint ventures and, in the case of Royal United
➱ continued on page 30
Hospital Bath, the taking over control of the local independent hospital competitor.
By contrast, several trusts declined by over £0.5m private patient revenues in 2022-23. Of the five highest revenue fallers, three are regional teaching trusts: Leeds, Southampton and Manchester.
It is expected that the Royal Surrey Hospital, Guildford, should recover private patient incomes in 2024-25 once the new Genesis cancer centre opens in a few months time.
England NHS trusts’ private
patient incomes have now effectively recovered in cash terms to the pre-Covid levels.
However, when reviewed by overall proportion of income, there is still some way to go.
Pre-pandemic private patient revenues were 1.10% of total NHS England trusts’ income, falling to less than half that at 0.52% of revenues in 2020-21.
Subsequent growth achieved 0.66% in 2021-22 and a further rise to 0.73% last year.
But this is still a significant under-achievement in that a
return to just 1.0% of NHS revenues would represent total revenues of £889m: an increase o£ 243m on present performance.
This potentially available ‘gap’ may effectively be lost market share by the NHS PPU sector and is perhaps a contributor to the increasing demand for insured and self-pay services reported by independent sector providers since the pandemic.
Philip Housden is managing director at Housden Group. See his website at www.housdengroup.co.uk
England NHS trusts’ private patient incomes have now effectively recovered in cash terms to the pre-Covid levels
Your emotions will not thank you for checking your portfolio too often. George Uglow (right) explains why the date of your annual review can have an impact
60/40 portfolio annually, but in different months: the first investor in January and the second in July.
In the greater scheme of an investor’s horizons, all investment review periods are relatively short and so subject to market noise and highly sensitive to the period under review
If we looked at an example data set from the last 70 years, it would show the experienced ‘after inflation’ return of a balanced portfolio over the 12 months leading up to the respective investor’s review.
ARE YOU guilty of checking your portfolio too often?
Many investors experience a different journey while getting to the same result based on the rolling period of their portfolio review.
Financial planners meet with clients throughout the year –investors may not have reviewed their performance in the interim – and will see different investors experiencing their own journey and emotions, based on the timing at which they are reviewing their returns.
We usually advise that periodic, but not too frequent, check-ins and maintenance of one’s investment portfolio is good practice.
Annual rebalancing back to a target portfolio or generating necessary cash for spending, for example, are times when investors may choose to peek at their investments. Often emotions around investing can be closely linked with the performance observed.
Reports of portfolio returns often include arbitrary backward-looking periods that investors are familiar with. Intervals of oneyear, three-year and five-year returns are common.
From one year to the next, the one-year return would be entirely new, and the three- and five-year periods lose 12 months at the start and have another tacked onto the end, which can drastically change the overall outcome.
This is a somewhat obvious but important point to remember when reviewing so-called ‘rolling returns’. In the greater scheme of an investor’s horizons, all are relatively short and so subject to market noise and highly sensitive to the period under review.
Consider a scenario with two investors, each reviewing their
Both investors would see a negative 12-month return below inflation around 1/3rd of the time, though the experience of each investor would have been, at times, quite different.
Having invested over this time period, both investors would have enjoyed a return of 4.3% above inflation.
However, one could have witnessed negative returns just before their annual review with their adviser while the other saw more positive results. However, they both received the same investment outcome.
Lacklustre or negative returns can – understandably – leave investors feeling down, confused or even frustrated with the result.
In contrast, consistent positive returns can lure one into the false sense that markets never take back. They do, and with quite a magnitude.
Having the patience and fortitude to stick with a well thoughtout plan and robust investment solution can be a challenging, but ultimately rewarding, part of being an investor.
We should stick with the plan, accepting there will be highs and lows along the way.
George Uglow is a chartered financial planner with Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions.
Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Dr Sophie Haroon (right) discusses a new global notfor-profit initiative aiming to shape the future of patient safety through funding ambitious research to find the answers to the ‘wicked’ problems of healthcare
Hands up if you’ve got a good idea to improve patient safety. Medical Protection would like to hear from you
Fact: Burnout is common among private doctors and has increased post-Covid. But need it be so?
Fact: In 2019, 46% of healthcare organisations in the UK were using artificial intelligence (AI) technology. Is your institution one of them or one of those missing out?
Fact: Up to one-in-20 hospital admissions has some form of preventable error. Can a focus on human factors reduce this?
Fact: Pitfalls in consent is the primary allegation in around 70% of surgical clinical negligence claims. How can consent be improved?
MY COLLEAGUES and I at Medical Protection see on a daily basis the many complex issues faced by today’s doctors – and their medicolegal repercussions.
These range from burnout and its impact on patient safety, through to problems at an individual patient level with issues such as consent and problems at a system level that can harm patients and clinicians.
Patient safety and the well-being of healthcare professionals and teams are more vital today than even, given the challenging medical environment, but research into both areas has been limited particularly in private settings.
In 2021, MPS set out to change this through establishing The MPS Foundation. Its aim is simple: to take a proactive step towards helping healthcare professionals
improve their well-being, reduce risk and improve patient safety by funding research, analysis, education and training in these areas.
Now at the end of its second year of funding, this global not-forprofit research initiative has supported more than 30 research projects across the world to make a difference and apply real tangible results in the workplace.
