Attracting self-pay patients
Our troubleshooter Jane Braithwaite advises on how to take advantage of the self-pay boom P18
Pearls of wisdom
Medical Billing & Collection celebrates its pearl anniversary with useful advice on getting paid P24
By Robin Stride
Consultants in private practice have been saved from huge losses after hiring billing experts who successfully chased and recouped more than £¾bn.
That is the value of the outstanding invoices collected from patients and debtors over the last three decades by financial specialists at Medical Billing & Collection (MBC).
The highest figure retrieved amounted to more than £1m for a clinic and £400,000 for an individual consultant.
But as the company divulged these figures, published as part of its 30th anniversary celebrations, it warned independent practitioners to be on the alert for a mounting threat of non-payments in the wake of Covid-19.
It warned that some problems were likely to come from an increase in self-pay caused by the growing NHS waiting lists, now consisting of a record 6.1m people.
MBC business director Simon Brignall said: ‘On realising we had passed £750m for our clients, I felt this needed more investigation. Private consultants are still finding that ensuring they get paid for their services is very challenging.’
The pandemic has already hit many practices’ finances due to: n Unpredictable incomes and problems with outstanding invoices;
n Revenue fluctuations resulting from the impact of various lockdowns and restricted access to hospital facilities;
n Cash flow problems due to a combination of reasons such as absences of staff employed by the practice and the administration departments of the insurance companies that consultants bill.
MBC also reported a reluctance among some practices to chase patients during a time of crisis.
It told Independent Practitioner Today another factor was the many consultants whose focus has been on supporting the NHS – at the expense of their private practice.
Mr Brignall added: ‘While the pandemic has had its own set of unique challenges, there were still well-established trends we have noticed that have been in place for the past ten years.
‘We partner with many practices that now come to us with 25-30% more outstanding invoices than they did a decade ago. Many now write off 5% or more in bad debts a year, which is ten times the bad debt rate we achieve at MBC. The pandemic has only made this worse.
‘There is now the usual problem around identifying, invoicing and chasing shortfalls and excesses for insured patients, but consultants are facing a raft of other issues.
‘Staff absences from Covid at any point in the revenue cycle have led to bottlenecks and delays in payments.
‘Consultants have been reluctant to spend money on adequate infrastructure due to the unpredictability of their incomes over the last two years.
‘This has meant that, when they reach out to us, many of these problems have been going on for some time.’
Mr Brignall said: ‘Another of the trends we have identified is the growth in the self-pay market. MBC has seen the proportion of self-pay invoices that we raise annually increase by 50% in ten years.
‘We expect the impact of the coronavirus on NHS waiting lists will only ensure that this trend is enhanced. Practices now need to be able to offer a range of payment options and pathways to accommodate these patients.’
He added that new MBC consultant clients, typically billing for about £150,000 a year, were often writing off £5,000 annually and had £25,000 outstanding.
Asked how consultants reacted to the recovery of their money, he said: ‘One consultant was so delighted he bought a nice new car. The most common and immediate reaction is expressions of genuine relief, especially when they had assumed their money was unlikely to be recovered.
‘There are stages, though, so after relief comes happiness and comments about what they will do with the funds. However, some express frustration about why they had chosen to leave it so long.’
n Pearls of wisdom from 30 years of medical billing: see page 24
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Many private practices remain under pressure as, two years on, they continue their recovery from the financial effects of Covid-19 on their businesses.
Income tax and National Insurance increases kick in next month and worrying inflation rises are putting pressure on staff costs and general expenses.
Paltry pay rises for those who also have NHS jobs are guaranteed to deliver the usual disgust and there are calls among consultants’ negotiators for action to reform the pay mechanism and catch-up on being down 40% since 2008.
Losses of 10% since December for managed portfolio market investors were not uncommon and that was before recent events in eastern Europe.
So hanging on to what you’ve got and ensuring you get paid for all the hard graft in your private practice seems like a good idea, especially now.
How much income is lost to all independent practitioners through administration inefficiency every year will never be known, but our front-page story provides a stark clue of how bad it could be.
Specialists at one company alone, Medical Billing & Collection, have retrieved over £¾bn for their consultant clients over 30 years. Presumably, even more was lost by those who took no action.
With an upturn in self-pay underway – and we hear of one private hospital which is now getting more than 50% of its income from self-pay – stopping the financial leaks is more vital than ever.
Yet, as accountant columnist Ian Tongue reveals on page 40, it is surprising how many consultants write off debts because they left things too long and never dealt with things at the time.
The vision behind an all-female team
An all-female team marks a milestone for Newmedica eye care clinics. We profile the unique set-up of the group’s Shrewbury Clinic P20
Sound advice on video hearings
We are now all familiar with Zoom, but do you know what to do if called to attend a virtual hearing? The MDU’s Dr Sissy Frank gives some advice P22
Don’t get star-struck by celebrities
Treating high-profile patients presents a unique set of medico-legal problems. Dr Emma Green of Medical Protection offers some help on the issue P28
The best bet against inflation
Higher inflation rates are very much in the news. Dr Benjamin Holdsworth of Cavendish Medical shows why it’s easy to get lost in the numbers P30
Prepare your case for a tribunal
Hempsons’ solicitor Julia Gray outlines the steps to prepare to defend yourself in an employment tribunal against a claim brought by a staff member P32
Figures tell a story
Philip Housden steps back from his monthly analysis of PPUs’ performance around the regions to note the changes over the past four years P38
Doctor on the Road: Electric cars are getting cleverer
Smart and sophisticated, this Audi package is hard to beat, says Dr Tony Rimmer of the Q4 P36
Starting a private practice: Avoid the pitfalls of running a practice
Accountant Ian Tongue examines the key areas where new independent practitioners come a cropper P40
Profits Focus: Getting a glowing report
Things have been getting brighter for radiologists, reveals out latest unique benchmarking survey P42
By Edie Bourne
Independent practitioner consultants who have been awarded a new national Clinical Excellence Award (CEA) are being warned they may be shocked to discover the tax implications of their good news.
Financial advisers say that, as a CEA boosts pensionable pay, awardholders may find they are now in a position to breach the yearly pension savings limit known as the Annual Allowance.
The standard rate is currently set
at £40,000, but the ‘tapered’ version of the allowance reduces this limit to as low as £4,000 a year for high-earning doctors.
Patrick Convey, technical director at financial planners Cavendish Medical, explained: ‘There have been lots of changes to the CEAs in recent years, which means it can be difficult to keep track of what this means for recipients.
‘The local awards were put on hold during the pandemic and the national awards are now under consultation.
‘Knowing the true value of your award is challenging, but it is important to check what it can mean for your tax position, particularly if you have complex income streams.’
The Department of Health and Social Care has launched a consultation on the current remit of the national CEA scheme with the aim of introducing a revised version from April 2022.
The proposal seeks to ‘broaden access to the scheme, make the application process fairer and
more inclusive, and to also change the application process’.
Mr Convey told Independent Practitioner Today: ‘The consultation will change the essence of the awards going forward, but hopefully improve the tax implications, as part of the proposal is to make them non-pensionable.
‘While we await any revisions, you should get your own position checked as soon as possible to avoid or reduce extra tax bills on what should be a reward for your dedication to the profession.’
NHS trusts are missing out on an income stream of around £1bn a year through lack of developing the potential of private patient units (PPUs), according to a new analysis.
It found they rarely collaborate and share best practice and there is a major opportunity for growth that is largely being ignored Housden Group commercial healthcare consultancy found few trusts engage meaningfully with their neighbours to ask for or to offer help with either private patient services management or business development.
But according to its managing
director Philip Housden, an Independent Practitioner Today columnist, there are huge opportunities for partnership activity.
He says: ‘Only in the South-west have trusts maintained their regional network of peer-group support to share best practice.
‘Several London trusts have from time to time made contact, but no meaningful grouping has been in place for several years. This lack of contact is to the detriment of the sector and means valuable knowledge gets lost.’
He argues that an on-site PPU offers several advantages to consultants.
These benefits are:
Convenience for them – and their trust employer;
Compelling governance and patient safety drivers;
A 24/7 infrastructure including critical care;
Specialist nursing and extensive diagnostic imaging.
Writing in this issue of Independent Practitioner Today, the PPU expert says lessons have to be relearned about collaboration between trusts.
Mr Housden states that relationships with the private medical insurers are not based on mutually recognised value and trusts are
unable to negotiate contracts and tariffs from a position of any strength. He says the sector is significantly undervalued across the NHS and underplayed to the market in general.
‘Outside of central London, few private hospitals have critical care capability and this leads to many trusts admitting insured patients as NHS cases for complex highvalue procedures and tests.
‘The true value of this missing potential income stream is not known but estimates certainly put the opportunity at perhaps £1bn a year.’
See ‘Figures tell a story’, page 38
Doctors with VAT-registered businesses are being reminded by HM Revenue and Customs to ensure they are prepared for Making Tax Digital (MTD) before it becomes mandatory for all VAT-registered businesses from 1 April.
The requirement is part of the
overall digitalisation of UK tax. Users’-reported benefits include submitting returns faster and increased accuracy confidence that they were getting tax right.
Businesses with a taxable turnover above £85,000 have already been required to follow MTD since
April 2019, keeping digital records and filing VAT returns using MTD compatible software.
In July 2020 it was announced that all VAT-registered businesses must file digitally through MTD from April 2022, regardless of turnover.
Businesses or their agents need to visit the GOV.UK website and choose MTD-compatible software, keep digital records from 1 April 2022 or the beginning of their VAT period, and sign up and submit their VAT return through MTD.
By Douglas Shepherd
Consultants representing the interests of those with NHS jobs have reacted with anger about pay restraint remarks from the Bank of England governor Andrew Bailey.
The BMA seniors’ leader hit back saying: ‘After the two years that we have just experienced, these comments will leave a bitter taste in the mouth for healthcare workers.’
The governor, who has a reported annual pay package of
over £575,000, told Sky News that the bank believed some price pressures driving inflation would ‘correct’, but it had to be ensured in the meantime that there was not more inflation pressure domestically.
He added: ‘That would come, for instance, from things like wage bargaining.’
Dr Vishal Sharma, BMA consultants committee chairman, responded that consultants would expect Government to roundly reject ‘this wholly unacceptable suggestion’.
He said: ‘During the pandemic, doctors and all healthcare workers have given their all, battling this deadly virus on the front line, putting their own lives at risk to help others. But the suggestion now is that it would be out of line to ask for a pay increase that reflects these extraordinary efforts and the spiralling cost of living.
‘After years of take home pay falling for doctors, to be told to accept another realterms pay cut is completely unpalatable.’
Independent healthcare’s online services specialist Healthcode has appointed the former chief executive of Simplyhealth Group, Romana Abdin, to chair its board and oversee a new chapter of planned innovation.
The company said she will work alongside managing director Peter Connor to enhance its products and services to independent practitioners, hospitals and insurers.
Former barrister Ms Abdin called it an exciting time to be chairing Healthcode as it took a leap forward with its online products,
A Londonbased specialist diabetes practice is launching a new centre in Birmingham and aims to follow this up with more in the UK.
The new clinic in Edgbaston has benefited from a £200,000 investment by the London Diabetes Clinic, part of the London Medical family.
It will initially focus on diabetes
services and engagement with stakeholders.
She said: ‘I’ve been impressed by Healthcode’s spirit of innovation, its focus on finding solutions which address the realworld challenges faced by the industry – such as The Private Practice Register –and its determination and ambition to be a force for technological progress.’
Ms Abdin takes over from Dr Doug Wright, who was at the helm for just over five years, alongside his role as Aviva UK Health medical director.
and weight loss, but will also be able to draw on the comprehensive cohort of specialists based in London and nationally.
The clinic, said to be the only specialist diabetes centre in West Midlands, will be led by diabetes and endocrinology consultant Dr Parijat De.
London Diabetes Centre chief executive Tony Graff said: ‘Our first clinic outside London is a truly specialist centre providing diabetes patients in Birmingham and the wider Midlands with a service that provides access to cuttingedge knowledge, treatments and technology.’
Romana Abdin
A specialist ophthalmology service in Wakefield has been rated outstanding following an inspection by the Care Quality Commission (CQC).
Inspectors said care by SpaMedica Wakefield gave patients more fulfilling lives.
It was rated outstanding overall and outstanding for being effective and caring, good for being responsive, safe and wellled.
Sarah Dronsfield, CQC’s head of hospital inspection, praised staff for going the extra mile. ‘During heavy snow, two patients became stranded in Wakefield on their way to get treatment. A manager contacted a hotel near the hospital to arrange and provide overnight accommodation and food until the weather improved.’
Feedback from people who used the service was continually positive about the kind and supportive way staff treated patients.
The service provided a 24hour, seven day on call service and managed any postoperative complication inhouse, when possible, rather than sending patients to an NHS provider.
Staff were proactively supported and encouraged to acquire new skills, use their existing skills and share best practice.
The service provided free transport to patients who lived within a set distance from the location.
Specialist mental health clinic
Green Door Clinic, in the Harley Street Medical Area, is trialling a revolutionary machine learning tool that tracks voice changes to offer a robust new way to manage depression.
One problem with managing the condition is that patients and clinicians often lack a robust way to monitor the progression of the illness over time.
Large gaps between consultations mean it can be difficult for people to remember or monitor
how they have felt between each session. Information can be missed out and this problem can be magnified if a patient sees several clinicians.
Affect.AI is a voicebased artificial intelligence tool stemming from a project at Imperial College London and uses machine learning along with formal assessments made by a clinician to determine changing characteristics of an individual’s voice to monitor changes in that person’s mood over time.
Staff at the opening of the Bupa Health Centre at the Rutherford Cancer Centre in Liverpool.
On hand for the ceremony were Sarah Melia (in red dress), general manager at Bupa Health Services, and Kevin Solly (back, left), general manager at Rutherford Cancer Centres
By Olive Carterton
Rutherford Health has partnered with Bupa Health Clinics to open new Bupa Health Centres at its network of cancer clinics, creating a one stop customer journey for patients, from diagnosis to treatment.
The first to open offers patients access to services such as private GP appointments, health assessments and physiotherapy under one roof within the Rutherford Cancer Centre North West in Liverpool.
If symptoms of cancer are identified in the Bupa Health Clinic, patients will be directed to Rutherford’s cancer specialists for
MRI and CT scans, mammograms and ultrasonograms on the same day, within the same facility.
