How to expand your practice
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Harley Street’s BID to boost business
Harley St. launches its Business Improvement District (BID) P18
What can trigger a tax official’s probe?
Accountant Richard Norbury on the issues to consider before filing a tax return P43
By Robin Stride
New figures demonstrating the extent of record business levels for consultants in the independent sector have sparked a timely warning as practices move into the next financial year: ‘Keep on top of your billing’.
The advice came after a report from Healthcode* revealed providers sent a record 10.2m invoices to insurers through its online clearing service in 2023.
This amounts to a 20% rise on the previous year, which brought the sector over £4bn and saw as many as seven in ten practitioners, practices, clinics and private hospitals using the service to submit invoices to all major insurers.
But the welcome growth in activity, which is expected to roll on, will bring challenges to the many consultants and their practice staff who already struggle with the administrative side of collecting their money.
Practice management system and medical billing collection company Medserv said consultants in the healthcare industry were ‘grappling with a myriad of billing challenges’, from delayed payments to disputes over services rendered.
These were posing a significant financial strain and administrative burden for practitioners and the new Healthcode data ‘underscores
☛ Areas to watch: self-pay, dealings with embassies, and medico-legal cases ‘where payment disputes are common’.
☛ Consultants may face additional tax liabilities on money owed to them, leading to further financial strain and complexity in managing their finances.
☛ Addressing billing problems requires comprehensive reforms, including streamlining billing processes, implementing robust payment mechanisms, enhancing regulatory oversight and providing adequate support and resources.
☛ Doctors’ common billing mistakes include inadequate documentation, failure to follow up on unpaid invoices promptly and lack of awareness about billing regulations and procedures.
☛ Group practices and solo practitioners both face billing challenges, but groups may have extra complexities due to the co-ordination of multiple providers and varying billing practices among members.
UK were collectively owed large sums from late payers. Although it did not go into any detailed figures, it is known some practices have been owed six-figure sums historically before seeking billing help .
Mr Kelly told Independent Practitioner Today: ‘This sum can be substantial, considering the large number of healthcare providers and the prevalence of billing delays in the industry.
☛ Explore innovative solutions: technology for billing automation, promoting transparency in billing practices and fostering collaboration between healthcare providers, payers and regulatory bodies to address systemic medical billing industry issues.
the magnitude of these challenges’.
The company’s marketing manager Derek Kelly said: ‘Consultants often face various billing challenges, including delayed payments, inaccurate invoicing and disputes over services rendered.
‘These problems can result in significant financial strain and administrative burdens for both individual practitioners and healthcare organisations.
‘There’s a growing concern among consultants regarding the worsening state of billing problems. Several factors contribute to
Source: Medserv
this trend, including increased administrative complexities, changes in healthcare regulations, and inadequate infrastructure for efficient billing processes.
‘When consultants seek assistance with billing issues, they often have substantial outstanding debts. The average amount owed varies depending on factors such as specialty, patient volume and the extent of billing discrepancies.
‘With the surge in invoice volumes, consultants are grappling with larger outstanding amounts, exacerbating financial challenges.’
Medserv said doctors across the
‘Some outstanding payments can be quite old, spanning months or even years. This ageing of receivables adds to the financial strain on healthcare professionals and organisations.
‘In extreme cases, consultants may face non-payment for services rendered, leading to severe financial distress and potential legal disputes. Such scenarios can disrupt healthcare delivery and erode trust between healthcare providers and patients.
‘The increase in invoice volumes exacerbates the risk of non-payment. It underscores the challenges in effective debt recovery, highlighting the need for streamlined billing processes and robust payment mechanisms.’
He said the older the debt, the lower the successful payment rate would be. If written off as bad debts, this caused further financial losses for healthcare providers.
* Read Healthcode’s detailed findings on page three
TELL US YOUR NEWS.
Contact editorial director Robin Stride (right)
Email: robin@ip-today.co.uk
On-call rotas work in private units
Co-operative private practice works well for independent practitioners. Anaesthetist Dr Simon Webster reports on a innovative succcess story P10
Phone: 07909 997340 @robinstride
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It’s not just you that needs cover
The MDU’s Carolyn Porton responds to some common questions asked by members about discretionary corporate indemnity in private practice P14
Hazards to watch in medical tourism
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New hospital offers big opportunities
We take a look inside Birmingham’s new £100m private hospital, which has just opened its doors and will also serve NHS patients P20
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Business Dilemmas:
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Dr Sally Old discusses what to do if you believe a patient or colleague poses a risk to themselves or others P38
Ten Years Ago: A trawl through the archives
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Doctor on the Road: Chinese EV given ‘seal’ of approval
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Right way to introduce new cures
Introducing a new treatment can help patients and be rewarding for private doctors, but it is not without risks, says Dr Clare Stapleton of the MPS P32
Want to bid for NHS contracts?
Hempsons’ solicitor Ross Clark provides a guide to the newly intoduced Provider Selection Regime for independent healthcare providers P35
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By Edie Bourne
Doctors are being urged to be aware of a new deadline announced by HM Revenue and Customs (HMRC) to apply for ‘protection’ on the amount of tax free cash they can take from their NHS pension.
The lifetime allowance (LTA), which limits taxfree pensions savings, will officially be abolished next month (April) and this means there will no longer be a tax charge on overall pensions’ savings in excess of the available lifetime allowance.
But specialist financial planners
Cavendish Medical has warned there will still be a cap on the ‘maximum pension commencement
lump sum’ – or ‘tax free cash’ –available when benefits are drawn for those without ‘protection’ schemes in place.
This limit is currently £268,275 – 25% of the previous lifetime allowance.
Those with pension protection schemes already in place, such as fixed protection or individual protection, have secured a greater LTA and therefore will also benefit from a larger taxfree cash amount, even though the LTA has been removed.
HMRC has now announced that the deadline to apply for two types of protection – namely fixed protection 2016 and individual protection 2016 – will be 5 April 2025.
George Uglow, chartered finan
cial planner at Cavendish Medical, explained: ‘Pension protection schemes are complicated, with multiple variations.
‘Each time the Government has reduced the lifetime allowance limit, it has tended to introduce a new protection scheme that would enable pension savers to safeguard their former savings limits, at the previous lifetime limit.
‘Given that there have been several changes to the pension rules, this means we now have many different versions of the schemes in operation and each one has a different set of criteria for eligibility.
‘It is important to know the rules, understand how your pension is valued for lifetime allow
ance purposes when applying for the protection and also how the protection is maintained.’
Mr Uglow told Independent Practitioner Today that in some circumstances the protection can be lost if pension contributions continue or if there is further benefit accrual, for example, so it was important to take advice and remain aware of the everchanging rules.
‘For doctors who think that they could be eligible for a form of protection, it could be useful to make an application in order to safeguard more of their lump sum, even more so given the deadline of April 2025.
‘Do seek expert advice – it is not an easy matter to get right and the devil is in the detail.’
Private healthcare providers sent a record 10.2m invoices to insurers through Healthcode’s online clearing service in 2023, a yearonyear increase of 20% bringing the sector over £4bn.
Over 70% of practitioners, practices and clinics and private hospitals now use the service to submit invoices to all major insurers.
The system automatically checks invoices comply with each insurer’s requirements, ensuring they enter the payment cycle quicker.
Higher insured activity levels drove volume increases across the sector, particularly for nonhospital treatments and specialties like physiotherapy.
Figures reflect more unique insured patients received treatment, rather than multiple samepatient invoices.
Healthcode’s managing director
Peter Connor said: ‘The growth in invoice volumes to insurers is a healthy sign as it shows that more insured patients received the invest igations, treatment and rehabilitation they needed to get their lives back on track.
cious time to focus on delivering high quality safe and timely care’ .
Peter Connor
‘The increase in physiotherapy activity, for example, reflects the prevalence of musculoskeletal conditions in the population and also the important role of physiotherapists in preparing patients for procedures and supporting them as they recover.’
He said Healthcode’s online technology developments had streamlined time consuming manual processes and given private health businesses back ‘pre
The company’s analysis of 2023 invoice activity found: Specialty
Orthopaedics and trauma remained the biggest hospital specialty with an insured invoice volume of over 657,000, up 13%.
Radiology was second with 459,000 (up 7%) and physiotherapy third with 317,000 (up 15%)
Gynaecology was the sixth largest hospital specialty for invoice volumes (223,000) but saw the largest growth (22%). Cardiology, the tenth largest speciality by volumes (141,000), posted 20% growth.
Physiotherapy was the biggest specialty for non hospital care with 1m+ invoices, more than 30% higher than 2022. Orthopaedics was second with 828,000 invoices (up 12%).
Physiotherapy had the largest invoice volume across hospital and non hospital settings, representing 27% growth.
Treatment setting
3.8m invoices were submitted by hospitals and 6.4m by nonhospitals – 24% up for nonhospitals and 12% for hospitals.
A vast majority of invoices for hospitals related to outpatient treatments (over 3.1m). Invoice numbers for outpatient and admitted treatments rose by 11% and 12%.
Hospital invoice volumes rose in all UK countries with yearonyear growth of 11% in England, 38% in Northern Ireland, 13% in Scotland and 20% in Wales.
All English regions saw 10%+ growth. The North east was top with 18%, London had 11%.
By Agnes Rose
The Royal College of Surgeons of England is reviewing its core standards document, Good Surgical Practice , to ensure it reflects this year’s changes to GMC guidelines and clarifies that sexual misconduct is completely unacceptable.
Mr Tim Mitchell, its president, has voiced his support for the council’s new specific guidance in Good Medical Practice on preventing bullying and sexual harassment.
Domain 4 states: ‘You must not demonstrate uninvited or unwelcome behaviour that can be reasonably interpreted as sexual and that offends, embarrasses, humiliates, intimidates or otherwise harms an individual or group.’
The addition follows a survey published in the British Journal of Surgery and reported in Independent Practitioner Today (October 2023).
Mr Mitchell said: ‘There is no place for these abhorrent behaviours in UK medicine and they bring shame to the profession.
‘We need to create a work environment where every person feels welcome, safe and protected. The GMC’s new standards send a strong message to the profession that these behaviours will not be tolerated.
‘ Good Medical Practice is the
foundation upon which all doctors in the UK base their practice. It provides the compass by which we navigate the ethical issues we can face in giving patients the best possible care.
‘The last decade has seen many changes in medicine and, with that, an evolving medical workforce. It is important that the profession has an up to date set of standards that reflects those changes.’
GMC updates have been made in five key areas: creating respectful, fair and compassionate workplaces; promoting patient centred care; helping to tackle discrimination; championing fair and inclusive leadership; and supporting continuity of care and safe delegation.
New additions have also been
We need to create a work environment where every person feels welcome, safe and protected
MR TIM MITCHELL
President of the Royal College of Surgeons of England
Consultants are being encouraged by the Private Healthcare Information Network (PHIN) to get help from its consultant engagement team to provide fee and other data.
With Competition and Markets Authority (CMA) enforcement action being beefed up this year, Anne Coyne, PHIN’s consultant services manager, has this message for specialists:
made on what to do if doctors, including those in leadership and management positions, witness any forms of bullying, harassment or discrimination.
GMC chief executive Charlie Massey said focusing on compassionate, fair workplaces, where people felt empowered to speak up, paved a solid foundation for teamwork and ultimately safer care for patients.
‘Good Medical Practice sets out a collaborative and shared understanding of what is expected of doctors working in the UK. It should be a catalyst for creating supportive workplaces that will benefit patients as well as doctors and will help guide medical professionals through the challenges they face today and into the future.’
‘Whatever your views on the CMA’s Private Healthcare Investigation Order – and we know for many of you they won’t be positive – the fact remains that consultants have a legal obligation to comply with the requirements it sets out –in particular Article 22: information on consultants’ fees.
‘The CMA has indicated it is going to step up its enforcement action in 2024, so simply ignoring the Order is not really an option.
