certificate worth having
The head of the Expert Witness Institute outlines its new certification scheme P18
Dr Michael Devlin takes a stark look at the future for private doctors if the clinical negligence system is not reformed P26
n See page 4
Litigation risk of falling between two stones
The problems of caring for patients who move between NHS and private care P36
By Robin Stride
Consultants are increasing their fees by up to one fifth in the runup to the new financial year.
Rampant inflation – higher in the medical sector than the UK’s national double-digit rate – has prompted a widespread review of pricing structures for self-pay work.
Many specialists are attempting to catch up after realising they have fallen far behind because they usually never considered annual adjustments.
Some reacted after specialist medical accountants recommended last month that Independent Practitioner Today readers should check their charges to see they at least kept pace with escalating costs.
But the advisers warned them to be careful about discussing pricing with colleagues, because the Competition and Markets Authority has been scrutinising the medical sector and has fined businesses where it believes uncompetitive practices have taken place.
A payments expert at Civica Medical Billing and Collection said many consultants who had not previously reviewed their fees were now doing so, citing increased practice costs from staffing and indemnity.
According to head of sales Simon Brignall, double-digit inflation fig-
ures had been a tipping point and were often being matched by similar fee rises from consultants.
Increased patient footfall in their practices, especially from self-pay growth due to the NHS’s current challenges, had given them scope to implement higher fees and the confidence to do so.
He warns in this issue (page 32) that consultants typically do not set their fees effectively due to not doing enough research at the outset – ‘or it may have been many years since they last looked at them’.
Practice management support company Designated Medical reported many consultant customers had raised self-pay prices from between 5% and 20%.
Managing director Jane Braithwaite said: ‘We have not seen patients complain. Mostly, the increases have been accepted with no comment. The sense is that they expected this and understand the reasons.
‘My personal experience is that costs have increased and this has to be absorbed or passed on. Most people are running very efficient practices and there is little room for reducing costs further.
‘The frustration, of course, is the lack of recognition by the insurance companies. Many consultants who signed up to fee assured status are really questioning the value of continuing.’
Alec James, a partner at Sandison Easson specialist medical account-
Consultants who revise their fees are being asked to ensure they update their pricing information held by the Private Healthcare Information Network (PHIN).
Its consultant relationship manager Anne Coyne said: ‘We contact consultants routinely to request they update the fee information they have submitted to PHIN. We are aware that, with the new financial year imminent, this may be a time when some consultants review and revise their fees.
‘We would remind anyone doing so to please update that information on the PHIN portal, https://portal.phin.org.uk, so
ants, said: ‘It is not surprising to see the fees rising like they are, given the cost of living and inflation rates.
‘I would envisage costs will increase for consultants, particularly in relation to clinic and staff costs. Ensuring their fees are increased accordingly in preparation of this is important.’
Meanwhile research is currently underway to examine and analyse price movements in hospitals’ selfpay packages.
One participant said increased self-pay volume could limit fee rises here, but some consultants were reportedly being charged more per hour for the consulting rooms they used for this work.
n See more on page 6
it is available to patients. We thank those who have already made the necessary amends.’
Specialists needing help with the process should contact consultants@phin. org.uk.
PHIN regularly reminds consultants of their responsibility to keep their data current.
But it told Independent Practitioner Today it did not currently evaluate and report on individual updates to fees, so could not say what percentage of consultants were currently updating their records in line with any fee changes.
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Email: robin@ip-today.co.uk Phone: 07909 997340 @robinstride
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Our front-page story on fees and a further article on page 6 are timely reminders for anyone who has not recently reviewed their self-pay charges.
Have you looked at yours recently? Feedback from those in the know indicates many independent practitioners are raising their fees in line with the UK inflation rate.
So their price rises will only be bringing them to around where they were a year ago.
That’s no increase at all really, but at least giving attention to fee levels ahead of the new financial year prevents slipping further below the levels they think they are worth.
Deciding not to increase fees is, of course, an option, but not recommended by specialist medical accountants.
What surprises us more, though, is the number of times we hear of doctors who have neglected raising their fees for
many years. Hopefully our coverage will be a useful reminder.
Hefty increases in practice costs, on the back of worsening or no earnings during the height of the Covid pandemic, have finally nudged good numbers of consultants who have not previously reviewed their fees to break with tradition.
It seems that reasonable fee rises in the present climate are what patients, hit like the rest of us with bigger bills all round, do expect and understand.
We await the results of current research into price movements in hospitals’ self-pay packages. The promise of volume must not be used as an excuse to tie consultants into making unfair sacrifices.
Meanwhile, for those who have raised their self-pay fees, don’t forget the Private Healthcare Information Network wants you to update your entry for its portal. There you can see what other consultants are doing.
How to make your group a success
Troubleshooter Jane Braithwaite summarises the ten main considerations to tackle to ensure your group has maximum potential for success P14
The power of patient testimonials
Are you getting positive feedback from your patients? Catherine Harriss reveals what doctors need to know about getting and using their testimonials P20
In healthcare, you are what you wear
Iain McMillan of Bupa expounds the benefits of healthcare technology and data which puts people in control of their health and well-being P28
The later stages of private practice
Medical billing expert Simon Brignall on the lessons to be learned when older consultants with well-established practices start looking at retiring P32
Ignore the noise of the markets
Dr Benjamin Holdsworth of specialist financial planners Cavendish Medical on how to avoid being spooked into action which will affect your investments P38
Failing to adhere to data protection rules can be extremely costly. Doctors’ duties in dealing with data are outlined by solicitor Henry Forrester P40
Accountant’s tips: Group work has different faces
Richard Norbury of Sandison Easson gives tips on the various business structures when forming a group P43
Business Dilemmas: Caught between two parents of your young patient
The MDU’s Dr Kathryn Leask advises what to do when a stepfather asks you to reveal records about him P46
Doctor on the Road:
The first affordable electric car?
Dr Tony Rimmer tries out the MG4 and concludes that its pricing could shake up the market P48
By Edie Bourne
Doctors should not have to reduce their pensionable pay to access the retirement flexibilities proposed in the Government’s recent NHS pension consultation, according to specialist financial planners.
The consultation, launched in December and closed at the end of January, sought views on plans to enable staff to work more flexibly up to and beyond retirement in a bid to retain vital skills of senior doctors in the workforce.
These proposals include:
A new partial retirement option to give access to the NHS pension while still working and building pension benefits;
Removing a limit to the hours newly-retired staff can work in the first month back;
Fixing the interaction between inflation and pension tax.
It is already possible to continue working while claiming pension benefits earned in the 2008 and 2015 section of the NHS Pension Scheme, but from 1 October 2023, it
will be available for benefits in the 1995 scheme too. But this option requires participants to reduce their pensionable pay by 10%.
Dr Benjamin Holdsworth, a director of specialist financial planners Cavendish Medical, explained: ‘In the main, these reforms will be largely beneficial and a positive step to helping seniors doctors work more flexibly in order to retain their skills in the service.
‘However, our area of concern is around the requirement for a reduction in pensionable pay in order to access the option.
‘Many clinicians will wish or will need to continue with their existing workload. For example, a significant number of consultants work in excess of ten programmed activities (PAs).
‘Our understanding of the proposed rules is that, for example, a consultant working 12 PAs would need to reduce their workload by 25% in order to qualify for this option.
‘For some, it is simply not possi-
Dr Benjamin Holdsworth, director of specialist financial planners Cavendish Medical
ble to continue their role and associated responsibilities within this reduced time – or they ultimately end up being paid less for doing the same work.’
He warned that this would also be problematic for clinical academics whose pay is linked to grants paid over very long periods.
Dr Holdsworth said: ‘This obligation to reduce hours seems to be
This obligation to reduce hours seems to be unnecessary and not in line with the original objective of the proposed changes, which was to retain staff
Dr Benjamin HoldswortH
unnecessary and not in line with the original objective of the proposed changes, which was to retain staff.’
The Government had yet to publish the outcome of the consultation as Independent Practitioner Today went to press.
Changes are due to come into force in April and October this year.
Specialist medical accountants have hit out at the Government’s consultation aimed at simplifying the NHS Pension Scheme.
In a detailed response, the Association of Independent Specialist Medical Accountants (AISMA) – whose 75 member firms act for thousands of consultants and GPs – said the proposals:
Were muddled in some respects;
Ignored issues that needed consideration;
Were sometimes incorrect.
Giving a technical critique, the accountants’ body also criticised
the approach given for failing to marry up with the relevant tax legislation. It wants further detail.
While agreeing with the need for change, AISMA added: ‘As there are so many complications within the various strands of the NHS Pension Scheme, which affect different members in different ways, we feel that a greater understanding of the issues is needed.’.
It wants more information on how the proposals, if implemented from 1 April 2023, might affect scheme members who have already decided to opt out or retire from
the NHS. There are fears some doctors may well be unfairly penalised.
AISMA said some of the complex proposals involving valuing pensions for annual allowance purposes were ambiguous and needed updating for clarity.
The accountants concluded it appeared that the current method of valuation by NHS Pensions for annual allowance purposes contradicted what the tax legislation said about valuation.
AISMA’s response to the consultation added: ‘We
recommend that additional research by the Department of Health and Social Care is required as to the detail of the proposed changes, together with a greater understanding of the limitations imposed by tax legislation.’
It criticised some proposals for lacking the detail needed to confirm that the intention behind them would be achieved.
‘If there is further detail or information not contained in the document this should be issued for consideration. If not, more work is required.’
By Robin Stride
Consultants who have yet to decide about making any increases to their self-pay fees have been advised to check their patient demographic.
According to a self-pay expert who advises specialists and private hospitals, it is ‘wholly reasonable’ for consultants to look to pass on some of the increased costs of doing business.
But Richard Gregory advised caution: ‘As in retail, passing through the entirety of the “hit” would be counter-intuitive and potentially result in falling business on what is predominantly a fixed-cost base.
‘There is a younger demographic that has come to self-pay since the pandemic and they may be more cost-conscious than the typical silver-pound generation, who are more cash rich and generally better off, especially after saving during lockdowns.
‘If they are more price sensitive, they may disappear from the selfpay market as more control is gained over waiting lists if prices
rise too steeply or too far. So a quick look at a consultant’s typical patient demographic would be a useful exercise.’
He argues that making it easier for the patient to engage in selfpay should be of equal concern.
‘Package pricing is a way to streamline the pathway as opposed to expecting a patient to get two prices and bolt them together.
‘Why make it difficult? Hospital and consultant teamwork makes total sense, building pricing packages and collaborating on opportunity generation and onboarding.’
Mr Gregory added that most pri-
vate hospitals were on a calendar year pricing cycle and were currently more aggressively promoting patient payment options such as allowing the cost to be spread over time, either with an interestfree or interest-bearing loan.
The Independent Doctors Federation (IDF) encourages doctors to review their charging structures annually, according to a member of its committee.
But the doctor said it was recognised that this was not regularly done, although everyone should take account of current rising costs. Supporting staff was important – even if doctors chose to take a relative pay cut.
‘Staff need to be kept content and happy and able to do a good job, there are rent increases, supply chain issues and there have been inflationary pressures. Doctors also need to spend more time not at the coal face, which incurs costs.
‘From what I’ve heard from individuals, about 10% is what people are increasing their fees by this year; some have already done it.’
Asked if there was concern that
As in retail, passing through the entirety of the “hit” would be counter-intuitive and potentially result in falling business on what is predominantly a fixed-cost base.
RICHARD GREGORY
consultants would lose business if they did raise prices, the IDF member told Independent Practitioner Today : ‘I think many recognise they can’t carry on having their fees chipped away and provide a good practice. We have evidence from outside London that a lot are doing extra NHS work.’
Outpatient consultation fees ‘for the majority of surgeons and physicians’ who treat AXA Health members were given a double-digit rise from February.
The revised fee schedule, for new patient and follow-up consultations, in-person or remote, represents a rise of around 11%.
Head of specialist and practitioner relations
Sarah Taylor said they were pleased to announce this rise for outpatient consultations.
‘We value the care our members receive from the surgeons and physicians who will benefit from this increase and we understand that private practice is under pressure, both from an increasing post-Covid workload and the rising cost of living.’
The Federation of Independent Practitioner
Organisations commented that it would be interesting to see whether other insurers followed AXA’s lead in the face of the large increase in self-pay patients.
It said: ‘Encouragingly, there has recently been some limited uplift in re-imbursements for consultation fees by AXA for those appointed after 2010.
‘This has been rumoured to be because of consultants choosing not to accept patients insured with AXA. While this increase is, of course, welcome, it exists against a significant and consistent increase in practice costs.’
But the increase paled against the rates of benefit which would exist if fees had simply increased with inflation from 1993, it added.
‘For newly appointed consultants in the NHS,
the start-up costs of entering private practice are a barrier that many are choosing not to breach. Doing NHS waiting list sessions is so much simpler.
‘For those established in the sector, whether on a full or part-time basis, persistently increasing costs, stagnant benefits and restricted patient access and referral pathways leaves hard work and professional expertise undervalued and unrecognised.’
Civica Medical Billing and Collection said the increase to fee-assured consultants had been generally well received, especially as many who had been with the insurer for over a year had chosen to initiate new fee negotiations. ‘This blanket approach will ensure consistency and fairness to those who benefit from this move.’
By a staff reporter
An internal review of the risk of bias in the way the GMC operates has resulted in a series of actions the regulator aims to implement during 2023.
The review was commissioned to check how the organisation monitors for, and mitigates against, bias in its decision-making.
It has recommended 23 actions, some of which are already being implemented, while others will be progressed in the coming months.
The GMC said the actions will ensure it actively seeks out and addresses any potential bias in its processes.
This was a key recommendation in a recently published report into the regulator’s handling of the case of a doctor who faced sanctions, later overturned, after claims she had been dishonest in attempting to obtain a laptop from her employer.*
The review’s recommendations cover five main areas:
1. The GMC’s approach to auditing
the fairness of its work, which are promised to be more consistent and will involve seeking more external feedback.
2. Introducing a single set of decision-making principles to increase consistency across the organisation.
3. Tailoring equality, diversity and inclusion (ED&I) training for GMC staff across different roles.
4. Publishing more detailed data about GMC fitness-to-practise processes.
5. Making sure fairness and ED&I are embedded into the way the GMC operates in future, when the Department of Health and Social Care introduces a new regulatory framework for healthcare professionals.