Funding focuses on five themes:
The impact of human factors;
The impact of processes and delivery models;
The well-being of healthcare professionals and team;
The impact of digital and technology solutions, their integration and use;
The effectiveness of teaching and learning innovations.
It seeks to annually support innovative research that can last up to three years, with funding of up to £200,000 available to a project team.
Importantly, a wide range of clinicians can apply, be they our members or non-members, NHS hospitals, the private sector, universities or local healthcare networks.
We are particularly keen to see projects from private healthcare and harness the wealth of experience from this sector in delivering substantial services to patients.
This sector is often forgotten in the UK as a rich research field, but it has unique challenges to be addressed and is a healthcare sector that is global.
For the year ahead, calls for expressions of interest for funding open on 1 March 2024 and close on 3 May 2024.
Those expressions of interest that are short-listed will be invited to submit a more comprehensive application setting out their proposed research idea in more detail. Applications are assessed and those best aligned with the foundation’s priorities will be selected by its board for support and funding.
The MPS Foundation continues to support the research team throughout the life of the research with regular visits to check on progress, technical and ethical support if needs be and promotional support to share the results.
With access to the global MPS network and more than 300,000 MPS members, we can often connect applicants with organisations and individuals who are willing to form collaborations and sometimes help with access to potential subjects and our data. All this is with the aim of supporting the research to be the success everyone hopes for.
With more than 150 applications a year, the strategic aims of the foundation are striking a chord with clinicians who have ideas synergistic and sympathetic to its principles.
In the last funding round, the foundation funded pivotal studies focusing on clinician well-being in the private sector and how to protect and promote it.
One study will be starting with a rapid review of the literature, coupled with a combination of qualitative and quantitative techniques exploring workplace-related risks specific to the private healthcare setting and what would be acceptable interventions to private practice clinicians to attenuate these.
The aim is to develop a host of person-centred action planning resources for individuals to protect and promote their own well-being as well as guides for managers so that they can lead actions within their team/organisation.
Another study is deploying techniques from fields outside of medicine such as sports psychology to inform the design of interventions for enhancing the resilience of doctors. The focus here is on individual resilience strengths related to professional performance, instead of general personal psychological traits.
The outcome will be a solutionfocused and strengths-based training intervention to improve the well-being and mental health of doctors and ultimately improve patient quality of care and safety.
It is not just clinician anxiety and well-being that is being addressed. The first year of funding saw the start of a private-NHS collaborative project tackling anxiety in patients through building a partnership between them, clinicians, filmmakers, ethnographers, researchers and the public.
Using videos of anxiety provok-
Using Dora, the first UKCAmarked AI-driven automated clinical assistant, patients will be assessed by ‘her’ for their perioperative pathway
ing clinical situations, the aim is for patients and clinicians to cocreate a reflexive toolkit to mitigate psychological angst and give a subjective voice that empowers patients.
It should also enable clinicians to better manage such situations across a range of healthcare settings to improve patient outcomes.
Research into the impact of the moral distress of death and dying on clinicians is also being funded.
One study will look at the impact of patient suicide on clinicians, what resources are available to clinicians before and after the suicide and what support services could be developed locally and nationally to help clinicians better manage these challenging experiences.
Another will explore the impact of death on the ‘personhood’ of palliative care clinicians and oncologists to provide a holistic understanding and inform the design of educational packages to improve the well-being and coping strategies of those working in these specialties.
The aim of both projects is to improve the resilience and wellbeing of clinicians and, in turn, enable them to deliver better patient care and outcomes.
The focus on patients, better outcomes, better safety and less risk does not just centre around the clinicians themselves.
One research group will look to address issues around consent and language barriers by using a cutting-edge AI platform to create avatars in educational video packages covering a number of surgical procedures across different languages.
The project seeks to improve doctor-patient communication, address disparities in race, equity and access to healthcare and focus
on a fundamental tenet of the surgical journey that is a common topic in clincial negligence claims.
Other research groups have focused on AI to improve the patient journey and throughput in the healthcare system. Using Dora, the first UKCA-marked AI-driven automated clinical assistant, patients will be assessed by ‘her’ for their perioperative pathway.
The group aims to establish the impact of this emergent technology on patient management and performance and how well or otherwise it could contribute to developing an autonomous care system.
Others are looking at the legal and ethical impacts of AI, how clinicians and AI interact in shared decision-making and how, in complex systems like healthcare, we can draw on the strengths of humans and machines to improve patient outcomes.
The MPS Foundation is not just about funding your ideas either. It also funds two other streams of work. The first is its own commissioned research on priority areas identified from the wealth of experience gained over many years dealing with doctors facing some of the most challenging issues of their careers.
The second is a series of competitions aimed at supporting the next generation of doctors focusing on patient safety and risk reduction research.
They utilise the opportunity to build research capability and capacity for the future across the NHS and private healthcare sector for the benefit of patients and the wider healthcare community.
So, whatever your specialty or background, if you have an idea or a ‘wicked’ problem to tackle that accords with the MPS Foundation, we want to hear from you in the next funding round.
Calls for expressions of interest for funding are open from 1 March-3 May 2024. Good luck!
Further details about the MPS Foundation and how to apply can be found at www.thempsfoundation.org.