The first Bupa Health Centre was opened by Sarah Melia, general manager at Bupa Health Services and Kevin Solly, general manager at Rutherford Cancer Centres. A second clinic will open in Rutherford Cancer Centre North East in Northumberland later this year.
Ms Melia said: ‘Our suite of health assessments are designed to give people a current picture of their overall health and wellbeing.
‘If any cancer symptoms are detected during an assessment, the partnership with Rutherford Cancer Clinics allows patients to quickly access treatment under the
same roof, improving outcomes and giving peace of mind.’
Mr Solly said: ‘In the UK, we are currently in the midst of a serious crisis in diagnosis and screening for cancer patients, and we know that early diagnosis of cancer saves lives.
‘These clinics will help to strengthen diagnostic capability in the UK by providing patients with a critical healthcare facility that will be able to fast track the time between diagnosis and treatment.’
He called the development a great example of how health providers could work together to improve care, create meaningful outcomes, and deliver tangible benefits to patients.
The private healthcare sector has welcomed the opportunities afforded by the Government’s announcement of a new tenyear cancer plan to improve the detection and treatment of cancer for millions of people every year.
David Hare, chief executive of the Independent Healthcare Providers Network (IHPN), said: ‘Independent healthcare providers played a vital role in ensuring NHS cancer care could continue during the pandemic – delivering over
140,000 cancer treatments to NHS patients during 202021.
‘To ensure as many people as possible can receive lifesaving treatment in the future, we need to build on these partnerships so that the NHS can access the high quality diagnostic, surgical and proton beam capacity that is available in the sector – helping to make the health system world leading in cancer care.’
Prof Karol Sikora, chief medical officer at Rutherford Health, said:
Independent practitioners in Scotland are being encouraged to benefit from a revision of their subscriptions to the Medical Defence Union (MDU) after suffering financial losses during the pandemic.
‘The terrible impact of the Covid19 pandemic means we have to go to war on cancer like never before and the Government’s announcement should be welcomed around the country.
‘It is all hands on deck and this war can begin in earnest today. A step change in rapid diagnostic services is the place to begin and there is a real opportunity for the NHS and the independent sector to work together to get to grips with this right away.’
The new head of Scottish affairs for the union, Mr Jerard Ross (right), said the country’s doctors in private practice had experienced a tough two years during Covid19.
He told Independent Practitioner Today: ‘The MDU recognises the pandemic has been a very challenging time for doctors in independent practice in Scotland.
‘Many doctors faced a drop in in their independent practice income and some will be unsure what their income might be going forward.
‘Our liaison managers and membership team understand these difficulties and can adjust subscriptions to reflect the realities of practice.’
Former consultant neurosurgeon Mr Ross said the MDU had a wide range of educational resources available to members, including a course available for doctors interested in setting up in private practice.
He aims to develop more educational resources for members in Scotland: ‘This has never been more important because doctors have needed to adapt their practice to the rapidly changing guidance and circumstances of the pandemic. We have increased our webinar programme accordingly with resources tailored for Scottish members.’
The defence body has appointed him to champion the interests of the MDU’s growing number of members in Scotland. Over the last four years Scottish membership has grown almost 30%.
Mr Ross, who has worked at the MDU for eight years and was previously a consultant in Edinburgh, will head up the organisation’s Scottish team.
By Olive Carterton
Plastic PPE waste is to be given another life in a ‘ground-breaking’ recycling collaboration between Heriot-Watt University in Edinburgh and Britain’s largest PPE manufacturer, Globus Group.
The soaring quantities of plastic PPE, including respirators and masks, that have been thrown away during the pandemic has been widely criticised as the world strives to reach Net Zero goals.
Since the start of the pandemic, an estimated 8.4m tonnes of plastic waste has been generated from 193 countries, most ending up in landfill or, in some areas, in the ocean.
Now a new Knowledge Transfer Partnership project is set to revolutionise how used plastic PPE is treated to turn the waste into a secondary raw material called pyrolysis oil, which can then be refined into new commercial products like new PPE products or fuels.
The project, which aims to create a robust circular economy approach for plastics, will run for two years.
Dr Aimaro Sanna, an assistant professor in chemical and process engineering at Heriot-Watt, said: ‘We will be working closely with our commercial partner Globus Group to develop a bespoke process that will be applied to PPE plastic waste that cannot currently be recycled mechanically due to various technological, economic or ecological reasons.
‘As the world strives to reduce its landfill, ocean impact and carbon emissions, this project is a significant step towards addressing the increased waste generated during the global pandemic.
‘Initially, the research will help to recycle over 100 tonnes of product generated by the manufacturing process every year – the equivalent to 10kg of waste every hour. However, our hope is that this new process will be adopted more widely.
‘Many countries have been unable to process their plastic waste PPE properly. Our ground-breaking research aims to address these challenges providing an exemplar technique for application globally.’
The joint project between Edinburgh’s Heriot-Watt University and the UK’s largest PPE manufacturer will treat the plastic waste so that the polypropylene is recycled into large, re-usable blocks
Since the pandemic’s onset, Globus Group has been producing one billion medical masks and 300m FFP respirators a year for healthcare trusts across the UK. The manufacturing process currently results in 7g of waste material per medical mask.
The new scheme launched by Globus Group and Heriot-Watt University will develop an innovative process for cost and energyefficient recycling and repurposing of this PPE waste.
As part of the initiative, Globus Group has implemented innovative sustainable thermal heating technology at its Alpha Solway factory in Golborne, Greater Manchester.
Developed by Thermal Compaction Group (TCG), the machine has been designed to heat and compact the plastic polypropylene into large, re-usable blocks.
These are then collected and processed, providing raw materials which Globus Group can use to make new PPE products – reducing the company’s PPE waste by an estimated 85%.
BMI Healthcare is to be known as Circle Health Group under a rebranding exercise following its acquisition by the smaller competitor in January 2020.
It is claimed the ‘agile blue’ colour of its new logo also aligns with the philosophy Circle launched last summer – ‘a combination of what staff and doctors said they wanted from the organisation. It is a combination of systems and process that had proven successful in BMI Healthcare and Circle’.
The company added that it reflected ‘the shared history of both organisations and the commitment that staff and doctors have to each other and the patients they care for’.
Circle’s chief commercial officer Mark O’Herlihy added: ‘With this brand change, we’re bringing a fresh, new look to our services which emphasises the modernity and high-tech investments that are in our DNA.’
Since the two-businesses joined together to become the UK’s largest independent provider, they have have been named Private Hospital Group of the Year from HealthInvestor and won the Hospital Group award from industry analysts LaingBuisson.
A new eye health clinic and surgical centre in Northampton plans to give greater choice to local NHS and private patients.
Newmedica Northampton will provide NHS and private treatment for cataract surgery, YAG laser treatment, glaucoma care and plans other services including oculoplastics.
It will be run by a team of five local partners, operational director Michelle Mulvaney and ophthalmologists Mr Bimal Kumar, Mr Muneer Otri, Mr Julian Robins and Mr Anant Sharma.
By Leslie Berry
HCA Healthcare UK has opened the doors to its latest investment in complex cancer care: a £26m specialist complex haematology and oncology unit at University College Hospital (UCH), London.
The investment is part of a longstanding partnership with UCH, where it has provided private patient care since 2006.
It sees the transfer and expansion of inpatient capability into a specially designed 43-bed unit in the new Grafton Way building.
The hospital group said its expansion at UCH will enable access to inpatient clinical trials delivered via its UK’s research arm, Sarah Canon Research Institute UK.
Features at the new unit include:
An eight-bed, HEPA-filtered advanced cellular therapy unit –the optimal clinical environment for highly specialised treatments such as CAR-T cell therapy;
A JACIE-accredited haematopoietic stem cell transplant unit for bone marrow transplants;
Direct access to a ten-bed haematology oncology specialist consultant-led intensive treatment unit for patients with complex needs;
Inpatient rooms with positive pressure lobbies to minimise the risk of infection for immunocompromised patients;
A dedicated isolation unit which means patients with transmissible infections can continue to be cared for within the unit safely.
Day care and outpatient services
for private patients will continue to be delivered at the UCH Macmillan Cancer Centre.
Claire Smith, chief executive of HCA UK NHS Joint Ventures, said: ‘This is another important milestone in our longstanding partnerships with the NHS, building on the 2021 investment in our theatres at The Christie Private Care and looking ahead to our exciting new development with University Hospitals Birmingham.’
The hospital group’s president and chief executive, John Reay,
HCA Healthcare UK has partnered with the NHS through Joint Ventures for over 15 years, with its first partnership established with University College Hospital in 2006. It also provides services at The Christie Private Care and Private Care at Guy’s.
In 2023, it is due to open the £100m The Harborne Hospital, a partnership with University Hospitals Birmingham.
said: ‘This £26m investment into HCA UK at UCH is part of our wider commitment to ensuring that across our healthcare system we are providing the complete pathway for cancer patients, from diagnostics through to the most specialist treatment and holistic care.
‘This depth and breadth of care, unmatched in the independent sector, attracts patients to us from across the world.’
Dr Panos Kottaridis, consultant haematologist and associate medical director at HCA UK at UCH, added: ‘The new 43-bed inpatient unit at HCA UK at UCH brings together the very latest advances in treatment and technology, with outstanding levels of expertise and care, making it the optimal environment to care for patients with complex cancer and haematology conditions.’
Compiled by Philip Housden
Royal National Orthopaedic Hospital Private Care improves customer support
The Royal National Orthopaedic Hospital (RNOH) has recently invested in improving the private patient customer experience.
RNOH Private Care has agreed to work with Doctify, the online review service, and self-pay patients will also now be able to spread the cost of treatment due to a collaboration with Chrysalis Finance.
Having the ability to offer customers 0% payment terms as well as other finance options will further broaden RNOH Private Care’s appeal to the self- pay market.
Rick Windas, head of the private and international care division at RNOH Private Care, who recently joined the trust from Cambridge University Hospitals, said he was looking forward to offering patients the ability to review their experience online in ‘real time’.
‘Apart from being able to easily write a review of their experience post-surgery, this will enable future customers to read first-hand accounts of what is available and what to expect, plus give our consultants visibility of how they are perceived,’ he said.
RNOH delivered private patient revenues of £5.5m in 2020-21, down only 28% on the record £7.6m achieved pre-pandemic and
significantly better than the NHSwide average drop of 44%. The trust is the 13th highest ranking NHS trust by private patient incomes in England.
The Royal Marsden reports return of strong private patient demand
The number-one NHS trust for private patient earnings, The Royal Marsden, reports continued recovery of private patient services and revenues over the last quarter.
Shams Maladwala, managing director at Royal Marsden Private Care, told PPU Watch: ‘We have seen growth at our Royal Marsden sites from UK private medically insured patients and also the
return of international patients as UK travel restrictions ease.
‘Our new Cavendish Square centre, only opened last year, has also experienced high demand for early diagnosis and treatment services.
‘I am delighted that we have excellent feedback from patients on their experience at the new facility, with 98% rating it as excellent or very good.’
The Royal Marsden Private Care contributed £102.3m to the trust in 2020-21; 29.5% of total income, and 26.9% of the total PPU revenues for all NHS trusts in England.
Philip Housden is a director of Housden Group. See his feature article on PPUs’ finances on page 38
Orri was founded in 2018 by chief executive Kerrie Jones, a leading psychotherapist in the eating disorder sector.
Working alongside clients with eating disorders for almost 20 years, she recognised there was a need for a treatment that provided not only expert support in managing the physical and behavioural complexities which come with eating problems, but also a profound need for a space where clients can choose to explore the underlying difficulties and causes in depth for a longterm and sustainable recovery.
Traditionally, there has been a heavy reliance on outpatient and inpatient treatment models, leading to a gap in eating disorder treatment pathways.
Orri’s specialist day treatment is a solution to this gap, offering care in the community that treats all aspects of the eating disorder, not just the symptoms.
‘The rating, alongside our third birthday, marks a key milestone for Orri. We have worked incredibly hard to demonstrate that our intensive day treatment programme and stepped approach offers an effective and compassionate alternative to traditional models.
‘We have seen a sharp rise in eating disorders since the pandemic, and hope that Orri can help many more clients over the coming years.’
Prof Paul Robinson, consultant psychiatrist and Orri’s director of research and development, said: ‘Having been associated with Orri from the outset, I was delighted to read this very positive report from the CQC.
By Agnes Rose
Orri, an independent specialist eating disorder service in Central London, has won an outstanding rating from the Care Quality Commission (CQC) following its very first inspection.
It went down so well with the inspectors that the watchdog’s head of hospital inspection praised it as ‘an excellent example to other providers who should look to learn from this report’.
Helen Rawlings said: ‘People’s needs were central to everything the staff and management did, which has resulted in an outstanding service.’
The service provides eating disorder day treatment to adults through face-to-face and online therapies.
Inspectors rated it outstanding for being safe, caring, effective, well-led and responsive to people’s needs. Ms Rawlings was pleased to see the excellent quality of care being delivered by Orri, especially against the backdrop of the Covid19 pandemic.
‘It has ensured patient safety throughout, and continued to deliver the support its clients need, aided by an effective online treatment programme,’ she said.
‘Orri was delivering an exceptional experience to people who used this service as well as their families, during an extremely challenging time in people’s lives.’
Inspectors found a strong community ethos throughout the service, creating an environment of mutual support.
They were particularly impressed that people who had completed their recovery kept in touch with the service and returned to deliver supportive and motivational groups to new clients.
The watchdog also welcomed the service’s strong social media presence, which gave those accessing treatment the opportunity to share their experiences safely through closely monitored blogs and online interactions, as well as enabling them to keep in touch with the service and receive regular motivation when it was closed.
At the heart of Orri is the belief that recovery is possible for all.
The team – comprising experts in psychiatry, psychology, nursing, psychotherapy, occupational therapy and dietetics – works collaboratively with clients and partners to provide expert, evidence-based treatment with compassion at its core.
Ms Jones told Independent Practitioner Today: ‘The whole team at Orri feels immensely proud of the Care Quality Commission (CQC) inspection report, not just for the ratings but for the incredibly positive comments made by the inspectors, our clients, team members and carers.
‘I have long been convinced that most patients with severe eating disorders do not require admission to inpatient care, and that for those who are admitted, some could have avoided admission with intensive community care and some, perhaps most, could be discharged early, when medically stable, to such care.
‘That was the basis for the service I developed at the Royal Free Hospital in the 1990s and I was so pleased when Kerrie invited me to be part of the Orri project in 2018.