GMC chief executive Charlie Massey said: ‘This was a comprehensive review of processes and decision-making across the GMC.
We are already implementing many of its recommendations and work on others will follow as part of our ongoing commitment to
equality, diversity and inclusion, and to learning from recent cases.
‘A degree of bias is inherent in human nature and so a fundamental principle of our approach is to look for the risk of bias and to assess the controls we have in place to manage it. The recommendations in this report are key to that.’
Report author Laura Harding, who has experience of leading internal reviews working with the
Nursing and Midwifery Council, higher education institutions and as a director of a public sector consultancy prior to joining the GMC, said: ‘All humans are biased in some way, even if they are not always aware of it.
‘It is our responsibility to look for the risk of bias in our work and to mitigate it. I am heartened that many of the improvements we identified are already being implemented and the GMC has made firm commitments to act on the others.
‘All of us in an organisation such as the GMC make decisions, and no matter how big or small they are, they each have an impact. Managing the risk of bias in those decisions is vital and will result in fairer decisions for everyone who interacts with the GMC.’
* In November last year, the GMC apologised after an independent review found it had incorrectly applied a legal test when considering allegations of dishonesty involving Dr Manjula Arora.
Doctors have welcomed the internal GMC review acknowledging that bias exists in the organisation and needs challenging.
The BMA, a longtime campaigner for reform of the council, welcomed ‘this change in approach.’
Its equality lead, Dr Latifa Patel, observed it was good to see to see the regulator moving away from repeatedly comforting itself that there was no evidence of bias in its decisionmaking processes.
‘The landmark case of Dr Omer Karim, who the GMC was found to have racially discriminated against in a fitness-to-practise case, had shown this was far from true,’ she said.
Only time would now tell if the GMC’s proposed actions to mitigate against bias and provide greater transparency and reassurance would be effective and improve doctors’ confidence in their regulator.
She said the review rightly highlighted the
need to involve stakeholders such as the BMA in future audits.
‘Any future equality, diversity and inclusion (EDI) training must set out explicitly how racism, homophobia and other discriminatory behaviour manifests in the workplace and may affect decision-making, and how the bias towards evidence from institutions against that from
doctors will impact those high-stakes decisions.
‘What this review and its associated actions proposes is a much-needed cultural change in how GMC decision-makers look at referrals, which will take significant time and resources to achieve.’
The BMA has long called for an independent comprehensive review of GMC decision-making to ensure doctors have a just, fair and proportionate regulation process.
Dr Patel added: ‘While this review’s findings and actions are a step in the right direction, the recent case of Dr Arora – where there were multiple missed opportunities for GMC staff to raise concerns – shows there is still a long way to go to address the flaws in the GMC’s fitnessto-practise processes.
‘We will continue to monitor the GMC’s progress and press for improvements until we have a regulator worthy of the full confidence of UK doctors.’
By Agnes Rose
Nursing and skilled healthcare staff shortages are set to be an ongoing challenge for the future of private healthcare, market analysts have warned.
They say the independent hospital sector is facing similar challenges to the NHS in recruiting and retaining sufficient nurses and other skilled healthcare staff to safely fulfil exceptional demand levels.
In a new report on the state of the market, LaingBuisson says: ‘The underlying causes of skilled staff shortages are pay, pandemic exhaustion, the as yet ill-understood high levels of economic inactivity following the pandemic and, crucially, a historically low unemployment rate of 3.7% across the economy as a whole,
resulting in a tight labour market generally.’
While it believes immediate pressures may recede during 2023, the UK will still have an underlying national shortage of trained healthcare staff due to a shortage of NHS training programmes in recent years.
The skills shortage was highlighted by Independent Practitioner Today 11 months ago when we revealed bosses were fighting even within the same hospital group to sign up targeted individuals by paying £5,000 signing-on fees.
LaingBuisson UK Healthcare Market Review, 34th edition, reports some independent hospital providers are adopting more innovative solutions such as a nursing apprenticeship programme seeking applicants from sectors such as retail and hospitality.
On a positive note, it says rising demand for self-pay and private medical insurance, alongside greater interest in corporate health and well-being, could be a boost for those providers who are prepared.
There could also be new opportunities, particularly for cheaper and less labour-intensive services, such as outpatients and primary care.
Some providers are taking on more private GPs to cater for rising demand caused by GP access difficulties in the NHS, it says.
Demand for private services are at ‘an all-time high’, but LaingBuisson warns it remains unclear if this will continue in the longer term due to economic uncertainty and inflationary pressure.
The report concludes that:
Self-pay demand is ‘strong, buoyed by long NHS waiting lists
and times, which are unlikely to fall back to pre-Covid levels in the near or medium term’;
Underlying PMI-funded demand is ‘stronger than it has been in recent years, re-inforced by rising PMI subscriber numbers’; The potential for additional NHS-funded demand is considered substantial ‘as newly formed Independent Care Boards – which took over commissioning of local NHS services from clinical commissioning groups in July 2022 –seek to outsource elective surgery that NHS trusts are unable supply in-house’.
Pandemic-induced measures brought some lasting changes in the independent sector.
New protection requirements and protocols to safeguard patients and staff against the virus became the norm but put upward pressure on operating costs.
The move to remote consultations and telemedicine during the pandemic was rapid, underpinning new service propositions which have now become a core part of patient pathways, the report notes.
‘Many hospitals now have established partnerships with specialist digital providers to offer secondary care consultations, and telemedicine to support before and after treatment.
‘In particular, remote services offered by hospitals and clinics with a strong focus on international patients, have enabled patients to access leading UK specialists at a time when global travel has been restricted.
‘In addition, the rapid development of remote services has supported improvements in clinical practice through knowledge sharing and multidisciplinary teams.’
Changes due to the pandemic were more stark for many private patient facilities at NHS trusts. Some private patient units (PPUs) were re-purposed either as respiratory wards or to accommodate urgent and essential specialties, or re-assigned to clear NHS waiting lists.
Larger specialist PPUs, particularly within oncology, cardiology, maternity, paediatrics and orthopaedics, were less affected and have returned to more normal private activity.
But private activity was limited for much longer for some trusts that still have large numbers of coronavirus patients or have used their private beds to reduce NHS waiting lists.
The UK’s independent acute medical/surgical hospital sector was around 8,800 beds at the end of 2022, about 3,000 down on its peak bed capacity in the mid-1990s before intensified day surgery.
There were 34 independent-sector day surgery units with full operating theatres by last December.
LaingBuisson estimates there are 83
dedicated NHS PPUs with 1,048 beds, with four of these units managed by independent sector operators.
The market analysts believe there could be up to 1,250 non-dedicated beds used to treat private patients on an irregular basis.
It estimates the UK private acute medical care market value was £6.75bn in 2019.
The sector’s four largest providers by revenue generated around 60% of the private acute medical/surgical revenue total.
Market leaders are Circle Health Group (who now own BMI) and Spire with revenues of £863.7m and £919.9m and a market share of 17.5% and 17.0% in 2019 respectively.
Next are HCA UK (16.2%) and the charity Nuffield Health (10.8%).
The report observes: ‘With ownership highly concentrated, the balance of market power between the major hospital providers and the major insurers (the Bupa/AXA PPP ‘duopoly’) is fairly evenly balanced. Neither side can operate successfully without the other.’
Compiled by Philip Housden
A report in The Observer has examined NHS trusts’ promotion of private healthcare services through PPUs and how the pandemic – and record waiting lists – has led to a review of private services by some trusts.
It highlighted the following five:
❶ King’s College Hospital NHS Trust in south London stood down inpatient and outpatient private services during the pandemic to allow the inpatient beds to be used for NHS patients.
The inpatient service has yet to re-open. King’s reported revenues in 2021-22 of £5.4m, 81% down on the pre-Covid income of £18.9m.
❷ Newcastle Hospitals NHS Trust , where waiting times are among the longest in England, said that its private patient facilities are ‘currently being used for NHS services’.
The trust accounts show private patient income was £1.8m last year, still only 50% of the £3.6m received in 2019-20.
❸ Great Western Hospitals NHS Trust , in Wiltshire’s 20-bed unit the Shalbourne Suite, has not operated a full private patient unit since before Covid.
It has been reported that where the trust does offer private treatment, it is out of hours and where there is capacity in empty out -
patient clinics, with NHS patients always receiving ‘priority care’.
Great Western’s private patient revenues were £1.9m in 2021-22, still only 45% of pre-pandemic income of £4.2m.
❹ Hampshire Hospitals NHS Trust’s Candover Clinic had private patient revenues of £5.5m in 2021-22, still 25% lower than two years previously.
❺ At Kingston Private Health, the private unit at Kingston Hospital NHS Trust in south-west London, the trust scaled back private activity in winter and used the space to relieve pressure on the NHS.
Kingston reported private patient income of £2.2m in 202122, a 23% decline from £2.8m in 2019-20.
Overall, private patient income from NHS trusts in 2021-22 was £544m, a substantial decline of
£131m and 19.4% lower than the pre-pandemic income of £675m in 2019-20.
This represents only 0.65% of total NHS trusts’ incomes, well below the pre-pandemic high of 1.10% in 2018-19.
All of this shows the relative lack of private patient mixed-model provision across England at a time when the NHS is under financial strain.
The NHS could do with – at the very least – accessing the benefits of charging insurance companies for the high complex treatment and care received by their members but as NHS patients and without charge.
This missing income is estimated at anything up to £1bn a year.
The Independent Sector Complaints Adjudication Service (ISCAS) reports that the University Hospital Southampton NHS Trust and the Royal National Orthopaedic Hospital NHS Trust have agreed to participate in NHS PPU pilot studies.
The Government has demanded these pilots in its response to the independent inquiry report into issues raised by former surgeon Ian Paterson. This involves: The complaints procedure in
Training sessions are underway to help consultants and their secretaries handle data requirements of the Private Healthcare Information Network (PHIN).
The virtual session events are helping specialists review each process required for adding and
approving data to the PHIN portal. Upcoming dates are:
➤Thursday 9 March 6-7pm;
➤Monday 13 March 1-2pm;
➤Thursday 16 March 8-9am;
➤Tuesday 21 March 6-7pm;
➤Thursday 23 March 8-9am;
➤Tuesday 28 March 1-2pm;
➤Thursday 30 March 6-7pm.
To book, doctors are asked to email PHIN at consultants@phin. org.uk or phone them on 020 3143 3177, quoting their GMC number, or visit the PHIN portal and book their place. They will be sent a link to join their chosen session.
both PPUs being agreed with the Patient Advisory Liaison service (PALs);
Both PPUs ensuring their consultants with practising privileges are aware of the Medical Practitioners Assurance Frame work (MPAF) and that it is being used;
The private patients’ policy in both PPUs being reviewed.
At the Private Healthcare Inform ation Network (PHIN) annual general meeting, there were offers of help for signposting to ISCAS and ensuring private patients being treated in NHS PPUs are aware of the service it provides.
MP puts forward Early Day Motion to limit NHS private patient services
Labour MP Margaret Greenwood has put forward an Early Day Motion (EDM 805) calling on the Government to put an end to NHS facilities being used to provide services to private patients.
She referenced the provision in the Health and Social Care Act 2012 for NHS foundation trust hospitals to make up to 49% of their money out of treating private patients.
As I write this, the motion has 29 signatories.
Philip Housden is director of Housden Group
If your PPU has achieved something special or if it’s planning to expand or merge, please get in touch and let us know. Contact Philip Housden by email at philip.housden@ housdengroup.co.uk
By Olive Carterton
Private healthcare providers say much more needs to be done to ensure people are fully aware of their treatment options.
According to David Hare, chief executive at the Independent Healthcare Providers Network (IHPN), nearly half of the public are unaware of their right to choose.
He said latest NHS performance figures revealing NHS waiting list figures of 7.2m showed that despite the huge efforts of staff, the numbers of patients waiting for planned care were not coming down.
‘These figures come on the back of an Institute for Fiscal Studies report which suggested that wait
ing lists are unlikely to fall until 2024 – something which will doubtless concern patients and their families,’ said Mr Hare.
‘Recent IHPN research conducted with the Patients Association found that patients could cut over threeandahalf months off their NHS waiting time by choosing an alternative provider and travelling on average just 30 minutes by car.
‘But with almost half of the public unaware of their right to choose, much more needs to be done to ensure people are fully aware of their options.
‘This includes maximising use of the independent sector and ensuring patients can make informed choices.
‘If we are to make progress, it’s vital that the NHS makes use of all available capacity in the health system to ramp up activity and ensure patients can access the treatment they need.
‘We welcome the Government’s recently announced taskforce which is rightly committed to driving progress in this area.’
21,273 operations in the NHS were cancelled at the last minute in the three months to the end of December 2022, with hospitals feeling ‘winter pressures’ well before the season officially started.
The data also shows 4,593 patients were not treated within 28 days of their cancellation, in a breach of the standard.
Official statistics set out operations cancelled at the last minute for non-clinical reasons. A ‘last-minute cancellation’ is one that occurs on the day the patient was due to arrive, after they have arrived in hospital or on the day of their operation.
NHS England’s monthly Referral to Treatment (RTT) statistics also report the total number of people waiting for consultant-led NHS hospital treatment saw a small increase on November 2022, with 7.20m on the list in December 2022.
Despite the huge efforts of NHS staff, the number of patients waiting more than 18 months started to increase again. In November 2022, it was 48,961 and rose to 54,882 patients waiting 18 months (78 weeks) or more in December 2022 for consultant-led hospital treatment.
The Government’s Elective Recovery Plan has
a target to eliminate NHS waits of over 18 months (78 weeks) by April 2023.
Most common long waits seen were for trauma and orthopaedic treatment (797,630), ENT (549,656) and general surgery (442,948).
Mr Tim Mitchell, vicepresident of the Royal College of Surgeons of England, commented that although NHS staff had worked ‘incredibly hard’ to dramatically reduce the longest waits for surgery, too many patients still suffered the distress of having their operations cancelled at the last minute.
He said: ‘Their lives, and sometimes livelihoods, remain on hold while they wait for a new date and the relief from pain that surgery will bring. In some areas, surgeons are telling us that they are dealing with more complex cases, more frequently, as patients’ conditions deteriorate while on long waiting lists.
‘No surgeon wants to be in the position of telling a patient their surgery has to be cancelled, but the very high demand we have seen in emergency departments since the summer, and problems discharging patients who
are ready to leave hospital when there is a lack of social care, mean this is too often what has to happen.