Dr Sophie Haroon is a medico-legal consultant at Medical Protection and member and vice-chair of the MPS Foundation Research Committee
Gearing up for Making Tax Digital (MTD), the Government initiative to modernise the tax system, is bringing benefits to independent practitioners. Derek Kelly (below) provides a roundup in this quick guide
MEDICAL PRACTITIONERS are not only dedicated to providing top-class patient care, but must also manage the intricate world of financial compliance.
One crucial aspect that has been reshaping the way they handle their finances is the introduction of Making Tax Digital (MTD) – a Government initiative aimed at modernising the tax system.
A brief overview
MTD is a key component of the Government’s tax administration strategy. Its primary goals are to reduce the tax gap, enhance accuracy in reporting and bring the tax system closer to real time.
For medical practitioners, this means adapting to a digital-first approach in managing financial records, using compatible software and submitting updates quarterly.
KEY COMPONENTS OF MTD FOR DOCTORS
Digital record keeping
Paperwork is making way for digital records. Medical practitioners are required to maintain accurate and
secure digital records of income and expenses. This not only ensures compliance but also streamlines record-keeping processes.
MTD-compatible software
The transition to MTD involves embracing software that aligns with its requirements. This is where companies like Medserv come in.
As your financial partner, we provide MTD-compatible solutions that not only facilitate tax compliance but also integrate seamlessly with your unique healthcare processes.
Quarterly updates
One of the significant shifts with MTD is the move towards real-time reporting. Practitioners are required to submit updates every quarter, providing a more accurate and upto-date reflection of their financial standing.
MTD’S BENEFITS
1. Easier tax management
MTD aims to simplify the process of getting taxes right. For medical
practitioners, this means a more streamlined approach to tax management, reducing the likelihood of errors and ensuring compliance with ease.
2. Integration with healthcare processes
MTD allows medical practitioners to integrate tax management seamlessly with various healthcare processes through specialised software. This integration enhances overall efficiency and reduces the burden of managing finances separately.
3. Productivity gains
By encouraging digitalisation, MTD contributes to wider productivity gains for medical practices. The shift towards a digital-first approach aligns with the broader trend of digital transformation in the healthcare industry.
MTD for VAT
For practitioners with a VATregistered practice, compliance with MTD for VAT is now mandatory. The transition involves keeping digital records, using
compatible software and submitting VAT returns digitally.
The move towards digital VAT reporting is a significant step in reducing errors and improving the accuracy of financial records.
MTD for income tax
For self-employed doctors or those with property income, the requirements for MTD for income tax are set to roll out based on annual business or property income thresholds. This phased approach ensures a smooth transition for practitioners, allowing them to adapt gradually to the digital tax landscape.
Choosing a partner in the MTD transition
At my company Medserv, and similar companies, we understand the challenges of transitioning to a digital tax landscape. Our mission is to simplify the complexities of healthcare finances and that
includes assisting doctors in the journey towards MTD compli ance.
Our MTD-compatible solu tions and expert guidance ensure a seamless transition, allowing you to focus on what matters most – providing exceptional patient care.
Navigating the complexities of MTD can be challenging, but medical practitioners are not alone.
Support is available in the form of webinars, YouTube guidance videos and email updates from HM Revenue and Customs.
These resources, combined with partners’ expertise, aim to provide practitioners with the knowledge and tools needed to successfully transition to the digital tax landscape.
Embracing the future of tax compliance
MTD is not just a regulatory requirement; it is an opportunity for medical practitioners to embrace the benefits of digitalisation in financial management. By keeping accurate digital
MTD is not just a regulatory requirement; it is an opportunity for medical practitioners to embrace the benefits of digitalisation in financial management
records, using compatible software and partnering with specialist companies, practitioners can navigate the digital tax landscape with confidence.
As medical practitioners continue to prioritise patient care, embracing digital solutions like MTD ensures that financial compliance remains a seamless and efficient aspect of their practice.
Derek Kelly is marketing manager at Medserv
Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes of free legal advice.
Advice is available on: Business structures (including partnerships) Commercial contracts Disputes and litigation HR/employment Premises Regulatory requirements and investigations
Dr Kathryn Leask (below) discusses what to do if you are asked to attend a multi-agency risk assessment meeting (MARAM)
QI am a private GP and have been asked to attend a multi-agency risk assessment meeting (MARAM) in relation to a patient who has been registered with me for about a year.
He has some mental health and behavioural problems which relate to his mother having taken cocaine when she was pregnant. He has a criminal record in relation to indecent images and has been involved in drug dealing and gangs in the area.
Now he lives with his elderly aunt who is finding it increasingly difficult to live with him. His social worker has contacted me as his main GP and has told me that I must be at the meeting.
I don’t know whether the
patient is aware of the meeting or whether he has given consent for information about him to be disclosed.
AWhile you would usually seek a patient’s consent before disclosing information about them, there are circumstances when disclosing information about a patient can be justified in the public interest.
If you have decided this is the case – for example, if not disclosing information could put others at risk of death or serious harm –you do not need to seek consent, but you may wish to let the patient know about the disclosure, if it is safe to do so.
The GMC says that you must seriously consider all requests for relevant information about patients who may pose a risk of serious harm to others.
For example, you must participate in procedures set up to protect the public from violent and/ or sex offenders, such as multi-
agency public protection arrangements (MAPPA) in England, Wales and Scotland and public protection arrangements in Northern Ireland (PPANI).
You must also consider all requests for information needed for formal reviews – such as inquests and inquiries, serious or significant case reviews, case management reviews, and domestic homicide reviews – that are established to learn lessons and to improve systems and services.