‘But the good news is that compliance is a relatively easy thing to achieve and that PHIN’s consultant engagement team is here to help you.’
PHIN has warned private hospitals to speed up their work to comply with CMA guidance.
It says compliance has improved over the last quarter across the sector with more sites ‘achieving milestones’, but with the full compliance deadline of summer 2026 fast approaching, significant progress is needed across providers. See feature article on page 40
Doctors are being reminded to get help if a patient makes an inappropriate advance.
This follows new GMC guidance placing more emphasis on reporting unacceptable sexual behaviour in the workplace.
In a recent MDU poll on receiving gifts from patients, around 15% of the 411 MDU members who responded had concerns about the reason for gift giving, including that the present was inappropriate.
Some doctors reported receiving cards and flowers on Valentine’s Day from patients, while others were offered and declined perfume and lingerie.
Dr Catherine Wills, MDU deputy head of advisory services, said:
‘The GMC’s newly updated guidance on Maintaining Personal and Professional Boundaries places more emphasis on reporting inappropriate sexual behaviour.
‘It advises that if a patient
behaves in a sexual way towards a doctor and they feel safe to do, to tell them their behaviour is unacceptable and ask them to stop. If this doesn’t work, doctors should excuse themselves from the encounter and seek help. They should report the incident in line with workplace policies.’
The MDU also advises doctors to record what happened and get support from their medical defence organisation and colleagues.
By Douglas Shepherd
A consultant ophthalmic surgeon has been appointed by eye health care group Optegra as its first Fellow under what it sees as a groundbreaking initiative to foster collaboration and knowledge exchange.
Mr Fadi Alfaqawi, aged 37, is based at the company’s eye hospitals in Birmingham and Bradford, where he splits his hours equally in a fulltime salaried post to perform NHS cataract surgery and vision correction procedures.
Involvement in the group’s Cataract and Refractive Surgery Fellowship Programme, overseen by medical director Mr Amir Hamid, extends to a 12 month research project with Optegra Eye Sciences.
His mentor, consultant ophthalmic surgeon Mr Shafiq Rehman, said: ‘We are excited to launch this new fellowship scheme as a means to attract new talent to Optegra and share our expertise with surgeons eager to expand their knowledge and gain valuable surgical experience.
‘Optegra’s comprehensive range of treatments allows us to offer extensive learning opportunities
and support talented junior consultants on their career path.’
The company told Independent Practitioner Today it aims to build up to three fellows annually across the group and will publicise the opportunities for applications as they arise.
Mr Alfaqawi began his ophthalmology training in Birmingham in 2015 and completed it in Liverpool. He has been recognised with a NEOS (North of England Ophthalmological Society) oral presentation award and is a Fellow of the European Board of Ophthalmology.
He obtained the Certificate of
Laser and Refractive Surgery (CertLRS) designation and went to Miguel Hernández University, in Elche, near Alicante, Spain, to complete an extensive refractive, cornea and lens surgery course.
Mr Alfaqawi said: ‘I am very pleased to pursue both cataract and vision correction paths as part of the Optegra Fellowship. I also value the importance of simulation and enjoy supporting junior doctors and optometrists in developing their skills.
‘I look forward to continuing to be involved in providing that training while I myself learn from more senior colleagues.
‘Working with Optegra is an honour, bearing in mind their clinical outcomes which are second to none, the thorough clinical pathways, the specialist clinical colleagues and latest technologies.’
He sees the opportunity as uncharted territory that offers great possibilities for shaping his own future. Talking of his experience so far, he said: ‘The fellowship has exceeded all my expectations. I felt settled very quickly – people genuinely listen and give constructive feedback instantly, which is amazing.’
Mr Alfaqawi lists the plus points:
Constant support from senior consultants: Fellowship programmes provide a unique chance to work closely with experienced mentors. Their guidance, insights and feedback can significantly enhance your skills and knowledge.
Structured course: A wellstructured fellowship programme ensures delivery of comprehensive training and exposure.
Different laser platforms: Exposure to various laser platforms is crucial. It allows the surgeon to understand their mechanisms, indications and limitations. This knowledge is essential for effective patient care.
Complex case management: Handling complex cases during a fellowship sharpens a surgeon’s clinical acumen. It challenges surgeons to think critically, collaborate with colleagues and devise optimal treatment strategies.
Early adoption of new technologies: Fellowships often provide access to cutting-edge technologies before they become mainstream. Being an early adopter allows the surgeon to stay ahead in your field.
High-quality research impacting patients: Engaging in research during the fellowship contributes to evidence-based practice.
A new private hospital in Birmingham is being supported by leading consultants covering specialties including cancer, cardiac care, orthopaedics, urology and digestive diseases.
HCA’s £100m The Harborne Hospital, at the Queen Elizabeth Hospital Birmingham campus, is a partnership with University Hospitals Birmingham NHS Trust.
Two of the hospital’s eight floors and 72 beds are for the care of NHS patients, operated by trust.
This is the latest in HCA UK’s joint venture partnerships, which
generate revenue to re-invest back into NHS services.
HCA said demand for private healthcare continued to be strong, particularly in the West Midlands where around 10% of people in the region had access to private medical insurance.
Facilities include 50 private en-suite inpatient beds, 16 private day care beds, outpatient services, four operating theatres, a day-care unit with outpatient chemotherapy and radiotherapy services, a pharmacy and an ITU.
See page 20
By Julia Price
Harley Street Medical Area clinicians took centre stage at the Arab Health Exhibition in Dubai, offering an exclusive glimpse into the future of healthcare.
One of the centrepieces of the exhibition was a state-of-the-art simulated operating theatre, where top UK hospitals and clinicians gathered to demonstrate surgical simulations.
Attendees were treated to demonstrations from renowned clinics in London’s prestigious Harley Street Medical Area, including Dr Robin Chatterjee, a prominent consultant specialising in musculoskeletal, sports and exercise medicine at HCA Healthcare UK.
In front of huge crowds, he showcased a series of revolutionary regenerative techniques. His live demonstration provided insight into how regenerative medicine is transforming traditional approaches to conditions like golfer’s elbow, runner’s knee, osteoarthritis and frozen shoulder.
Dr Chatterjee said: ‘This live presentation was a unique opportunity for Middle Eastern audi -
ences to witness first hand the advancements that allow for faster patient recovery and the avoidance of traditional surgical procedures and their associated side-effects.
‘It was great to showcase how modern regenerative techniques can enhance patient care and outcomes.’
Attendees also witnessed an array of modern and sophisticated regenerative and orthobiologic techniques, including ultrasoundguided injections of platelet-rich plasma (PRP), hyaluronic acid (Ostenil Plus), Arthrosamid and hydrodistension. These extraordinary techniques represent a paradigm shift in non-surgical musculoskeletal care.
Another highlight was the presentation by leading London
neuroradiologist Dr Emer MacSweeney, chief executive and medical director of the awardwinning Harley Street clinic Re:Cognition Health.
Visitors gathered to witness history in the making as she unveiled results from groundbreaking trials revolutionising Alzheimer’s treatment.
Re:Cognition Health’s experts have been intimately involved in several groundbreaking clinical trials for new generation treatments for Alzheimer’s disease, with the first of these entering the market, and many more currently in development, in global clinical trials.
Dr MacSweeney was on hand to detail a new perspective and a cautiously optimistic outlook for early-stage Alzheimer’s and how
Dr Emer MacSweeney of Re:Cognition
Health gives her talk at Arab Health 2024
the definition of the disease has changed completely in the light of these recent scientific advances. She said: ‘There is every reason to be cautiously optimistic, as these new-generation medications, available in the UK and in international clinical trials, can potentially change an individual’s future.’
Established 49 years ago, the Arab Health Exhibition is the Middle East’s premier healthcare trade show, ranking among the largest events of its kind worldwide.
Every year, it attracts over 100,000 visitors eager to explore cutting-edge solutions and innovative products shaping the healthcare landscape.
The 2024 edition boasted an impressive global presence, with more than 3,450 exhibitors from 73 countries.
In total, there were over 40 international pavilions, including the ever-growing UK Pavilion, offering a stellar platform for leading industry players, hospitals and clinics from the UK to showcase their latest healthcare advancements.
Doctors and other professionals are being alerted to be on their guard for bogus tax refund offers following January’s self-assessment tax deadline.
The HM Revenue and Customs (HMRC) warned that fraudsters could set their sights on self-assessment customers who could now be
taken in by an email, phone call or text message offering a tax rebate.
These phishing scams are designed to use personal details for selling on to criminals or to access people’s bank accounts.
HMRC responded to 207,800 referrals from the public of suspicious contact in the past year to
January – up 14% from the 181,873 reported for the previous 12 months. More than 79,000 of those referrals offered bogus tax rebates.
Kelly Paterson, HMRC’s chief security officer, said: ‘With the deadline for tax returns behind us, criminals will now try to trick peo-
ple with fake offers of tax rebates. ‘Scammers will attempt to dupe people by email, phone or texts that mimic Government messages to make them appear authentic. Her advice is: ‘Don’t rush into anything, take your time and check HMRC scams advice on Gov. UK.’
By a staff reporter
A defence body is advising doctors to only post information on private WhatsApp groups and other social messaging services that they would be happy to be made public.
The Medical Defence Union (MDU) issued the advice following new GMC guidance on doctors’ use of social media in its revamped Good Medical Practice
For the first time, the guidance specifies that ‘when communicating privately using instant messaging services, messages or other communications in private groups may also become public’.
The GMC also makes it clear that it has ‘a legal duty to investigate any concerns raised to us that reach our fitness-to-practise threshold’.
As many as 300 healthcare pro-
fessionals have been issued with advice from the MDU over social media queries in the past three years.
work-related. Many are not aware of this.
A third of these sought support to deal with a complaint following a social media posting.
The MDU also reports other cases where private communications have been considered in professional disciplinary proceedings.
According to Dr Catherine Wills, MDU deputy head of advisory services, doctors are increasingly asking for advice on their social media use.
She said: ‘It can be a tricky area, as doctors are expected to uphold professional standards when using social media and this extends to their private lives. They can be held accountable for things they say, like or share in private messaging groups, even those that are not
‘Our advice is to carefully consider the private messaging groups you join and the information you post, like, share and comment on within them. Think about how you would feel if a colleague or patient saw the chat or if it was shared to a wider audience.’
GMC guidance advises doctors that the standards remain the same whether communication takes place face to face or via a social media platform.
Doctors are expected to:
Identify themselves when commenting on health issues;
Maintain appropriate professional boundaries;
Take care not to breach patient confidentiality;
Behave respectfully to colleagues.
Two new operating theatres are being built by Nuffield Health and Vanguard Healthcare Solutions at Nuffield Health Tees Hospital for NHS and private patients. They will replace two 43-year-old existing theatres and will allow surgeons to offer a wider range of operations from the autumn.
Nuffield’s Stacey Brunton (above, middle) said the development would provide leading clinical facilities for its consultants to provide ‘best-in-class connected healthcare’, including joint replacements, spinal care, eye care, prostate, gynaecology and women’s health services.
A private hospital has been recognised by the Care Quality Commission for its ‘outstanding’ work for patients with autism.
Spire Nottingham Hospital maintained the highest overall rating after being accredited with an autism inclusion award which inspectors said demonstrated its commitment to understanding the condition.
They praised it for setting the standard for autism practice and offering excellent support to autistic children and adults.
The CQC accolade followed an unannounced inspection of surgical services and the healthcare watchdog praised how the care was tailored to meet individuals’ needs and to ensure flexibility and choice for patients.
Facilities and buildings were described as ‘innovative’ with outstanding practices including:
Establishing a new critical care resident doctor programme to develop and collaborate with services across the region;
Developing working groups of people from multiple healthcare professions to care for hard-todiagnose patients, cited as ‘an example of collaborative working to improve patient satisfaction and clinical outcomes’;
Fundraising for a local school, most recently to provide funds for a new sensory room;
Having three mental health first aiders.