‘Gaps in the workforce also play a huge part. Often there will be a surgeon available to operate, but no theatre nurses or anaesthetists.’
NHS England has announced 37 new surgical hubs, ten expanded existing hubs and 81 new theatres dedicated to planned care in a bid to speed up the recovery of waiting lists.
Mr Mitchell added: ‘These new surgical hubs will go a good way to helping bring down waiting lists. It is excellent news for patients and positive news for surgeons who have shared with us their frustration at not being able to get patients in for their operations due to a lack of theatre capacity. But there is more to be done.
‘We would like to see surgical hubs established in every area of the country with a particular focus on those areas that are underserved and struggling to bring down waiting times.
‘All of this will also mean nothing in the long term unless we have a resilient workforce to staff hubs. The Government’s much anticipated workforce plan couldn’t come soon enough.’
By Douglas Shepherd
Patients are being encouraged to put private doctors, their clinics and hospitals under increased scrutiny.
Official watchdog the Care Quality Commission (CQC) has announced it wants more people aged over 55 ‘to share their experiences of care with us’.
A spokesman told Independent Practitioner Today: ‘The avenues for feeding back on care are open to all. So, no restrictions on the private sector; we want to hear from across the sectors.’
The CQC is telling patients: ‘The feedback people give helps health and social care services to improve. It can help make care better for everyone.
‘Whether your experience is good or bad, it’s valuable to us. We use it to keep track of the quality of care services provide.
‘You can give feedback anonymously if you want to. But it’s especially helpful if we can contact you to check details or get more information about what you’ve told us.’
It explains it needs patients’ help to understand the quality of
care they get from any type of health service.
The CQC emphasised the importance of positive feedback because it helped it recognise good practice and kept up staff morale.
Meanwhile, results of a nationwide questionnaire of patients, run by the Patients Association, is due to be published this month.
It said its ‘survey of experience’ would help it understand what patients are experiencing when trying to get the healthcare they needed ‘to live healthy lives’ and help it represent their concerns to providers and the Government.
A newly opened eye-health clinic and surgical centre has been praised by the Care Quality Commission (CQC) following its first and unannounced inspection.
Newmedica Norfolk, in Norwich, has been providing NHS and private
treatments for a range of eye conditions, including glaucoma, cataracts and age-related macular degeneration, since November 2021.
The CQC highlighted two ‘outstanding’ aspects of its fast access to services: initial
Left to right: Consultant ophthalmic surgeons at Newmedica Norfolk: Mr David Spokes, Mr Nuwan Nyadurupola, Miss Aseema Misra, Mr Anas Injarie, operations director Mrs Karen Hansed and Mr Narman Puvanachandra
appointments within three to five days and low complications rates following cataract surgery, which was 0.24%, compared to the national average of 1.10%.
The clinic received a ‘good’ overall rating.
Mayo Clinic has opened a patient information office in Mumbai, India, to assist patients who want to make appointments at Mayo Clinic locations worldwide.
The office staff, fluent in Hindi and English, will help patients, their families and physicians who refer patients to make appointments at Mayo healthcare clinics in London and also its US ones in Rochester, Minnesota ; Phoenix and Scottsdale, Arizona ; and Jacksonville, Florida
The Mumbai office staff will assist with travel, lodging, billing and insurance arrangements, provide general orientation to Mayo Clinics, facilitate Mayo review of medical records and co ordinate future appointments.
The office staff may be reached by email at indiaoperations@ mayo.edu
Mayo Clinic also has patient information offices in Canada, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama and Peru.
Mohamad Bydon, a Mayo Clinic neurosurgeon and executive medical director of academic affairs and its Europe, Middle East, India and Africa regions, said: ‘Mayo Clinic seeks to serve as a resource for patients and health care providers around the world. Our international patient information offices help us provide patients with a seamless experience when seeking care at Mayo Clinic.’
Cleveland Clinic London is to open a new medical outpatient building at 77 Coleman Street in the City of London.
Cleveland Clinic Moorgate Outpatient Centre will welcome patients in autumn 2023 for outpatient appointments, diagnostics
(including MRI) and general practice appointments.
The centre follows the opening of Cleveland Clinic Portland Place Outpatient Centre in 2021.
The 184 bed Cleveland Clinic London hospital was opened in March 2022.
The hospital’s interim chief executive Tommaso Falcone said: ‘We are excited to be expanding our London footprint with a third location, in the heart of the City of London.
‘This will extend our unique model of care to more patients,
with fast access to consultants, GPs and diagnostic services in a stateoftheart facility.’
Cleveland Clinic London said it had seen nearly 60,000 patients across its hospital and Portland Place Outpatient Centre since opening.
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Shocked doctors found they faced huge extra pension tax charges after breaching lower annual allowance limits in 2011-12.
After completing their normal January tax returns and settling their private practice bill, some learned they still owed up to £35,000 more.
Financial planning experts Cavendish Medical said several new clients had been unaware of stringent new limits or subsequent punitive tax charges. In 2011, the yearly allowance rate was cut from £250,000 to just £50,000.
The company’s technical director Patrick Convey said doctors being helped had unwittingly breached the lower annual allowance limits and might not have any available carry-forward from the previous three years.
Independent Practitioner Today urged doctors to use a mileage logbook to keep track of their legitimate expense claims and avoid unnecessary hassle with the taxman.
Specialists were warned they needed to be even more vigilant over what journeys they claimed for.
Accountants said evidence of a proper log helped back up future mileage claims, which were coming under increased scrutiny from HM Revenue and Customs.
Health department plans to limit NHS consultants’ private work under their ‘new’ 2003 contract had been achieved, the National
Audit Office (NAO) reported. It claimed the deal ensured specialists’ independent practitioner work did not increase and that the number of consultants taking on private practice patients stayed ‘relatively stable.’
An NAO report, Managing NHS Hospital Consultants, said that the previous year 39% of consultants worked privately, ‘a significant fall’ from the 66% reported at the turn of the century.
Applying these percentages to the consultant headcount, it estimated 16,349 had private patients in 2000 (67% of 24,401) compared with 15,754 in 2012 (39% of 40,394).
The NAO found most consultants prioritised NHS work in line with contract terms.
‘Consultants who work ten programmed activities or fewer must provide one additional programmed activity to the NHS before carrying out any private work. 72% of trusts stated that all or most consultants do so, where required.’
Practices and hospitals were being urged by the Information Commissioner’s Office (ICO) to review their policies on how personal data was handled.
This followed the Nursing and Midwifery Council being issued
with a £150,000 civil monetary penalty for breaching the Data Protection Act.
The council lost three DVDs related to a nurse’s misconduct hearing which contained confidential personal information. An investigation found the information was not encrypted.
ICO director of data protection
David Smith said: ‘I would urge organisations to take the time to check their policy on how personal information is handled.
‘Is the policy robust? Does it cover audio and video files containing personal information? And is it being followed in every case?
‘If the answer to any of those questions is no, then the organisation risk a data breach that damages public trust, and a possible weighty monetary penalty.
How about making the news today? Independent Practitioner Today is always keen to hear from doctor entrepreneurs willing to share their stories in private practice – and from independent practitioners embarking on the journey.
Contact our editorial director Robin Stride at robin@ip-today. co.uk
• Reduce bad debts to less than 0.5% • Increase net income by up to 25%
• 24/7 online access to your data • Enable faster payments through e-billing for insurers and patients • Focus on your practice whilst our account managers manage it all for you
A group of doctors working together can benefit the group members and their patients. There are numerous examples of groups working very well, but there are also some examples where things haven’t worked so well and ultimately failed.
Jane Braithwaite (above) summarises the ten main considerations to ensure your group has maximum potential for success
MAKES a successful group?
The guidelines for creating and maintaining a successful group reflect similar ones that would be set for any team of people working together.
Undoubtedly, a successful group is one motivated by the shared core values of its members. When your group shares the same sense of purpose, they celebrate and champion each other, creating a culture of excellence within the business.
When the group was formed, the group members agreed on the group’s goals and objectives.
Each group member documented this agreement in writing and signed to signify their understanding and commitment.
This important document is referred to as their contract and they took advice from their accountant and lawyer to ensure all eventualities were catered for. This activity gives the group clear direction and a common aim to work towards collectively.
When any change is made to the group – for example, a member
leaving or a new member joining – the contract is updated to reflect this.
Clearly defined goals enable everyone within the group to maintain a clear vision of what the group is aiming to achieve.
A group is usually a partnership where all members are of equal standing.
But a successful one will have nominated one individual to act as the group leader or managing partner.
This is often the group founder, the person who originally created the concept of the group, or it may have been a joint decision, choosing the individual with the greatest leadership skills.
The leader is trusted and respected by the group members and encourages everyone to work collaboratively. The leader also encourages a positive work environment and work ethic.
Ultimately, the leader is required to ensure good decisions are made in a timely manner. This is especially important when consensus cannot be reached promptly.
➱ continued on page 16
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Every month, the group members meet to discuss the performance of the group. They communicate openly with each other, sharing their thoughts, opinions and ideas and they take time to consider what others have to say.
On a daily basis, the group members are open and honest in their communications, highlighting concerns or issues and enabling them to be addressed before they become bigger problems. Everyone trusts one another and feels able to speak up.
This continuing open dialogue helps ensure that conflict is mostly avoided, but when conflict does occur, it is handled professionally.
Everyone recognises that running the group is equivalent to running a business, which brings additional responsibilities.
The group has identified the relevant management roles and responsibilities and has allocated these fairly across the group members.
Everyone contributes their fair share towards the workload of running the group and each individual understands their responsibilities and where they fit in with the overall running of the business.
This helps to prevent overlap, miscommunication and misunderstanding. They take ownership of their area, are committed to their work and they care about the success of the group overall.
When the group was formed, its financial model was clearly defined and described in the contract that each group member signed.
Each individual has clarity on how their financial rewards will be calculated and, therefore, clearly understands how their work contributes to their financial success. Rewards are fair and unbiased and represent the hard work and contribution made by each individual.
The agreed financial model is motivating and increases job satisfaction. The agreements made were realistic and expectations were met. It was understood that,
like any business, the group would take time to establish itself and the financial rewards may take time to build.
The group regularly discusses and reviews financial performance throughout the year to ensure a clear understanding of progress made and how this impacts each individual to avoid any surprises at year end.
When important decisions need to be made, the group members can openly discuss their views and contribute to making the best decision for the group overall.
When there is disagreement, the group members actively listen to each opinion and aim to compromise to reach an agreement. When needed, the nominated leader of the group can make the decision, and the group members respect and support the decision.
A lack of decision-making can be damaging. It is critical that people communicate their concerns, have a clear vision of where they are headed and make decisions.
Not everyone may agree on the decision, the tactics or how to work together, but still the team must make a decision and move forward.
The group members share a common view on the level of care that their patients should receive and aim to deliver a similar patient experience.
When the group was formed, the clinicians discussed their views on patient experience and agreed on standards of care that the group would commit to delivering and they adhere to these expectations daily.
This enables them to feel comfortable referring their patients to their colleagues within the group for additional treatments and to care for each other’s patients during periods of absence and holidays.
When a patient complaint is made, the group reviews the complaint together and investigates the causes openly and honestly.
There is no blame, so the discussion focuses on how to manage the situation to achieve the best outcome for this particular patient and how to learn from this event
Successful groups invest time at the outset to ensure everyone shares common goals and objectives and are aligned with the same vision for the group.
This important work creates strong foundations for the business to build on and enables the group to prosper. Communication and decision-making must be maintained daily to ensure the group continues to grow and thrive.
These aspects of the group dynamics rely on the softer skills of the individuals involved and this may be more challenging than the clinical work.
If your group is struggling, don’t give up hope. There is always a strategy to effect change. For example, if the group finds the management of the group more challenging, perhaps in terms of decision-making, it may be wise to enlist outside assistance from a suitably experienced consultant.
A solution can be found when everyone in the group is committed to its success.
and improve processes to prevent a recurrence.
All group members commit to continual learning to ensure their knowledge is up to date. They share their expertise widely within the team and aim to enhance everyone’s skill sets.
Each clinician professionally manages their own practice. The administration is well managed and patient communication is exceptional.
The business itself is also run in an organised and disciplined manner. Each group member manages their responsibilities diligently and delivers their work to the agreed deadlines.
Each group member is respectful of others by attending meetings on time and submitting their contributions on time.
Regular meetings are held to ensure everyone is on the same page and deadlines are being met,
The doctors perform well as a team and the group exhibits a collaborative work environment.
Each group member has a positive attitude and work ethic, and the group is efficient and productive. No single individual dominates discussions and each person has an equal opportunity to be heard.
The culture of the group is supportive, with each group member actively supporting others when needed; for example, when one individual is under pressure with
their workload or facing a difficult clinical decision.
Each clinician has different expertise and experience, utilised across the group through collaboration. This diversity is respected and embraced to offer patients the best possible care.
Within a truly successful group, the doctors enjoy their work and they enjoy working together, having a sense of achievement and of fun. They enjoy the company of their colleagues and value their discussions, both clinical and business related.
Positive relationships built across the group help create a relaxed environment and reduce conflict.
The group members have constructive chats about work-life balance and they encourage one another to maintain a healthy balance, recognising this helps prevent burn-out and ensures they are all able to perform to the best of their abilities.
If you have any specific questions you would like answered in Independent Practitioner Today , please feel free to get in touch.
See ‘Group work has different faces’, page 43
Jane Braithwaite is MD of Designated Medical, which offers flexible, experienced support for all your private practice needs. It offers bespoke support across accountancy, marketing, medical PA and book-keeping and can work to suit your requirements
Access to the advice line is unlimited, and the number of times you call has no impact on your subscription. Whatever the issue, you can be confident of 24/7 support, 365 days a year. Our experts are always there, ready to provide you with support when you need us.
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Following our top news story last month, Simon Berney-Edwards (right), chief executive of the Expert Witness Institute (EWI), outlines its new certification scheme for expert witnesses, why it is important and how you can apply
SCRUTINY OF expert witnesses has increased in recent years and the courts have responded with both criticism and severe penalties for those individuals who put themselves forward to do this job but who clearly do not understand the role or their obligations.
In Beattie Passive Norse Ltd & Anor v Canham Consulting Ltd (No. 2 Costs) [2021] EWHC 1414 (TCC) (28 May 2021), Mr Justice Fraser remarked: ‘There is a worrying trend generally which seems to be developing in terms of failures by experts generally in litigation complying with their duties.’