The MARAM framework would fall into this category of review, with its aim being to protect the patient and the wider public by minimising risk and I think failure to co-operate with the request could leave the practice vulnerable to criticism.
I recommend that you ask the social worker whether the patient is engaged in the process and what consent has been sought from him to allow disclosure of information from the various agencies involved.
If the patient’s consent has not been obtained for disclosure of information, then any information shared must be carefully considered. It is important to be able to justify your decision to disclose and any disclosure should be of relevant information only, and be proportionate to the risk posed. You may also wish to have more information about which other organisations would be participating. Make careful documentation of the decisions you have made and who you have discussed this with so that you are able to justify your decision if you are asked to do so in the future.
References
Paragraph 63-70, GMC: ‘Confidentiality: good practice in handling patient information’.
Paragraph 71, GMC: ‘Confidentiality: good practice in handling patient information’.
Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union
What do you do if you are invoiced for alleged dental damage during treatment?
Dr Kathryn Leask has the answer
QI am a consultant anaesthetist and have just received a letter from a patient who underwent a private procedure. I was responsible for the anaesthetic which included inserting an endotracheal tube. I have recorded that the patient had no chipped teeth before the procedure and am not aware I caused any dental damage during intubation or extubation. Had I done, I would have recorded this in the anaesthetic record and spoken to the patient once they had recovered.
The letter states that the patient suffered a chipped tooth during the anaesthetic, and they have asked me to reimburse their dental costs. They have sent me an invoice which is on headed paper from their dental practice.
Would I be admitting liability if I paid the invoice? The cost isn’t excessive and I’d rather have this dealt with and out of the way.
AYou really have two options. As this is an expression of dissatisfaction, you could deal with this as a complaint and offer to reimburse the patient, but making it clear that this is a gesture of goodwill.
In your response, you can remind the patient of the discussion you had with them about the possibility of dental damage,
assuming this was discussed. You can also explain what your findings were with regards to the condition of their teeth before and after the anaesthetic was administered.
You can let the patient know what your normal practice would be if you were aware that you had inadvertently caused dental damage and apologise if the chip to their tooth was caused by you. According to the Compensation Act 2006, an apology or offer of redress, such as paying for treatment, is not, of itself, an admission of liability.
Alternatively, if you are not willing to pay for the patient’s dental work, you could suggest that they formally make a clinical negligence claim. You should contact your medical defence organisation to advise them of this incident.
This will give your defence organisation an opportunity to review the information you gave to the patient during the consent process about dental damage and to obtain and scrutinise their dental records to establish whether damage to the tooth already existed.
Based on the findings, your defence organisation will discuss the possible courses of action with you with regards to defending or settling the claim.
Whether you choose the first or second option, you should contact your defence organisation to discuss what approach to take and so they can advise you on the wording should you decide to write to the patient offering a gesture of good will and response to their complaint.
The Independent Healthcare Providers Network (IHPN) has for the
first time
produced a
report which draws on a variety of data to evaluate the quality and
safety of independent healthcare. Dawn Hodgkins (right), its director of regulation, highlights the main findings and the implications
THERE IS an increasing recognition that independent providers are an integral part of the UK health system, providing services to NHS and privately funded patients across primary, community, diagnostic and secondary sectors.
In 2022, around 2¼m acute patient journeys took place across the sector, including more than 830,000 private patient journeys and over 1.4m acute NHS patient journeys.
Beyond hospitals, IHPN members alone provide over 300 community services, many of which are commissioned by integrated
care boards or local authorities delivering a wide range of services, from prison healthcare to virtual wards.
More than 3.5m scans and tests were delivered by the sector last year to NHS patients. Some were directly commissioned diagnostic services and others were provided by independent providers that run NHS trusts’ inhouse services.
Increasing demand
The sector employs over 150,000 people and contributes to the training of a wide range of clinical staff.
In summary, the independent
healthcare sector, and its performance on safety and quality, matters.
Independent Practitioner Today readers will be well aware that there has been increasing demand for private healthcare in the past few years alongside an increased use of the independent sector to deliver NHS funded care.
With that demand, and as usage increases, there will inevitably and rightly come greater attention and scrutiny. Now more than ever there is a need to ensure the quality and safety of care in the independent sector is the best it can possibly be.
I’m also keen – and I know other clinical leaders feel the same – that when it comes to quality and safety, we never rest on our laurels. We remain committed to improvement, working collaboratively and openly, to challenge ourselves to do better.
It’s with that improvement journey in mind that we decided to produce this first report: Quality and Safety Review – Independent Healthcare in 2023
It is the first time that we have brought together so much qualityrelated information across the full range of independent providers, but it does not include a review of mental health provision.
Our aim on behalf of our members is to provide an up-to-date and transparent view of what we can currently measure and help members to drive further improvement, share good practice and learning.
We have used published data from the Care Quality Commission (CQC) and others and provided comparative information about NHS providers where information was available.
But we have done this cautiously, due to the differences between sectors, regulatory approach, geographies and size of service, as there are undoubtedly limitations in the current data.
The report focuses on England and specifically draws on data published by the CQC, as it covers the largest number of providers, but we hope to build and extend the scope further in coming years.
So, what were our headline findings?