Bupa Health Clinics has acquired all 22 Blackberry Clinics, the specialists in treating muscle, bone and joint conditions.
Blackberry’s medical director Dr Simon Petrides said: ‘We’ve had a partnership for over 20 years and we are confident that our customers and people will be very happy with the support, benefits and ser-
vices that Bupa can provide.’ Sarah Melia, manager, Bupa Health Services, said the acquisition was part of its strategy to provide more Bupa services directly to customers.
Bupa Health Clinics also recently acquired The Smart Clinics, four specialist clinics in London providing private GP appointments and healthcare services.
A new Rapid Diagnostics Centre has been opened by The London Clinic at 142-146 Harley Street.
It will focus on urology, gynaecology, breast and dermatology conditions and on early diagnosis, particularly in cancer.
Patients are being told they can book in and be seen within 24 to 48 hours.
According to market research conducted by The London Clinic through Censuswide, a fifth of people in Britain are currently waiting for a symptom to be diagnosed and 58% say waiting for a diagnosis causes them stress and anxiety.
Hospital chief executive Al Russell said: ‘We know outcomes are hugely influenced by early diagnosis and our Rapid Diagnostics Centre will deliver exactly that.
‘It will combine the best in sci-
ence and clinical expertise with a warm and caring environment.
‘As a charity, we want to advance healthcare for the benefit of the wider community. We will ensure access into service is broad, regardless of means, to support and extend as many lives as possible.’
The Rapid Diagnostics Centre is in a new six-floor purpose-built
facility opposite the main hospital.
With its own pathology lab onsite, The London Clinic can conduct and review tests and scans, and get the results reported directly to doctors within 72 hours of testing.
An official opening is due this month.
Private providers are keen to expand their work in community diagnostic centres (CDCs) following recognition of their contribution to non-emergency testing by an MPs’ group.
A report by the All-Party Parliamentary Group for Diagnostics, which reviewed the impact and delivery of CDCs since their launch two years ago, highlighted positive impacts of the programme, but said ‘the pace of activity is slow’.
David Hare, head of the Independent Healthcare Providers Network, said it was good to see the report’s recognition of the independent sector’s important role in delivering high-quality diagnostics services to NHS patients.
The report highlighted case
The King Edward VII’s Hospital has hired Jabeen Ahmad as its first patient safety partner (PSP). This is a new role for both private and NHS healthcare settings, working under the new Patient Safety Incident Response Framework (PSIRF), which aims to establish a systems-based approach to responding and learning from patient safety incidents. She will work alongside staff, patients and families to influence and improve safety and ensure patients’ voices are an integral part of decision-making.
studies of effective partnership projects between the NHS and independent sector.
Mr Hare sees CDCs, which the report found conducted 6.5% of tests, as crucial for delivering quick and effective patient care.
‘We believe the independent sector is a vital partner in the future of CDCs and hope to see continued commitment to using the sector more fully. It’s an effective and value-for-money way to deliver these services – levering in private sector capital and expertise over the long term to build new facilities and to help more NHS patients get the tests and scans they need.’
The IHPN said independent healthcare providers delivered an estimated 3.5m diagnostic procedures for NHS patients annually.
Bupa is giving all its permanent and fixed-term staff free access to its personalised care plan for those with heavy, painful or irregular periods.
The Period Plan includes 45 minutes with a GP, plus a followup appointment and advice for a year.
The Private Healthcare Information Network (PHIN) has achieved Government-backed Cyber Essentials accreditation as part of its work to ensure healthcare data it collects from consultants and independent hospitals is kept secure.
By Olive Carterton
As many as 60% of patients would consider paying for tests they need if they faced a long NHS wait.
Findings of a Patients Association survey of 1,000 NHS patients also include:
93% of respondents want investment in testing capacity so patients can receive faster tests and diagnosis;
91% want investment in diagnostics and new technology prioritised;
Compiled by Philip Housden
GOSH’s International and Commercial signs deal at Arab Health exhibition
Several NHS trust private patients and commercial teams attended Arab Health, the region’s health trade fair.
Great Ormond Street Hospital for Children (GOSH) signed an innovative three-year deal at the event for the Middle East with M42, a global tech-enabled health company.
GOSH and M42 will partner to introduce an innovative education initiative to enhance paediatric critical and complex care in the region, with an initial focus on M42’s Danat Al Emarat Hospital for Women and Children, a pioneer in paediatric health in the United Arab Emirates (UAE).
The agreement ceremony, at the M42 stand during Arab Health, was signed by Ashish Koshy, group chief operating Officer of M42, and Christopher Rockenbach, managing director of international and commercial, Great Ormond Street Hospital for Children NHS Foundation Trust.
Mr Rockenbach said: ‘We are proud of our long-standing relationship with the UAE and excited
77% would be happy to test themselves at home;
82% want more discussion of testing options when being referred;
88% want a realistic time-line for receiving results;
36% said their physical health declined while waiting for tests and 34% reported their mental health was affected.
With private diagnostic services mushrooming, the Patients Association said the main message was clear: patients view diagnostics as a
fundamental part of the NHS which should be a priority.
It is urging the Government to listen to patients’ experiences and expand community diagnostic hubs by removing NHS estate restrictions. It said: ‘With demand rising by 7% annually, the current 5% capacity target for new hubs is inadequate.’
The pressure group added: ‘As with other findings in our research, the fact that so many patients would be willing to pay to have the test they need done once
to be strengthening our commitment to the region with such an esteemed partner as M42.
‘We look forward to contributing to improving children’s health through this collaboration.’
Leeds considers private operator partnership
Leeds Teaching Hospitals NHS Trust (LTHT) is considering options to enable the successful development and delivery of its private patient business.
It is one of the largest and busiest acute hospital trusts in the UK with a budget of over £1.4bn and employing more than 21,000 staff. Last year, it treated more than 1.7m patients from two main sites: Leeds General Infirmary (LGI),
again shows the importance they place on getting results and diagnosis in good time.’
Patients’ comments included:
‘In the end, I was forced to obtain private treatment and surgery.’
‘I had a wait but I also appreciated how stretched the NHS is. However, if it had been a serious test, I would have paid privately (no, I’m not rich!).’
‘The diagnostics wait on the NHS is too long. Four out of five times I have had to go private.’
‘The NHS refused to refer me for testing due to my age, as “it wouldn’t be accepted”. I got this test privately which showed I had cysts in my breasts. It’s unfair that I had to go elsewhere to be taken seriously.’
The findings are consistent with Independent Healthcare Providers Network research showing a growing demand for private primary care and diagnostic procedures.
Signing the deal were: Christopher Rockenbach, director of International and Commercial at Great Ormond Street Hospital for Children, and Ashish Koshy, group chief operating officer at M42. The agreement was signed in the presence of Prof Sir Stephen Powis, National Medical Director at NHS England; Aphrodite Spanou, director of healthcare at the UK Department for Business and Trade; Gareth Johnson MP, UK Prime Minister’s Trade Envoy for UAE; James Sibley, chief finance officer at M42; Omar Al Naqbi, acting executive director at Danat Al Emarat Hospital for Women and Children.
including the Leeds Children’s Hospital and Leeds Dental Institute, and St James’s University Hospital – including Leeds Cancer Centre.
The trust reported private patient income of less than 0.1% of total trust incomes in 2022-23. This was only £1.4m, down £2.4m and 63% on the prior year. However, pre-Covid private patient revenues reached £5.5m in 2019-20.
LTHT has invited expressions of interest from UK and international private hospital groups interested in collaborating with it to jointly progress a successful long-term private patient business across specific or all LTHT’s clinical specialties and sites.
The trust’s objectives are stated as:
Enhancing its private patient offering to give patients the opportunity to receive private healthcare on an LTHT site;
Support LTHT clinical teams who provide private healthcare to do so on an LTHT site;
To create an income generation source which will allow money to be re-invested in NHS staff, care and services.
Exploratory meetings are due this month (March).
Philip Housden (right) is director of Housden Group commercial healthcare consultancy
Co-operative private practice works for consultants in private practice, drives change for the better and improves the business. Anaesthetist Dr Simon Webster reports on a forward-thinking success story
‘WORKING TOGETHER is success’. This somewhat selective use of Henry Ford’s quote describes the multitude of benefits to participation in cohesive, collegiate cooperative working by a group of specialists leading to successful private practice.
The concept of co-operative working is not new, but now there appear to be decreasing reasons why individuals would want to continue their activity in the private sector in a siloed fashion.
As hospitals, patients, surgeons and, importantly, regulatory bodies look for reassurance that the risks of patients coming to harm are minimised, a modern and engaged anaesthetic group practice is perfectly aligned to these expectations.
Gloucestershire Anaesthetic Services (GAS) was established in the county by forward-thinking and like-minded individuals in 1987.
Somewhat uniquely, this involved, at the time, the collaborative working from two NHS hospitals: East Gloucestershire Trust and Gloucestershire Royal Trust.
The co-operative working of these anaesthetists pre-dated the formal and harmonious merger of the two trusts in 1995 to form Gloucestershire NHS Trust.
From those few anaesthetists who made up the initial members, GAS has now expanded to 37 individuals who work across two private hospitals, NHS facilities and a local charitable hospital to cover work in up to nine theatres a day.
The complexity of this degree of service is significant, but by a principle of even distribution of work and equal financial benefits with the support of several excellent
administration staff, the success of GAS has grown over the decades and especially over recent years.
The last few years have seen, with changing ideas and expectations, the development of highquality wrap-around care for our patients, benefiting them, our hospitals and colleagues.
We have been extraordinarily lucky to work in two private hospitals, Nuffield Cheltenham and Ramsay Winfield, who have been unflinching in their support both in discussions, time and financial support to help us develop these services.
One of the most important changes we undertook was to formalise a weekend on-call rota to provide 24/7 anaesthetic cover with a single point of contact from 5pm Friday until 8am Monday for both private hospitals.
To facilitate this, all the GAS members work three weekends a year in a split of ‘A’ and ‘B’ weekends.
When this system was introduced, it was understandable that more senior members of GAS, who hadn’t been on call in the NHS for many years, were anxious about the return to on call. To facilitate this, 26 individuals contributed to two ‘A’ rota on calls (Fri-Mon on call) and one ‘B’ rota shift (daytime list on Saturday) per year.
The remaining senior members undertook three ‘B’ weekend shifts a year. This pattern ensured weekend work was shared but that the whole membership felt supported. There is no financial charge for these on-call weekends, but they are accepted, as they ensure safe and comprehensive ongoing
patient care and, importantly, ensure weekend cover didn’t purely fall to those anaesthetists unfortunate to only work on Thursdays and Fridays.
Since the introduction of the weekend on call, we no longer face challenges in covering Friday and weekend lists and, on several occasions, we have been rapidly able to assess unwell patients.
The NHS has developed its practice in view of pre-operative assessment over the last decade and this has expanded considerably in the last five to six years.
GAS has been able, with the support of the Nuffield and Winfield hospitals, to mirror this to ensure all high-risk patients are identified early in the operative booking pathway and reviewed in clinic.
Due to the size of the membership, GAS can provide between two and four regular consultant pre-operative assessment clinics weekly, delivered by a cohort of anaesthetists with experience and interest in pre-op assessment.
Related to this service, we have fostered close relationships with colleagues from cardiology and respiratory medicine such that specialty reviews can usually take place within five to seven days of being reviewed in an anaesthetic clinic.
Through our support of preoperative assessment, we have worked with our hospitals to develop inclusion/exclusion criteria, reduce on-the-day cancellations and work towards patients only being listed for surgery once the pre-operative assessment phase is completed.
Any patients that are not deemed fit for the independent sector are seamlessly anaesthetised by a GAS member in an NHS facility.
The final part of our wraparound patient care is the provision of peri-operative care, believed to be our only responsibility when I started private practice 12 years ago.