The importance of training in the core competencies for being an expert witness have been highlighted in a number of recent cases.* They more importantly identify the need for trained expert witnesses to:
Keep up to date with the latest rules and regulations;
Ensure they remind themselves of their role and obligations;
Undertake ongoing professional development which is relevant to their role as an expert witness.
In an environment where anyone can put themselves forward as an expert, you can provide a clear and demonstrable indication that you take your role and duties seriously through membership of the EWI and signing up to our code of professional conduct.
EWI certification is an assessment process which enables applicants to gain both recognition and validation for their current practice as an expert witness.
By becoming an EWI certified expert, individuals will commit to undertaking ongoing continuing professional development (CPD) and they will be required to go through the certification assessment every five years to revalidate their practice and retain their certified status.
EWI certification is an assessment process which enables applicants to gain both recognition and validation for their current practice as an expert witness
The assessment builds on the vetting procedures in place for EWI membership by adding a higher-level membership category for highly experienced experts.
Certification assesses all the core competencies required as an expert witness, recognising those who can demonstrate excellence in report writing, discussions between experts and giving oral evidence in court.
More importantly, applications for certification, and revalidation of certification, are assessed on the expert’s ability to demonstrate actual practice in real scenarios.
Why should you become a certified expert witness?
Over the last year we have continued to see the credibility of expert witnesses called into question where experts have acted in the role without fully understanding their duties to the court.
Certification provides a clear indication to those who instruct you that you can deliver.
It provides validation of your practice as an expert witness by a professional body and demonstration of your commitment to professional development.
Certified expert witnesses appear at the top of all search results on the EWI’s ‘Find an Expert Witness’ Directory.
They can make use of the postnominals MEWI (Cert) or FEWI (Cert) – if they have been previously accepted as a fellow of the Institute.
The Scottish Qualification Authority (SQA) has endorsed EWI Certification in the Scottish Credit and Qualification Frame work (SCQF). It has awarded it 15 SCQF credit points at SCQF Level 11 –masters level – which you can transfer to another academic or vocational qualification.
This accreditation provides EWI Certification with an equivalent rating comparable with other qualifications and evidences the academic weighting.
All certificates will be issued with the SCQF logo as proof of achievement. In some circumstances holders of certification may be eligible for recognition of prior learning in the pursuit of a further qualification, but this is at the discretion of the relevant training/learning provider.
The benefits of having SCQF credit rating are that it provides certification with national recognition and improved quality assurance processes that are regularly assessed by the SQA.
The EWI has set out the core competencies expected of expert witnesses. These competencies will be assessed for certification and are used as the basis for the assessment criteria for applications.
There are four stages of the application process:
You are required to complete an online application form which includes the submission of key pieces of evidence in support of your application.
You will complete an online assessment (20 multiple-choice questions) of your understanding of the rules and regulations of the jurisdiction and court in which
The importance of appropriately trained expert witnesses is already recognised by the judiciary.
EWI Certification is attracting endorsements such as:
‘I welcome the EWI’s initiative in creating a certification programme for expert witnesses. The complexity of much of modern litigation means that expert witnesses often play an essential role in the administration of justice.
‘Unfortunately, judges have had to criticise experts for failing to understand and comply with their duties. Such failures can result in injustice and such criticism can cause serious damage to a person’s professional reputation.
‘I hope that the initiative will assist experts, the parties who instruct them to give evidence, and the judiciary in their collaboration to ensure high standards in the administration of justice.’
Lord Hodge, Deputy President of the Supreme Court
‘It is crucial that expert witnesses are properly trained and qualified so that they are able to comply with their duties to the courts and tribunals before which they appear. I welcome the work of the EWI in promoting the introduction of an SQA accredited programme in support of that objective.’
The Right Hon Lord Carloway, Lord President of the Court of Session
the report which forms part of your application was submitted in
You will write and submit a 250500 word statement detailing your experiences in participating in expert discussions and reflecting on the joint statement submitted.
Where you do not have any experience or an example of a joint statement, you will be asked to submit a statement on the practice in your jurisdiction
Examination/cross examination
You will be invited to undertake a mock examination in chief /crossexamination with an advocate/ barrister based on the report submitted.
The advocate/barrister will seek to test your competence in giving oral evidence. In most cases these will be conducted via Zoom. However, we also can conduct these in-person. They last no longer than 30 minutes. If you have successfully completed the cross-examination module with expert witness training company Bond Solon in the last five years, then its certificate will be accepted as evidence.
The result of the quiz, all your documents including reflections on joint statements and CPD, plus the three references will be collated into one form.
This form, and the recording of the mock cross-examination will be assessed separately by two assessors.
If both come to the same result then we will let you know the result at this stage.
If they disagree, we will ask a third assessor to moderate. You will be notified of your final result within four weeks after the mock cross-examination (assuming all references have been received in time).
Full details of the requirements, application and membership fees, and the online application form can be found at: www.ewi.org.uk/ Certification.
* Pal v Damen [2022] (non-compliant report and partisan expert), Patricia Andrews & Ors v Kronospan Limited [2022] (noncompliance with the rules around expert meetings and joint statement), Palmer v Mantas & Anor [2022] (unconscious bias), and Reynolds (for CSB 123 LIMITED) v Stanbury [2021] (poor performance in giving evidence).
Are you getting positive feedback from your patients? Catherine Harriss (right) reveals what private doctors need to know about getting and using their testimonials
BACK IN 2014, I wrote an article for Independent Practitioner Today about the importance of testimonials.
Even then, despite knowing testimonials were important for private practice marketing, I didn’t fully appreciate exactly how important they were.
Testimonials remain the mainstay of business, never more so than for private practice.
The type of testimonials I am referring to are those written with meaning – usually some time after the event – and convey the true emotions connected with their time with you.
I have no time for testimonials sought on the day, that are written in a couple of words: ‘great thanks!’ or ‘lovely doctor!’ What I do have time for are those that convey why they are thankful and include within them the story of how the patient(s) were affected.
To convey other people’s experiences
Trustpilot, in 2020, identified that nine out of ten people read other people’s reviews to understand more about the provider and the outcome thus indicating exactly the importance placed on the customer journey and the trust that others have in fellow users’ opinions.
To check for authenticity
I have always posted on line reviews that I have received via email. These are often full of spelling and grammar mistakes, which may go against the grain of correcting text, but they show authenticity.
I also keep them on file should anybody ever query them.
Alternatively, I also encourage people to let me know about their experience via writing a Google
review or writing a Facebook review.
These cannot be altered and can only be removed by approaching Google – and then Google will only remove them if the review contravenes Google’s policies.
So, for the most part, Google reviews remain telling a ‘warts and all’ story of a person’s experience. If your care is good, then there is nothing to fear.
Of the free services, Google reviews are more trusted than other review sites, with nearly 60% of people looking to see what is said there before looking elsewhere.
Google reviews produce Google stars and it is these that show up alongside listings on the search engine. We know that people are more likely to click on a link that has Google stars.
Facebook reviews also cannot be altered nor can they be deleted. This is a good point. In all the thousands of patients that I have helped book in for care, only two stand out as writing negative reviews. On both occasions, I contacted the individuals and talked through their issue and in both situations, they altered their testimonials to be favourable. Communication remains important for the whole time of your patient journey.
Research by Brightlocal in 2020 identified that 79% of people trust a review as much as a personal recommendation.
We all understand how word-ofmouth recommendations work so the fact that testimonials for the majority are viewed in this way,is only beneficial.
Testimonials don’t come across as ‘selling’, as they are written from the heart
The passion emitted from this can be very persuasive and so encourage others to visit the same practitioner to obtain the same feelings and results.
I came across this day after day when potential patients quoted testimonial they had read and asked if their history could lead to a similar outcome.
➱ continued on page 22
These testimonials literally lift the spirits and can do more for your practice than any other amount of information.
Testimonials don’t create objections, they break them down In marketing speak, objections are all those questions that generally start with ‘but’.
‘But I am 46 and therefore too old’. ‘But I am too overweight so I won’t be able to have surgery’. It is surprising how often individuals’ stories via testimonials tackle these objection directly and so ring true for many other people.
Again, their persuasive nature helps break down barriers that people perceive to having the surgery. In essence, when a testimonial is received from an individual who is very surprised that they had a positive experience, it can help so many others in similar circumstances.
They substantiate your claim
If your service aims to eradicate, reduce or cure a certain condition or problem, then this is what your testimonials should reflect.
The detail and expression within them can be of so much benefit to your private practice.
They help make you more relatable
When a testimonials writer provides detail of how they came to arrive at your door, how they found you and why they chose you, this indicates a significant
The GMC’s Good Medical Practice guide (updated in April 2019) exists so that patients can trust their doctors. The guide states that patients need good doctors and that ‘good doctors make the care of their patients, their first concern’.
The law, set out in the Consumer Protection From Unfair Trading Regulations 2008, states that ‘falsely representing oneself as a consumer’ on the context of promoting a product to consumers is deemed to be unfair commercial practice.
The false practice of attracting business through trying to get grassroot support from non-genuine comments or recommendations is called ‘astro-turfing’, which is a criminal offence. The Advertising Standards Authority’s UK advertising code says that ‘marketers must hold documentary evidence that a testimonials or endorsement used in a marketing communication is genuine’. Fake testimonials are not fair, legal, decent, honest nor truthful.
thought process that they have gone through to find you.
They endorse the key benefits of your product/ service
Often in the medical world, we hope that patients come and visit us for a sole treatment, whether that involves starting a long-term course of treatment or a single operation where there is no need for repeated care.
This is very different to many business models where you are thinking of ways to encourage repeat business. If the testimonial indicates that they came to see you with a problem and you provided a solution and it worked, then you will have done well.
If the patient provides information about added benefits, then even better. It re-inforces that your treatment will help them find the solution they have been looking for.
They enable comparisons
It is never good to hear that individuals have had a poor experience elsewhere, but this can happen and it does happen for many different reasons.
Again, a comparison to this poor experience really helps your credibility.
Are testimonials important?
A study by Big Commerce found that 92% of customers read online reviews before buying and 88% of consumers trust online testimoni-
als and reviews as much as recommendations from friends and family.
This is backed up by a study by Nielson, that found 70% of reviews and recommendations were trusted by strangers. The search engine Watch found that 72% of consumers took action only after reading a positive review.
How many testimonials matter?
Vendasta found that 73% of consumers read six or fewer reviews before making a decision and then identified that 12% of consumers read more than ten reviews.
Earlier in this article I mentioned Google stars. Research by Opt-in Monster identified that a site needed 40 or more reviews before consumers felt that the star rating on Google was accurate.
Big commerce noted that once 50 or more testimonials are received, then the conversion of visitors into bookings or purchases increases by nearly 5%.
Do testimonials affect outcomes?
The impact of testimonials does affect the revenue of a business. I have first-hand business experience of the power of testimonials. One business I helped generated more than 1,500 testimonials and a similar number via social media. I know from conversations that many booked in for surgery after reading about other people’s experiences.
Research by Strategic Factory found that testimonials regularly
generate 62% more revenue. Dimensional Research found that 90% of buyers who read positive customer success content claimed that it influenced their purchasing decisions.
How important are they?
Of all the online content that you can produce for your business, testimonials are the most important. They convey trust and as a provider of specialist health services; this is the number-one factor that you can control and capitalise upon to boost your private practice.
How to capture testimonials
I have always encouraged my clients to seek testimonials but also, importantly, for clients to write testimonials with ease. These can be done via email that provides follow-up information for the patient and links to Google or Facebook where a testimonial can be left.
Alternatively, testimonials can be done via a third-party software such as Feefo and Trustpilot. These are trusted sites used in many areas of commerce and enable reviews to be left that are honest.
I know from experience that by using one of these sites, it is possible to seek answers to the questions that you want to pose that will help solicit a response. It is not possible to alter these, but it is possible to respond to them.
Catherine Harriss founded MultiWorks Marketing in 2011. See https://attractdreamcustomers.com
Eye Health Care’s chief executive Dr Peter Byloos reveals how the company has changed focus and the way it works with consultants
AT A TIME of expansion and new opportunity, the Optegra specialist eye hospital group has a sharp, precise view of how it works with its consultants and how it secures the best outcomes for patients.
Since I joined in 2018, we have reviewed and challenged the strategic focus of the business and the way we work with our consultant surgeons.
As a business, we have also made inherent, necessary changes as a direct result of the global pandemic, which have shaped our approach for the future. These combined factors have led to great success as we see increased patient numbers across our private self-pay treatments and a dramatic increase in NHS patients, particularly for cataract surgery. We have also secured new investment, which allows us to expand our business both in the UK and in Europe.
When I joined Optegra, we were very much offering ‘the A to Z of eye health’ in terms of treatments. We had an extensive range of procedures available – from laser eye surgery and a miniature telescope for age-related macular degeneration (AMD) to oculoplastic surgery.
This meant we drew on the expertise of a broad number of consultant ophthalmic surgeons, some of whom would spend perhaps just half to one day a week in our consultation rooms and theatres, and the remainder of their working week in their own private practice.
Recently, we took the strategic decision to re-align our priorities, and, in fact, the pandemic gave us the opportunity to do so.
When our hospital doors had to close, rather than furlough our clinical teams, we used this time to draw together all that fantastic
expertise and medical knowledge to really streamline our pathways.
We established a process which was tight and focused, with all clinical teams in each hospital following the same consistent and standardised approach and, most importantly, this has led to excellent clinical outcomes for all our patients, across all our hospitals.
We also took the decision to refine our focus and move the clinical teams to largely concentrate on cataract surgery and vision correction treatments. We also continue to provide AMD injections.
The rationale for this is that by focusing on higher volumes across fewer pathways and serving those patients really well, we continually drive standardisation and provide excellent care and outcomes in these specialist areas.
It also means we can treat more patients a day and so reduce the
➱ continued on page 24
wait times for patients to have essential cataract surgery.
All Optegra patients receive a clinical phone call within 48 hours of the optometrist’s referral, diagnostic tests within three weeks and treatment within just six-seven weeks.
E-clinics became a necessity as the hospital clinics opened again after Covid and a welcome approach to keep patient time in the hospital to a minimum.
Our optometrists and ophthalmologists have adapted well to this approach and it is a benefit for patients to respond to initial questions and discussions from the comfort of their own home. E-clinics are certainly here to stay.