Supporting and nurturing an open learning culture has long been recognised as crucially important to improve patient safety and health care quality
One of the most interesting trends we have observed at IHPN is around the increasing usage of private GPs. Our report, Going Private, released at the end of last year, showed that particularly for younger people, this was a huge growth area.
More recently, there has been growth in the number of privately funded general practices, classed by the CQC as independent doctors.
Because the healthcare they provide is quite different to NHS provision, comparative information is not available.
Overall, I think we can say with some pride that the sector provides a high quality of care.
Ninety-four per cent of healthcare locations run by IHPN members have an overall rating of ‘good’ or ‘outstanding’ from the CQC.
As we set out in the report, what’s clear is that significant improvements have been made in the past few years. Considering hospitals specifically, 92% of independent sector hospitals (nonspecialist) are rated overall ‘good’ or ‘outstanding’ by the CQC compared to 52% of NHS hospitals.
This is a significant improvement since 2018 when around 70% of independent sector hospitals (non-specialist) were rated overall ‘good’ or ‘outstanding’.
The picture is positive in diagnostic imaging services too. Here 85% of independent providers are rated for diagnostic imaging services are ‘good’ or ‘outstanding’, and in the community, again over nine in ten (92%) of independent community healthcare providers are rated ‘good’ or ‘outstanding’.
Supporting and nurturing an open learning culture has long been recognised as crucially important to improve patient safety and health care quality.
We have been pleased with the engagement and collaboration we’ve seen on important topics such as the Patient Safety Incident Response Framework (PSIRF), which represents a significant shift in the way providers of NHSfunded activity respond to patient safety incidents and the engagement with Learning from Patient Safety Events.
Both will help increase the ability to look across the health system at quality and safety.
959 independent doctors have been rated by the CQC, of which 94% are ‘good’ or ‘outstanding’.
In 2023, IHPN worked with members and the Independent Doctors Federation to define a set of metrics that can be used to support CQC inspections as well as create opportunities for individual practices to benchmark their performance against other similar organisations.
Working with the CQC and others, we are committed to continuing this work throughout 2024.
So, there has been excellent progress which we should celebrate, but there’s still more that we can do.
For example, there are now more than 330 Freedom to Speak Up Guardians promoting the speakup agenda at independent providers.
This represents an increase of over 70% since the beginning of 2022, which is terrific, but there is more to do, both by encouraging more organisations to appoint these roles and by continuing to spread awareness of the vital function that they perform.
Another example is the shocking abuse and harassment we saw reported last year by female surgeons working in the NHS which showed over six in ten had been the target of sexual harassment from colleagues.
Although we didn’t look at this specific issue in this particular report, we must make sure that, in the independent sector, we take a zero-tolerance approach, supporting colleagues to call out this behaviour, to investigate incidents and to make sure appropriate action is taken.
More generally, we see a need for greater consistency in the way that quality, safety and outcome data is collected.
That is why we have welcomed
working with colleagues at NHS England Patient Safety Incident Response Framework (PSIRF) and Learn From Patient Safety Events (LFPSE) teams helping to develop a consistent approach which can be used across the independent sector.
Other key areas such as the sector’s ability to contribute to national audits and registries, including NHS England’s Outcomes and Registries Platform, will be important, so that patients can expect the same standards, regardless of where care is delivered.
We look forward to continuing our work with partners on this and other important areas.
Similarly, we recognise the significant work carried out by providers and the Private Healthcare Information Network (PHIN) to collect and disseminate information about privately funded acute activity, which is already enabling greater visibility of the services provided by the sector
We look forward to data flowing from private activity into a single dataset via the Acute Data Alignment Project (ADAPt), which will ultimately support a common view of the whole of UK healthcare.
So, in summary, there’s lots to be pleased about, but lots we can develop too – 2024 will be busy, for sure.
While the guidance will only apply to doctors initially, the intention is that the GMC will in due course regulate physician associates and anaesthesia associaties
Good Medical Practice 2024: what you need to know from a legal viewpoint. Jordan Laybourn and Dr Tania Francis report
LAST SUMMER, for the first time in a decade, the GMC updated its Good Medical Practice (GMP) guidance.
The changes – which have already received lengthy coverage in previous issues of Independent Practitioner Today – were due to take effect last month on 30 January 2024 and, until then, the current GMP guidance remained applicable.
They follow a consultation period with feedback sought from a multitude of healthcare professionals, patients and members of the public, the goal being to:
Refine and enhance the existing guidance;
Make it fit for purpose in an ever-changing society;
Provide clarity on what is expected from a doctor practising within the UK.
While the guidance will only apply to doctors initially, the
intention is that the GMC will in due course regulate physician associates and anaesthesia associates, at which point GMP will also apply to them.
Many of the underlying principles of GMP will be familiar to doctor because they will remain the same, but there are some revisions you need to make yourself aware of.
The GMC states that the standards have been updated in five key areas to:
Create respectful, fair and compassionate workplaces for colleagues and patients;
Promote patient-centred care;
Tackle discrimination;
Champion fair and inclusive leadership;
Support continuity of care and safe delegation.
To achieve this, the GMC has renamed and restructured the domains contained within the guidance and substantiated a number of areas with written examples that can be applied to a contextual scenario, particularly where sexual misconduct and workplace bullying is concerned.
These are two areas the council has clearly placed emphasis upon when preparing the new GMP.
The first – included in Domain 1
– instructs doctors that they must not ‘abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others’.