This aspect is the core of our group’s unique selling point: having 37 members all with a differing area of interests, skills, knowledge and clinical experience ensures that we can always cover any surgical specialty list and, due to the
By a principle of even distribution of work and equal financial benefits with the support of several excellent administration staff, the success of GAS has grown over the decades and especially over recent years
resilience in our system, last-minute challenges such as sickness, busy overnight on-calls don’t impact on the delivery of anaesthetic services.
The memberships’ collegiate working extends to the ‘helping hand’ both in a crisis and electively, and the burden of difficult decision-making – an unexpectedly high-risk patient on list and whether to cancel or, in Covid, when only low-risk surgery was permitted – is shared without fear of ‘losing face’, reputation or the greatest fear: losing the list!
Co-operative private practice works for us individually and as co-operative membership. It has undoubtably driven change for the better regarding patient care, surgical support and reassurance for the hospitals.
Together, GAS has been able to work to improve our business both from a financial and quality perspective, but this has also helped our hospital partners build their business in partnership with us.
However, finally, and maybe most importantly, it has maintained a happy and cohesive group of individuals within our NHS department. I, for one, find the reassurance of colleagues who will work with me for the better of all stakeholders truly does prove that ‘working together is success’.
Dr Simon Webster (right) is a consultant in anaesthesia and intensive care and clinical lead for critical care at Gloucestershire Hospitals NHS Foundation Trust
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Independent Practitioner Today has called in private practice troubleshooters Sue O’Gorman and Hannah Browning (below) to help doctors deal with the big questions affecting their business
QWHAT ELEMENTS should
we consider to successfully expand and commercialise our clinic, which has focused on women’s health over the last few years, while also protecting our brand and reputation?
AThere may come a point within your business whereby you have thought long and hard about how to take it to the next level. You may have even attempted to do so before now, but struggled to gain momentum.
And while the ‘next level’ will look very different from one practice to the next, there are some important fundamental questions you need to ask of yourself to truly understand how to achieve successful commercialisation:
What defines success to you and what is your end goal?
What are the constraints, if any?
Are these financial, time sensitive or resource orientated?
Are there other considerations such as family commitments that need to be factored into the equation?
Once you have explored the options to these questions, you can begin to reverse engineer those actions you then need to take to transition the business forward.
Ultimately, the decision will be
multifactorial, particularly in an ever-changing and competitive environment, but here are some key considerations to bear in mind to guide you through this process:
Do your market research
Understand the demand for your proposed services within your local area:
Is there an appetite for these services or is there a gap in the market place?
Are there waiting lists within the NHS trusts for these services and what percentage of your potential patients will have the ability to self-pay?
What is the private medical insurance penetration in the area?
Having a good understanding of the demographics, competitor landscape and potential needs of future clients will help you best develop a sustainable and profitable business.
Recruit other specialists who share your vision and values
Ensure you engage and attract other specialists who have a reputation for providing great care. They may have a clinical niche currently unprovided for in your local area or share the same work ethic as you.
Physical location and logistics
Can you continue to operate from within your existing building or will your plans for expansion require additional space?
If you lease your existing premises, are there penalty clauses attached?
If you are leasing a new premises, understand the requirements that will ensure you remain compliant with the Care Quality Commission (CQC) and the building is fit for purpose.
Don’t lose sight of your core values
Do the additional specialties align with your defined core values of the business?
You will have built your business around these values over the years and the expansion should not compromise your personalised service.
For example, you may need to consider a phased approach to offering out new services if your back office function is not geared up to cope with the additional workload, which may be an integral part of your brand and reputation.
Create a strategical road map
Outline your plan to introduce
new specialties, with careful consideration of marketing, budget and resource allocation, staffing, training, governance and compliance.
Carefully document each of the required actions for the defined areas and run through your checklist on a regular basis.
For example, do you have the right staff in place to support the new entity or do you need to recruit specialists into certain areas to ensure expertise.
Break the road map down into sections addressing operational, financial, marketing actions and do so over a phased approach. Plotting these actions onto a Gantt chart – a graphical representation of activity against time –may help keep you on track.
Allocate admin time to focus on your new venture
If you are already running a busy practice, finding time to allocate to developing it is crucial to success. It should not be underestimated how much time and effort is required at the end of an already demanding day. We have seen many a good idea fade simply because the investment of time has not been built into the road map.
Do you have the right systems in place to support the expansion?
You may need to think about telemedicine platforms, apps, e-commerce sites so the patient can book online.
Also consider how you track and measure your in-bound calls and conversions. Perhaps a customer relationship management (CRM) system would work well for your new practice to help you keep track of your customer interactions and sales data.
Ensure that staff are consulted, as they are likely the ones who will need to use it on a daily basis and facilitate any training support asap so that you can iron out any blips before the ‘go live’ date.
Seek professional support to navigate any specific regulatory changes to ensure you do not leave yourself and your organisation in a vulnerable position.
Introduce measures to consistently maintain your high standard of care. Take time out to review, assess and improve processes to ensure patient satisfaction and positive outcomes.
Keep your patients and potential patients updated and informed of your new services and reassure them that the additional services will enhance your clinic’s point of differentiation.
Think about how your patients shop. What channels best serve them to ensure you remain engaged and at the forefront of their minds?
Gain a thorough understanding of the financial investment you will need to set aside to support your expansion.
Formulate a short business case that looks at set-up costs, including marketing and launch costs, demand analysis, ramp-up and revenue per procedure that will clearly show you the projected financial contribution the new services will deliver to the business.
Rather than invest in kit, equipment and new premises, you may wish to think about partnering with other healthcare service providers who already offer these specialties.
Collaborations can enhance credibility, reputation and brand-
ing and broaden even further the range of services available to your patients.
Finally, review and evaluate
All businesses regardless of size, must regularly evaluate and monitor their success. It is helpful to agree what success benchmarks will help you understand this by outlining key performance indicators (KPIs) at the inception of the expansion.
Be prepared to make adjustments along the way and continuous improvements. Consider how you engage with your patients, because they are a vital source of feedback.
Navigating an expansion can be a complex process, but by addressing these elements you will have a much clearer picture of what success looks like to you and how to achieve it.
Sue O’Gorman is director of Medici Healthcare Consultancy.Website: www.medicihealthcareconsultancy. co.uk. Email: sue@midicihealthcareconsultancy.co.uk. Hannah Browning is director of Beyond Excellence Healthcare Consultancy. Website: www.beyondexcellenceconsultancy.co.uk. Email: info@ beyondexcellenceconsultancy.co.uk.
Discretionary corporate indemnity is raising increasing numbers of inquiries from doctors in private practice. Here, Carolyn Porton (left) responds to some of the most frequent questions asked by Medical Defence Union (MDU) members
MANY OF the MDU’s consultant and GP members are now setting themselves up in private practice to offer their services to patients as an alternative to the NHS.
Also, we are also seeing primary care networks setting themselves up as limited companies.
So here is what you need to know about discretionary corporate indemnity and how we can assist you.
What is discretionary corporate indemnity?
Discretionary corporate indemnity provides coverage in the event of a company being sued for clini-
cal negligence. This could be for its liability arising from the acts of the company’s own actions or for its individual employees and subcontractors.
It is important to understand what this means, because, in our experience from speaking with members, clinicians are not always aware that, as a medical director of a company, they can face litigation and complaints relating to clinical practice carried out by that company.
Who needs to have it?
If you have a company that provides clinical services, then it can
It is important to note that that the corporate entity can be sued alongside or instead of the individual clinician get sued as a separate entity instead of, or as well as, the individual clinicians who carry out the clinical work.
This will apply if you employ any other clinicians to work in your company; for example, another doctor, nurse or healthcare assistant.
It is important to note that corporate indemnity is in addition to indemnity held by the individual clinician and to understand that the corporate entity can be sued alongside or instead of the individual clinician.
It is suitable for any type of company, such as public limited companies, limited liability partnerships and community interest companies.
Arrangements such as these are established to provide private practice services for both primary and secondary care where GPs and consultants become medical directors.
Who qualifies for sole trader membership?
Alternatively, if you are the only practising clinician in your private company, many indemnity providers – including the MDU – offer a sole trader supplement to your existing subscription.
What types of claims could a private practice face?
Clinical organisations that set up as a limited company may be held liable for a range of issues, including:
The poor performance or con-
duct of individual staff and subcontractors, particularly employees who don’t usually have their own indemnity;
Inadequate practice systems and procedures such as patient referrals, infection control and data protection;
Poor-quality training and lack of regular assessment of staff;
Failure to properly investigate complaints or patient safety concerns.
What are the benefits of discretionary corporate indemnity?
The MDU is a mutual organisation which supports its members through a discretionary fund. This means that, as a non-profit organisation, there are no hidden costs to the indemnity we offer.
What can the MDU offer?
The MDU can help members understand their responsibilities
and the impact this has on their business.
You will also have access to a key account manager, who is available via phone, video conferencing platforms and who can visit your practice to understand your needs in-person.
Corporate members of the MDU also receive access to 24/7 support and guidance from our medicolegal team, all of whom are qualified doctors, and have access to a 24/7 employment law and health and safety helpline, and a 24/7 employee assistance helpline, which is accessible to all employed staff in the practice.
To find out more, visit the MDU corporate website where you can make an inquiry and request a contact from the team: www.themdu. com/join-mdu/corporate-membership.
Carolyn Porton is corporate liaison manager at the MDU
Medical tourism is no holiday for doctors in private practice. Lawyers Lauren Halliday, Elena Goodfellow and Hannah O’Brien tackle a big topic that’s been hitting the news and give practical tips to consider when providing services both at home and abroad
MEDICAL TOURISM is increasing for various reasons.
While low-cost treatment and the lure of exotic destinations has always been an attraction, in a post-Covid world, the efficiency of treatment abroad is a decisive factor for patients whose treatment is a necessity rather than purely cosmetic.
Countries such as Singapore, Thailand, Malaysia, India and Turkey have all announced policies and government schemes to increase the number of internationals travelling for treatment, which helps to boost economic growth.
The latter, for example, has established tax-free healthcare zones and is implementing regulatory bodies to help bolster its reputation as an important global medical hub.
However, despite this progression, reports of deaths and nearmisses abroad continue to crop up in the press.
As we are lawyers, our thoughts naturally veer towards the complexities of dealing with cross-border litigation, particularly when independent practitioners practise both abroad and in the UK.
A few recent cases have provided guidance and authority on where contractual liability and liability in tort – that is to say, negligence –may lie where treatment is pro -
What is clear is that cases will turn on their facts, which makes it more important than ever for private doctors to have welldrafted contracts in place, both with clinics and patients
vided by clinicians through multi-party arrangements.
In the case of Clarke v Kalecinski, a woman brought claims for negligence and in contract for damages against the surgeon, the clinic and the insurer of the clinic for personal injury arising from a cosmetic procedure performed in Poland.
The parties agreed that English law applied to the contract and Polish law to the claim in tort.
Contract in place
It was held that there was a contract between the surgeon, claimant and the clinic, despite arguments that the clinic held no contractual responsibilities.
References to ‘our team’ on the website suggested care would be provided by other staff members such as nurses and other doctors, rendering the clinic and surgeon jointly liable.
The judge decided that evidence
of local standards of care was unnecessary because there was an implied term in the contract that the surgeon would operate to the standard of a UK surgeon through representations on his website as to his qualifications and experience.
Surgeon’s liability
By comparison, in the case of Geraint Mabey v Mr Kulkarni and St Joseph’s Hospital, Newport, Gwent, it was held that a surgeon was an independent contractor of a hospital rather than an employee, placing liability solely on the surgeon.
The judge took into account the fact that he was not paid wages, there was no employment contract, he did his own tax and insurance and was in control of his hours and the number of patients he saw.
Only the surgeon owed the claimant a non-delegable duty of care and the hospital was not contractually liable, as the contract explicitly stated it was not respon-
sible for the provision of the surgeon’s services.