‘The idea that one can treat people with severe eating disorders in day care has been supported by [the charity] BEAT and NICE, but unfortunately not taken up universally, for reasons that escape me. Thankfully, Orri has now shown that it can be done effectively and safely.’
Ramsay Health Care UK (Ramsay) and IMS MAXIMS have announced a successful roll out of the MAXIMS Electronic Patient Record (EPR), now fully live and operational in all 35 Ramsay hospital sites.
Introducing a single patient management system makes the independent healthcare provider the first in the UK to implement something of this scale across all its hospitals.
More than 11,000 system users can now manage all aspects of the patient pathway.
These include patient admissions, discharge, triage, referral management, scheduling, appointment correspondence, order communications, referral to treatment pathways and real-time bed and theatre management.
The implementation approach adopted by the two organisations ensured active engagement by stakeholders, with a focus on working with consultants and staff to ensure they were fully prepared and trained for the live launch.
Ramsay chief executive Nick Costa hailed the system’s introduction as a transformation in the way the organisation operates and provides its services.
He said: ‘Bringing all parts of the patient record into one place and providing a consistent approach to how we carry out processes means we are able to ensure we are constantly providing the highest quality of care to our patients.
‘This has been a monumental achievement for the UK team working alongside our colleagues
in IMS MAXIMS and sets the bar for our digital health journey.’
Ramsay said its strategy aims to build an integrated healthcare system to deliver advanced digital health services to clinicians, patients and payers.
The EPR now provides it with consistent outcome data which allows for benchmarking and continuous improvement to services to ensure high quality.
IMS MAXIMS’ Jacinta Ni Suaird added: ‘This completes the roll-out of MAXIMS EPR across all of Ramsay’s hospitals to support them at the core of their digital journey.
‘The simultaneous go-live of a new EPR at 21 hospitals on the same day is an unprecedented achievement.’
Personalised lists of ‘favourite’ orders, providing consultants with a quick way to find and order their most common radiology investigations, pathology tests, other clinical investigations such as ECGs, and order sets
A personalised longitudinal patient record (LPR) dashboard providing consultants with one-click access to a summary record of a patient’s orders, results, diagnoses, alerts, future and historic appointments and admissions, procedures, waiting list entries, referral documents and more
Surgical operation notes which can pre-populate a consultant’s personalised text on a per-procedure basis ready for editing, saving consultants time in recording operation notes
Specialty hotlists for procedures, diagnoses and comorbidities, providing quick access to find common terms, which also supports searching for results using clinical codes such as CCSD and OPCS
Clinical activity is captured in real time in MAXIMS, including charge codes recorded in the background, ensuring consultants can get paid without needing to complete paper charge forms
Mayo Clinic Healthcare in London has expanded its advanced cardiac imaging tools to include 3D transoesophageal echocardiography
The addition supports full diagnostics for heart valve diseases , with assessments and review by Mayo clinicians in the UK and their colleagues in the US.
Transoesophageal echo, a stateof-the-art imaging assessment that provides immediate, accurate and cost-effective diagnostic information about the heart, works through a thin scope that accesses specific internal views of the heart via the oesophagus. The patient is under mild sedation during the process.
The scope allows the clinicians to view moving images of the patient’s beating inner heart on a monitor. These can be measured and used for diagnosis, allowing for detailed planning of therapies.
Examples of MAXIM’s ‘Favourites’ page (above) and longitudinal patient record (right)
Dr Gosia Wamil, a cardiologist at Mayo Clinic Healthcare, said: ‘Using transoesophageal echo, we can confirm an initial diagnosis of heart valve disease or provide a useful second opinion to guide a patient’s next steps.’
➲ Mayo Clinic Healthcare in London has reached an agreement with Aviva that allows the insurer’s policyholders to access care at the clinic.
The agreement is retroactive to 1 December 2021. Coverage will depend on a person’s health insurance policy, the clinic said.
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
A huge package of patient-focused initiatives to attract private healthcare business to consultants in London was unveiled by the capital’s biggest independent hospital provider.
HCA said it was targeting what it saw as a ‘£20m revenue opportunity’ over the forthcoming year in the self-pay market.
It announced it aimed to grow foreign visitor and UK self-pay earnings from 17% to 25% with an ambitious programme of novel incentives aimed at making the whole process of going private far easier for patients.
And the group said its ambitious marketing package also aimed to make it more attractive for doctors to work in its hospitals too.
The initiative aimed to bring more patients to London from all over the world, improve pricing clarity and giving a better response to potential self-payers.
Consultants who were awaiting payment for work with patients who had medical insurance were warned they might be the victims of a simple error – in their office.
As many as 60% of consultant bill failures were due to the patient’s insurance policy number
being quoted incorrectly on the bill.
The problem was revealed by Healthcode, the electronic bills clearer for the private market.
Over a 12 months period, more than 3,500 bills, representing 0.59% of the total, failed.
With more consultants sending their bills electronically, they were advised to ensure extra checks when preparing invoices.
Private hospitals should stop giving financial incentives for consultants to work with them, according to an independent hospital group.
Jill Watts, chief executive of Ramsay Health Care UK, said her company now believed the best
way to attract high-quality consultants was with investment in excellent facilities and equipment.
This was why it had worked to remove the ‘few’ direct financial incentive deals made historically by its hospitals with doctors.
Ms Watts said: ‘For some time, we have had no direct financial incentives at all. Ramsay believes that the private healthcare industry should move away from direct financial incentives, especially ‘lock-in agreements’ in which a doctor agrees to carry out a high percentage of their procedures at a particular hospital irrespective of the needs of the patients.
‘Lock-in agreements, more than other incentive schemes, stifle competition and patient choice.’
Her comments followed an Office of Fair Trading Private Healthcare Market Study the previous year which criticised providers’ incentives to consultants and led to stiffer rules implemented by the Competition and Markets Authority (CMA).
A new Health and Social Care Bill could lead to huge fee variations for doctors treating NHS patients in the private sector, according to a BMA private practice committee member.
The anaesthetist warned a conference that, without pay parity, the profession would see an emergence of ‘surgical millionaires at the expense of every other supporting clinician’.
The way it used to be. . .
Only 44% of 639 respondent doctors to a Medical Defence Union survey said they used a smartphone.
Just 3% used Twitter in their day-to-day work, 24% used apps at work and seven-in-ten had recommended a health website or app to a patient.
Share your experience of what has and has not worked in your private practice. Even if it’s bad news, let us know and we can spread the word to stop others falling into the same pitfalls.
Contact editorial director Robin Stride at robin@ip-today.co.uk
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Signposting patients to the Independent Sector Complaints Adjudication Service (ISCAS) is now essential to implement recommendation 6 of the Paterson Inquiry and ensure good complaints management, says Sally Taber (right)
GOOD COMPLAINTS management was highlighted in the Paterson Inquiry report published back in February 2020.
It has been very encouraging to see progress being made in the private healthcare sector in recent months.
The Paterson Inquiry report said: ‘We recommend that information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector.’
And this was reiterated when the Government released its longawaited response to Paterson in December.
In a oral statement to Parliament on the Paterson Inquiry report in December, junior health minister Maria Caulfield said: . . .‘regardless of how their care is funded, all patients should be confident the care they receive is safe, meets the highest standards, with appropriate protections. . .’
She went on: ‘The inquiry did not jump to a demand for the NHS and the independent sector to invent multiple new processes, but to actually get the basics right, implement existing processes and for all professional people to behave better and to take responsibility.’
To us at ISCAS,that means having an external review stage to an independent sector organisation’s complaints process.
Patients who are looking beyond the organisation where they were treated are increasingly being signposted to our service.
For instance:
☛ The Royal College of Surgeons of England signposts to ISCAS and has a hyperlink directly to the ISCAS website. See signposting here: www.rcseng.ac.uk/ patient-care/cosmetic-surgery/ after-surgery.
☛ The Patients Association www.patients-association.org.uk/ making-a-complaint.
☛ The Private Patients Forum https://privatepatientsforum.org/ how-to-complain.
☛ Independent Doctors Federation www.idf.uk.net/patients/patientcomplaints.aspx.
☛ Parliamentary and Health Service Ombudsman (PHSO)
www.ombudsman.org.uk/making-complaint/if-we-cant-help/ private-healthcare.
☛ Action Against Medical Accidents is signposting to the PHSO only: www.avma.org.uk/ help-advice/complaints, although it does mention private patients. ISCAS has been talking about signposting too with both the Federation of Independent Practitioner Organisations (FIPO) and the London Consultants Association (LCA).
Consultants co-operating on patient complaints
As part of their practising privileges at an ISCAS subscriber hospital or an NHS private patients unit (PPU), the consultant agrees to cooperate with the hospital’s complaints policy as part of their practising privileges with the provider.
For ISCAS subscriber hospitals, this is a three-stage process:
1. The registered manager is responsible for Stage 1 of the complaint when the complaint is first raised.
2. Stage 2 is conducted by the corporate head office – in the case of group hospitals – or in the case of individual hospitals by the chairman of the board or appointed non-executive director.
3. ISCAS is enacted at Stage 3 if the patient remains dissatisfied.
Patient complaints are an inevitable aspect of a consultant’s professional career and the ISCAS Code of Practice provides an invaluable framework for specialists to manage them.
A direct entry mediation scheme has been introduced for those small organisations who do not have the infrastructure to undertake adjudication.
We have considered recommendation 6, in two parts. The first part calls for more effective communication to patients of the means to escalate a complaint to an independent body, namely ISCAS.
The Parliamentary Ombudsman is piloting the NHS Complaints Standards which set out in one place the ways the NHS should handle complaints. This includes the need for organisations to ensure people know how to escalate a complaint to the Ombudsman.
WHAT THE GOVERNMENT SAYS IN RESPONSE TO RECOMMENDATIONS OF THE PATERSON REPORT, CONDUCTED BY THE FORMER BISHOP OF NORWICH RT REVD GRAHAM JAMES
RECOMMENDATION 6A
We recommend that information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and the independent sector. Government response – accept The Parliamentary and Health Service Ombudsman (PHSO) is currently piloting the NHS Complaint Standards, which set out in one place the ways in which the NHS should handle complaints, including the need for organisations to ensure that people know how to escalate to the Ombudsman.
These have been developed with the Independent Sector Complaints Adjudication Service (ISCAS), who have included it in their code of practice.
We will continue to work closely with key organisations involved to ensure that standards are reinforced.
RECOMMENDATION 6B
We recommend that all private patients should have the right to mandatory independent resolution of their complaint. Government response – accept in principle Care Quality Commission will strengthen its guidance to make clearer that it expects to see arrangements in place for patients to access independent resolution of their complaints regarding independent sector providers.
We will review uptake across the independent sector in the next year, and if uptake is not widespread, we will explore whether current legislation needs to be amended to ensure that all providers make provision for independent adjudication.
These have been developed with ISCAS and we have included the framework in our 20-page updated code of practice that we have just launched – see https://iscas.cedr. com/patients/complaints-process.
The second part of recommendation 6 proposes that all private patients are given the right to mandatory independent resolution of their complaints.
Now the Care Quality Commission (CQC) will be strengthening its guidance to make clearer that it expects to see arrangements in place for patients to access independent complaints resolution.
The Department of Health will review the impact of this guidance in the coming year and will explore whether legislative action is needed if insufficient action is taken.
Subscriptions for ISCAS start at £515 a year and rise in relation to private patient turnover.
Sally Taber is director of Independent Sector Complaints Adjudication Service (ISCAS)
TEN POINTS FROM THE ISCAS CODE OF PRACTICE FOR COMPLAINTS MANAGEMENT
1
Good complaints management is an integral component of good governance, quality management and an organisational commitment to customer focus.
2
Good complaints management and learning from complaints should be part of the wider quality management system.
3
Actively seeking feedback from patients, focusing on enhancing customer satisfaction and maximising opportunities for continuous quality improvement through learning from complaints enables organisations to enhance and improve the quality of care and service.
4
ISCAS, an independent notfor-profit organisation, is recognised by subscribing independent healthcare providers as an appropriate body for the escalation of complaints in the UK. It is independent of all private healthcare providers and is owned by the Centre for Effective Dispute Resolution, which is a registered charity.
5
ISCAS is recognised by the following regulators, with whom it has an information sharing agreement: The CQC, Healthcare Improvement Scotland, Healthcare Inspectorate Wales and the Regulation and Quality Improvement Authority. It is rec-
ognised by other relevant bodies, such as the Parliamentary and Health Services Ombudsman (PHSO) as an appropriate body for the escalation of complaints in the independent sector.
6 The ISCAS Code sets out good practice standards for independent adjudication services, which are provided by ISCAS, and offers an impartial way of resolving disputes between complainants and subscribers.
7
The Standards, where appropriate, refer to the requirements made by the systems regulators across the UK who oversee compliance with good practice principles and quality and regulatory standards in each of the four UK countries.
8 Costs associated with independent adjudication are met by the relevant subscriber and not the complainant.
9
ISCAS is not a regulator and has no powers to take enforcement action against a subscriber. But it will take ‘appropriate’ action including termination of a subscriber’s participation in the scheme for organisations who fail to meet the standards or who bring the code into disrepute.
10
The code does not exclude other good practice models – such as using patient partners – and encourages subscribers to continuously improve the effectiveness of their complaints handling in the light of best practice and good governance.
HCA Healthcare UK has invested £7m in four new da Vinci Xi robots, confirming its status as the largest provider of robotic surgery in the independent sector with a fleet of seven da Vinci systems across its healthcare system. Mr Jay Chatterjee (right), consultant gynaeoncologist at HCA UK’s London Bridge Hospital and The Lister Hospital, discusses the rise of robotics
THE PROGRESSIVE adoption and evolution of robotic surgery as the preferred modality for minimal access surgery over the last decade, has many reasons.
Surgical precision, ergonomics and patient outcome has driven this advanced technology which has now captured the imagination of most surgeons and surgical specialties.
The most complex minimalaccess surgeries are now performed robotically due to the ergonomic advantages over straight-stick laparoscopic surgery, which subsequently translates into better patient outcomes.
The transformation from open surgery to laparoscopic and robotic surgery has largely been driven by enhanced recovery of patients from their complex surgical procedures and quicker discharges with less hospital stays.
Greater precision surgery leads to fewer complications. Surgical innovation in recent years, has effectively given rise to surgical possibilities that were never before imagined and thought to be achievable in an operating theatre.