This applies to all interactions, including online. In addition, doctors should take action, or support others to take action, if they
in September, the MDU feared doctors wouldn’t have time to read and absorb all the changes ➱ continued on page 44
‘witness or are made aware of bullying, harassment or unfair discrimination’.
In Domain 4, a specific reference to sexual harassment says: ‘You must not demonstrate uninvited or unwelcome behaviour that can be reasonably interpreted as sexual and that offends, embarrasses, humiliates, intimidates or otherwise harms an individual or group’ – a topical addition, given the recent survey published in the British Journal of Surgery and reported in Independent Practitioner Today (October 2023) .
The previous Domain 1 (Knowledge, skills and performance) has been replaced with ‘Knowledge, skills and development’.
Domain 2 (Safety and quality) is now Domain 3 (Colleagues, culture and safety).
Domain 3 (Communication, partnership and teamwork) is now Domain 2 (Patients, partnerships and communication).
Domain 4 (Trust and professionalism) is now ‘Maintaining trust’.
In a sign of the times, there is a new paragraph on remote consultations, making it clear that if you cannot provide safe care remotely, you should offer an alternative, if available, or signpost to other services.
There is also recognition of the environmental impact of healthcare.
You should choose sustainable solutions – although it is recognised that this is not always possi-
We featured an MDU analysis of the new GMC guidance in our October issue
The GMC has done away with the notion that only serious or persistent failure to follow GMP would put a doctor’s registration at risk
ble and should not affect patient care.
There is reference to supporting initiatives to reduce the environmental impact of healthcare, but the obligation is only to consider doing so.
There is more about the role of medical managers, who ‘must take active steps to create an environment in which people can talk about errors and concerns safely. This includes making sure that any concerns raised with you are dealt with promptly and adequately’.
This is particularly topical given the recent discussions about the regulation of managers in the health service.
Alongside GMP, the GMC has published more detailed guidance covering:
Intimate examinations and chaperones;
Providing witness statements or expert evidence as part of legal proceedings;
Using social media.
The Medical Defence Union (MDU) expressed concern about the time needed by doctors to consider this guidance before it came into effect at the end of January 2024, particularly as the run-up was a very busy time of the year.
Of further note is the restructuring and rewording of GMP’s relationship with the GMC’s fitness-to-practise framework.
The GMC has done away with the notion that only serious or persistent failure to follow GMP would put a doctor’s registration at risk.
Optegra celebrates its 15th birthday with opening of
Maintaining personal and professional boundaries;
‘Tell
Instead, the GMC will act ‘where there is a risk to patients or public confidence in medical professionals or where it is necessary to maintain professional standards’.
We reported in our October issue on the findings of a poll published in the British Journal of Surgery on sexual harassment
The new language, which will be mirrored in guidance provided to both the GMC and the Medical Practitioner Tribunal Service, affirms that when a doctor’s fitness to practise is questioned, any investigation will consider any current or ongoing risk to one or more of the following – in line with what we have seen at hearings across the country for years:
Protecting, promoting and maintaining the health, safety and well-being of the public;
Promoting and maintaining public confidence in the medical professions;
Promoting and maintaining proper professional standards and
conduct for members of those professions.
This will be done by considering how serious the concern is, any relevant context and how the doctor has responded to the concern. When looking at how serious the concern is, the GMC will consider how far the doctor has strayed from GMP, as well as evidence of premeditated or persistent behaviour, abuse of power, and whether the incident is isolated or has been repeated.
While this can be seen to align the guidance with what we see in practice, there has been criticism of the removal of the ‘serious or persistent’ statement – something which the Medical Protection Society is concerned may lead to an increase in cases pursued which fall well short of the threshold for action. Only time will tell.
If you have received a letter from the GMC or you require independent advice with regard to an upcoming fitness-to-practise hearing, you should contact your insurer or defence organisation for assistance. Alternatively, one of our regulatory lawyers will be happy to assist.
Jordan Laybourn is a trainee solicitor and Tania Francis a partner at Hempsons. You can email them at: j.laybourn@hempsons.co.uk and t.francis@hempsons.co.uk
As you approach retirement, and even before, you will likely need to consider what will happen to your private practice when you retire. Can you sell it? Who could buy it?
Alec James (right) looks at ways your private practice could be sold, ways of improving the business viability for someone purchasing the business and alternative options to selling
SELLING PRACTICES is the norm in other professions such as accountancy or legal practices.
The valuation of these businesses will include something called ‘goodwill’, as these businesses typically have limited tangible assets.
Goodwill is an intangible asset and represents things such as brand reputation, recurrent income stream from customers or clients, staff knowledge and expertise.
In medical practices, things are a little different.
Most specialties will not have regular, repeat patients. Those patients may come back to you in the future if your expertise is required, but as your expertise and skills are not sellable, it is unlikely that someone would pay for goodwill related to historic patients.
For specialties where you do have patients with longer-term conditions that will require repeat treatment, it is more likely that you have some goodwill to sell.
In other types of businesses, the business name is often what carries
➱ continued on page 46
For those who agree to work more formally as a handover, a bespoke price acceptable to both parties needs to be reached
significant value, rather than a particular owner or member of the business team.
In private practice, the brand is usually you and your expertise that you have developed through years of training and practising. This is often the draw for patients to the practice and therefore if you are no longer personally involved, the brand value of you as the expert is lost.