These cases appear to be at odds in terms of determining where liability will lie between a health provider and the individual clinician.
What is clear, however, is that cases will turn on their facts, which makes it more important than ever for independent practitioners to have well-drafted contracts in place, both with clinics and patients.
Check out our practical tips you may want to consider when providing services both at home and abroad (see box to the right).
These pointers will hopefully help you as medical professionals consider the various issues you may face when seeking opportunities to work abroad and indeed when faced with patients who are considering or who have chosen to partake in medical tourism.
As can be seen, though, there are a lot of uncertainties arising from cross-border care and, with medical tourism on the rise, we suspect more cases are likely to end up in court.
As always, we would recommend seeking legal advice and also liaising with your medical defence provider to ensure you are best protected against complaints and, ultimately, claims.
1
Government advice suggests patients should discuss procedures with their UK doctor before proceeding to have treatment abroad. This itself brings with it a whole host of potential issues, but as doctors providing advice to patients pre-departure, you should consider whether you should be discussing the benefits and risks with patients and should think about signposting patients to the questions they should be asking.
These questions include asking about:
Qualifications and medical licences;
Whether they have spoken to their surgeon or previous patients;
Whether they have used a travel agency;
Whether there is a written contract.
You may also be asked to complete medical history forms to pass on to foreign treatment centres.
2
If you are undertaking surgery abroad, the consent process needs to be robust.
It is advisable that, as the surgeon, you should share the decisionmaking with the patient and not delegate this to others.
As with other procedures, consent should not be left to the day of the operation. Patients should not be asked to sign documents in a foreign language and consideration should be given to translator services if this becomes an issue.
As above, clinicians should also readily provide documents requested, such as qualifications or licences and co-operate in providing the patient with their medical records following treatment and upon return to the UK.
3
Clinicians and clinics need to be aware of making representations on any website or social media which could be interpreted as implying terms into a contract.
Following Clarke v Kalecinski (see main story), this is particularly important in relation to determining whether liability should be joint and the standard of care to be applied.
4
Lauren Halliday is a partner in the health and care team at Bevan Brittan LLP. She specialises in defendant clinical negligence and medical malpractice, working with both public and private providers and clinicians.
Elena Goodfellow, a senior associate solicitor in the team, advises both public and private sector clients in a variety of clinical negligence claims. She has acted for both independent practitioners and clinics/practices in claims concerning cosmetic, ophthalmic and orthopaedic surgery.
Hannah O’Brien is a trainee at Bevan Brittan LLP
Both clinicians and clinics should review their contractual documentation to ensure liability is placed where intended between the parties and to correctly define the role of any purported employees/independent contractors so as to avoid vicarious liability, if so desired.
This will necessitate reviewing employee processes too; for example, looking at how clinicians are paid, how they use a hospital’s facilities and who decides how many patients they see.
5
The same can be said for the contract held with patients. Clinics and clinicians should review these to ensure contractual liability is placed where it is intended.
Particularly if you are practising in the UK and abroad, you should consider whether you want this contract to extend to pre- and postoperative care.
Post-operative care is a particular issue with medical tourism, as patients may be keen to get home to recuperate and may take risks in flying home before medically recommended.
6
It is worth noting that contracts are only one part of the puzzle –liability in tort can be established even if contracts are clear as to where the contractual liability lies. Because of this, indemnity clauses should be considered.
7
Finally – and this hopefully goes without saying – you should ensure you have appropriate defence cover which covers all of the care you are providing – whether in the UK or abroad.
The establishment of the Harley Street Business Improvement District (BID) marks a significant initiative aimed at enhancing the infrastructure, services and community engagement within Harley Street – one of the world’s most renowned medical districts. Its director Nicki Palmer (right) reveals more
BY ADDRESSING the evolving needs of the area, the Harley Street Business Improvement District endeavours to uphold and augment Harley Street’s global reputation as a premier destination for medical excellence, while fostering collaborative efforts among local businesses and stakeholders.
The recent Arab Health Exhibition (see story on page 6) served as an exceptional platform to showcase the collective efforts of the Harley Street BID and highlight the unparalleled healthcare expertise available within our district.
As one of London’s most iconic streets and a renowned medical hub, Harley Street boasts a legacy dating back to the 1800s.
Today, with over 3,000 medical professionals and 200 clinics offering expertise across every conceivable medical specialty, Harley Street stands as Europe’s largest concentration of medical expertise.
Diversity lies at the heart of our district’s success. From state ofthe art cancer facilities offering access to the latest diagnostics to renowned plastic surgery practices offering cuttingedge treatments, our district epitomises the fusion of modern advancements with a rich historical heritage.
It is this unique blend that continues to attract patients seeking
quality and excellence from all corners of the globe.
The Harley Street BID is a notforprofit organisation committed to provide improvements, building on the area’s legacy as a pioneering and worldleading centre of medical excellence.
Tailored activities
With a membership comprising businesses, landowners, medical organisations and charities, we are dedicated to delivering tailored activities that support business growth and enhance our area’s unique opportunities and its global standing.
We serve as a collective voice for our exceptional medical community, as well as the other businesses within the renowned Harley Street district.
Together, we are dedicated to improving the entire area, transforming it into a unique destination for all.
We are delighted to be part of the expansive network of 370 BIDs throughout the UK. These networks provide invaluable platforms where local businesses and partners can come together in collaboration.
In Westminster alone, there are 18 BIDs and London boasts over 70. BIDs have proven to be effec
tive avenues for fostering collaboration and investment, while also serving as a conduit for businesses to showcase and enhance their areas.
Collaborating closely with the Howard de Walden Estate – longterm landlord of the Harley Street Medical Area – and other stakeholders, we are committed to supporting healthcare providers and businesses alike.
Global destination
We aim to ensure Harley Street remains a global destination of choice for medical treatment, while working with the medical and wider business community to develop an exciting vision for its future.
We are aligned with four key themes:
Public realm and wayfinding;
National and international marketing;
Safety and business resilience;
Business sustainability and connectivity
Our mission is to comprehensively address the diverse needs and opportunities within the vibrant Harley Street district. Through these dynamic initiatives, our overarching goal is to cultivate a thriving and sustainable business environment that
benefits both our esteemed medical institutions and the broader community.
For instance, our safety and business resilience efforts are intricately woven with the operations of the area’s renowned hospitals, ensuring their safety and security measures are robust.
From providing reassurance to staff working during unsociable hours to offering tailored safety and training sessions for healthcare businesses, our recent implementation of a lone working scheme has been extremely well received by businesses in the area.
Meanwhile, our public realm theme is dedicated to enhancing the area’s infrastructure and accessibility through a wide range of initiatives, such as augmenting public access, enhancing signage and creating additional seating options.
This comprehensive approach aims to ensure that visitors have a seamless and exceptional experience when they visit the area for their healthcare needs.
Moreover, we are dedicated to supporting the healthcare sector by facilitating networking opportunities and by promoting the district’s excellence through social media and marketing campaigns. By showcasing the area as a
We warmly invite medical professionals in Harley Street to actively participate in shaping the future of our esteemed medical district
vibrant destination, we aim to amplify awareness of the excellent retail, leisure and amenities available, catering not only to patients but also to their families and visitors.
We are eager to engage further with medical businesses in the area to understand their challenges and pain points – and where we can help.
Whether it is navigating visa issues, improving access or enhancing promotional efforts, we are committed to providing support and finding collaborative solutions.
As we continue to collaborate with local authorities, ministers and stakeholders to drive continuous improvements, we warmly invite medical professionals in Harley Street to actively participate in shaping the future of our esteemed medical district.
Our aim is to enhance the excellent reputation that has made Harley Street one of London’s most iconic streets and, together, ensure it remains the destination of choice for patients from all over the globe.
☛ To get in touch with the Harley Street Business Improvement District (BID), there are various official and effective channels.
The primary source of information is the Harley Street BID’s website (https://harleystreetbid. com), where one can find comprehensive details about ongoing initiatives, upcoming events and staff contact information.
Subscribing to the BID’s newsletter is another excellent way to stay informed about all things related to Harley Street, ensuring you receive regular updates directly to your inbox.
Additionally, the BID maintains active social media presence on platforms like LinkedIn and Twitter, providing yet another avenue for engagement and communication.
Whether seeking information about events, resources or specific inquiries, leveraging these channels ensures timely and reliable access to the Harley Street BID’s support and services.
Alternatively you can email contact@harleystreetbid.com
Independent Practitioner Today features an online advertising directory to complement our journal and website.
To be included, contact Andrew Schofield at Spot On Media. Phone 0161408 3912 Email: andrew@spotonmedia.co.uk.
NEW PRIVATE practice opportunities for consultants and GPs across a range of specialties are available in Birmingham following the opening of the £100m The Harborne Hospital.
Located on the Queen Elizabeth Hospital Birmingham campus, it is a partnership with University Hospitals Birmingham (UHB) NHS Foundation Trust, with two of the hospital’s eight floors and 72 beds dedicated to the care of NHS patients, operated by UHB.
The development ( see our news story on page 5), from primary care to outpatients and diagnostics through to complex care and surgery, is supported by leading consultants covering specialties including cancer, cardiac care, orthopaedics, urology and digestive diseases.
Facilities include 50 private ensuite inpatient beds, 16 private day care beds, modern outpatient services, four operating theatres, a day-care unit with outpatient chemotherapy and radiotherapy services, onsite pharmacy and a dedicated intensive treatment unit for one-to-one, around-theclock critical care for complex conditions.
Equipment includes the region’s first da Vinci Xi in the private sector, enabling minimally invasive complex surgery.
The hospital is also equipped with the latest generation of CT and MRI scanners, ultrasound, X-ray including digital fluoroscopy, 3D mammography and provides patients with access to a radiotherapy linear accelerator.
The hospital is equipped with the latest generation of CT and MRI scanners, ultrasound, X-ray including digital fluoroscopy, 3D mammography
Equipment includes the region’s first da Vinci Xi surgical robot (left) in the private sector, enabling minimally invasive complex surgery
New private practice opportunities for consultants and GPs across a range of specialties are available in Birmingham following the opening of the £100m The Harborne Hospital
A day-care unit includes outpatient chemotherapy and radiotherapy services
Digital technology and artificial intelligence are arming clinicians with more data than ever before and offering the possibility of faster, more accurate diagnosis, more personalised treatment and better outcomes, reports Dr Tim Woodman (below) in the second part of his analysis which began last month
DIGITAL ONCOLOGY refers to the integration of digital technologies and data-driven approaches into the field of oncology.
It involves the application of various technologies, including, but not limited to, digital platforms, data analytics and AI, to enhance cancer research and patient care.
The relationship between AI and digital oncology is closely intertwined, as AI often underpins many of the digital solutions developed.
Digital oncology offers the option to enhance patient-centred aspects of oncology care.
One example is telemedicine, which allows patients to consult with oncologists and receive follow-up care remotely, reducing the need for frequent in-person visits.
Then there is remote screening and diagnostics through devices, tools and technologies ranging from a simple at-home test to more advanced devices.
It also plays a key role in enabling precision medicine by providing the tools to analyse and interpret complex patient data to determine the most effective treatment options.
Digital oncology enables remote monitoring, meaning healthcare professionals – or credible chatbots in the future – can assess information remotely for symptom management, treatment guidance and to check on progress and detect complications.
Such is its potential that the NHS has introduced its ‘Cancer digital playbook’, which provides support to organisations looking for digital tools that support the delivery of cancer pathways.
It provides case studies across the patient pathway from referral
management to end-of-life care as an example of how to implement digital oncology technologies.
For clinicians:
➲ Reduced need for in-person visits with oncologists and hospitalisations because telemedicine, remote monitoring, screening and diagnosis, and digital therapeutics will contribute to more efficient cancer care delivery and closer monitoring by multidisciplinary teams.
➲ Increased use of automation and technology, which will help distribute or spread out the delivery of services, supporting the healthcare workforce and decentralising care.