Skilled laparoscopic surgeons have honed their skills with years of practice. Arms poised like a mar-
ionette, but without the benefits of strings to take the strain; these surgeons operate through tiny incisions.
Lift your elbows up at right angles to your body, and see how long and how comfortably you can sustain this pose. My guess is that it isn’t long.
With years of practice, expert laparoscopic surgeons learn to relax their posture, but operating still requires significant physical fortitude.
Small incisions are made in the abdomen, through which ports are placed. Slim, crocodile mouthlike instruments provide the means of operating. These tiny mouths can open, close and rotate at the touch of a surgeon’s finger.
Moving the surgeon’s hand forward moves the instrument backwards within the body cavity.
Highly skilled laparoscopic surgeons develop their skills over tens of years, building both skill and stamina.
Laparoscopic surgery is not a skill that comes easily to all surgeons, with many unable to perfect the necessary skill or 3D depth perception and co-ordination nec-
essary to do more than the most simple of operations.
As with all levers, small movements at one end translate into large movements at the operating end. Tremors are amplified. This demands a skilled steady hand from the surgeon. Despite these challenges, many excellent laparoscopic surgeons perform lengthy and complex surgeries using these instruments.
Occupational injury, however, in the form of neck, shoulder and repetitive strain injuries can negatively impact on clinical perfor-
mance, even leading to the premature end of a surgeon’s career.1
Robotic surgery is a progressive development from the world of laparoscopic surgery. It is robot assisted/enhanced laparoscopic surgery. Instruments are again inserted though ports in the abdomen, but are held and supported by robotic arms.
The surgeon sits comfortably at the surgeon’s console, rather than standing at the bedside, able to relax and concentrate on the detailed surgery in front of them. Microsurgical instruments are controlled by signals translated from the natural movements of the surgeon’s fingers.
Enhanced and magnified 3D vision supports microsurgical fine dissection. Instead of tremors being magnified, tremor and movement control keep movements fine and precise.
Some patients may fear that it is the robot performing the surgery, but nothing could be further from the truth; the operation is performed by the surgeon but enhanced by the robotic system. Robotic surgery is physically less demanding and so supports the use of minimally invasive surgery in
Miss Christina Uwins, who co-authored this article, is a subspecialty gynae-oncology fellow
Robotic surgery is physically less demanding and so supports the use of minimally invasive surgery in longer and more complex surgeries in hard-to-reach areas of the body
longer and more complex surgeries in hard-to-reach areas of the body.
In our own specialty of gynaecology and gynaecological oncology, we routinely provide robotic surgery for women with endometrial cancer and other complex pathologies, many with significantly raised BMI >50.
Women routinely go home after only one overnight stay or even on the same day following a hysterectomy. Blood loss is known to be much lower with robotic surgery as is the length of stay.
Before the introduction of robotic surgery to our trust, a woman undergoing a hysterectomy would typically expect to stay in hospital for six days and now routinely stays only one or goes home the same day. Blood loss has also been reduced from an average of half a litre to only 50ml.
Robotic surgery provides the benefit of excellent magnified 3D vision together with microsurgical instruments, providing precision operating.
Blending surgeons with the technological benefits of the robotic system should be seen as a means of future-proofing.
Image overlay with cross-sectional imaging guides precision surgery, as does the use of fluorescence dyes such as Indocyanine green used in sentinel lymph node and bowel perfusion assessment.
Remote proctoring/operating provides exciting opportunities to provide the best surgery for our patients not limited by borders of time or travel.
The potential for interspecialty co-operative working using the robotic platform is an exciting prospect. This is increasingly becoming a reality with the expansion of robotic surgery into diverse surgical specialties.
Find out more about minimally invasive robotic assisted surgery at HCA at www.hcahealthcare.co. uk/about-hca-uk/robotics-andtechnology-at-hca/the-da-vincisurgical-system.
This article was co-authored by subspeciality gynae-oncology fellow Miss Christina Uwins
Reference
1. Plerhoples TA, Hernandez-Boussard T, Wren SM. The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery.
J Robot Surg. 2012; 6: 65-72.
Independent practitioners provide an excellent training ground for NHS junior doctors. David Hare says the aim now is to have more private doctors take part
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INDEPENDENT PROVIDERS and practitioners have long played a key role in delivering healthcare to millions of NHS and private patients every year.
But while the independent sector has played an important role in the education of a wide range of clinical staff, there have been growing calls for the private sector to play a bigger role in the training of the next generation of doctors.
The onset of the coronavirus pandemic, and in particular the national NHS/independent hospital partnership that saw whole NHS teams transferring across to the sector to keep non-Covid services running, gave real impetus to this issue.
And as Independent Practitioner Today readers will know, following detailed conversations between a range of stakeholders, an agreement was reached in September 2020, between the Independent Healthcare Providers Network
(IHPN), Health Education England (HEE), NHS England/Improvement and the Confederation of Postgraduate Schools of Surgery (CoPSS) to significantly increase NHS junior doctors’ access to training with independent providers delivering care funded by the NHS.
Since then, more than 4,000 NHS doctors in training have accessed training opportunities in the independent sector, with a growing recognition of the role private providers can play in supporting the next generation of medical professionals.
But what have we learned from this experience to ensure that doctors in training can have the best possible experience working with independent practitioners? IHPN has recently published a report on just this question.
Firstly, it is important to recognise the important contribution
the independent sector can make to medical training.
In specialising in routine elective procedures such as hip and knee operations and cataract surgery, independent providers offer an ideal training ground for junior doctors to learn from the best independent practitioners in the business, hone their skills and achieve their training targets.
And, since 2020, the sector has been vital in ensuring medical training could continue at a time when there was huge upheaval and acute pressures in the NHS.
However, there remains a number of practical barriers to ensuring the sector can fully support the training of junior doctors.
Through talking to trainees and providers across the system, IHPN has found time and time again that simple administrative issues are often a key barrier in accessing the independent sector and can place a significant burden on both independent practitioners and providers.
While, of course, the necessary governance processes need to be followed, too often trainees report having to process large volumes of paperwork to be able to enter independent sites, which can delay or prevent access to training opportunities.
A significant proportion of the paperwork and checks required are duplications of what has already been done for other training placements, and the process could be considerably streamlined without any consequences for quality and safety.
We therefore want to see much more co-ordination and information-sharing to enable trainees to move more easily between sites and access training across the entire healthcare system.
This is a current priority for HEE which is part funding a new Clinical Information Sharing System (CISS) solution, which will offer a ‘single point of truth’ for trainees and allow credentials and other information required for placements to be shared – increasing the mobility of trainees while ensuring governance requirements are adhered to.
More can also be done to improve planning around trainee
placements. Many independent providers report that requests to have trainees were sometimes done at short notice, making it more challenging for practitioners to fit them into existing schedules and ensure employment checks were undertaken.
Including the independent sector as part of the Doctors in Training rota and implementing more comprehensive, systemwide processes to allow for advanced planning and communication would help with this.
Such a system-wide approach would also be beneficial with regards to data collection about both the quality and access to training in the independent sector.
We know independent practitioners provide an excellent training ground for junior doctors and we want to make sure this is captured and recognised by all those in the sector.
IHPN has therefore begun work with HEE to help consolidate the experiences of trainees in the sector, such as by ensuring questions about accessing training in the independent sector are included in the next National Education and Training Survey (NETS) survey.
Looking back over the last few years, it is clear there has been a much needed cultural shift on this issue, with a recognition that independent providers and practitioners have a key role to play in the training the next generation of medical professionals.
While there is still more progress to be made, particularly around taking a more system-wide approach to communication and data-sharing around trainees, IHPN will continue building on this momentum.
And we will ensure independent practitioners have the opportunity to impart their wisdom and can fully contribute to medical training in the long term.
David Hare (right) is chief executive of the Independent Healthcare Providers Network (IHPN)
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There are so many patients on NHS waiting lists and many of these are considering self-pay private treatment. How do I attract them to my practice?
Jane Braithwaite (below) turns troubleshooter to answer independent practitioners’ frequently asked questions on business matters.
This month, she gives advice to help you take advantage of the self-pay boom
A DEEPLY CONCERNING impact of Covid has been the increase in NHS waiting lists for healthcare treatment and this is generating growth in the number of patients in the UK opting for self-pay private treatment.
Reports suggest a 30% increase in self-pay treatment in April 2020 compared to pre-Covid levels.
It was reported in Independent Practitioner Today in October 2021 that self-pay patients amounted to one third of all private hospital activity for the first time.
When planning to access private care, a self-pay patient needs advice from a knowledgeable and responsible source, regarding which hospital and which consult-
ant to see and this advice would often be offered by their GP. But a significant impact of Covid has been the increased pressure on GP services throughout the UK. And one of the most worrying impacts for patients has been their inability to make an appointment with their GP, either face to face or online.
In recent months, the Government has been pushing GPs to make more face-to-face appointments available and, in October, they announced a major NHS drive to improve access for patients.
The Government has promised an additional £250m extra for GP practices to enable these improvements. GPs will need to extend their opening hours and offer walk-in appointments to access these additional funds.
In the short term, though, we can assume that there are an increasing number of individuals in the UK who are looking for private healthcare.
If you are a consultant in private practice who is keen to provide support to self-pay patients, then you will want to ensure they are able to find out about you and the services and treatments you offer.
I know a lot of doctors feel uncomfortable with the concept of marketing and, to overcome this concern, I prefer to talk about communications.
Your communications with existing and potential patients and potential referrers will increase your opportunities to see additional private patients.
The starting point for any marketing plan is to clarify your target audience. Think about:
The treatments you offer;
Who is your audience;
Who is your ideal patient.
Think about age, sex, geography and lifestyle. By having a clear definition of your audience, you can make good decisions about how to reach your target patients.
As the pressure on GPs is currently significant, patients may be using other routes to find their treatment: asking friends and family.
Word-of-mouth referrals and recommendations are hugely valuable to all doctors working in private practice and a positive way to increase the number of patients that you treat.
Every patient you have seen in the past is a potential source of referrals for you. We also know that potential patients will do their due diligence before booking an appointment with you to validate the recommendation they have
You want to create a consistent online identity and ideally every mention of your name and your practice should have that same identity been offered and to check that you are the right doctor for them.
The easiest way for them to do so is performing a Google search on your name and the results of this search are what we refer to as your ‘online reputation’.
Your potential patients will be checking out your ‘online reputation’ prior to booking an appointment with you, so I recommend you regularly check your online profile and ensure it provides an accurate and positive representation of you and your practice.
A very basic, but often overlooked, starting point is to ensure that your contact details are correct on all websites where your profile is published.
Ideally, you should include the name of your medical PA – as this reassures patients that your practice is professionally set-up – a phone number that is not a mobile and an email address with your own domain and not a Gmail address.
It is also important to check that the content on each website is appropriate, considering who the audience will be. Most profiles are aimed at potential patients and yet many doctors write their profiles with their medical colleagues in mind, listing their CV and medical education.
A patient wants to know if you are the right doctor for them.
Do you treat their condition?
Do you understand their symptoms?
Do you offer the right type of care?
So your profile needs to be written to reassure the patient that you are the right doctor and ensure they follow through to book an appointment to see you.
One great asset that is totally free is your own personal profile on private hospital websites where you practise.
Each private hospital group has
a directory of consultants on its website and your profile will be featured here for potential patients to review. It is really important to ensure that your profile is up to date and accurate. You should also make sure you list all treatments that you offer.
When a patient visits the hospital website, they will be looking for a particular treatment and you want to make sure your name comes up as a potential consultant in the search results.
The word ‘branding’ may sound like marketing jargon and so we encourage you to think about it in terms of your identity. You want to create a consistent online identity and ideally every mention of your name and your practice should have that same identity.
This should also extend to your stationery, business cards, email signature and letterheads. All your photos must also be professional and should look consistent.
First impressions count Your website is the most important and valuable aspect of your online profile, as you are completely in control of the content and the look and feel.
Visitors to your website will decide in the first 30 seconds whether your website is relevant to them and so first impressions are important.
The look and feel of your website, the branding, your logo and the colour palette will have a significant impact on your visitor’s decision to stay or leave.
Once you have convinced the visitor to stay on your website, you need to ensure it is easy for them to find the information they are looking for and, most importantly, you need a strong call to action.
Your ideal call to action is to encourage your visitor to book an appointment with you either via phone, email or ideally online.
Online booking is common in many industries and is growing in popularity in private healthcare. In the next couple of years, we expect to see this become the norm and it is important that you implement an online booking system to avoid being left behind.
An alternative call to action is to ask your website visitors to sign up to receive your regular newsletter.
A patient newsletter on a
monthly or quarterly basis is an effective way to stay connected with your growing community of patients and doing so is likely to increase word-of-mouth referrals, as patients will remember to mention you to friends and family.
Please ensure that your newsletters are managed in a manner that complies with the General Data Protection Regulations, though.
All doctors should be encouraging patients to leave reviews about their practice, as these are incredibly powerful to prospective patients looking to book with you.
It is human nature to be influenced by others and reading your previous patients reviews are very reassuring.
There are several platforms for gathering reviews that you can choose to use and you may decide to use more than one, but it is certainly vital to be using at least one. You should also promote your patient reviews on your own website.
Social media gives you the opportunity to communicate regularly with your patients and potential patients and, as with your website, you are completely in control of the content.
Ideally, your social media will create engagement with your patients and so as well as posting relevant content, it is important that you respond and engage with your community.
The choice of social media platform you use should depend on your target audience and the type of content that will appeal to them.
Whichever platforms you choose, you should ensure consistent branding across your social media presence and plan regular updates to avoid a social media graveyard where nothing has been posted for several months.
Finally, if you are willing to invest in your marketing, you may be interested in using Google AdWords and Pay Per Click (PPC).
This is paid advertising that you can set up to target your potential patients when they search on your chosen search terms. These campaigns can deliver remarkably successful results.
Jane Braithwaite is managing director of Designated Medical, whose experts offer bespoke support across accountancy, marketing, medical PA and HR
An all-female team marks a milestone for Newmedica eye care clinics and tell Independent Practitioner Today their story
WHEN NEWMEDICA Shrewsbury opened late last year, it marked the latest in a long line of successful openings for the independent healthcare provider, which operates from 23 sites across England.
But it also marked a milestone for the company, as the first eye health clinic and surgical centre in the network to be run by an all-female partnership.
For operational director Cinty Yarnell and consultant ophthalmologists Ms Carmel Noonan and Miss Kaveri Mandal, the opening marked the culmination of three
long years of preparation for a partnership for which the professional links had long been in place.