We have increased the responsibilities of optometrists running pre- and post-op checks, which allows our surgeons more time within theatre and so we are able to increase the number of patients treated on each list.
At the same time as these practical medical changes, we really reviewed our relationships with our surgeons. They are now enveloped into the business to levels we have not seen in the past.
This has been created out of trust and by investing in the very best technologies, training and clinical support teams. So our consultants now spend several days a week with us and many work with us full time.
This, in turn, means they can develop stronger relationships with their scrub nurses, patient liaison team and optometrists – a win-win for both clinical outcomes and successful, enjoyable working relationships.
While the UK faces a shortage of medical staff, we like most other hospitals are eager to attract more clinical staff.
By providing five-star facilities, latest technologies and excellent support, we are in a strong position to attract and retain new clinical colleagues and are always happy to meet and discuss such opportunities.
Our medical director and consultant ophthalmic surgeon, Mr Amir Hamid, shares his opinion on this: ‘Optegra aims to provide an efficient and stress-free environment for surgeons working
with us, where excellent patient outcomes and high satisfaction rates take centre-stage in our standardised pathways.
‘We always take on board the suggestions of our consultants to improve and innovate. This collaborative effort is hugely beneficial for our patients and the consultants themselves.’
A further big change to Optegra in recent years is our increased commitment to NHS patients. Prior to the pandemic, we worked with the NHS to provide both AMD injections and cataract surgery. During the pandemic, we kept some of our hospitals open for NHS teams to provide essential AMD
treatment and ensure patients could retain their existing vision at a time when that was at risk.
However, the demands on the NHS have provided a huge opportunity for us to increase our cataract offering to the many thousands of patients around the country who were facing large waiting lists.
So we have gone from treating 3,000 NHS cataract patients in 2019 to more than 30,000 in 2022.
We predict this rising to over 50,000 patients this year.
Our newly standardised pathways give our consultant surgeons the reassurance that all adequate processes are in place – and the outcomes speak for themselves.
From January to September 2022, for example, outcomes included:
Cataract surgery: visual outcome of 6/12 or better 94% –against RCOphth/NOD benchmark of 86%;
Cataract surgery: zero operative complications 99.46% – against RCOphth/NOD benchmark of 98%;
We always take on board the suggestions of our consultants to improve and innovate. This collaborative effort is hugely beneficial for our patients and the consultants themselves
clinics: in Newcastle, Maidstone and Uttoxeter.
We are launching in Brighton in April and have a further three UK clinic launches planned for later in 2023.
Lens replacement: visual outcomes on 6/12 or better 98% –compared to benchmark Rosen et al of 96%.
From a corporate viewpoint – as, of course, from my chief executive perspective I also need to keep our investors happy – Optegra is in a very strong position.
Alongside our ongoing relationship with H2, we also have new majority shareholders, MidEuropa, which provides an opportunity for us to escalate our expansion programme.
In order to further meet the surgical needs of patients throughout the UK, we have recently launched three new NHS cataract Optegra
Of course, this is an opportunity for us to also attract more consultant surgeons to the business, where they can lead on treatment for NHS patients initially; with a view to the clinics also offering private cataract – with multifocal lenses – and vision correction at future dates.
On an international level, we have recently invested in a series of eye clinics in Slovakia, and we continue to have a very strong presence in Poland and the Czech Republic, which is a very sophisticated eyecare market. We are the number-one provider in those regions.
Optegra continues to respond to market need, to identify opportunities for growth and we are excited for the years to come as we continue to work with leading doctors, nurses and clinical teams, providing the highest visual outcomes for our patients.
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What lies ahead for the unbalanced clinical negligence system? Dr Michael Devlin (right), MDU head of professional standards and liaison, takes a disturbing look – and it’s not good news for independent practitioners
AT THE last estimate, the cost of meeting future claims liabilities for the NHS in England stood at a staggering £128bn, a figure which has increased more than six-fold in the last decade. It was £17.5bn in 2011.
This bill doesn’t exist in isolation. Every penny expected to be spent on claims means less money for patient care at a time when the NHS is already struggling to cope with a seasonal influx of patients, staff shortages and historically long waiting lists.
This is bad news for independent practitioners.
As well as being taxpayers and patients, you may work in the NHS alongside your private practice and want both to thrive.
And, of course, the rise in compensation costs inevitably exerts an inflationary pressure on professional indemnity for those not covered by the NHS scheme. But it’s a myth that the increase
The rise in compensation costs inevitably exerts an inflationary pressure on professional indemnity for those not covered by the NHS scheme
be published ‘in good time for implementation in October 2023’.
In the MDU’s view, action on disproportionate legal costs is long overdue. It cannot be right that the costs paid to claimants’ lawyers can exceed the damages paid to claimants by double or triple the amount.
Figures in the MDU’s most recent annual report, show the average sum paid in claimants’ legal costs on medical claims settled for up to £10,000 was in excess of £18,500.
For claims settled between £10,000 and £25,000, the average was nearly £35,000.
current assumption that all care will be provided privately.’
Unfortunately, the Government has not yet formally responded to the report, although it has expressed commitment to reform. Action on this recommendation should be a priority in 2023.
Compensation is not awarded in an equitable way under the current system, as it differentiates between high and low earners.
in the cost of clinical negligence is something doctors can control.
This is not a symptom of clinical care standards but of our dysfunctional legal system.
The MDU successfully rebutted 85% of medical claims that were closed in 2021, while NHS Resolution’s chairman noted, that ‘the number of Clinical Negligence Scheme for Trusts (CNST) claims reported to us has remained essentially static over recent years’.
He observed that ‘the biggest single influence on our provision remains the long-term discount rates set by HM Treasury’.
In addition, claims awards are affected by the personal injury discount rate, which is a mechanism by which compensation for future losses in claims are calculated.
The Government has at least introduced measures to reform how the discount rate is set after the chaos that followed the Lord Chancellor’s dramatic cut in 2017, which caused compensation awards to rocket overnight.
However, it has yet to take meaningful action on three other legal reforms advocated by the MDU, which we believe would have a significant long-term impact on unsustainable claims inflation.
A Government consultation on introducing fixed legal costs for negligence cases valued up to £25,000 closed in January 2022. However, despite expectations that the change would happen relatively quickly, implementation has now been delayed until the Autumn.
This is according to the Ministry of Justice, which says details will
Claimant legal costs are also far in excess of those for defendants. Within the NHS, claimant legal costs increased in 2021-22 by 5.1% to £470.9m, while NHS legal costs for the same period were £156.6m.
Although we recognise the merits of introducing, in the first instance, a scheme with a £25,000 upper limit, for it to have a real impact, we believe it should apply to claims up to £250,000. We believe what the Government is proposing must be the start, not the end.
Section 2(4) of the Law Reform (Personal Injuries) Act 1948 is a significant if outdated piece of legislation. It pre-dates the NHS and is one of the reasons why the cost of clinical negligence is so high.
It means that, when determining compensation in clinical negligence claims, the possibility of avoiding those expenses by taking advantage of NHS care must be disregarded and the award instead based on the cost of private provision.
The MDU has long led calls for this legislation to be repealed. It was advocated for in a number of submissions to the Commons’ Health and Social Care Committee last year during its hearing into NHS litigation, including by the MDU, the BMA and Sir Robert Francis.
We were pleased that this was one of the recommendations in the committee’s final report, which stated: ‘Compensation should be based on the additional costs necessary to top up care available through the NHS and social care system, rather than the
The idea that the child of an investment banker who is negligently injured should receive a higher compensation settlement than the child of a refuse collector in two similar hypothetical cases is both outdated and perverse.
This was another point that we raised in our submission to the Commons’ Health and Social Care Committee.
We called for a cap on earnings in clinical negligence compensation settlements, so those being compensated receive no more than three times the national average salary for loss of future earnings each year.
In its final report, the committee agreed it was unfair to assess parental earnings when calculating damages for children and recommended this should be scrapped for all NHS-related clinical negligence claims for the under-18s.
It further recommended standardising compensation against the national average wage. We await Government proposals on this.
On behalf of our independent practitioner members, we continue to raise the seriousness of this issue and the financial implications to the Government.
Meanwhile, if you are involved in a claim, rest assured that at the MDU, we know how much your professional reputation matters. We offer members expert guidance, personal support and a robust defence.
Find out more about the reforms of the clinical negligence system called for in our fair compensation campaign. See www.themdu.com/ about-mdu/fair-compensation/ the-campaign.
The MDU is committed to championing vital reform in this area.
Technology and data are putting people in control of their health and well-being like never before, says Iain McMillan (right) director of distribution at Bupa.
Reflecting on over 20 years’ experience in the industry, he shares his views on how health insurance clients and intermediaries are benefiting and how their needs are a driver for change
CHANGE CAN be stressful, especially when it happens over a short space of time as it did during the pandemic. It takes time for people to adapt.
The changes to people’s workplace and work-life balance were exacerbated by the ensuing business and labour market uncertainty, as well as difficulties accessing healthcare.
This combination has been the driving force behind increasing conversations with our clients and intermediaries about employee health and well-being.
Google searches for health insurance have increased by 56% between 2021 and 2022.1
And our Bupa UK Wellbeing Index 2 found that a third of employees (33%) believe their employers have a responsibility to support their health and wellbeing.
More than half (53%) say they are more likely to choose to work
for an organisation which offers good health and well-being benefits.
This is backed up by research from the global professional services firm, Aon, which found a much greater focus on mental well-being, with the number of employers who think their teams expect more support for mental health leaping by 44% in a year to 82%.3
And data from the Bupa UK Wellbeing Index confirms significant need, and demand, for this sort of support, with a third (33%) of those with employer-provided health and well-being benefits reporting they had used some kind of mental health support service in the previous 12 months.
With people increasingly looking to their employer for health and well-being support, employers are focusing on ways to make healthcare more equitable and give employees the same access
regardless of where they work. This is fuelling demand for more innovative healthcare provision.
Technology is empowering people to take control of their health, as well as changing the prevention, diagnosis and treatment of illnesses.
Wearable devices that unobtrusively track, analyse and transmit personal biometric data, such as heart rate and sleep patterns, are already popular consumer electronics.
Some insurers are using them to incentivise customers to adopt healthier lifestyles. In return, the data collected gives a more accurate continuous view of the customers’ health than the usual metrics, such as age, and it better informs pricing.
However, some of the biggest benefits lie in their medical application as well as their capacity for behav-
Firms are looking at ways to implant devices underneath the skin to test blood oxygen levels, track prescription drugs and monitor other vital signs
iour change. Doctors can reference data collected by these devices in real time to speed up a diagnosis or better inform treatment.
For example, continuous glucose monitoring (CGM) systems are already giving people with diabetes more accurate and efficient blood sugar monitoring.
The future for wearable technology looks very promising. Firms are looking at ways to implant devices underneath the skin to test blood oxygen levels, track prescription drugs and monitor other vital signs, which would be very beneficial for patients with chronic illnesses.
Another of the technologies with great remote diagnostic potential is smartphones, with their in-built capabilities such as cameras, touchscreens, networking, computation, 3D sensing, audio and motion.
Alongside wearable devices, these capabilities will bring ele -
ments of the doctor’s office much closer to the patient.
At Bupa, we work with Skin Analytics to offer our customers a faster diagnosis when they have a concerning skin symptom.
Skin Analytics posts them a kit which includes a smartphone and a dermoscopic lens to take highresolution photos of moles or lesions. Once the customer uploads the photos to the app on the phone, they will then be assessed by a dermatologist alongside the customer’s medical history.
If there’s nothing to worry about, the customer will receive a report and have peace of mind within 24 hours, much faster than the usual time to arrange a face-toface appointment.
If further investigation is needed, Bupa contacts the customer to discuss next steps and helps arrange a referral to a specialist.
The customer benefits of wearable and other technologies are that important health data can be gathered conveniently with less disruption to day-to-day life, offering greater satisfaction as they provide opportunities to spend less time in a clinical setting.
For insurers, their corporate clients, and doctors, there is the potential to help reduce the costs associated with traditional healthcare facilities, to improve care pathways, and accelerate diagnosis and treatment.
In the corporate sphere, the future of workplace well-being could be driven by data collected from smartphones and wearables to improve employees’ physical health and support their energy levels and mood management.
And it offers greater opportunity for pro-activity and early intervention to keep employees healthy, mentally and physically. Our clients recognise that technology is playing an essential role in driving innovation through healthcare.
Increasingly, our clients and intermediaries are looking to give their employees and clients faster access to the right care that is personalised to them.
Precision medicine is allowing patients to receive more accurate individualised diagnoses faster, with less treatment trial and error.
Precision medicine is allowing patients to receive more accurate individualised diagnoses faster, with less treatment trial and error
Doctors more frequently have access to the genetic information of an individual, their personal health risks and how any treatment might affect both person and disease.
While the idea of precision medicine is not new, the use of genetic or other biomarker information to make treatment decisions about patients is ever growing.
Biomarker testing is already commonly used in cancer treatment, for example. Bupa covers an ever-increasing range of diagnostic and prognostic services that enable our customers to receive the best care possible based on their individual needs.
Although potentially expensive in the short term, precision medicine offers the opportunity to reduce waste in the longer term through the avoidance of incorrect or inappropriate treatments, particularly in the field of oncology, where new treatments are increasingly expensive.
For corporate clients facing rising business costs themselves, it’s imperative that they keep healthcare costs down. Precision medicine offers them the opportunity to achieve best value, as well as best outcomes, for their employees.
One of the most valuable sources of information we have at our fingertips is the health data gathered from wearables, digital health apps, home monitoring devices, lab tests, claims data and health records.
Analysing this data and looking for patterns allows us to make healthcare more patient-centred and pro-active, with the potential to improve health and well-being.
Last year, GE Healthcare signed a ten-year partnership agreement with Circle Health Group to allow Circle’s clinicians to make faster, more targeted and more informed
decisions in the diagnosis, treatment and monitoring of patients.
This will be achieved through intelligent devices, data analytics, applications and services with the aim of improving patient outcomes across the company’s UK-wide network of hospitals.
As well as providing insight to clinicians, data can provide a valuable health check for businesses enabling them to better support their employees’ health and wellbeing.
This is key in a world where one in five of those surveyed as part of the Bupa UK Wellbeing Index said they have already changed jobs to secure better benefits.
At Bupa Health Clinics, we have reshaped our health assessments to drive positive change for businesses and employees. We have introduced home-based assessments to account for the increase in home working.