For patients:
➲ Greater convenience and access, and the ability to gain greater control over their health. As digital health solutions become widespread, it is likely that patients will be able to benefit from increased adoption.
➲ The ability to self-manage their conditions as data is fed back to them. Also the opportunity to support patients dealing with their diagnosis and reduce suffering from the side-effects of cancer treatment by being able to monitor patients more dynamically, intervene earlier and empower them with ways to understand and apply that data.
➲ More aspects of the care journey will be delivered from the comfort of patients’ homes, including services or procedures that can be conducted remotely or through home visits.
➲ Access to 24/7 cancer support. In future, these technologies will be able to detect changes in the patient’s biology, before they even realise and will ➱ continued on page 24
AI-related developments will have a significant impact in grading and classifying tumours, and providing more reliable diagnoses within the next decade
flag them to the patient and their clinicians.
For healthcare systems:
➲ Improved co-ordination among healthcare providers, patients and insurers. Real-time data-sharing and communication will streamline claims processes, reduce administrative tasks and ensure patients receive appropriate care faster.
➲ Integrated patient data in the same platform, such as a centralised personal health record, giving patients control over their data and whom they allow access to it.
➲ Better tailored insurance products, as insurers can leverage the data gathered from digital oncology tools and technologies to make informed decisions about coverage, pricing and risk assessments.
In future, digital oncology solutions will become standard practice in cancer care.
As they continue to mature, their proficiency in processing and analysing diverse types of data, including data from wearable devices, will increase.
The integration of a diverse range of digital oncology AI-driven solutions will enhance pro-active risk management in cancer care.
Remote monitoring, screening and early diagnosis of cancer will increasingly involve novel connected devices that leverage AI.
Cutting-edge solutions on the horizon include:
➤ A new test using infrared spectroscopy as a non-invasive and low-cost tool for breast cancer screening.
Increasingly over the next five years, AI-driven cancer risk assessments will be comprehensive and dynamic, considering vast amounts of data, including genomic data, to provide personalised risk profiles.
Regular health check-ups that incorporate AI-powered risk assessment will allow for the early detection of potential cancer risk. And people will also receive personalised recommendations for lifestyle modifications to reduce their cancer risk.
As these AI-driven assessments become more sophisticated, they will also be able to provide realtime feedback on how lifestyle factors are impacting cancer risk.
Better understanding of a people’s risk will allow healthcare providers to stratify them and offer tailored screening and early, more personalised interventions to those at the highest risk with the aim of improving cancer outcomes.
This will lead to a more personalised experience and increased satisfaction.
A comprehensive understanding of people’s risk also enables the design of personalised insurance plans that reflect individual risk and better suit their needs.
This test, which uses small liquid plasma samples, could be used as an alternative to mammography.
➤ Advanced ambient intelligence may also be used to monitor patients remotely in their homes and alert professionals of unexpected changes.
This technology makes a person’s surroundings ‘smart’ by using sensors and data to understand and monitor individuals and their environment.
Artificial intelligence (AI) will play an important role in the future of oncology.
It will be widely used in various forms across the entire healthcare journey from risk prediction and stratification to diagnosis and helping to inform treatment regimes.
AI is a broad concept, usually referring to the development of computer systems which can perform tasks that typically require human intelligence.
It encompasses any technique that enables computers to mimic human intelligence, using logic, if-then rules, decision trees and so on.
Machine learning (ML) which includes complex statistical techniques that enable machines to improve at tasks with experience.
Deep learning (DL) which is a subset of ML composed of algorithms that allow software to train itself to perform tasks like speech and image recognition by exposing multi-layered neural networks to vast amounts of data.
Generative AI (GAI) which is a subset of DL that can produce new content such as text, code and pictures based on the information it is given as input.
One of the most well-established applications of AI in oncology is the interpretation of medical imagery findings. However, it can support at many different stages of the patient journey.
For example, AI is also being used to help predict people at high-risk of getting cancer and stratifying patients into risk categories.
According to a survey of more than 1,000 cancer experts, 1 AI-related developments will have a significant impact in grading and classifying tumours, and providing more reliable diagnoses within the next decade. The survey respondents highly favoured AI applications related to early cancer detection and diagnosis.
Here are some examples of AI-based tools that may support different stages of the cancer patient journey.
☛ Risk prediction and stratification – identifying high-risk individuals: A new AI tool is being developed to predict a woman’s ten-year combined risk of developing and then dying from breast cancer.2 Despite promise, further validation is needed before the model is implemented in clinical practice.
☛ Personalised screening based on risk level:
Tempo3 is an AI tool for personalised cancer screening that assesses individual risk profiles and recommends the timing for future mammograms based on the patient’s history and evolving risk. It could improve early detection while reducing the number of unnecessary mammograms. Scientists are currently working to further refine their model.
☛ Delivering personalised prevention: Google and DeepMind have developed MedPaLM M, a multi-modal large language model able to interpret and understand connections across different forms of patient data including clinical text, images and genomic data.4
Med-PaLM M outperformed other AI models and was able to diagnose tuberculosis in chest X-rays without being trained with such data previously.
The model is now available to a select group of Google Cloud customers for testing and feedback.
The timing and frequency of cancer screening will be optimised based on a person’s risk profile. This will help avoid over-screening low-risk individuals while ensuring high-risk individuals receive appropriate and timely screening
that this tool would present huge cost savings for the NHS and reduce environmental impact by 460 tonnes of carbon.
Although promising, AI models are not currently widely implemented in oncology care and are often used as stand-alone activities, so lack integration across other relevant digital systems.
There is also a need for a more experienced workforce to support the appropriate implementation of these tools into clinical practice.
Additionally, the use of these algorithms involves significant ethical, risk and privacy issues.
AI will play an important role in creating personalised prevention plans, which may include recommendations for lifestyle modifications and interventions to reduce risk factors or preventive medications.
Within the next few years, multimodal AI models will be able to analyse and consider different types of patient data, including medical records, imaging, genetic, lifestyle and environmental data to determine their impact on cancer risk and the likelihood of customers developing cancer.
☛Timely and efficient diagnosis: An AI-based algorithm that analyses chest X-rays to detect potential lung nodules and masses has received FDA 510(k) clearance. 5 This tool can help enhance patient care and support the healthcare workforce by providing a second read on X-rays.
☛ Delivering tailored treatment: Researchers at the University of Sussex are developing a new AI prediction tool to assess genetic changes in tumours. 6 This may potentially allow oncologists to personalise cancer treatments for patients.
☛ Predicting treatment outcomes and prognosis: Digistain is an AI tool that uses an optical scan of tumour tissue to determine the likelihood of breast cancer recurrence and so inform treatment decisions.
It is gaining adoption worldwide, including in the UK, India and the US. Research concluded
1. Future of Artificial Intelligence Applications in Cancer Care: A Global CrossSectional Survey of Researchers, Current Oncology, 16 March 2023.
2. Predicting ten-year breast cancer mortality risk in the general female population in England: a model development and validation study, The Lancet, September 2023.
3. Seeing into the future: Personalized cancer screening with artificial intelligence, Massachusetts Institute of Technology News, January 2022.
4. Med-PaLM M is a Multimodal Biomedical AI from Google Research and Google DeepMind, Maginative, July 2023.
5. FDA OKs IMIDEX’s AI-Powered Device to Spot Lung Nodules, Medical Product Outsourcing Magazine, August 2023
6. Sussex researchers use Artificial Intelligence to personalise cancer patient treatments, University of Sussex Broadcast, February 2023
The timing and frequency of cancer screening will be optimised based on a person’s risk profile. This will help avoid over-screening low-risk individuals while ensuring high-risk individuals receive appropriate and timely screening.
As well as improving health outcomes, this approach will also optimise use of medical resources.
AI also has the potential to significantly influence the discovery of new cancer drugs by detecting trends in data – for example, clinical trials, genomics – and suggest promising drug candidates, predict the efficacy of novel treatments and offer insights into overcoming treatment resistance.
It may also accelerate the process of screening existing drugs for repurposing in cancer treatment, potentially uncovering new applications. This not only speeds up the drug discovery process but also improves the chances of finding more effective and personalised cancer therapies.
Technology and improvements in digital infrastructure are set to revolutionise oncology, supporting a connected care model and making high-quality cancer care increasingly accessible to many more people.
This has the potential to speed up screening, improve diagnosis accuracy, enable personalised treatment and improve patient outcomes.
As digital tools and solutions continue to be introduced, more sources of data will be available and shared in real-time with clinicians and healthcare providers.
This increased volume of data will enable AI-based algorithms to identify irregular patterns, paving the way for pro-active cancer care.
Dr Tim Woodman is medical director, policy and cancer services, Bupa UK Insurance
More than 15,000 medical professionals were trained in independent healthcare settings in the 2022-23 financial year –despite under half of provider respondents reporting not having received any funding to support training. Now the private sector needs to do even more, says David Hare
WHEN THE Elective Recovery Taskforce was convened in December 2022, its challenge was quite clear: better utilising the independent sector – and patient choice – to help reduce NHS waiting lists.
At that point, two years since the end of the National Hospitals Contract, three things had become very clear.
First, the full, efficient utilisation of independent sector capacity is essential to reducing NHS waiting lists.
Second, dealing with workforce challenges is going to be a major factor in sustaining the elective recovery over the next decade.
Third, with ever growing numbers of patients turning to private care, the contribution of private providers to training the next generation of clinicians was going to come under close scrutiny.
One of the actions that the Independent Healthcare Providers Network (IHPN) took away from the taskforce was the creation of a baseline dataset on clinical training in the independent sector.
data
Remarkably – considering its importance – there is very little routine data collected and published on clinical training within the NHS, let alone outside of it.
Conversations around training have always presented a challenge for the private sector. Anecdotally, we know that some really great work on developing the clinical workorce takes place in the sector, but, a few case studies aside, it has historically been hard to refute accusations of the sector taking staff from the NHS and not giving back to the ecosystem through training in return.
Our new report, In Train , demonstrates for the first time that this
view couldn’t be further from the truth.
Based on a survey of IHPN members who, between them, account for more than 90% of NHS activity delivered in the independent sector in addition to their private work, we can now confidently tell the story of training in the sector. And on the whole, it is a fantastically positive story.
In the last financial year, the sector supported more than 15,000 learners, including by delivering more than 11,000 placements for trainee clinical staff.
We think that is a really strong number – IHPN membership employs about 80,000 clinical staff – and is a clear sign of the importance that independent providers place on training the future workforce.
The nursing workforce is clearly an area of real focus and success. The sector delivered more than
The Independent Healthcare Providers Network’s report showed that the private sector’s past reputation for simply recruiting trained staff from the NHS is misguided
5,000 nursing placements in 202223 and supported more than 300 graduate nurse training programmes.
Overall, there is one nurse in training in the sector for every four nurses employed by independent providers – a really significant contribution to the health sector’s training delivery.
This success is repeated among radiographers, physiotherapists and other allied health practitioners, with 6,000 placements combined over these roles and more than 1,000 graduate training programmes.
We have identified some challenges, of course. The IHPN and our members are working hard to ensure that more junior doctors can access placements within the sector.
This has always been a challenge
due to the often highly-specialised nature of independent providers’ delivery models – and because of accreditation on training and access to learning support.
But during the Covid-era National Hospitals Contract, the sector was able to support several thousand doctors with their training and we think there is scope to vastly expand the number of junior doctors who can receive part of their training in the sector again going forwards.
Another interesting aspect that the report highlights is the increasing role of apprenticeships in training the future healthcare workforce.
NHS England’s Long-Term Workforce Plan focuses on apprenticeships as a key means to develop a sustainable workforce pipeline. And the independent sector is already taking a lead here – some 1,045 clinical apprentices were employed in the sector last year, with many providers already having plans in place to expand their apprenticeship offer.