And last month a fourth partner joined the team in the shape of consultant ophthalmologist Ms Natasha Spiteri, completing the all-female quartet.
Growing organically
But, as Cinty explains, while an allfemale leadership team in ophthalmology is unusual, in their case it was entirely organic.
‘Carmel and I have known each other in a professional capacity for
two decades now, and she introduced me to Kaveri, whom she knew well, three years ago,’ she says.
‘They later introduced me to Natasha, whom they had worked with and respected. So our partnership is based on strong relationships built in other roles in the sector and on mutual respect, not on having tried to build an allfemale team by design.
‘We all work together really well, as we have the same passion for delivering a great service. Based on my experience elsewhere, it does feel like a different dynamic in a
The four partners of the Newmedica Shrewsbury clinic – on the right – at its opening by mayor Julian Dean and Specsavers’ founders Doug Perkins and Dame Mary Perkins
really good way, and we are all true partners.’
Partnership matters
Carmel continues: ‘When Newmedica approached me about becoming a partner at the Shrewsbury service three years ago, I suggested they bring Cinty on board too. She and I have worked together in a number of roles over the last 20 years, and I knew that her operational expertise was essential if the new clinic was going to be a success.’
The new partnership is proving
highly effective so far, as, since they opened in November 2021, the team has already had to more than quadruple its number of surgical days to support local patients as part of the NHS England Covid Recovery Plan.
And all three clinical partners are active trainers of future ophthalmologists and are continuing this work at the Shrewsbury clinic – their first trainee started at the end of last month.
But opening a new service during the Covid-19 pandemic was not without its challenges. The team at the clinic has a strong relationship with their local clinical commissioning group (CCG) and Care Quality Commission locally, although registration proved to be a slower process than expected – as for all providers – due to the pandemic.
Cinty says that the biggest challenge they faced in the run-up to opening the clinic is one common to the rest of the ophthalmology sector at the moment: finding staff with the right mix of skills to deliver the service.
‘I think skill mix is an issue right across the sector at the moment’, she says. ‘For us, personality was the most important factor in
Newmedica clinics are ophthalmology joint venture partnerships (OJVs). Each OJV is a separate, registered company, which typically has four or five partners. So each is an individual entity, which is unaffected by the performance of other businesses.
Partners are employed by and paid a salary by their OJV business entity and are entitled to their share of the business’s profits.
Partners are required to invest a capped sum of money, which is repayable as the business becomes established – typically after the third year of trading.
There are no specific set limits on the length of a partnership.
Each partner has an equal share in the business as a shareholder, so in a four-partner OJV each partner will own 25%. So while the risk sits with the partners, so does the reward.
Their shares act as an equity-builder for each partner and will have a value should a partner later decide to leave the business.
Pricing is set nationally for private patients, but the vast majority of work carried out is on behalf of the NHS.
While Newmedica itself can be a partner, this is not always the case. It is responsible for providing a range of support services to the business and for developing the brand, for which it charges a management fee on the turnover of the business.
These support services include NHS commissioning and contract management, accreditation with the UK’s leading private medical insurance companies, marketing and PR, learning and development, HR and financial back office and property services support, insurance, procurement, purchasing and other support benefits. It also covers support with Care Quality Commission registration and revalidation. Equipment is paid for by the business, as is rent, but the support services provided are there to assist with these processes.
Some partners approach Newmedica, while others are approached.
Being equal
Newmedica
means that we can make the decisions we want to make based on our local patients and local partners
choosing our wider team, as skills can be developed and we want to develop our people to become the best that they can be, whatever their professional background.
‘But we would love to see a sector-wide approach, like an academy, to make sure that the required skills are available to all providers, right across the UK.’
Their partnership in Newmedica Shrewsbury gives the partners the chance to set their own agenda based on local needs, something which has not always proved to be as easy in other roles.
As Kaveri explains: ‘In some larger organisations, decisions which have a serious impact on service delivery are often made outside the service, which – while understandable as part of a wider
A spokesman said: ‘The advantage of becoming a partner in a Newmedica business is the opportunity to own and run your own business your way, while leveraging a recognised brand and having access to a wide range of support services which mean partners can focus on putting patients first.’
Further details are available on application to the company.
system – means you have less autonomy locally.
‘Being equal partners in Newmedica Shrewsbury means that we can make the decisions we want to make based on our local patients and what our local partners like optometrists and the CCG need from us.
‘This gives us a tremendous sense of job satisfaction, as ultimately, all we want to do is provide our patients with quick and effective care which lets them regain their quality of life.’
For all the partners at Newmedica Shrewsbury, making the leap to running their own service has been a really positive one. For Carmel, Kaveri and Natasha, who all still work in the NHS alongside the partnership, it provides an interesting contrast and different way of working which really enhances their professional lives.
Carmel says: ‘Our partnership is an equal one, which means that any of us individually only get out what all of us put in. While we have to work within guidelines, we have a tremendous amount of autonomy which is really satisfying – especially when you get great feedback from happy patients who are really satisfied with the care you have designed and delivered.’
The future is female?
For all the partners at Newmedica Shrewsbury, gender is not a factor in their partnership. But they are pleased to see more women than there once were in senior roles in ophthalmology and new recruit Natasha is really pleased to be part of the team.
‘I’m really delighted to be working with Cinty, Carmel and Kaveri to support local patients, and am excited to see what the future holds,’ she said.
Every organisation has adopted new ways of working to keep people safe from Covid-19.
We are all now familiar with virtual consultations and virtual meetings with colleagues, but would you know what to do if you are called to attend a virtual hearing? After two years supporting practitioners in this position, Dr Sissy Frank (below) shares some important lessons
ONLINE VIDEO conferencing technology made it possible for doctors’ fitness-to-practise proceedings, NHS England performance hearings and even inquests to continue during the pandemic, helping to prevent stressful delays and a huge backlog in cases.
Virtual hearings have other benefits too – they may feel less intimidating and eliminate the need to travel long distances, which means they are likely to continue in some form.
For example, The Medical Practitioners Tribunal Service (MPTS) has now moved to a mixed approach of virtual and in-person hearings in Manchester, depending on the case.
The Medical Defence Union broadly welcomes this approach, especially in less complex cases where the facts are uncontested.
But don’t be lulled into a false
sense of security because you are sitting in the comfort of your own home or office rather than appearing in person: it is just as important to prepare and present yourself professionally.
Your reputation and even your livelihood could still be on the line.
☛ Ensure you have all the case documents
Ask for these to be sent to a secure email address, preferably in encrypted form.
If possible, use an electronic device associated with your professional practice, rather than a personal one.
Read through material and if you feel something is missing, tell the organiser in good time or speak to your medico-legal adviser.
☛ Test your tech Download and familiarise yourself with the relevant app to allow you to join the meeting before the day of the hearing. Test your headphones, microphone and video and turn off distracting notifications during the proceedings.
Ensure your laptop or tablet is fully charged and ensure you are close to a charger and electric socket, just in case.
☛ Consider the background
If you are in a clinical location such as an office or clinic room, make sure no confidential information is visible.
Make sure the room is not affected by external noise. Choose somewhere quiet and, if necessary, lock the door to prevent interruptions.
☛ Check the camera angles
Position yourself and your webcam so you will appear central within the frame and can make eye-contact with the other participants. If you need to look away, for instance to look at your notes, you should explain this to the participants.
☛ Dress professionally
Casual clothing may look disrespectful and could potentially put you in the wrong mindset for the occasion.
Consider your entire outfit rather than just your top half – you never know whether you may have to stand up.
TO DO DURING THE
☛ Log on early
This will give you time to flag up any problems and ensure you are ready. Ensure you have all the relevant documents to hand and have a glass of water close by if you know you are going to have to speak.
If the hearing is lengthy, there should be bathroom breaks. But do take a comfort break before the hearing begins, as it’s better to ensure you are comfortable from the start.
☛ Mute your mic
Unless you are speaking, mute your microphone to prevent feedback or unwanted noise during the hearing. You may be asked to turn off your video if you are not speaking, so make sure you know how to do this and turn it back on when necessary.
☛ Be aware of your body language
You may be sitting on your own, but it’s better to behave as if you are in the room in person. Consider your posture and expressions.
☛ Speak clearly to the camera
Keep documents and notes in front of you. You may also find it helpful to mark any relevant pages for ease of reference.
You may be sitting on your own, but it’s better to behave as if you are in the room in person. Consider your posture and expressions
☛ Keep in touch with your representative
If you have someone to support or represent you, they should be able to join the meeting remotely as well.
Agree with them in advance how you will keep in contact with each other during the meeting, such as by messages on a different device.
☛ Don’t leave until you are told
Let the panel know if you are having to refer to your notes so they understand why you may be looking away.
☛ Answer the question
When it’s your turn to speak, answer the questions put to you and don’t be afraid to ask someone to repeat or clarify something if you’re not sure you have understood the question or if you miss what has been said; for instance, due to technical problems.
Get ready in advance of April 2022 when the proposed changes to the NHS Pensions will allow you to reclaim some or all of any Annual Allowance tax you may have suffered in the past.
With our knowledge and in-house calculators, we will be able to predict in advance and check statements produced by NHS Pensions and Scottish Public Pensions Agency for accuracy for any refunds due.
For further information contact us at aa@semail.co.uk or telephone 01625 527351.
Once the hearing has ended, wait for direct instructions before logging off. Make a note of any further actions required so you can attend to these as soon as possible after the hearing.
If you need assistance with a virtual inquest, GMC or disciplinary hearing, seek advice from your medical defence organisation. They’ll be able to guide you through the process from the start and can help you best represent yourself.
Dr Sissy Frank is a medico-legal adviser at the Medical Defence Union
As Medical Billing & Collection (MBC) celebrates its 30th year of partnering with consultants in private practice, Simon Brignall marks its pearl anniversary milestone by sharing some pearls of wisdom gathered over the last three decades
Split the two sides of a practice
An often overlooked but important benefit from outsourcing medical billing is fewer conversations with patients that involve the mixing of two subjects: medicine and money.
So split the two sides of private practice. There are real benefits to be gained if you do.
Dividing the payment pathway from the patients’ clinical journey allows your medical secretary to maintain a warm and engaging relationship with them because they no longer have to have those difficult conversations about outstanding invoices.
Many medical secretaries find these discussions challenging and I have noticed that this is one of the reasons the money bit is often deferred.
Split things up and it also makes the role of the billing company simpler because they are only required to have a focused dialogue about the bill with a patient.
If the patient wishes to then discuss any clinical matters, they are politely passed back to the practice. That improves the patient experience and benefits the practice because the secretary can focus on responding to new and existing patient inquiries.
Once the two aspects of the practice have been split, the consultant is free to be able to make decisions about future needs for staffing or the practice management software without this impacting the practice’s cash flow.
Be able to adapt to the changing landscape of private healthcare
The private healthcare sector is unrecognisable from where it was when MBC started and this has meant practices have had to adapt to often difficult and disruptive change.
New consultants entering private practice today face challenges
and opportunities their more established colleagues never did.
Some of the major changes we have seen over the past ten years include:
➲ A large reduction in fee schedules and consultation fees from the private medical insurers (PMIs). This has resulted in the average invoice value we raise dropping by 25%. So the practice must see many more patients to generate the same amount of revenue.
➲ The introduction of raising invoices electronically to insurance companies – resulting in the need to have internal systems in the practice to facilitate this.
➲ The sector has also seen a consolidation in the PMI sector resulting in the adoption of the acquisition companies’ fee schedules and coding principles. This has led to more downward pressure on fees.
➲ The incredible rise of the selfpay market has driven the need for a range of payment pathway options to facilitate these patients, such as the ability to take card payments 24/7 and collect money up front. The impact of the pandemic on NHS waiting lists has only reinforced this demand.
➲ The Competition and Markets Authority investigation into private healthcare was a gamechanger for the sector, with the reverberations still being felt today.
One of the main results of this is increased regulatory control through bodies such as the Private Healthcare Information Network, leading to practices having to provide greater transparency around the fees they charge.
We have provided advice and guidance to the practices we partner, alongside everincreasing functionality to meet their needs. Some of the functions we have introduced include:
E-billing of patients and insurance companies;
The most successful practices take the time to review their activity and finances and make decisions based on data and not what they think they know about their practice
The rate of change over this period has increased, which has predominantly been driven by the increased adoption of new technology.
It is important to be aware of the impact or opportunities these developments will have and that you adjust accordingly. Partnering with an outsourced billing company ensures your practice is future proofed for what comes next.
From many conversations with consultants over the years, the two most common areas for discussion are about problems with their aged debt and how they can grow their practice.
24/7 payment collection;
Text message chasing of outstanding invoices;
Multi-payment pathways for self-pay patients;
24/7 access to your financial data;
Website payment links.
1. How can I grow my practice?
This is a common topic, and it is not confined to consultants who are new to private practice. It does not have one simple answer, as your practice growth can be the result of many factors, such as location, specialty, experience and patient mix.
One thing is universal, however: the most successful practices take the time to review their activity and finances and make decisions based on data and not what they
think they know about their practice.
It is very easy to make assumptions based on what was historically the case but which do not reflect the current situation.
To carry out a comprehensive review, a practice needs access to up-to-date accurate information. This should include the following:
☛ How much the practice has invoiced broken down by a range of criteria, including location, patient type (self-pay, insured, medico-legal), payment company (such as Bupa), the type of activity carried out and where their patients are coming from.
☛ How much is outstanding from the work you have carried out, as it is vital that you are being paid for the work you are doing.
Our consultants have the advantage of 24/7 access to our reporting platform, which includes an array of reports to interrogate their practice data.
We use this information as part of the review process to see if it is appropriate to add another location to attract a different patient mix or to analyse the type of activity the practice is conducting and how that compares to what was previously carried out.
2. Problems with aged debt
It comes as no surprise that many of the questions I am asked are about outstanding debt. Common examples are:
What is the most you have ever been given to chase?
How far can you go back?
What is your collection success rate?
Should I give you everything?
We have been asked to assist practices with over £300,000 in outstanding invoices many times, including a couple of amounts around £1m from clinics. Legally, we can go back six years in relation to unpaid debts.
MBC maintains bad debts across the life of the company of less than 0.5% when we have been responsible for the entire billing cycle.
Experience with outstanding debts depends on many factors, but we commonly collect over 90% of the backlog. For anything we are unable to collect, we ensure bad debts are written off against tax, because we provide endof-year tax reports to consultants’ accountants.