And we use behavioural science to promote health improvement, resulting in 92% of customers improving their lifestyle following their assessment.
We also introduced new technology, including an app, to provide year-round digital engagement. These developments resulted in improved data to help drive employers’ well-being strategies.
It is clear that technology, and the infrastructure that supports it, is integral to provide healthcare that is fit for the present day. Healthcare that is pro-active not reactive and preventive rather than curative.
This will not only help to reduce spiralling costs, but it is being demanded by consumers who are used to convenience and personalisation. Bupa is already facing into this future in many ways.
1. Google Weekly Industry Trends Report – Finance, Health Insurance (Generics) section, 29 October 2021.
2. Bupa commissioned Censuswide to poll a nationally representative sample of 8,001 UK adults. The data was collected between 29/07/2022 and 09/08/2022.
3. UK employers seeing significant changes in what employees expect at work: Aon Benefits and Trends Survey 2022, Aon, 2022.
Spire Healthcare – hospital group winners in the LaingBuisson annual awards – also won the Nursing Practice Award. Leslie Berry reports
SPIRE’S TWO awards in the prestigious medical ‘Oscars’ in London were in recognition of:
Hospital Group – a clear commitment to its people and wider stakeholders, which is evidenced by the culture of inclusion and developing staff;
Nursing Practice – exhibiting excellent work in employing digital technology to improve patient communication and drive efficiency.
The company’s nursing ‘gong’ was specifically for the delivery of its electronic pre-operative assessment (ePOA) process across its hospitals.
The pandemic provided the impetus to accelerate the shift to a greater delivery of digital services, such as ePOA.
Developed in-house, ePOA covers the entire pre-operative assessment process by helping nurses manage their patient’s pre-assessment process from the point of booking and assignment of a patient questionnaire, right through to their specific procedure.
The ePOA system generates red flags, alerts and prompts to support Spire nurses with clinical triage and the pre-operative assessment.
Spire says ePOA also helps patients to be better prepared for their medical procedure at any one of its hospitals and clinics across the UK, as well as improving clinical efficiency.
With development supported by nursing and medical experts, the process was piloted at three
Spire sites in 2020, rolled out companywide in 2021 and fully completed in January 2022.
A spokesperson told Independent Practitioner Today : ‘Pre-operative assessments used to include a paper questionnaire completed by patients prior to surgery.
‘ePOA reduces the use of paper, while providing a better patient experience and shorter processing time. This frees up nurses’ time so they can focus on the most at risk patients, and hospital consulting rooms for other use.
‘Access to, and integration with, the NHS Summary Care Record helps Spire nurses get a holistic view of patients’ medical history.’
Spire was pleased to have worked with patient groups in the roll-out; testing the process with patients to ensure it was easy to use, the language was right and that it met all patients’ needs.
Patients were able to access their pre-operative questionnaires via a secure online portal, meaning
A feature article in our February issue detailed
they no longer needed to visit hospital for their pre-op assessments.
A total of 75,000 ePOA questionnaires were sent to patients in 2021 and reported patient feedback was that ePOA is quick and simple to complete.
All of Spire’s nurses are trained on ePOA, with patient groups helping to gauge and act on colleagues’ views.
The group is delighted with the results. It says feedback has been positive in that ePOA provides more information about patients and makes it easier for nurses to triage them. The overwhelming majority say that it is easy to use.
Consultants have also reported satisfaction with the process. ePOA has boosted efficiency, as clinical teams now have visibility of patient flow through the pre-op process across all Spire hospitals.
Spire Healthcare chief executive Justin Ash said: ‘We are all very proud to have received two LaingBuisson awards for best Hospital Group and Nursing Practice.
‘I congratulate my clinical and management colleagues who continue to focus their efforts to make a positive difference to people’s lives through outstanding personalised care.
‘This is our purpose at Spire, and these two awards demonstrate the amazing results of our teams who continue to work together to deliver our patients the high-quality care they have come to expect when at Spire hospitals.’
There are some useful lessons to be learned from when older consultants with well-established practices were starting to look at retirement. Simon Brignall (right) reports
IN LAST month’s article, I discussed some of the challenges consultants face when starting out and growing their private practice. In the start-up phase, everything is new and exciting. You are constantly having to learn new things about practice management and you are possibly worrying about where your patients will come from.
Then, in the growth phase, your practice may experience growing pains as you struggle to accommodate the increase in workload. This can put strains on your practice administration and infrastructure, and that will quickly highlight any performance deficiencies.
So, it is very easy to see why, when their practice hits the third stage – maturity – many consultants feel they can take their foot off the gas and start to reap the rewards.
This is never a good idea. The best practices ensure they stay in this sweet spot by following some simple steps which I will outline in this article.
The fourth phase of business is decline/renewal. While decline is a fact of life, some practices do choose to do something new. Every great civilisation the world has seen has had its day in the sun. But it is often as important to plan your exit as well as you did your entrance and that is why I shall also touch on some of the conversations I have had with consultants who are approaching that milestone.
The view from the top
When your practice reaches maturity, it can be very satisfying, as you will, no doubt, have built up a strong referral network from colleagues and satisfied patients and you are likely to be less impacted by new consultants starting out. Like any business, the biggest risk can be becoming stagnant and resting on your laurels. It is important to keep doing things that made you successful in the first place such as consultant/GP engagement, seminars, marketing or having patient referral platforms.
Surprisingly enough, I get many calls from consultants whose practices are extremely busy, but they do not feel their income or cash flow reflects this.
When deciding to either have a better work-life balance or when you have set an end date for work, it is just as important to plan this as you did when you were starting out and growing your practice
This is on top of making the practice look unprofessional –something which, again, can negatively impact its reputation and subsequent revenue.
It is important to ensure your administration team meets your current needs and that you have access to up-to-date financial information on the practice.
As collection experts, we have a bad debt rate of less than 0.5% and for many practices it can even be as low as 0.3%.
Managing their practice into retirement.
The first three options often allow the consultant to continue to see a revenue stream as they reduce their own activity and, in some instances, may profit from an equity sale in the future.
We are happy to provide advice and assistance if you are looking at any of these options. But let me deal with the managed retirement option here.
Ironically, enough success can create its own problems.
The importance of billing
I have added the statement below from a previous Independent Practitioner Today article from one of our consultants, as it is a common example of many conversations I have had with established practices over the years.
‘As my practice grew, the increased workflow put more and more demands on me and required me to take on a medical secretary to help with practice administration. More recently, I started to feel that, despite working hard with a busy practice, my cash flow was not mirroring the work I was doing,’ consultant cardiologist Dr Dinos Missouris said.
‘When I started to review the finances of the practice, I found two main problems: I was not getting the visibility that I wanted on my aged debt and the information, when provided, was not always accurate or up to date.
‘My age debt was running at over 20% and so I knew it was time to take some form of action. I had heard or Civica Medical Billing and Collection through a colleague and so I contacted them.’
We often find it is the larger practices who struggle with their finances. This is due to the volume of patients they see, which makes it is very easy for tasks to be set aside.
Even if they manage to remain on top of the billing, it is often the reconciliation and chasing process that is impacted.
This not only affects cash flow but means problems are not identified quickly. In turn, this reduces the likelihood they get resolved satisfactorily, which can also lead to losses in income.
Access to accurate practice data detailing your activity at the various locations where you practise or the type of patients you are seeing allows you to spot trends over time and adjust accordingly.
It is easy to make assumptions about your practice that do not reflect its true position. This may lead you to open another clinic at a popular location or add functionality to better support a rise in self-pay activity you are seeing.
Our company’s reporting dashboard provides reports on the type of procedures a practice is conducting and can track GP/marketing referrals so that the practice can monitor their impact.
Armed with this valuable data, consultants can then engage with their referral network about new or popular treatments that will benefit their patients.
It is important to review your fees regularly. I appreciate this is a difficult area, both within the insurance market as well as the self-pay sector.
In our experience, consultants typically do not set their fees effectively because they have not done enough research when initially conducting this exercise or it may have been many years since they last looked at them.
When deciding to either have a better work-life balance or when you have set an end date for work, it is just as important to plan this as you did when you were starting out and growing your practice.
I have had many calls from consultants over the years that have involved all sorts of options including:
Setting up their own clinic;
Group arrangements;
Bringing in new consultants into their practice;
I often speak with consultants who have set an end date and reach out to us to get their finances in order over their last working years.
Some have chosen to leave the NHS and plan to devote themselves fully to private practice. Ironically.
This signals an increase in activity and so to ensure they maximise their potential, this means focusing on patients and not administration.
To do this effectively, they need to ensure they have the adequate resources in place to best manage this activity and often the simplest solution is to partner with an experienced medical billing company.
It is important for consultants to put robust processes in place to manage their finances.
For any practices with a substantive aged debt problem, it is vital for this to be followed up so they know the status of all outstanding invoices.
When thinking of retirement, this is the time to prioritise the aged debt issues, because time may be a factor. You need to know every opportunity has been taken before you make decisions about writing off any bad debts to ensure you gain the tax benefit.
If any points I have raised here resonate, then hopefully I have provided you with some effective solutions.
Of course, your best option may be to reach out experts such as a medical billing and collection company who can not only provide valuable support but has a wealth of knowledge to help.
Simon Brignall is director of business development at Civica Medical Billing and Collection
The Independent Healthcare Providers Network is working to ensure doctors in private practice can fully contribute to national clinical audits. David Hare reports
INDEPENDENT PRACTITIONERS
and providers are rightly proud of the quality of care they deliver and the sector is constantly looking for ways to make continuous improvements across all areas.
As part of this, the sector has long recognised the importance of internal and external audit to understand and benchmark performance.
In some areas such as orthopaedics, independent providers have a long history of high levels of participation. More procedures have been submitted to the National Joint Registry (NJR) by independent providers than by their NHS counterparts since 2020.
However, in other clinical areas, there exist significant hurdles and barriers that prevent similar levels of participation.
To tackle some of these issues, the Independent Healthcare Providers Network (IHPN) has been working closely alongside the Healthcare Quality Improvement Partnership (HQIP) and NHS England in the last few years to ensure our members can take part in appropriate national clinical audits.
Below I list some of the key takeaways Independent Practitioner Today readers should be aware of.
Working with HQIP, which commissions the National Clinical Audit and Patient Outcomes Programme (NCAPOP), IHPN identified two key initial areas to focus on that would capture the range of challenges posed by quite different types of work carried out by the sector.
These were cataract activity as part of the National Ophthalmic Database (NOD), run by the Royal College of Ophthalmologists, and
the National Vascular Registry, which is run by the Royal College of Surgeons of England.
Running these programmes across the pandemic, unsurprisingly, led to some unexpected dynamics.
For example, some larger independent providers with high ophthalmology volumes began to participate fully in the NOD. This allowed us to focus on understanding barriers facing organisations yet to deploy specialist ophthalmology electronic medical records (EMRs).
We also experienced challenges testing data flows into the NVR, which were largely down to changes in activity as independent providers flexed away from their usual casemix to respond to changing local clinical demands in response to the pandemic.
Participation in audits – as many readers will be aware – is not something that is done lightly.
Providers need to commit suitable resourcing, which often means embedding new working practices and infrastructure.
Having a clear framework within which to make and implement those plans is therefore essential, and below are just some of our key reflections on how to make them work at a system level.
While the NCAPOP run by HQIP comprises around 40 audits, registries and reviews, many are currently out of scope for the independent sector.
For some audits, this is quite reas onably due to their focus on clinical areas that are rarely delivered by independent providers.
But in many cases, a clear specification of inscope activity, readily available and defined by procedure or diagnostic code, would be hugely beneficial to identify relevancy and encourage participation.
participation
Requirements that inadvertently exclude independent providers should be proactively avoided.
For example, highvolume minimum thresholds effectively rule out participation by independent sector hospitals, which tend to be smaller than their NHS counterparts.
Explicitly involving the full range of providers that deliver relevant care in the design process of audits from the outset would ensure future iterations are inclusive by design and do not inadvertently rule out independent sector providers.
Many independent providers –and likewise in the NHS – are currently scaling up their digital capability, investing significant resources to procure EMRs and build their informatics and clinical support teams.
Given the clear opportunity to embed the collection of data for clinical audit into the fabric of the infrastructure that we are building as a nation, audit providers should present a clear technical specification that is consistent with current and future standards.
This presents a huge opportunity to improve the quality of data, to reduce avoidable administrative burdens and to increase audit participation across both NHS and independent sector.
The public is becoming ever more sensitive to privacy concerns and independent providers rightly comply with wide ranging legal requirements to protect patient information.
There is significant scope to reduce the range of administrative pre requisites, that determine how information can be safely and legally shared, by agreeing common templates and approaches
With a move towards much greater transparency across UK healthcare, ensuring independent providers and practitioners can fully contribute to audits has never been more important
applicable across the range of audits and registries.
It is, of course, recognised audit activity needs to be funded. But it is also vital for funding mechanisms to be appropriate for all organisational structures.
For example, some independent providers operate from a single site, while others will have many hospitals and community based locations within their group structure.
Fee structures should therefore reflect this and adhere to principles of fairness, proportionality and transparency.
With a move towards much greater transparency across UK healthcare, ensuring independent providers and practitioners can fully contribute to audits, registries and reviews has never been more important.
Clearly, making this work in practice is a complex job, requiring full engagement by providers and practitioners, audit providers, commissioners, regulators, and of course, the IHPN.
But the benefits in showcasing the high quality care delivered in the sector and ultimately further improving the care provided to patients will be immense.
The IHPN will continue to advance this agenda alongside its members and we look forward to taking you on this journey.
David
Hare (right) is chief executive of the Independent Healthcare Providers Network (IHPN)
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Problems can arise when transitioning patients between private and public care. Sarah Baggot (below) identifies some of the common issues and explains how risks can be reduced for both the patient and the practitioner
PRIVATE HEALTHCARE is experiencing a growth spurt.
According to a survey by a leading independent think tank, difficulties accessing NHS services during the Covid-19 pandemic have prompted more patients to use private healthcare.
But not all patients continue with private care and a proportion will move back to the NHS for treatment, often because they lack funds to continue treatment privately.
The NHS is accessible to all, yet problems can arise when moving between private and public care.
Communication is key
Communication is the lifeblood of any relationship, the doctorpatient relationship being no exception.
Any cracks in this relationship can be thrown sharply into focus when moving from one area of care to another.
CASE SCENARIO 1
A patient of a private provider of psychiatric services wants to move to the NHS, as funds for private treatment have run out.