Still, the report does flag some of the barriers to improving the training offer. Despite the overall use of apprenticeships closely mirroring that within the NHS, only half of independent providers currently make use of apprenticeships.
There are several reasons for this – access to academic capacity and support for upskilling in maths and English have been raised before.
Perhaps of greater interest though is the challenges faced in non-traditional healthcare settings.
It’s very easy to train a new clinician in a large hospital, where they have access to multiple specialties and a wide range of procedures all in one location. It becomes a much greater challenge in community settings or in a sector where many providers deliver care in a single specialty.
Some providers told us that they have explored offering degreelevel apprenticeships for nurses, but, because of the nature of their work, would be unable to offer exposure to the full range of areas needed to satisfy the NHS Knowledge and Skills Framework.
TRAINING IN NUMBERS: Some of the statistics highlighted in the IHPN’s report on training in the private healthcare sector
Overall, there is one nurse in training in the sector for every four nurses employed by independent providers – a really significant contribution to the health sector’s training delivery
Clearly this is an area for future improvement. One suggestion is a greater focus on passporting within training – allowing training placements to take place across multiple providers, sharing support infrastructure where appropriate.
This would, of course, represent a major change from how things have worked in the past. But as care delivery models evolve, it is likely that exploring these different models of training will benefit NHS providers as well as support more learning in the independent sector.
We also think there are many areas of training where the NHS can learn from independent sector innovation.
Our report shares several fantastic examples – whether it be members partnering with universities to deliver foundation degrees on radiotherapy or developing their own training programmes to enable staff without any prior clinical experience to develop a career in healthcare as scrub technicians or clinic and theatre assistants.
IHPN and the sector as a whole are committed to a sustainable healthcare workforce. Indeed, the future of the sector depends on it.
So, over the next 12 months, we are going to be working closely with NHS England and the Department of Health and Social Care with a focus on identifying and resolving barriers to the sector delivering even more training, so that the great work that we see across the country can be allowed to grow and develop.
David Hare is chief executive of the Independent Healthcare Providers Network (IHPN)
The FTSE 100 is turning 40! George Uglow celebrates the milestone, but reminds us why it pays to have a global rather than purely UK investment focus
AT THE start of 2024, the UK’s FTSE 100 Index turned 40. It covers the top 100 stocks listed on the London Stock Exchange weighted by their market capitalisation.
Put simply, this is calculated by multiplying the total number of shares of a company by the present share price.
It is the most commonly cited UK equity market index by the media, often referred to as the ‘Footsie’ or the ‘index of the leading 100 companies’.
You will, no doubt, have heard newsreaders making somewhat meaningless statements such as the ‘The Footsie was up by 23 points today’.
The index took over from the FT30, which was a subjectively selected portfolio of 30 companies equally weighted, which had been around since 1935.
So, the story goes, 100 stocks were selected, as it was a nice round number and also because it was the maximum number of securities that could fit on the screens of market terminals at the time.
The FTSE provides a good case study of equity market characteristics.
Data shows us that since 1986 the index, with no costs deducted, has turned £100 into around £2,300 before inflation, or £790 after inflation, when dividends were reinvested – known as ‘total return’. That is a pretty good reward for brave and patient investors.
In comparison, those holding cash received about 1.8% a year after inflation, although since the start of the Global Financial Crisis (November 2007), holders of cash would have seen their purchasing power fall by over 25%. As we’ve previously advised, it is risky being a long-term holder of cash.
As recently as the start of January 2020, £1 invested in the FTSE 100 had the same value as £1 invested in global developed markets.
However, in the past three years, the so-called ‘Magnificent Seven’ mega-cap tech stocks have driven the performance of the global markets. These are Apple, Amazon, Alphabet (Google), Meta, Microsoft, Nvidia and Tesla.
Over the period January 1986 to December 2023, the best annual return was 42% in 1989 and the worst was -28% in 2008 – although in total the market fell 40% from peak to trough. The worst month was October 1987 when the market fell by around 26%.
Forty years is a long time in both life and markets. The make-up and influence of the market has changed quite considerably over time.
Two key statistics stand out. Only around one third of the original FTSE 100 constituent names remain today, even taking account of various re-incarnations of firms following mergers and acquisitions.
Data shows us that since 1986 the index, with no costs deducted, has turned £100 into around £2,300 before inflation, or £790 after inflation, when dividends were re-invested –known as ‘total return’
ferences between the UK and the US market.
For example, the UK has around 23% in financials, 12% in energy and just over 1% in technology companies, whereas for the US these numbers are 13% in financials, 4% in energy and a very material 29% in technology companies.
The performance of different sectors ebbs and flows, but it does make good sense to be globally diversified – rather than UK market-focused – to ensure that you own a broad swathe of global capitalism.
Some companies got relatively smaller and fell out of the index, some went bust, others delisted and a few decamped to other markets.
The other point of note is that in 1984 when the FTSE 100 was born, the UK market represented around 7% to 10% of global markets, depending on how it is measured.
Today, that sits at a paltry 4%. At the end of 2023, Apple Inc. had a market capitalisation larger than the whole of the UK stock market.
Today there appears to be quite a bit of negative sentiment surrounding the structure of the UK equity market, which is in part driven by the relative surge in the value of US stocks over the past few years.
This also reflects the sector dif-
George Uglow (right) is a chartered financial planner with Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Forty years is a long time in both life and markets. The make-up and influence of the market has changed quite considerably over time
Derek Kelly (below) looks at the pivotal role of remote practice management in liberating you from administrative burdens
THE DEMAND for efficiency and streamlined processes is more pronounced than ever.
Consultants in the UK find themselves at the intersection of delivering high-quality patient care and navigating the complexities of administrative tasks.
Enter remote practice management. It is a transformative solution that not only eases the administrative burden but also liberates valuable time for specialists to focus on what truly matters: patient care.
The evolution of healthcare administration
The traditional model of healthcare administration often entails manual processes, paperwork and intricate billing procedures that consume a significant portion of a medical consultant’s time.
But these administrative responsibilities, while crucial, can be time-consuming and divert attention from patient-centric activities.
The advent of remote practice management represents a paradigm shift. It encompasses a suite of tools and technologies designed to streamline administrative tasks, from appointment scheduling and billing to managing patient records.
By leveraging cloud-based platforms, consultants can access these services anytime, anywhere, paving the way for a more flexible and efficient healthcare ecosystem.
One of the primary advantages of remote practice management is the creation of streamlined workflows.
Administrative processes that
once required manual intervention and co-ordination are now automated, reducing the risk of errors and saving valuable time.
Appointment scheduling, for instance, becomes a seamless process with digital tools.
Consultants can efficiently manage their calendars, schedule appointments and send automated reminders to patients, minimising no-shows and optimising the use of available time slots.
Billing, a historically intricate and time-consuming task, undergoes a significant transformation.
Remote practice management services integrate advanced billing systems that automate the invoicing process, track payments and ensure compliance with the latest regulatory standards.
This not only accelerates the revenue cycle but also mitigates the risk of billing errors.
The core essence of healthcare lies in patient-centred care. Remote practice management serves as a catalyst in enabling consultants to reclaim time for meaningful patient interactions.
As administrative tasks are efficiently managed, doctors find themselves with more opportunities to engage with patients, understand their needs and provide personalised care.
Patient consultations become less hurried and more focused, fostering stronger doctor-patient relationships.
And enhanced communication not only improves patient satisfaction but also contributes to better health outcomes.
In the context of chronic disease management, where ongoing patient engagement is vital,
remote practice management becomes a valuable ally.
Consultants can allocate more time to educate patients, discuss treatment plans and ensure adherence to prescribed medications. This pro-active approach contributes to improved patient outcomes and a more comprehensive healthcare experience.
Efficiency and accessibility in a digital age
Remote practice management brings efficiency and accessibility to the forefront of healthcare administration.
Cloud-based platforms provide secure and centralised access to patient data, allowing consultants to retrieve information swiftly and make informed decisions during consultations.
Regulatory compliance: a seamless experience
Adherence to regulatory standards is non-negotiable. Remote practice management services incorporate features to ensure consultants stay compliant with the latest regulations and standards in the healthcare system.
From data security protocols to billing code updates, these services actively monitor changes and implement necessary adjustments, alleviating the burden of consultants to stay abreast of ever-evolving compliance requirements. This pro-active approach not only safeguards the practice from legal ramifications but also fosters a culture of trust and reliability among patients.
For consultants considering the adoption of remote practice management, selecting the right ser-
vice provider is paramount. The market offers a myriad of solutions, each with its unique features and capabilities.
I recommend they conduct thorough research, considering factors such as user interface, scalability, integration capabilities and customer support.
Collaborating with a reputable and experienced remote practice
Beyond the qualitative advantages, remote practice management delivers tangible financial benefits for medical consultants.
The automation of billing processes ensures accuracy, reduces billing errors and accelerates the re-imbursement cycle. Consultants witness a more robust financial flow and gain better control over their revenue streams.
By minimising administrative overhead and optimising resource utilisation, consultants can allocate their time strategically, balancing patient care with business management.
This dynamic equilibrium contributes to the financial sustainability of healthcare practices, ensuring a win-win proposition for both consultants and their patients.
management partner ensures a smooth transition and ongoing support.
The right partner tailors the
solution to the specific needs of the consultant’s practice, providing a customised and effective implementation.
Sandison Easson is a firm of truly specialist medical accountants who provide personal and tailored advice to clients.
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Accountants
A future focused on patient well-being
Adopting remote practice management heralds a future where medical consultants can reclaim their time and refocus on what truly matters: patients’ well-being.
Streamlined workflows, enhanced efficiency and improved financial sustainability are not just aspirations but achievable outcomes of embracing this transformative approach to administration.
Remote practice management offers a path towards a patientcentric, financially robust and technologically advanced future. By unlocking time for patient care, consultants not only elevate the quality of health services but also contribute to a healthcare ecosystem that is adaptive, resilient and centred around the wellbeing of every patient.
Derek Kelly is marketing manager at Medserv
WE PROVIDE THE USUAL SERVICES YOU WOULD EXPECT FROM AN ACCOUNTANT SUCH AS PREPARATION OF YOUR ACCOUNTS AND TAX DECLARATIONS BUT OFFER SO MUCH MORE INCLUDING ADVICE ON:
• SETTING UP A NEW PRIVATE PRACTICE
• BUILDING AN EXISTING PRIVATE PRACTICE
• BUSINESS STRUCTURES TO PROTECT WEALTH
• BUSINESS STRUCTURES TO MAXIMISE TAX EFFICIENCY
• CLAIMING TAX REFUNDS INCLUDING OVERPAID ANNUAL ALLOWANCE TAX
• REMUNERATION PLANNING FOR YOU AND YOUR FAMILY
• UNDERSTAND ANNUAL ALLOWANCE TAX
• MAXIMISING LEGITIMATE EXPENSE CLAIMS
Introducing a new technique or treatment can bring benefits to patients and be personally rewarding for doctors in private practice. However, it is not without its risks. Dr Clare Stapleton (right) explores the issues
AT SOME point , you may be the person introducing an intervention or equipment into the hospital where you do your private practice, whether it be something that is already established else
where or a completely novel technique.
Any novel therapy should always have patient benefits at its core. The evidence for this could come from the National Institute for Health and Care Excellence (NICE) guidance or research studies where the technique has been adopted at an earlier phase.
In the case of an interventional technique not yet the subject of published NICE guidance, the Royal College of Surgeons of England advises within Good Surgical Practice (section 1.2.4) that you should contact the Interventional Procedures Programme at NICE to learn the status of the procedure.
You may also wish to liaise with your specialty association, which may have further information on the technique, its use and whether it is recommended by them to be used in the circumstance you propose.
Where the proposal is novel, but licensed and used elsewhere, its introduction through an agreed service evaluation process may be appropriate.
If unlicensed, then this would need to follow a research proposal route and have the necessary approvals.