This allows the practice to review how it markets its services to both its patients, through its website and hospital consultant page, as well as its referral network including GPs and colleagues.
Even established consultants can benefit from taking the time to update their referral network that they offer a new popular treatment.
I am often asked to provide activity data to assist a consultant who is carrying out an annual review of their fees. It is important that a consultant’s fee schedule should remain competitive and reflect both their expertise and the demand for their services.
Having activity data broken down by patient payment type enables a practice to calculate the impact of any fee changes it implements and ensure these are targeted where they will derive the most benefit.
My recommendation to new clients is to do a spring clean, because it makes sense to pass us everything so we can run it through our chase process. This is managed sensitively, as we explain to patients that we have recently taken on the billing role for the clinic.
Hopefully, these pearls of wisdom will be useful for you as we look forward to continuing helping consultants for many more years to come.
Simon Brignall (right) is director of business development at Medical Billing and Collection
A new way of paying for healthcare is rapidly gaining pace and helping to fuel significant growth in self-pay business. In part 1, Richard Gregory (left) introduces point-of-sale finance and its impact on customer service and sales
good budgeting sense to purchase goods with low-cost or 0% finance rather than dip into savings or pensions. For very little effort, retailers will see increases in sales
2. Increase transaction value
MUCH MODERN consumerism is fuelled now by the emergence and development of retail finance.
All medium and large-ticket items are offered alongside a variety of ways for the consumer to pay at point of sale, even for luxury car brands such as Rolls Royce. Often the payment of a product or service is either through interest-free credit or interest-bearing credit and over a fixed term.
Virtually all payment offerings are through a third-party lender. Credible lenders undertake a credit check, performed to ensure the purchaser is credit-worthy, a credit agreement is signed, direct debit set up and the purchaser walks away with the product.
This is all done on virtual and electronic systems. In recent times, other products have emerged, the most commonly quoted one being ‘buy now pay later (BNPL)’ offered by firms such as Klarna, or deferred interest-free credit whereby the consumer is initially offered payment holiday periods.
Some of these BNPL schemes have, however, attracted adverse publicity because of irresponsible and unregulated lending.
Credit is, of course, not free. In the case of interest-free credit, it is the retailer who pays for the cost of credit and it is, of course, the consumer who pays the interest on interest-bearing products.
Most consumers traditionally pay either with point-of-sale (POS) finance products or they put the cost on their credit cards. What are the merits of each approach?
There are certain credit cards which have their merits. For example, there are those with interestfree periods on purchases of over two years. Some even give you the opportunity to earn rewards. But careful consideration should be given. As I said, credit is never free, despite some dubious and aggressive advertising.
We are tempted by credit card
companies into these deals because many of us will not pay off the debt within an initial interest-free period, if offered, and will find ourselves with a balance subject to high annual percentage rates (APRs).
In other cases, we may only pay the minimum repayment each month and not realise to what extent we are extending the period of debt or how much we are increasing the total cost of credit.
In this respect, point-of-sale (POS) finance products provide a more transparent alternative. Both the APR and the total cost of credit are fixed and the repayment period and instalment amounts are therefore fixed too.
Also, the APRs offered through POS finance products are very competitive and, in many cases, 0%.
In a fast-moving world, customers increasingly expect a more dynamic set of payment options. POS finance products certainly fit the bill, particularly for larger value purchases over £1,500.
They remove the deterrent of a significant up-front cost and allow us to sensibly pay off the cost of the purchase over a period of monthly instalments, even for individuals with significant savings or assets.
It is a frictionless process with an instant decision, it makes purchases affordable and makes it easy to budget. For retailers, there are three further fundamental advantages:
1. Boost to sales
Ask yourself the question. Would you rather pay £1,000 up front for a product or make ten monthly repayments of £100?
POS finance products allow the item to be promoted in a moreaffordable way, which is highly inclusive, as those with smaller disposable incomes don’t have the same barrier to buying.
Equally, even for those with larger incomes, it often makes
You have a customer ready to purchase, so by offering POS finance products, you effectively reduce the initial hit to their budget. In many cases, depending upon the nature of the purchase, this can encourage a customer to buy more or buy better.
3. Better customer retention
What drives customer loyalty, more so than the best price, is our experience when dealing with a retailer.
If a patient, for example, experiences a convenient, seamless journey with the ease and affordability of paying through a slick POS finance scheme, they are more likely to return for any future treatment and to tell others about their experience.
Offering POS finance products also attracts a wider audience to your products and service, drives customer goodwill and enhances your brand image as being customer-friendly.
Industry statistics strongly support these points:
69% of customers who used POS finance products said it enabled them to buy the product sooner (Barclays).
55% of customers said they bought because of the availability of POS finance products (Hitachi Capital).
Sales increases lie on a spectrum between 17% and 40% according to global market research company Forrester, with some outliers who have experienced sales uplift in excess of 60%.
A Forrester study found that POS finance products increased order value by an average of 75% and that 78% of consumers said they would purchase high-ticket items using POS finance products.
34% of consumers – in this case, patients – said they would be more likely to spend with an organisation that offers POS finance products (Chrysalis Finance).
Richard Gregory runs an independent healthcare consultancy, specialising in self-pay
Treating high-profile patients can often present a unique set of medico-legal challenges and it is important that doctors protect themselves, as well as the patient. Dr Emma Green (right) discusses the common issues and gives advice
IMAGINE YOU have a patient presenting with a viral sore throat and insisting on a course of antibiotics. In the case of the ‘everyday patient’, we know that the right thing to do usually is to advise on symptomatic treatment, not antibiotics.
But what would you do in a situation involving a high-pressure patient – perhaps a well-known politician or celebrity? Would you feel it safer to prescribe the antibiotics when your patient is in a position of power and used to getting what they want?
From a medico-legal point of view, of course, your medical judgment should not be swayed depending on the social status, wealth or other influence of the patient you are treating.
As a doctor, you have a duty of care to all your patients regardless of whom they are. Your prime consideration should be their medical condition and what you can do in your capacity as a doctor to help.
Open any gossip magazine and you will find examples of celebrities’ personal health and mental health battles. For doctors who treat these patients, dealing with issues around confidentiality can be problematic.
As a result, celebrities may request for details of their medical condition to be omitted from their records, or for no records to be made, in fear of it being leaked into the public domain.
The first step is to instil trust between yourself and the patient. Everyone has a right to confidentiality and high-profile patients may need extra reassurance that this right will be respected.
However, it is never appropriate to intentionally leave relevant clinical information out of a medical record and this must be explained to the patient.
Your duty to your patient includes ensuring there is continu-
ity of care. Omitting information from the record could mean other healthcare professions are misinformed about their condition.
The GMC’s guidance on this matter is clear. Its publication Decision Making and Consent states: ‘Keeping patients’ medical records up to date with key information is important for continuity of care. Keeping an accurate record of the exchange of information leading to a decision in a patient’s record will inform their future care and help you to explain and justify your decisions and actions.’
However, under the General Data Protection Regulation, patients have the right to ensure their information is accurate and they can request factual inaccuracies in their record to be rectified.
But they do not have the right for a medical opinion made by you as a professional to be changed. The Information Commissioner’s Office has further detail about complying with these requests, situations where requests may be refused, and also time-scales.
If you need to make a correction, make sure you enter the date of the amendment and include your name. You should only comply with a request if you are satisfied the entry is indeed factually inaccurate, but if you decide a correction is not warranted, you should annotate the disputed entry with the patient’s view.
Even the most demanding of patients should understand that it is your professional obligation to keep a record of their care, for their well-being and yours.
Reassure them that they can take comfort in the fact there are laws to protect against disclosure against their wishes and ensure their need for confidentiality is respected.
Sometimes, despite building up a trusting doctor-patient relationship, outside influences such as
celebrities’ managers or other individuals involved in their day to day lives may take it upon themselves to make decisions on behalf of their client.
This can pose problems when the decisions they make conflict with what you believe to be in the patient’s best medical interests.
If you feel you are being pressured into a decision by a patient or third party, take time to consider your position.
Ultimately, the right thing to do is to outline your concerns, the options and tell them what the worse-case scenario would be if the patient was to refuse the advice.
Except in emergency situations, you cannot enforce any treatment without the patient’s consent; equally, you shouldn’t proceed with treatment you think is wrong merely because the patient has requested it.
As with any patient, ensure you include details of all these discussions, including any refusal to treatment, in the medical notes.
You may wish to obtain the patient’s consent to discuss potential treatment options with other clinical colleagues as you might do with other patients. You can reassure the patient of confidentiality in any discussion and explain that this would be considered to be good practice.
It is important to remember that you have been tasked with providing medical advice and treatment. No amount of pressure should deter you from maintaining the professional boundaries of the doctor-patient relationship to the best of your ability.
When treating high-profile patients, we also need to take particular care in discussing and considering the patient’s individual needs and circumstances. For example, would a possible treatment impact on their career or talent?
A cautious approach is also required if the patient is present-
ing with problems relating to their particular talent.
For example, if a well-known singer presents with increasing hoarseness and an ear, nose and throat specialist confirms polyps on the vocal cords. If you fail to warn them about the possible complications, or discuss the options available, you leave yourself open to criticism if something goes wrong during the procedure.
Although adverse complications would be distressing for any patient, the potential loss of earnings of a famous singer could mean a claim brought against you would be of a much higher value than a patient who does not rely on their voice to make a living. And this sort of claim may also risk damaging your reputation.
When faced with treating a highprofile patient, many doctors react in different ways. Some will be nervous, worried the patient could ask them to go outside the boundaries of what they consider to be best practice.
Others may feel intimidated or even flattered that they have been chosen to consult for medical treatment or advice.
Despite these feelings, as a professional, you must maintain the same high professional standards as to any other patient. The usual rules apply:
Communicate openly;
Keep detailed medical records;
Manage professional boundaries;
Seek informed consent;
Maintain their confidentiality. You may feel extra pressure when dealing with those in the public eye, but as long as you act in their best interests and can justify any decisions you make, your integrity and professionalism should remain intact.
Dr Emma Green is a medico-legal consultant at Medical Protection
LEFT UNCHECKED, inflation can be a dangerous foe to the longterm investor, eroding the purchasing power of one’s hardearned cash over time.
Since the Covid-19 pandemic began, inflation numbers have frequented the headlines. Financial stimulus around the globe has meant that more money circulating in the economy is chasing a similar, or fewer, number of goods and services, resulting in price increases.
Table 1 (below, right) shows the latest global annual inflation figures from the Office of National Statistics measured using the consumer price indexes (CPI). Most countries have not seen numbers this high since the early 1990s.
Contrary to its negative implications, the consensus of economists has shifted over the years. The modern position being that a small amount of annual inflation is, in fact, desirable.
Deflation danger
The Bank of England, for example, targets an annual inflation rate of 2%. Primarily, this is to avoid an alternative scenario where prices are falling each year and consumers are encouraged not to spend at all, but to wait until prices fall further.
The danger with a deflationary environment is that it is a very hard cycle to get out of. Price falls tend to lead to further price falls –just ask Japan!
Although the inflation rate is generally thought of as a single number, the consumer price index in the UK is measured using around 180,000 different prices across 720 different goods and services each month.
What is more, the ‘shopping basket’ is weighted using estimates of the average UK consumer, which is updated each year depending on spending patterns.
This is a valid criticism of CPI indexes, as they do not account for
Higher inflation rates are often in the news. Dr Benjamin Holdsworth (right) shows why it is easy to get lost in the numbers
The consumer price index in the UK is measured using around 180,000 different prices across 720 different goods and services each month
Source: Koyfin © All rights reserved. Inflation measured using Consumer
Data source: ONS (2022)
substitutions of expensive products for less expensive ones.
The chart above shows a breakdown of the December 2021 inflation figure and the contribution of each basket of goods or services. Around half of the 5.4% came from increases in transport and energy prices, whereas healthcare and communication services had negligible impact.
The reality of the chart above is that, while it provides a reasonable estimate for the average consumer, everyone is subject to their own unique inflation rate.
For example, individuals living in older houses that are poorly insulated are likely to be feeling the effects of higher energy costs more than those living in newbuilds with modern insulation and renewable energy sources.
Similarly, as table 2 shows, those that are frequent flyers –not that there are many people in this bracket at present – have experienced hefty price hikes, whereas other transport services were far less impacted.
Despite inflation being more nuanced than just the headline figure, it is true that a general rise in prices can be uncomfortable for investors, reducing the ‘real’ (after inflation) returns earned over a given period.
That said, the systematic investment philosophy adopted in a
Food and non-alcoholic beverages
Alcoholic beverages and tobacco
Clothing and footwear
Housing, water, electricity gas and fuels
Furniture, household equipment & maintenance
Health
Transport
Communication
Recreation and culture
Education
Restaurants and hotels
Miscellaneous goods and services
Cavendish portfolio was built to weather such storms. Equity markets offer the opportunity to participate in the future earnings of global corporations, whose prospects rely on the goods and services they provide.
Exposure to smaller and value companies – those that appear cheap relative to a fundamental measure such as book-value – offer the opportunity of diversification and higher expected returns.
While no perfect inflation hedge exists – gold and commodities, for example, are no silver bullet – it is sensible to expect a well-diversified, low-cost portfolio consisting of equities and high-quality bonds to deliver above-inflation returns over the medium to long term – in other words ten years or more.
Dr Benjamin Holdsworth is a director of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions.
Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
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In her article last month, Julia Gray (right) described the process of responding to an employment tribunal claim. Here she considers the steps to prepare the case for hearing or otherwise resolve the claim
DIRECTIONS – also known as ‘case management orders’ – will be set out in writing by the tribunal telling the parties how to prepare the case for the final hearing.
The most common directions that an employment tribunal (ET) makes relate to disclosure, bundles and witness statements, so this article focuses on those aspects of tribunal preparation.
Sometimes the ET will list the case for a preliminary hearing to decide discrete issues or to set a case management timetable. ET rules differ slightly in Scotland and Northern Ireland; those described here apply to England and Wales.
The ET process is intended to be accessible to parties who do not have legal representation, but in practice most respondents are rep-
resented by solicitors. Preparing for a hearing can be complex and timeconsuming and little practical guidance is provided by the tribunal.
My article last month considered the role of Acas in ‘early conciliation’. Acas continues to offer its services to the parties for the duration of the case and many are settled before they reach a final hearing.