A month after seeing his private psychiatrist, and before his NHS psychiatry appointment, the patient has an acute episode of hypomania, requiring admission under Section 2 of the Mental Health Act.
The NHS team try to contact the private practitioner to obtain previous history, but the doctor is on leave and so is the doctor’s secretary.
Although the patient had been in the process of moving to NHS care, the patient’s family were dissatisfied that the private practitioner was uncontactable at the time and a complaint was made.
Commentary
Transition from one area of care to another, or from one service to another, can be a difficult time.
Our experience and that of the NHS suggests that if communication between a doctor and a patient is perceived to have fallen down, this will increase the likelihood of a complaint or claim.
A comprehensive communication plan is essential whatever the circumstances. If you are planning to take leave, do ensure that a
Experience suggests that if communication between a doctor and a patient is perceived to have fallen down, this will increase the likelihood of a complaint or claim
1
Good communication between all parties concerned – the patient and equally all healthcare practitioners involved in the patient’s care – is paramount in any scenario involving a change in the care regime from private to public.
2
A shared care agreement could help to clearly set out the management of and responsibility for a patient’s follow-up care, provided the patient’s condition is stable and predictable.
3
4
The practitioner taking on follow-up of the patient should recognise and adhere to working within their competence.
Care of the patient remains the first concern no matter whether in a private or NHS setting.
5 Transitioning care between private and public sectors can create challenges in ensuring this is as safe and smooth as possible for the patient.
If a doctor has any concerns about the medico-legal implications of private-to-public transfers, they may wish to seek advice from their medical defence organisation.
robust plan covering all eventualities is in place in your absence. Patients should be kept well informed and know whom to approach in the event of any issue. Even if the patient is technically under the care of the NHS, they may still look to their previous practitioner for advice and support.
The private practitioner may need to liaise between the patient and the new NHS practitioner who has taken over care to ensure a smooth transition.
It is best that communication with patients during a transfer of care be continued so that they feel fully supported and NHS practitioners are informed of this to avoid any confusion in provision of medical care.
A plan could be discussed and agreed with patients and/or their carers detailing whom to contact and how to obtain support when they are transferring to a new service or the NHS. This should ensure continuity and a smoother transition of their care.
Prescribing: a prescription for disaster?
CASE SCENARIO 2
A patient with systemic lupus erythematosus was discharged from a private hospital on a gradually reducing steroid regime.
The patient was issued with a three-week prescription for steroids. The hospital consultant’s expectation was that the patient’s GP would continue prescribing steroids for the patient.
Although it was specifically
stated on the patient’s discharge note that the patient should remain on steroids until review, this was not picked up by the GP and the patient had an unplanned break of two weeks from the steroids.
The patient quickly deteriorated, with severe weakness, fatigue and a relapse of the condition, requiring re-admission. The patient was unhappy with both the GP and the private consultant and decided to make a clinical negligence claim.
Commentary
The responsibility for prescribing can become blurred when patients move between private and public care, and this can result in errors and omissions.
A shared care agreement or plan may be helpful. This is a formal, local agreement between the patient, the patient’s GP and the hospital consultant to enable the care and treatment received for a specific health condition to be shared between a hospital consultant and the patient’s GP.
The patient must agree to this and their condition should be stable or predictable before a shared care agreement is put in place.
The GMC has specific guidance on shared care and it is important for both the consultant and the GP to be fully aware of their responsibilities.
Consultants must ensure that they provide GPs and the patient with sufficient information to permit the safe management of the patient’s condition, including the
dosage, means of administration and protocol for the treatment.
The GP must be satisfied that their role in the shared care agreement is within their clinical competency.
In particular, they should take steps to ensure they keep up to date with the relevant guidance on prescribing the medication safely, being able to recognise any serious or frequently occurring adverse side-effects as well as ensuring that appropriate clinical monitoring arrangements are in place.
GPs should raise any concerns with the consultant if they do not feel comfortable with their level of responsibility in the shared care agreement. In such a circumstance, it may be more appropriate for the consultant to take responsibility for the ongoing prescribing and any necessary monitoring.
Sarah Baggot is a case manager at Medical Protection
References
1. Revealed: A third of adults struggled to access NHS during pandemic, driving many to private healthcare. IPPR.
2. https://digital.nhs.uk/data-andinformation/publications/statistical/ data-on-written-complaints-in-thenhs/2020-21.
3. GMC: Delegation and referral, paragraph 9. www.gmc-uk.org/ethicalguidance/ethical-guidance-for-doctors/ delegation-and-referral/delegation-andreferral.
4. GMC: Good practice in prescribing and managing medicines and devices Paragraph 75: Shared care – ethical guidance. www.gmc-uk.org.
When investing, it is important not to react to market falls. Dr Benjamin Holdsworth (left) warns of the error which will affect your long-term investment success
BEING AN investor is never easy because, as humans, we tend to live in the moment, responding to our emotions, the environment around us and the circumstances we find ourselves in.
That has served us well as a species helping us to survive, but as investors we need to remain focused on the long-term goals we have and not what is going on in the day to day, month to month or even year to year of the markets.
Historic market data shows that, if we listen to this noise, we would spend most of our time being afraid of markets instead of embracing them for the returns that taking on sensible risks should deliver.
Short-term market falls are frequent and a normal part of investing. Any investor looking to profit from these movements would need to have some amazing form of 20-20 foresight to predict when they might happen.
They would also need to act in advance of them happening and then get back into the market again at the appropriate time.
Simply reacting, post-event, to market falls will invariably be a losing strategy. In reality, at any point in time, all of the information held by all investors trading in markets is reflected in current prices quite efficiently.
Prices will therefore move only on the release of new information, which is, by definition, a random event.
As the Nobel Laureate Prof Robert Merton recently stated: ‘If the market is disagreeing with me, or doesn’t seem to be aligned with me, that could be that I know things the market doesn’t, but it also could be that the market knows things I don’t.’
Investors were reminded in 2022 that bond returns can go down as
Short-term market falls are frequent and a normal part of investing. Any investor looking to profit from these movements would need to have some amazing form of 20-20 foresight to predict when they might happen well as up. The same challenge in terms of reacting to falls in bond markets applies. In almost every year, bond markets fall from a midyear high.
Trying to time when to be in or out of bonds – and presumably into cash – could result in eroding away the benefits that a sensible structure of short-dated global bonds hedged to Sterling has the opportunity to provide for those
focused on their true investment horizons.
Remaining focused on your long-term goals, staying invested and rebalancing regularly are the key drivers for a simpler life and the likelihood of better investment outcomes.
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.
Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes of free legal advice.
Advice is available on:
Business structures (including partnerships)
Commercial contracts
Disputes and litigation
HR/employment
Premises
Regulatory requirements and investigations
Failing to adhere to the data protection rules can be extremely costly.
Independent practitioners’ responsibilities in dealing with personal data are highlighted here by solicitor Henry Forrester (right)
WE LIVE in an era increasingly concerned with regulation and management of an individual’s personal data.
This means businesses who handle personal data need to understand the requirements around handling that information.
And that is particularly the case for health carers, who are often handling sensitive patient records as well as – like most businesses –managing their own employees’ personal data.
In this article, I will discuss:
The current data protection regime in the UK;
Issues that can arise for independent practitioners during the course of managing personal data;
Some solutions.
Post-Brexit, the EU General Data Protection Regulations (GDPR) 2018 were incorporated into UK law, and GDPR is now part of our domestic law.
A key concept within UK GDPR is personal data, that is: information that relates to an identified or identifiable individual and is capable of identifying a living individual.
A vast amount of data is capable of constituting ‘personal’ data. There are the types of personal data we might immediately associate with personal data, such as names, addresses and date of birth.
There is also data which does not seem to be personal data but can become so when provided with other data which might allow it to identify an individual.
This includes, for example, rare medical conditions and data which conveys a rough geographical location – such as GP practice or hospital – which might then allow someone to identify that particular individual.
It is always worth thinking about context when examining whether data constitutes personal data.
Practitioners will often be dealing with special category data. The key categories for special category data for practitioners relate to genetic data, health data or data relating to sex life and sexual orientation.
Special category data is considered particularly important pieces of personal data and a data breach involving special category data is considered particularly severe, with ramifications of penalties and fines imposed by the Information Commissioner’s Office (ICO).
The six key points to take out of UK GDPR are:
1UK GDPR is heavily informed by principles and it is important to remember these principles when dealing with personal data. Personal data should be processed lawfully, fairly and in a transparent manner, according to those principles.
Often, if it is unclear as to whether something is right, it is helpful to reference these principles. We will examine some of the specifics in more detail below.
Post-Brexit, the EU General Data Protection Regulations (GDPR) 2018 were incorporated into UK law, and GDPR is now part of our domestic law
2 Data must be collected for a specified, explicit and legitimate purpose and processed only in a way that is compatible with that purpose.
There are six categories of purpose but the most relevant ones for practitioners are either:
a) ‘Consent’ – which should be freely given, specific, informed and unambiguous;
b) ‘Protecting the vital interests of the data subject’.
3
Personal data collected must be relevant and limited to what is necessary for the purpose for which it is being processed. It is important to consider the relevance and necessity of that personal data when collecting it.
➱ continued on page 42
Employee personal data is another main area of personal data held by doctors’ practices.
Therefore, it is important to ensure there are express personal data provisions contained within an employment contract, for the following reasons:
The practice has consent to process an employee’s personal data for the purpose of employing them to carry out their role or, where relevant, ensure that the employee processes in accordance with the practices privacy policy;
To ensure that the employee is required to comply with the practice’s data protection policy. This is to ensure that an employee handles personal data appropriately and to mitigate the risk of employees handling personal data inappropriately and incurring possible ICO attention and any enforcement action.
This requirement should also be complemented by adequate training and support for employees on data protection issues and the practice’s data protection policy.
Practices should designate a Data Protection Officer. This is not a mandatory obligation for private organisations, but to be accountable for data protection issues within the practice, to act as a point of contact for raising any issues and ensure compliance with UK GDPR.
Practices should undertake a data protection and data security audit regularly to ensure that it is complying with the latest requirements and following best practice to protect the data it is controlling and keeping it secure.
For independent practitioners, it is important to think about relevance and necessity.
Lots of personal data is being collected in these settings, often for relevant and necessary administrative, diagnostic or health care delivery functions, but it is important to consider the reasons as to why you are collecting that data and the purpose it will serve.
4
Personal data must be accurate and kept up to date. For practitioners, this is a key consideration. Where you are holding lots of personal data on file for patients, you will need to ensure you regularly check and update that personal data and design processes which compel you to keep that information up to date.
5 Data integrity and confidentiality: Data must be processed in a secure manner, using appropriate organisational and technical methods.
It is important for doctors to ensure they have appropriate secure technical and organisation measures in place to store and process personal data, whether that is having a secure piece of software to store data or having an internal data processing policy in place.
6
Every practice needs to be registered with the Information Commissioner’s Office (ICO).
The news is full of recent, high-profile examples of data breaches, where personal data has been lost, hacked, stolen or inappropriately revealed. For example, there have been breaches in the leaking of the recent Cabinet Office’s New Year’s Honours and also by British Airways.
All manner of organisations are affected by data breaches and these breaches have usually culminated in financial penalties.
In the healthcare sector, Brighton and Sussex University Hospitals NHS Trust was fined £325,000 in 2012, as highly sensitive personal data about patients and staff, including some HIV and genito-urinary medicine patients, were stored on hard drives and sold by an individual in the trust’s IT department.
The key point here is that policies and processes should have ensured that data was not saved on hard drives, which are prone to being lost or stolen, in the first place.
Other recent examples include a prosecution of a former health adviser who obtained records of 14 patients without consent and was fined £3,000.
The Tavistock and Portman NHS Foundation Trust was fined £78,400 for sending bulk emails via Outlook to 1,781 gender identity clinic users. Here the fine was reduced from £784,000 on account of revised ICO guidance for enforcement against public sector bodies.
It is unlikely that this guidance would be taken into account when enforcing against practitioners operating outside of NHS contracts.
The ICO is responsible for regulating the application of the data protection regime in the UK.
It has the power to
Obtain information via service of an Information Notice;
Serve enforcement notices, which require corrective action to be taken;
Carry out inspections and/or enforcement notices with powers to impose fines of up to £17.4m or 4% of worldwide turnover.
COMMON ISSUES AND SOLUTIONS
Contracting or sub-contracting of services
Contracting or sub-contracting services is common in the healthcare sector and data protection is a significant consideration when contracting for services involving a transfer of personal data.
There are several steps you can take to mitigate risk in this instance:
➤ Create a privacy notice to ensure patients are made aware of how their data is being handled. This will inform patients of the basis on which their data is being held and processed and informing those patients that their data will be processed by third-party suppliers for a specific purpose.
➤ Create a data protection policy which the contractor will have to comply with, as part of the contract, and ensures data handling
Where you are holding lots of personal data on file for patients, you will need to ensure you regularly check and update that personal data and design processes which compel you to keep that information up to date
ity over their role in managing the personal data involved.
The risk is, without these types of clauses, you could potentially become liable for any data breaches made by the contractor and therefore potentially subject to ICO review and enforcement action.
Data protection clauses in a contract should give you a clear lever to resolve any data protection issues arising during the course of the contract and a route to a financial remedy if anything goes wrong.
arrangements are aligned between the practice and the contractor.
Dealing with personal data in the contract
Ensure any contract which involves a transfer of patient data deals with data protection issues that may arise in the life of the subcontract.
Examples of standard terms include: establishing a controller and processor for the data, processing in accordance with the specified purpose, giving notice of a data breach, deletion of personal data upon expiry of the contract and indemnity for data breaches by either party.
Having these clauses in a contract will help you manage situations where a third-party is handling personal data you have collected and give all parties clar-
Having appropriate data security measures in place is another important crucial aspect to consider with data protection, which relates to the UK GDPR requirement to preserve ‘confidentiality’. Ensuring you put in place and maintain adequate security to protect the personal data you hold is vitally important.
There are various elements to this. It ensures the data is secure and able to withstand cyber attack and also ensures that the data protection policies and processes in place within the practice re-inforce that data security.
Henry Forrester is solicitor in the corporate and commercial healthcare team of the specialist healthcare firm Hempsons
Opportunities to work in groups are now on the increase for more consultants. Richard Norbury gives tips on the various structures you need to consider
WITH THE NHS’s current challenges, the focus is on cutting waiting list times – but many consultants are understandably anxious about performing additional work and being paid extra salary under PAYE.