As you are approaching winding down in private practice, you may have colleagues who are just starting out.
This could present an opportunity for both parties, as they will not yet be familiar with the business model of carrying out private practice and working together would enable them to potentially gain a head start.
In this situation, it is difficult to value this and many may draw on their own experiences of starting out, which could mean that you would not be comfortable receiving payment when someone may have taken you under their wing in the past when you were in the same position.
For those who agree to work more formally as a handover, a bespoke price acceptable to both parties needs to be reached.
For those who are selling their business, it is common for the business and possibly assets as well to be acquired by a new business, usually another company rather than buying the shares in your existing business if it is a company. But there may be reasons why acquiring the shares of an existing business is preferable.
If you have a limited company, it is likely that your company will have sizeable reserves. Reserves are the post-corporation tax profits which have not yet been distributed to the shareholders of the business.
If you were to sell your shares, the reserves of the company often form part of the valuation driving a much higher price of the shares. Because of this, a fellow consultant buying your shares off you and continuing the business is uncommon.
There is also the liability for previous work that the purchaser would not want to inherit.
Instead, they may offer to purchase the assets of your business. This is only really likely to be beneficial if you or your business has developed their own clinic from which they operate from.
Other assets such as medical equipment are likely to be fairly modest in value. The tax treatment will depend on the assets
sold and taking advice prior to any sale will help you understand the associated liabilities.
If a third party is interested in your business, the valuation is usually taken by taking the Adjusted EBITDA – the abbreviation for earnings before interest, taxation, depreciation and amortisation –and multiplying it by a factor. In a nutshell, your annual profits before writing off assets and corporation tax.
Usually your business will show higher profits, as you will usually choose not to take a salary from your company, instead drawing dividends or utilising other taxefficient strategies for your circumstances.
A third-party owner will therefore not achieve the level of profits without replacing your hours and, as such, they adjust the EBITDA to factor in a doctor’s cost.
There may be other adjustments depending on other factors. The EBITDA is then multiplied by a factor which is negotiated based on the specialty.
Buyouts like this are rare and often require the consultant to remain with the business for a certain number of years post sale to ensure continuity. There may also
be price adjustment clauses if the business acquired is not as expected based on set criteria. To increase the likelihood of the business being sold, changes can be made to your business which help third parties see how the business could run. It can be worth considering involving other consultants within your business and them seeing the practice patients too. Any business which functions without the owner having to actively contribute to the business too much will carry a higher value and this shows a third party that they won’t need to invest much time.
Following Covid and the reduction many consultants saw in terms of access to private hospitals, there is a growing trend that private practices are operated out of consultants’ own premises. These businesses often carry a higher value, again as the buyer can see continuity of the business and is not reliant on other parties. When making significant changes to your business, you should ensure you have forecasts to see how the changes may affect your business profits and cash flows.
Regular management accounts
may also be beneficial, as these will give up-to-date information rather than waiting for the annual accounts.
In order to find prospective buyers of the business, you may wish to appoint the services of a broker. These brokers will generally take a percentage of the proceeds of your business.
Negotiations will often include whether you need to remain in the business for a period of time, whether you will receive all the cash at the point of sale or whether some will be deferred to the future. There may also be targets set for the future, the outcome of which affects whether or not you receive the full deferred payment amounts.
Lump sum payments to you are usually regarded as a capital payment and would therefore normally be subject to capital gains tax. Capital gains tax is usually at 20%, but, providing certain strict criteria are adhered to, Business Asset Disposal Relief may apply which reduces the capital gains tax rates from 20% to 10%.
It is important that you obtain advice on the tax structure of any sale, particularly if there are deferred payments and milestones to the deal.
If you are required to work in the business for a period of time after
In order to find prospective buyers of the business, you may wish to appoint the services of a broker. These brokers will generally take a percentage of the proceeds of your business
If you are unable to sell your business in one form or another when you come to cease private work, you will need to close your business.
Before this can be done, monies owed to the business will need to be collected and liabilities will need to be settled. If you have any assets in the business such as vehicles, premises or equipment, these would need to be either sold or transferred to the owners.
You should always take advice from an accountant before closing your business to ensure that you are fully aware of the tax implications from disposing of assets. Cessation accounts will then be drawn up to reflect the final months of trading activity. These are used to calculate any resulting tax liabilities or refunds due.
Once these steps are taken, if you are a sole trader or working with others in a partnership, closing your business is usually a very simple process whereby the remaining funds and assets are transferred to the business owner(s) and HM Revenue and Customs is informed that the business has ceased trading.
If you trade via a limited company, things are more complicated.
When you cease trading, there will likely be reserves left in the company. The level of reserves when you come to close the company will determine who winds up the company.
the sale, these payments are normally paid as a salary and therefore follow the usual income tax rates.
Before any sale or making changes to your business, you should always seek the advice of a specialist medical accountant so that you understand the impact of the changes or sale.
While not selling your business, it is worth considering whether you can repurpose your existing business into a new type of business. This is particularly relevant if you have invested in creating a Care Quality Comission-registered premises. Rather than selling the property or terminating the lease and face dilapidation costs, you may be able to generate income by subletting the rooms to other consultants.
A company could also be repurposed into an investment company, owning things like managed investment funds or property. These options could potentially provide additional income into retirement.