Even if one or both parties intend to settle out of court, until the case has finally settled, they must still comply with the ET directions, unless the ET has excused them.
Failure to comply with case management orders can lead to you being ordered to pay the other party’s costs or even lead to your defence being struck out, so it is
important not to assume that your case will settle.
Another way of achieving a settlement is through ‘judicial mediation’, which involves a day or half-day of negotiations facilitated by an employment judge.
Participation is optional and is subject to the ET and all parties being willing to engage.
If no agreement can be reached, the case will continue to a hearing, which will be dealt with by a different judge, and the parties will not be permitted to refer to what happened in the judicial mediation.
Disclosure is the process in which the parties share with each other the documents that are relevant to the case.
The aim is to then agree which of those documents will be included in a common pack of documents covering all aspects of the case –the pack is called the ‘bundle’.
Preparing the bundle is usually the responsibility of the respondent or their advisers.
The final bundle will eventually be presented in chronological order, paginated and indexed. All parties and the ET itself will need a copy of the bundle, which often runs to hundreds of pages.
‘Documents’ does not just mean paper and computer files; they include anything on which information is stored or recorded – for example, video recordings, emails, photographs, text messages and social media posts.
You must disclose all relevant
documents that are in your possession or under your control – for example, held by a third party such as your employee or a payroll provider.
Whether the document in question helps or hinders your case or your opponent’s is irrelevant.
Documents that would usually be confidential are disclosable unless they come within a specific exemption such as privilege or without prejudice.
If you have instructed legal advisers, they will guide you on this.
You must not dispose of or
destroy damaging documents to try to avoid disclosure. Ideally, care should be taken not to create documents in the first place that could be damaging in the case of future litigation.
Your defence to the claim will comprise the ET3 Response that you submitted at the outset –which we covered in last month’s article – and witness evidence, which will be presented orally in the ET hearing.
Written statements must be prepared in advance for any witnesses
that you intend to call to give evidence in the final hearing.
Witnesses need to be selected carefully, ensuring that between them they address all the allegations. In a claim for unfair dismissal, for example, a respondent would be expected to call anyone with decision-making powers, such as the dismissing officer and appeal officer.
In a case involving allegations of discrimination, you would usually call anyone accused of discriminatory behaviour, so that they can rebut the allegations.
Some cases require expert witnesses; for example, to give evidence about the claimant’s health where it is disputed whether they are disabled.
The witness statements must cumulatively tell each party’s side of the story, address each allegation and refer to the key documents in the bundle.
Your legal representative will
help to draft the statements, but it is important that the evidence is the witness’s own and that it is complete, accurate and honest.
Witness statements should be signed and include a ‘statement of truth’, which is a form of words that makes clear that the witness understands that contempt of court proceedings may be brought if anything in the document is untrue.
Witness statements are exchanged between the parties in advance of the hearing. This is usually done simultaneously by email so that neither side has the advantage of seeing the other’s evidence in advance.
The third and final article of the series in next month’s issue will look at ET hearings, the role of witnesses and the damages that ETs can award.
Julia Gray is an associate at Hempsons Solicitors
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.
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Dr Sissy Frank, (below) medico-legal adviser at the MDU, explains how to respond to a court order provided by the police
Must I disclose patient’s data?
QAs a private GP, I was recently emailed a copy of a court order by a police officer.
The order states that the patient’s GP is to provide the police officer with a copy of the medical record of my patient pertaining to their mental health or alternatively allow the police officer access to the relevant portions of the record.
The police explain that the patient had committed a serious crime, harming another person. There is no consent from the patient to disclose the information. Should I disclose this data?
AThe GMC’s guidance on confidentiality explains the importance of the ethical and legal duty of confidentiality, but makes it clear that this is not an absolute right. A doctor may disclose confidential information with the explicit consent of the patient, if it is justified in the public interest, if the disclosure would be of overall benefit to a patient who lacks consent or if the disclosure is required by law.
Paragraph 17 of the new guidance indicates that you must disclose information if you are ordered to do so by a judge or presiding officer of the court.
Paragraphs 90 to 95 go on to explain that you should only disclose the information that is required by the court and that you should object if attempts are made
to compel you to disclose information that appears to you to be irrelevant.
In addition, if you think that disclosure of the information might put someone at risk of harm, the guidance says you should inform the judge. If you do not understand the basis for the order, you should ask the court or a legal adviser to explain it to you.
You also have a duty to tell the patient whose information is being requested what information you will disclose, unless this is not practicable or it would undermine the purpose of the disclosure or you feel that doing so might put yourself or others at risk of serious harm.
Prior to disclosing the informa-
You should inform the patient of the information that you have disclosed, unless it is not appropriate or practicable to do so tion you should check the validity of the court order. Each page of the order should be signed by the judge or presiding officer and should contain a stamp. If you have concerns about the validity of the order, you can contact the court directly or seek advice from your medical defence organisation.
You should only disclose that information required by the court and you should document in the notes the reason for the disclosure and keep a copy of the court order for the records.
You should, if possible, inform the patient of the information that you have disclosed unless it is not appropriate or practicable to do so.
Dr Sissy Frank discusses what to do if a patient requests access to their records
QI am a private gastroenterologist who recently discharged a patient with nonspecific abdominal pain.
After a thorough investigation, I diagnosed irritable bowel syndrome and I provided the patient with lifestyle advice. He did not appear to be unhappy with this.
However, I have now received a letter from a solicitor with a signed form of authority from the patient requesting a copy of the complete records.
They have indicated they are investigating a potential negligence claim against me. Do I have to comply,and do I have to provide all correspondence?
I am concerned about providing a copy of my letter to the patient’s GP stating I could find nothing physically wrong and thought the patient’s symptoms might be a result of psychological issues. What should I do?
AThe solicitor’s letter is a request for records and is accompanied by a signed form of authority from the patient.
In effect, this may be deemed a Subject Access Request (SAR) and is applicable to all doctors, UK businesses and organisations.
Patients have a legal right to access the information you have stored about them and it can be requested for any purpose, including in contemplation of a claim. As a data controller, you cannot charge a patient or their legal representative for reasonable access to their records.
Bear in mind that you cannot exclude information on the basis you think it may be harmful to your position or simply because you think that it might upset the patient.
Unless you have obtained their consent, you should redact information in relation to third parties, such as references to a relative of a patient who has raised concerns or provided information regarding the patient without the patient being present.
This does not apply to information written by other healthcare professionals involved in treating the patient. In situations such as these, it is acceptable to redact the identification of the third party, as well as the data they have provided.
It is also possible to redact information if you believe it is likely to cause serious harm to the physical or mental health of the patient or another individual, unless it is information of which the patient is already aware.
Again, this is unlikely to be a common occurrence and your reasons for redacting information should be documented.
It should not be used as justification to remove information that you think may annoy or upset the patient and may make them more likely to pursue a complaint or a claim.
You only need to provide private records that are within your direct control. There is no obligation to obtain and provide records held by others; for example, NHS hospital records. These would be for the claimant’s solicitor to seek themselves from those organisations.
As the solicitors have indicated that the patient wishes to bring a claim for compensation, it is advisable to inform your defence body as early as possible.
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Smart and sophisticated, this Audi package is hard to beat, says our motoring correspondent Dr Tony Rimmer
Because the Audi’s electric-drive chassis is an all-new design, rear passengers benefit from a flat floor and plenty of leg room. The drive selector on the central console has a solid and classy feel
EARLY ADOPTERS of new technologies will always pay more, so it is no surprise that those of us who have already joined the pure electric car club will have paid about 50% more for their car than an equivalent petrol or diesel model. But things are starting to change. The steady flow of new electric cars coming to market shows no sign of slowing and many of them are getting relatively cheaper.
The huge Volkswagen Group’s first release, based on its new dedicated all-electric MEB platform, was the iD3. An impressive allrounder, it was soon joined by the larger iD4 and the Skoda Enyaq, which share the same underpinnings.
The iD3, like its sibling the Golf, is great for most people most of the time, but the quality of the trim and the general refinement is a level below premium brands like BMW and Mercedes.
Enter the new Audi Q4 e-tron that uses the same MEB platform and has similar dimensions to the petrol Q3. The original e-tron is a bigger vehicle – Q5 sized – and is not based on a dedicated platform and is a lot more expensive.
The Q4 range starts at £40,470 for the 35 model with 170bhp and a battery size of 52kWh, but the sweet spot of the range is the £44,275 40 model with 204bhp and a 77kWh battery.
This is enough to give it a realworld range of around 240 miles,
so long journeys are a possibility without too much inconvenience. This is the model that I tested.
Sporting a textured but solid front grille, the styling is unmistakably that of an Audi SUV. That means it is a smart and modern design with some real road presence. The interior is pure Audi too.
The high-quality trim and controls are immediately obvious and exude a premium feel as soon as you step inside, either as driver or a passenger.
Its Virtual Cockpit digital dashboard works well and the heater controls are far more user-friendly than those found in the Q4’s electric VW cousins. As is the drive selector which, on the central console, has a solid and classy feel.
Because the Audi’s electric-drive chassis is an all-new design, rear passengers benefit from a flat floor and plenty of legroom. The Q4 is roomier than the similarly sized Q3 and close to that offered by the bigger Q5.
Open the powered hatch and you will notice that the boot space is pretty good too. An inexpensive optional height-adjustable boot floor can store the charging cables out of sight.
Out on the road, the Q4 impressed me. Like its bigger E-Tron sibling, progress is silent and swift.
Although not Tesla fast, the
acceleration is seamless and instantly accessible and the regenerative braking is progressive and adjustable; something that VW Group electric vehicles seem to have got just right.
My test car had the £950 optional adaptive suspension and provided ride comfort to challenge any limousine.
Handling is pretty good for a heavy electric SUV (2,125kg), but you won’t deliberately go searching for winding roads to enjoy the drive. That attribute is the preserve of BMW’s new i4 and Porsche’s Taycan.
No problem, though, because the Q4 is great in its natural urban environment with light and precise steering. Its physical size is perfect too; easy to thread through traffic and not too large to park easily.
I must mention the optional
Body: Five-seat hatchback SUV
Matrix LED headlights which are an Audi feature that light up the road on full-beam all the time while blanking out passing traffic as it moves by so as not to dazzle other drivers. Clever stuff and surprisingly effective. If you do a lot of night driving, you might find it worth the £1,075 extra cost.
I have now driven lots of different electric cars and it is interesting to see what niche each manufacturer is trying to carve to attract customers. Audi has created a car that is true to its brand.
The Q4 is basically a smart and sophisticated iD3, much in the same way that the A3 is a posh Golf.
If you value a quieter more sophisticated ride surrounded by higher-quality materials from a premium brand, the extra £10k will be money well spent. I really liked the Q4 and I think that many medics will feel the same. The overall package is hard to beat.
Engine: One electric motor. 77kWh battery
Drive: Rear-wheel drive
Power: 204bhp
Torque: 310Nm
Top speed: 99mph
Acceleration: 0-62mph in 8.5 seconds
Claimed range: 308 miles
Efficiency: 3.5miles/kWh
On-the-road price: £44,275
Dr Tony Rimmer (above) is a former NHS GP practising in Guildford, Surrey
Philip Housden steps back from his monthly detailed analysis of PPUs’ performance around the regions, notes the changes over the past four years since he began his Independent Practitioner Today series and warns there are important lessons to learn
THE MAIN changes over the last 48 months have been a reduction in the number of trusts through mergers, a continuation of structural trends and, of course, the disruption caused by Covid-19.
In 2017-18, there were 153 NHS acute services trusts in England, between them reporting £618.1m revenues. This represented 1.09% of total trust incomes.
Since then, the number of NHS trusts has declined to 141. Famous names to go include the Birmingham Women’s, Aintree, Poole and Royal Brompton and Harefield.
By 2019-20, total revenues had risen by 9.1% to £674.2m, although the impact of Covid was such that revenues fell back by 44% to only £380m in 2020-21.
The number of trusts has not impacted significantly on the structural trends within the sector. The first of these is that most private patient services and income are concentrated in London and the South-east and, beyond that, disproportionately from specialist trusts in other regions.
The proportion of NHS income in England from the Top Ten trusts has risen year on year (see Figure 2 opposite). This rate has grown from 61.3% in 2017-18 to 65.5% in 2020-21.
It shows that the ‘winners keep on winning’ and is largely a result of the focus that these trusts give to the service once it becomes a material proportion of total trust revenues.
And it is also true for several years that these Top Ten trusts have all been in London. That was until 2020-21 when the impact of Covid seems to have had a differential effect across the NHS with London and the other main conurbations hardest hit.
For 2020-21, University College Hospitals and Royal Free London Trusts dropped out of the Top Ten to be replaced by Cambridge University Hospitals at eighth and Oxford University Hospitals at ninth.
The long-standing number-one is The Royal Marsden, where incomes rose from £104.3m in 2017-18 to £132.6m in 2019-20 before falling back to £102.3m last year.
This trust enjoyed 36.3% of total incomes from private patients before Covid, the highest in the NHS, up from 33.3% three years ago.
To put that in context, the next highest proportion of total incomes from private patients is 11.1% at Moorfields Trust, and only 14 trusts report private patient incomes in excess of 2% of
total revenues before the pandemic in 2019-20.
This spread has remained largely unchanged, with the average earnings for all trusts only varying between 1.0% and 1.1% over the recent years before falling back to 0.52% last year.
The impact of Covid has been significant and is ongoing, although, as I write, there is recovery underway, principally in London.
As my 2020 NHS PPU Barometer predicted, total private patient income declined by up to 75% in some high-earning trusts in 201920 as staff, capacity and facilities were directed to the NHS-wide effort to combat the pandemic.
The Barometer forecasts for the present year 2021-22 are, in the main, optimistic for a return to
growth, dependent of course on the effects of the Omicron variant this winter and any future waves of the disease.
There are approximately 54 trusts that have inpatient facilities and capacity dedicated to private patients and, unsurprisingly, they fare considerably better than those who do not.
The proportion of total incomes for these trusts with a PPU or designated beds from private patients averages nine to ten times that of other trusts: being 2.23% in 201920 (1.16% last year) and 0.24% that same year (0.12% last year) for trusts without a private patient unit.
My crude estimate for the annual income achieved per NHS private bed was just over £300,000 last year, with a high of £530,000 in 2019-20 (see Figure 1 above).
WHAT ARE some of the lessons that can be gleaned from this analysis of the sector?
Here are three to consider:
1. Trusts are not successful without top management support
Trusts rarely collaborate and share best practice and there is a major opportunity for growth that is largely being ignored.