They are obviously concerned for a variety of reasons, including:
High tax rates;
Loss of certain childcare benefits;
The potential tapering of the annual allowance causing additional pension tax charges.
Now NHS trusts are becoming
more innovative to try and reduce their waiting list times and are under significant pressure to do so.
And that means consultants may have opportunities to group together.
This could be in a variety of formats with different levels of commitment, starting from a loose/ cost-sharing arrangement to a more formal legal structure such as a company or limited liability partnership (LLP).
It is important to establish the common goals and objectives of the group as early as possible,
because this will, no doubt, have an impact on the decisions made, including which tax structure you choose.
Consultants who are new to their posts may find they are offered the opportunity to join existing arrangements. They will have varying commitment levels to such groups, from being very involved in the management to effectively subcontracting.
The following sections will explain some of the more common arrangements that may be available.
Often referred to as ‘chambers’, due the connection with many barristers who operate like this, expense sharing is perhaps the simplest of the structures. Here you are simply trying to achieve either economies of scale or a practical solution to a problem.
The most common example of this would be two or three consultants who may share secretarial costs for an employee.
This offers job security for the person working for you and solves
➱ continued on page 44
the practical issue of the workload for one consultant not being enough to justify a full time employee.
Various differing arrangements can be agreed as to how the cost is apportioned, but it usually depends on the level of work done for each consultant.
There are also more complex arrangements that may include rooms or premises sharing arrangements.
Some consultants decide to operate as a limited company and this is a common structure for groups.
Many specialists will already have experience of this trading structure and have their own companies. This familiarity may be attractive, but you should take care to consider whether this is the best trading structure before making the decision.
Companies appoint directors to ensure they meet all their responsibilities. Introducing working capital may take the form of a loan to be repaid once the company has funds and paying a nominal sum for the shares.
Alternatively, a more formal purchase of shares for an agreed value over and above the share value – usually £1 per share – will introduce cash to the business.
Companies are subject to corporation tax instead of income tax.
Profits will likely be higher in a group structure due to the increasing number of people available to generate income compared to a company owned individually. So corporation tax rates may be payable at the new rates from April 2023 onwards.
As a company is a separate legal entity, the money can be shielded from your own personal tax returns until paid or distributed from the firm.
Sometimes this process can be more rigid than other structures and you should always take specialist advice before setting up any arrangements in order to ensure that you satisfy the conditions set by HM Revenue and Customs (HMRC).
Some individuals may take a more active role in the management of the company, so an agreement can be made to remunerate them, usually by paying a salary.
Legal advice should be taken and a members’ agreement drawn up for all parties to sign. This protects the existing members and formally sets out the trading agreement between them
agreement drawn up by a corporate solicitor is more appropriate and bespoke conditions can be considered.
In most cases, the liability of the directors and shareholders is limited to the initial share capital which offers some protection.
If you already have an involvement in a company, then you should check to ensure that entering into any new arrangement does not impact on your current one.
For example, if you control two companies, then they may be considered as associated companies. This means certain corporation tax limits can be reduced and ultimately you could end up paying more corporation tax.
Limited companies have a set of rules dictating how the stakeholders should trade, commonly known as memorandum and articles. Often, when a group of consultants trade together, they may feel that a shareholders’
This is another example of a legal entity and requires filing accounts and other details annually at Companies House, which is similar to a limited company. This type of structure is often seen as a hybrid between a limited company and a partnership.
Instead of directors, LLPs appoint designated members who take responsibility to ensure all requirements are met, such as filing accounts at Companies House. LLPs are not subject to corporation tax, but instead prepare a partnership tax return to apportion the profits between the members in much the same way as a traditional partnership. They can allow corporate members and individual members –ultimately the tax will be either
paid under corporation tax or income tax.
This structure is popular for groups of consultants, as it allows flexible profit-sharing arrangements. It is important to discuss this with a specialist medical accountant who will be able to explain the options in detail. As with companies, you can reward more active members. The most common way would be to allocate a proportion of the surplus to these members.
Legal advice should be taken and a members’ agreement drawn up for all parties to sign. This protects the existing members and formally sets out the trading agreement between them. It would also deal with other matters such as sickness, admitting new members, and profit-sharing arrangements. Consultants will typically introduce cash on acceptance as a member and this will be their capital account. The members have
limited liability and, assuming excess profits are paid out, the amounts left behind in the LLP can be kept to a minimum, as the exposure is usually limited to the capital.
Traditional partnerships are treated differently for accounting purposes because there is no requirement to publish accounts at Companies House. Consultants here may find tendering for contracts becomes harder than trading via a limited company or an LLP.
A partnership tax return still needs to be filed with HMRC to apportion the profits between the partners. As with an LLP, corporate members are allowed to be partners.
This structure is less common among consultant groups following the introduction of LLPs because each partner shares the
As a company is a separate legal entity, the money can be shielded from your own personal tax returns until paid or distributed from the firm
you check this with them first. Additional policies sometimes need considering.
Many consultants will be familiar with the term ‘IR35’ or ‘off payroll working’. You should take expert advice to protect against any challenge of status by HMRC, especially if the group members are also employees of the same organisation.
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risk due to being joint and severally liable for the actions of the others.
Successful groups often start by entering an arrangement with one organisation. Once the blueprint for success has been outlined, this may give rise to opportunities to offer vital clinical services elsewhere, allowing opportunity for future growth.
You may be covered to trade in the structures explained in this article by your existing defence provider, but it is very important
Be sure to involve a specialist medical accountant as soon as possible in your discussions to ensure a viable and tax efficient structure is set up from the start.
Next month: Simplifying your records. Alec James gives advice on managing record-keeping
Richard Norbury (right) is a partner at Sandison Easson and Co, specialist medical accountants
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QI am a consultant paediatrician and have been contacted by the stepfather of a five-year-old patient.
He made a Subject Access Request (SAR) for information asking for any documentation that relates to him – for example, records of phone conversations he’d had with me and my secretary and emails he had sent in.
I understand that there is a dispute between him and the child’s mother and she is accusing him of contacting me and providing false information about the child’s mental health. He is trying to prove no such records exist.
I explained I could not provide information due to my duty of confidentiality to my patient, but he is insisting I provide this information, as it is about him, not the patient.
Do I have to help him?
AI wasn’t sure how to respond to this request. I have established that he doesn’t have parental responsibility for the child.
While the stepfather isn’t asking for information about patients under your care, I assume that, for you to establish whether there has been any contact between him and you or your secretary, it would require access to the child’s records as, presumably, this would be where the information would be stored.
The information would not be stored under the stepfather’s name directly, as he is not your patient. Therefore, although he is not asking for information about patients, what you would need to do is access the records without the consent of someone with parental responsibility for the child, such as the mother, and without a clinical reason to do so.
What he is asking for does, therefore, have an impact on your patient.
The Data Protection regulations do expect you to have done a reasonable search where a SAR is made.
It may be possible for you to see whether any calls have been made between the stepfather’s mobile/ landline number and your professional number or whether you or your secretary have received/sent any emails for the stepfather’s email address.
This could be done without the need to access the patient’s records. You are not required to conduct searches that would be
You are not required to conduct searches that would be unreasonable or disproportionate to the importance of providing access to the information
unreasonable or disproportionate to the importance of providing access to the information.
You may wish to contact the stepfather again and explain to him that, as he is not your patient, you do not hold information about him in a relevant filing system that would easily identify him.
You can explain that when a third party gets in touch with you about a patient, the information they provide will be stored in the patient’s record and not under the informant’s name.
His request, therefore, would involve looking in the record of his stepchild when there is no clinical indication to access that record and, presumably, no consent from a person with parental responsibility.
You could offer to look at the relevant phone logs, if he could provide you with the phone number he would have made any calls from, and the sent and received emails to see whether there are any between you.
I assume you wouldn’t be able to identify any physical letters that
may have been hand-delivered or posted, as these would have been scanned into the child’s records and the original destroyed.
If you decide that you cannot comply with his SAR, you should explain the reasons why and let them know that they have the right to make a complaint to the Information Commissioner’s Office or seek to enforce their rights through the courts.
Another option would be for the mother to provide consent to allow you to access the child’s records to look for the information. The stepfather would also have to agree to this, as you would be disclosing information about him to the mother, as to whether he had been in touch or not.
Finally, you could explain that while you don’t know what the background to the request is, the stepfather and mother could attend the practice together to look at the notes.
If you have a Data Protection Officer, you may also wish to discuss this request with them.
Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union
What are the implications of acting as a Good Samaritan following retirement? Dr Kathryn Leask (right) advises
QI am due to retire from both my private and NHS work as a consultant cardiologist. What I am trying to decide is whether to remain registered with the GMC after relinquishing my licence to practise.
One consideration is whether I would still be indemnified for Good Samaritan Acts should I be involved in an emergency.
I understand that doctors need to be registered with the GMC to be a member of a medico-legal organisation.
What legal protection will I have if I am no longer on the register?
AParagraph 26 of Good Medical Practice states that while you are still on the GMC’s list of registered medical practitioners you have a professional obligation to offer help if an emergency arises in the community, taking into account your own safety, your competence and the availability of other options.
The GMC also says you must recognise and act within the limits of your competence when providing care to a patient at paragraph 14 of the same guidance.
Once you are no longer on the GMC register, you are not bound by its guidance, but I imagine you would still want to assist in an emergency if you were able. Again, what assistance you provide will depend on your own competence and what other options exist.
With the MDU, members are entitled to seek assistance in relation to their involvement in a Good Samaritan Act anywhere in the world and this includes nonpaying members such as those who are retired members and are no longer registered with the GMC.
This is assuming they have retired from membership rather than resigned. Good Samaritan Acts occur when assistance is offered when the doctor is a bystander and would not include organised events – for example, if you volunteered for a charity or sports even.
In England and Wales, the Social Action, Responsibility and Heroism (SARAH) Act 2015 applies to someone who is present at an incident as a bystander and steps in to help.
If a claim for negligence is later brought against the Good Samaritan, courts in England and Wales must take into account whether the person acted for the ‘benefit of society’ and took a ‘predominantly responsible approach’ in protecting other people.
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MEDICAL PRACTICE and healthcare systems have had many disruptors during the last century, from new technology to new drugs.
I can guarantee that the way you run your private practice now is subtly different to how it ran a decade or two ago, both clinically and organisationally.
There have been many disruptors in the history of the automobile, such as Henry Ford intro ducing mass production and, more recently, Elon Musk introducing the world to electric vehicles (EVs).
Disruptors. They influence all aspects of our lives and they challenge the current perceived normal in whatever arena they appear. Our motoring correspondent Dr Tony Rimmer (right) gives a big welcome to a new market shaker from MG
As the whole EV market has emerged and moved forward, there have been constant developments and innovations to increase efficiency and drive down costs.
Electric cars have always been expensive when compared to comparable internal combustion engine (ICE) vehicles, but we are
now reaching a point where the average buyer might well be able to consider an EV without excessive extra outlay.
This change has been facilitated by a new wave of manufacturers entering the market – all of them with the might of Chinese industry behind them.
MG is an iconic British brand that we all recognise and it has been revitalised by its Chinese owners, the Shanghai Automotive Industry Organisation (SAIC), who bought the company in 2007.
MG’s first offerings of electric powered cars, such as the ZS EV, have been built on altered ICE chassis and although they are impressive and represent good value, they are compromised when compared to EVs built on dedi -
cated EV platforms – such as Volkswagen’s ID series.
However, things are now set to change.
The MG4 is the brand’s first ground-up-design electric car and it has shaken the market because it is one of the cheapest EVs you can buy.
So, is it a true disruptor? Is this the vehicle we medics have been waiting for that is practical enough and priced sensibly enough to get us involved with all-electric movement?
The new MG4 is a VW ID3-sized hatchback that has been devised and developed in MG’s UK-based design centre. It is available with two battery sizes, 51kWh and 64 kWh, and two trim levels, SE and Trophy.
Prices start at an impressive £26,995 and peak at £32,495.
There are two dashboard infotainment screens and both have ApplePlay and AndroidAuto compatibility as standard
These are even more remarkable since the level of standard equipment, even in the SE model, is very generous.
I have been driving a 201bhp Trophy model, only available with the 64kWh battery, that offers a claimed range of up to 270 miles. So, the first thing to say is that the MG4 looks smart and modern from most angles. Light bodywork colours make the most of the contrasting black trim and sharp panel creases and I think the car
looks best in white – not normally a favourite colour of mine.
Climb behind the wheel and you are greeted by a lovely leather steering wheel, leather-trimmed seats and an interior that feels classier than the ID3 – an unexpected surprise. There are two dashboard infotainment screens and both ApplePlay and AndroidAuto compatibility feature as standard.
All the optional driving and safety features are easily accessible through the intuitive screen menu and steering-wheel buttons.
A 360º camera facility in the Trophy model is a boon for easy parking.
Passenger space is generous for what is externally a Golf-sized car and MG has made this a really family-friendly vehicle with lots of useful storage spaces and a large 363litre boot. Also, the charging cables can be slipped out of the way under the boot floor.
With 201bhp, rear-wheel drive and instant EV performance, urban driving is a real joy and the regenerative braking can be set for maximal retardation and efficiency that allows for almost one pedal driving.
Things remain impressive on the open road. Sharp steering and great body control give the MG a real sporty feel that is satisfyingly true to the marque.
The icing on the cake is that the ride is smooth, comfortable and controlled – not firm and harsh like most hot hatchbacks. Road and wind noise are nicely suppressed too, so motorway travel is relaxed and the excellent sound system can be enjoyed at speed. I really enjoyed my time with the MG4. It is well made and comes with a comprehensive standard specification.
It has decent useable range – a real-world 200-210 miles – and is satisfyingly fun to drive; not something that can be said for most EVs.
While it is not perfect – there is no rear wiper and there are no interior grab handles – at £5,000 cheaper than the worthy but anodyne VW ID3, it represents an excellent package.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Five-seat hatchback
It has decent useable range – a real-world 200-210 miles – and is satisfyingly fun to drive
Engine: Single electric motor. Rear-wheel drive
Power: 201bhp
Torque: 250Nm
Top speed: 100mph
Acceleration: 0-62mph in 7.5 seconds
Claimed range (WLTP): 270 miles
CO2 emissions: 0g/km
On-the-road price: £32,495
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