Next month: Richard Norbury highlights what you need to know about HMRC inquiries
Alec James is a partner at Sandison Easson & Co, specialist medical accountants
If the reserves of the company are below £25,000, the company can be wound up and removed from the Companies House register by yourself or by your accountant. This is done by submitting a strike-off form to Companies House.
Prior to the submission, the remaining company funds should then be paid to the shareholders in the ownership percentages and the company bank account closed. Any funds which have not been distributed prior to shareholders once the company has been struck off shall belong to the Crown.
More often than not, the reserves will be well in excess of £25,000. In these cases, the company will need to be liquidated. A liquidation is formal name given to the company realising its assets and paying the funds to the shareholders.
This will need to be performed by a liquidator. These people are special types of accountants and can dissolve these companies.
Liquidations are often more tax-efficient than dividends because, providing certain key criteria are met, the final distributions from the company will be subject to capital gains tax rather than income tax, particularly if Business Asset Disposal Relief (BADR) applies.
There are a number of options available to you once you decide to cease working privately. Taking advice from a specialist medical accountant prior to your cessation of private work can help you understand your options and the associated tax implications.
DOCTOR ON THE ROAD: BMW M2 COUPÉ
Independent Practitioner Today’s motoring correspondent Dr Tony Rimmer (below) finds BMW’s latest M2 is another great M-car – but fears it may be one of the last of the breed of internal-combustion-engined sports coupés
This is a true sports car and competes at the same level as the excellent and more expensive Porsche Cayman –praise indeed
All the usual BMW attributes abound: a perfect driving position, plenty of leather and clear and easy-to-use controls
I HAVE , in previous articles, referred to the importance of brand image with regard to the clinics we work from and, in some cases, individual practitioners. If we can inspire confidence in our clients that is based on high quality and reliable service, then our business will thrive. The carmakers are no different.
Their sales are influenced heavily by their brand status and this is half the battle when it comes to attracting potential buyers into their showrooms.
We medics are attracted to the more premium brands and there is one make that stands out when it comes to buying a car with a reputation for sportiness and quality: BMW.
This long-held reputation was created by BMW’s links to motorsport and the production of wellmade road cars with great performance and genuine appeal for the keen driver.
Body: Four-seat coupé. Rear-wheel drive
Engine: 3.0litre straight-six.
Twin-turbo petrol Power: 454bhp
Torque: 550Nm
Top speed: 155mph (limited)
Acceleration: 0-62mph in 4.3 secs
Claimed economy: 29mpg (WLTP combined)
CO2 emissions: 220g/km
On-the-road price: £67,030
Although the vast majority of the cars that BMW sells and makes its profits from are the lower-powered and cheaper models, it is the ‘halo’ low-production M-series cars that grab the performance headlines and attract us to the brand.
This is clever marketing, but it would not stand up for long if the M-series cars did not continue to deliver real thrills on the road. So, can they still do so? Do the latest M cars continue to fulfil the brief?
I have been driving the latest M2 coupé to find the answers. Based on a shortened 3-series platform, it uses the same brilliant 3.0litre six-cylinder engine as the M3 saloon and the M4 coupé, so it is compact and powerful.
With 454bhp on tap and being rear-wheel drive, it actually has slightly larger 20-inch rear wheels to allow greater rubber contact with the road to aid traction.
What makes the M2 special is the availability of a six-speed manual gearbox. It may be a bit slower to 62mph than the standard eightspeed auto model – 4.3 seconds versus 4.1 seconds – but imparts a real analogue feel to the driving experience.
Call me old-fashioned, but the days of manual gearboxes are severely limited and the real satisfaction you get from slotting the ratios at exactly the right time with smooth pedal work is something to be savoured.
Well done to BMW for offering this option – even if it is at a £1,200 premium.
Visually, the M2 stands out from lesser 2-series coupés with an aggressive stance which, in my eyes, is a little over the top in a boyracer way. I prefer more subtle styling that doesn’t attract too much of the wrong attention.
However, it does look like it means business and would look comfortable on a racing track.
Inside, all the usual BMW attributes abound, with a perfect driving position, plenty of leather trim and full, clear and easy-to-use controls. Front-seat passengers are spoiled by excellent sports seats, but rear space is slightly compromised.
You can fit two adults in the rear for short journeys, but this is not a full four-seat tourer. Boot space is generous for a sporty coupé, although the opening is a bit narrow.
The M2 is designed and built to
be driven and as I gripped the lovely and perfectly sized leather steering-wheel, pressed the red start button and engaged first gear, I prepared, hopefully, to be entertained.
I need not have worried – the steering is sharp with great feedback and power delivery is very strong, smooth and linear.
The chassis has been tuned with the driver in mind. Along challenging B-roads, the adjustability offered by simple alterations of the throttle through corners is very impressive.
This is a true sports car and competes at the same level as the excellent and more expensive Porsche Cayman – praise indeed.
What I did not anticipate is the superb ride quality that is not expected in a car of such performance capabilities.
Yes, it is firm, but it absorbs most road imperfections without complaint – a perfectly judged compromise. This helps on the motorway too, where supressed wind and road noise combine to make this a great mile-eater.
We medic petrolheads can breathe a sigh of relief – BMW has done it again. The latest M2 is another great M-car and may be one of the last of the breed of internal-combustion-engined sports coupés.
I am all for electrification for our future driving needs, but let us hope that it won’t be long before an electric vehicle can impress and excite the driver as much as the M2 did for me.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
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