Time and again, surveys undertaken of the opinions of trust consultants regarding in-house private practice has identified the weight that many put on visible and consistent trust board support.
Without such support, trust consultants are often wary of changing their practice, as most, if not all, have a choice regarding where to practise, with the typical experience being that there are two or more independent hospitals vying for their business.
This leaves many consultants
with nowhere to take their most complex patients.
And many other consultants that would have a small private practice, perhaps based on these fewer but higher-value cases, are unwilling to join the sector and set up a private practice at all.
An on-site PPU offers several advantages to both these groups of consultants, built as it is on the twin advantages of convenience –for the consultant and the trust employer, of course – and the compelling governance and patient safety drivers underpinned by 24/7 infrastructure
These advantages include critical care, specialist nursing and extensive diagnostic imaging and more – important for the consultant, the patient and also insurers.
2. Trusts rarely collaborate
Few trusts engage meaningfully with their neighbours to either ask for or to offer help regarding pri -
vate patient services management or business development.
Despite the constraints of competition law and, of course, the significant day-to-day operational demands of the service, there is a lot of room for such partnership activity.
Only in the South-west have trusts maintained their regional network of peer-group support to share best practice.
Several London trusts have from time-to-time made contact, but no meaningful grouping has been in place for several years. This lack of contact is to the detriment of the sector and means valuable knowledge gets lost.
Lessons have to be re-learned and relationships with the private medical insurers are not based on mutually recognised value. That is, most trusts are just not able to negotiate from a position of any strength in relation to contracts and tariffs.
3. The sector is undervalued
What this amounts to is that the sector is significantly undervalued across the NHS and underplayed to the market in general.
Outside of central London, few private hospitals have critical care capability and this leads to many trusts admitting insured patients as NHS cases for complex highvalue procedures and tests.
The true value of this missing potential income stream is not known, but estimates certainly put the opportunity at perhaps £1bn a year.
Part two next month considers the key challenges and opportunities facing the sector
Philip Housden (right) is managing director of Housden Group commercial healthcare consultancy
It’s not uncommon for doctors in private practice, especially those who are new to running a business, to run into financial problems. Ian Tongue (left) picks out some key areas to be aware of and shows how to stay out of trouble
WITH THE busy demands of a consultant carrying out private work, it is easy to encounter financial pitfalls that can result in significant financial pressure or loss.
Let’s look at some of the more common areas to focus on to avoid a potentially costly mistake.
One of the most common problem areas is not treating your private practice as a business.
It may sound simple, but the career path towards carrying out
private work rarely sees you paid outside of the PAYE system.
Therefore, patients and insurers paying you without tax deducted – and robust chasing systems when they don’t pay or part pay – are essential to ensure that you are not working for free.
All private practices are required to maintain adequate accounting records and, as a minimum, this should enable you to understand the financial position of the practice at any time.
Records of work undertaken
Most consultants will be in the NHS Pension Scheme. There are different schemes that you could be in and there has been a recent legal challenge to the newest (2015) pension scheme, which was implemented illegally and needs to be remedied. This is known as the McCloud remedy and will take a period of time to implement.
Irrespective of which NHS Pension scheme you are a member of, they all have one thing in common: what you get out of the pension pot as a pension is not determined by how much you have put in. The various schemes largely use a combination of earnings and service to determine how much your pension is worth and has grown by annually.
HM Revenue and Customs allows you to have pension savings of £40,000 a year unless your earnings exceed £200,000, in which case you may have a lower allowance which could be as low as £4,000.
Tax charges arise if your pension savings exceed allowable limits and this can be a significant risk area for consultants if you have not had specialist advice.
The McCloud remedy will restate historic figures, so it is important that your accountant and independent financial adviser are on top of this to advise you of your specific circumstances when NHS Pensions inform you of your revised historic pension figures.
Significant financial loss may arise from this process not being managed correctly, so get in touch with your accountant to discuss things further.
together with details of when payment was received are the absolute minimum required.
Likewise, expenses need to be meticulously recorded to ensure all your spending is included thereby minimising your tax liability.
Where payment is not received, systems to investigate and chase this money are required to avoid financial loss.
It is surprising how many consultants write off debts because they left things too long and didn’t deal with things at the time.
When it comes to financial loss, often this can take the form of not being tax-efficient for your circumstances. Trading structure is one of the most important decisions you need to make for your business and can save you thousands of pounds every year.
But it is important to note that there is no one-size-fits-all approach to structure, so do not be swayed by other colleagues’ circumstances. Speak with a medical accountant who can assess your circumstances in detail and advise you on the best approach.
Factors such as employment earnings, spouse’s earnings, disposable income needs and pen -
and little or no backing documentation is supplied.
HM Revenue and Customs (HMRC) police this system through making inquiries into tax returns it feels may be incorrect. Penalties are applied for incorrect disclosure and therefore it is extremely important to fully disclose your financial circumstances.
When entering into the selfassessment system, you need to understand when tax is due and how the payment on account system works, as this can amplify the tax due, particularly in the early years where your profits are usually rising rapidly.
Not saving enough tax can be extremely stressful and can be avoided by understanding the system from the commencement of trading.
your practice, you are inevitably losing profit, as those functions can be carried out at less cost by others.
One of the most crucial decisions when carrying out private work is your choice of secretary. Your secretary can make or break your practice. Choose wisely and if you are not happy with their services, make sure you reconsider your options if they are not able to improve.
The finances for a consultant carrying out private work can be complex and their needs develop as they progress through their career and look to retirement.
sion all come into play and can make a big difference.
With the new tax rates for companies coming into force from 1 April 2023, together with increases to income tax on dividends from 6 April 2022, some doctors in private practice may need to reconsider their trading structure.
If fully affected by the 6% corporation tax rise and 1.25% income tax rise on dividend income, it will make a significant difference to your tax position.
The PAYE system generally looks after itself to deduct the right amount of tax, provided that the monthly tax allowances are applied appropriately.
When carrying out private practice, you are inevitably entering the world of self-assessment, which is a fundamentally different way of disclosing and paying your tax and National Insurance.
Self-assessment requires you to submit a tax return annually by the following 31 January of the tax year in question.
For example, the tax return for the year ended 5 April 2022 needs to be submitted by 31 January 2023. As the name suggests, it is self-declaring your earnings and other tax-sensitive transactions
If your private practice began in May 2022, for instance, many doctors would, in my experience, be surprised to find that their taxes may not be payable until 2024 on those earnings.
The system allows a long delay for the first payment of tax but then the liability is significant, so it is important to save from the outset.
For example, if you owed £30,000 for the year ended 5 April 2023 and had not made any previous payments under self-assessment, in January 2024 you would owe £30,000 plus a further £15,000 as a payment on account for the 2023-24 tax year.
A further payment would be required in July 2024 as a second payment on account. Again it would be £15,000 for this example, which is 50% of the previous year liability.
With rising profits, these payments on account do not keep pace with your liability, resulting in catch-up payments in January. Thereafter you will be making regular payments on these dates.
Running a successful private practice requires the right team around you. One common problem is taking on too much yourself, whether that be administration or financial. Whenever your precious time is diverted from earning money in
Having a medical accountant and an independent financial adviser who understand the medical profession are extremely important to ensure you maximise the returns on your hard efforts while you are working and are best positioned for a comfortable retirement.
Another essential aspect of running your private is your choice of medical defence provider.
When you carry out private practice work, you will need to project your income and explain the source to your defence body.
You will need to keep it informed about whether this was accurate and provide a projection annually for the following year’s premium.
It is extremely important to be as realistic as you can with regards to these projections, because you could find yourself without cover/ insurance or facing large back premiums which many find they have difficulty paying.
Building a successful private practice involves many moving parts and not just your skills and reputation.
Ensuring that you set aside enough time to consider how your business operates and review things regularly is key to maintaining success and avoiding financial pitfalls.
As always, work closely with a medical accountant who should be a key member of your team. Next month: A recap on VAT and how this may affect your private practice
Ian Tongue is a partner with Sandison Easson accountants
Things have been getting brighter for radiologists, reveals our latest unique benchmarking survey. Ray Stanbridge reports
Today readers will recall that it was not so long ago that we observed that many radiologists viewed themselves as the Cinderella of the medical profession.
But extremely good growth in income in 2019-20 and 2020-21 suggests that now radiologists may, in fact, be the shining star of the medical sector.
There has been a significant growth in the number of those working as part of a group in recent years and this is one reason why radiologists have enjoyed private sector growth.
And admittedly limited evidence suggests that radiologists working in a group format enjoy a 15% income enhancement over those who continue to trade in the traditional sole trader format.
Our headline figures suggest that consultant radiologists’ gross incomes have grown on average by 7.1%, going up from £168,000 in 2018-19 to £186,000 by 2019-20.
Costs have risen by £6,000 or 13% from £45,000 to £51,000.
As a result, net margins have risen by £12,000 from £123,000 to £135,000 or 10.1% between the two years. AVERAGE INCOME AND EXPENDITURE OF A CONSULTANT RADIOLOGIST WITH AN ESTABLISHED PRIVATE PRACTICE
Radiologists working in a group format enjoy a 15% income enhancement over those who continue to trade in the traditional sole trader format
The market is unquestionably growing and we have seen other consultants are making increasing use of radiological investigations in their diagnoses.
New techniques allowing more sophisticated diagnoses are also encouraging market growth.
There have been one or two suggestions that, in real terms, the costs of radiological investigations are falling. If so, demand is likely to increase.
We note that the period under review covers the first few months of the Covid pandemic. But there has been some significant growth in demand for radiology following this.
We are now expecting further growth in the market and therefore increased radiology incomes following the subsidence of the pandemic.
On the subject of costs, there is little to say save that they seem to be rising in line with level of business activity and inflation.
Many radiologists employ family members to help them with the administration of their practices. Costs paid here tend to rise with personal allowances.
Subscriptions and professional indemnity costs continue to rise under inflationary pressures.
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‘Other’ costs have tended to show inflationary pressures. Initial review suggests that expenditure on IT was significantly less in 201920 than in the previous year,
What then of the future? As indicated above, perhaps one of the side-effects of Covid has been
increased demand for radiological services, particularly given the extent of the patient log-jam.
We suggest that the prospect for most radiologists will be good over at least the next five years.
While our consultant surveys are not statistically significant, the
intention is to try to reflect in a broad-brush basis what is happening in the consultant market. Much has changed in the radiology sector in recent years.
For consultant radiologists to qualify for our report, they must:
Have had at least five years’ experience in the private sector; Earn at least £10,000 a year a from private sector activity; Hold either an old-style or a new-style NHS contract;
Be seriously interested in pursuing private practice as a business.
As we have stated previously, these requirements effectively exclude most small or occasional independent practitioners who may be looking from their private practices for funds to meet school and/or holiday costs.
Consultants in this survey work in a variety of ways – as a sole trader, through a formal or informal partnership, limited liability partnership or a limited liability company.
Next month: Urologists
Ray Stanbridge is a partner with accountancy, finance and tax advisory medical specialists, Stanbridge Associates Limited
Healthcode is the UK’s official medical bill clearing company and has provided secure and encrypted systems to healthcare professionals since 2000. Pre-pandemic we processed around 27,000 electronic medical bills to insurers daily.
The Healthcode Academy provides:
FREE 1-2-1 online training available to anyone with a Healthcode user ID
Training sessions lasting between 30–60 minutes
Shorter bitesize options available
Training tailored to your needs using your own site and data
Certificate awarded on completion
We want to make sure you and your team have the tools on hand to make those important work tasks quicker and easier – and, ultimately, make your practice more efficient.
To find out more and book your training simply click here and select the module you require!
To find out more about our solutions visit our website www.healthcode.co.uk
Coming in our April issue, published on 5 April.
Charging patients – here’s two big questions consultants are asking:
1. ‘Should I charge patients for phone calls and answering their questions sent by email? Dealing with these takes up a lot of my time.’
2. ‘How do we charge patients appropriately for these new interactions? Our business Troubleshooter Jane Braithwaite gives her view
The impact of climate change on our health: Climate change is inextricably linked to health and its serious worldwide adverse health outcomes are undeniable. James Sherwood, Bupa’s general manager, operations and healthcare management, discusses this and why healthcare providers and insurers need to understand this relationship to better support patients and customers now and in the future
Get your money! In part 2 of his feature on point-of-sale finance, Richard Gregory explores its adoption in the UK healthcare market and explains how it contributes to greater self-pay sales growth
2022: the difficult second album for Circle Health Group? Chief medical officer Dr Paul Manning reflects on recent award-winning successes and outlines plans for future releases
30 billing mistakes to beware of – Simon Brignall of Medical Billing & Collection advises how to steer clear of them
PPU expert Philip Housden suggests how to tackle three of the main challenges and opportunities for the NHS private patient sector
Published by The Independent Practitioner Ltd. Independent Practitioner Today is editorially independent and thanks Bupa for its assistance with distribution. Material is governed by copyright. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form without permission, unless for the purposes of reference and comment. Editorial layout is the copyright of the publishers. If you wish to use it for promotional purposes on websites or for reprints, we would be happy to discuss licensing the copyright to you.
© The Independent Practitioner Ltd 2022 Registered office: 7 Lindum Terrace, Lincoln LN2 5RP
In our Business Dilemmas column, Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union, advises a private GP about what to do when an elderly patient requests a fitness-to-drive letter. And a consultant’s fears about potential problems disclosing records to a parent with parental responsibility are tackled by her colleague Dr Sally Old
Profits Focus: Specialist medical accountant Ray Stanbridge puts the microscope on consultant gynaecologists’ earnings
‘Start A Private Practice’ columnist Ian Tongue gives an update on charging VAT in private practice
Keep it legal: In the third of three articles about Employment Tribunals, solicitor Julia Gray explains what to expect from the hearing
Orri clinic – Consultant psychiatrist Prof Paul Robinson explains why he thinks this clinic rated ‘outstanding’ by the Care Quality Commission is a model for others to follow
Retiring? Dealing with medical records and the handover of patients are likely to be the most burdensome tasks when winding down your practice. Dr Lucy Hanington looks at the rules and practicalities that doctors in private practice may need to consider
Our ‘Doctor On The Road’ columnist Dr Tony Rimmer gets to handle the Ford Focus ST
Plus all the latest news and views
And don’t forget to check out our additional news updates every week online
ADVERTISERS: The deadline for booking adverts in our April issue is 18 March
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