Any new technique will require approval by the relevant committee at the institution you propose to introduce it at.
Private providers will almost certainly have existing policies that
It is essential when introducing a technique to demonstrate that you, and those involved in supporting the performance of the technique or care of the patient, have received appropriate training
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govern the process of introducing new techniques or treatments into their institution. It is important to ask for a copy of this policy at the outset and follow it.
Failure to do so may result in your introduction being unsuccessful and may put you at risk of criticism.
Your own evidence of how it will benefit patients will be helpful in reassuring a private provider and your team that they should support your change in practice.
All doctors have an obligation to regularly monitor and improve their own standard of care as described in the GMC’s Good Medical Practice (see box on page 34)
This is never more important than when you are introducing a technique not previously established in an institution.
Training colleagues
It is essential when introducing a technique to demonstrate that ➱ continued on page 34
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you, and those involved in supporting the performance of the technique or care of the patient, have received appropriate training.
It would be unwise to begin practising a new procedure or using new equipment without clear evidence of your training, experience and competence in that technique.
You will most likely be asked for this evidence when seeking agreement with the private provider. As set out in Good Medical Practice: ‘You must recognise and work within the limits of your competence.’
You will also be required to develop and maintain your skills in the technique by attending regular educational activities specific to this aspect of your practice.
There may well be other healthcare professionals you work with who will not have experience or knowledge of this new treatment or technique.
Training the whole team will be vital to its safety and success, as they may assist in its delivery or the care provided to the patient. The private provider, if they agree to its introduction, may ask you to be involved in training others and monitoring their competence.
Training may incur a financial cost. It would be important to agree in advance who is going to be responsible for delivering, funding, and monitoring this training.
It is a good idea to include professionals who may not be directly involved but have a role in caring for patients; for example, ward staff, outpatient staff, pharmacists and GPs, who will be caring for the patients in the community.
These professionals should be aware of any impact the new technique may have on their management of these patients and be fully informed of any variance to their usual care.
The consenting process for any patient undergoing a newer technique will be required to be in line with GMC guidance on decisionmaking and consent.
Patients and their carers should be informed of the benefits and
The private provider, if they agree to the new treatment’s introduction, may ask you to be involved in training others and monitoring their competence
Doctors are obliged to regularly monitor and improve their own standard of care as described in the GMC’s Good Medical Practice:
13. You must take steps to monitor, maintain, develop, and improve your performance and the quality of your work, including taking part in systems of quality assurance and quality improvement to promote patient safety across the whole scope of your practice.
This includes:
A) Contributing to discussions and decisions about improving the quality of services and outcomes;
B) Taking part in regular reviews and audits of your work, and your team’s work, and responding constructively to the outcomes, taking steps to address problems and carrying out further training where necessary;
C) Regularly taking part in training and/or continuing professional development;
D) Regularly reflecting on your standards of practice and the care you provide, including:
i. reflecting on any constructive feedback available to you;
ii. considering how your life experience, culture and beliefs influence your interactions with others and may impact on the decisions you make and the care you provide.
risks in comparison with previously used and alternative techniques.
The Royal College of Surgeons of England also emphasises that you should tell patients if the technique is relatively new and be open about your experience and training, as well as your outcomes to date.
There may be no published patient information leaflets available at the institution you plan to introduce the technique to. You should be involved in drafting these leaflets and ensure that the information within them is clear, accurate and in line with any established national guidance.
The Royal College of Surgeons of England recommends that you discuss the proposal with your colleagues locally. You may find that the introduction is more easily accepted when your colleagues understand what you are doing and are on board with the decision.
Doctors should be mindful of the possibility of a conflict of interest and appreciate their professional obligations, particularly where there is a commercial organisation involved in the introduction of a new technique.
The Association of the British Pharmaceutical Industry’s code of practice sets out the ethical framework for organisations that promote medicines.
Medical technology companies have an equivalent association –the Association of British HealthTech Industries – which has published its code of business practice for its members.
You should ensure that you are open with the private providers and patients about any financial interest.
You should follow local policy on commercial interests of doctors working within that organisation.
The GMC has its own guidance for registrants within Good Medical Practice as well as further guidance on financial and commercial arrangements and conflicts of interest. It states: 36. You must be open and honest with patients about any interests you have that may affect (or could be seen to affect) the way you propose, provide or prescribe treatments, or refer patients. You must follow our more detailed guidance on financial and commercial arrangements and conflicts of interest.
94. You must not allow any interests you have to affect, or be seen to affect the way you propose, provide or prescribe treatments, refer patients, or commission services.
95. If you are faced with a conflict of interest, you must be open about it with patients and employers, declare it in line with local and national arrangements, and be prepared to exclude yourself from decision making. You must follow our more detailed guidance in Financial and commercial arrangements and conflicts of interest.
Gaining expertise and practising using a relatively new technique or treatment can bring many benefits to your patients, as well as being personally rewarding. However, it is not without its risks and can be time consuming and expensive. An understanding of the potential pitfalls and your professional obligations in this area are essential components of a successful new addition to your private practice.
Dr Clare Stapleton is medico-legal consultant at Medical Protection
THE TIME is ripe for independent healthcare providers to expand their practices by bidding for NHS contracts.
That is because the Provider Selection Regime (PSR), which officially came into force on 1 January 2024, significantly changes healthcare procurement law for both contracting authorities and providers.
Leading healthcare law firm Hempsons has worked along -
side NHS England on the development of the PSR over the past two years and in this article I outline the new regulations and what these changes mean for private practitioners
NHS waiting lists are at a record high and with mounting pressure to tackle crippling bed and workforce shortages, the service is increasingly reliant on the private sector to help ease the burden.
With both the NHS long-term plan and the Government’s elective recovery plan aiming to drastically reduce waiting times and demand on NHS services by giving patients more control over their treatment options, there has never been a better time for independent healthcare providers to expand their practices by bidding for NHS contracts.
However, the way in which
those contracts are awarded has changed significantly with the introduction of the PSR and this article will give private practitioners a solid understanding of the new procurement processes and principles.
Which services are covered by the PSR?
The PSR applies when relevant contracting authorities, such as
➱ continued on page 36
NHS England, integrated care boards, NHS trusts and foundation trusts and local and combined authorities, procure ‘relevant healthcare services’ relating to both physical and mental health conditions.
There is no minimum threshold for the application of the PSR regulations, so, regardless of the financial value, all contracts are subject to the same selection processes.
The regulations do not apply to goods and nonhealthcare services such as medicines, medical equipment, cleaning, catering, business consultancy services and social care, unless they are integrated as part of mixed procurement.
The new regime introduces a totally new approach to how healthcare contracts are awarded. Whether you have an existing NHS contract that is due to expire or are considering submitting a bid for a new contract, there are several practical considerations you must keep in mind before proceeding:
The biggest change under the new regime is the departure from lengthy, competitive tendering processes being the standard route for awarding healthcare contracts.
The new decision-making processes are designed to foster stable partnerships between commissioners and providers and promote greater collaboration across the healthcare system.
Where the existing provider is successfully fulfilling their contractual obligations and delivering a quality service – whereby quality is determined by a balance between overall costs and the benefits to individual patients, taxpayers and the general population – and there is no considerable change to the contract, this relationship is encouraged to continue.
Where changes to services are necessary, the regime gives contracting authorities more flexibility in choosing a new provider. However, this flexibility comes with the need to ensure all decisions are fair, transparent, proportionate and in the best interests of the service users.
Transparency is a cornerstone of the PSR. Commissioners must be transparent about their intentions and decisions during the selection process. They will be required to publish notifications of all their decisions and outcomes.
This transparency may affect how you approach commissioners and how you market and communicate your service offerings. Keep in mind the public’s ability to access the documented rationale around why a commissioner did or did not consider your service appropriate for their needs. If you fall short of the requirements, this may impact negatively on your future business.
Don’t mistake fewer competitive tendering opportunities for less competition; the emphasis on quality and outcomes of services puts the pressure on providers to prove they are maintaining high-quality standards and continuously improving their services. With increased scrutiny around all decisions made under the PSR, it’s essential you can justify how you meet the key criteria and maintain clear and comprehensive records of your successes.
You will be required to report on several performance indicators, including clinical outcomes, patient satisfaction and compliance with best practices. Patient feedback will be instrumental in the new decision-making processes, so ensure high-quality patient care is at the heart of your service.
Nor do they apply when an independent provider with an NHS contract wishes to subcontract a healthcare service to another, as those providers are not considered relevant authorities under the PSR.
The new provider selection processes
One of three new provider selection processes must be followed when awarding a contract under the PSR:
Direct award processes A, B and C;
Most suitable provider process;
Competitive process. If there is little to no reason for
an existing provider to change or for multiple providers to be assessed against each other for a new contract, one of the direct award processes will be used.
Direct award process A must be used when the existing provider is the only provider that can successfully deliver the relevant healthcare services due to their nature.
Direct award process B must be used when patients have a legal right to choose their provider.
The relevant authority does not restrict the number of providers and is able to award contracts to all providers who express an interest and meet all the necessary requirements.
Direct award process C may be used when:
The relevant authority is not required to follow direct award processes A or B;
The existing contract is due to expire and a new contract is proposed;
The existing provider is satisfying its existing contract and will likely satisfy the new contract;
The proposed new contract has not changed considerably from the existing one.
Where the lifetime value of the new contract is at least £500,000 or 25% higher than the lifetime value of the existing contract, this will constitute a considerable change.
It’s important to note that if all the criteria are met for direct award process C, the commissioner has the discretion to choose whether to follow this process or one of the following:
☛ The most suitable provider process may be used to award a contract without running a competitive process when the relevant authority can identify the most suitable provider.
☛ The competitive process must be used if none of the direct award processes apply, and the relevant authority cannot, or does not, wish to follow the most suitable provider process.
This process must be used if the relevant authority wishes to end an existing framework agreement.
The key decision making criteria
There are five key criteria that must be considered when using either direct award process C, the
The biggest change under the new regime is the departure from lengthy, competitive tendering processes being the standard route for awarding healthcare contracts most suitable provider process or the competitive process. The criteria are:
1
Quality and innovation – ensuring good quality services and supporting the development and implementation of new or significantly improved delivery or outcomes.
2 Value – balancing costs with overall benefits and financial implications of proposed contracts.
3
Integration, collaboration and service sustainability – promoting successful, longterm relationships across the health and social care sectors.
4
Improving access, reducing health inequalities, and facilitating choice – ensuring patients have choice and access to the healthcare services and treatments they need.
5
Social value – improving economic, social and environmental wellbeing.
Increased opportunities for market engagement
Increased scrutiny, transparency and defensibility around decisionmaking means it’s more important than ever that commissioners carefully consider the provider landscape.
The should make use of the comprehensive data available to them
through provider performance reports to gain an indepth knowledge of all potential providers and make informed, datadriven decisions.
This means the potential for bias will be minimised, while allowing commissioners and providers to openly communicate with each other before and during the procurement process.
This opportunity gives you the ability to build strong relationships with commissioners you hope to work with, gain a better understanding of their needs and ensure you are meeting them.
Contact Hempsons’ dedicated procurement specialists for more information about the PSR and expert legal advice on bidding for NHS contracts.
Solicitor Ross Clark is a partner and specialist in independent practitioner work at Hempsons. Contact him at r.clark@hempsons.co.uk
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
what to do if you believe a patient or colleague poses a risk to themselves or others
QI am a private GP and recently saw a patient who I believe, based on comments they made during the appointment, may have been radicalised.
Obviously, this is a very serious allegation and, as such, any advice on how I should go about raising my concerns while maintaining patient confidentiality would be appreciated.
AUnder the Terrorism Act 2000 it is a criminal offence not to tell the police ‘as soon as is reasonably practicable’ if you become aware of information that you know or believe ‘might be of material assistance’ in preventing an act of terrorism and/or securing the arrest, prosecution or conviction of someone involved in ‘the commission, preparation or instigation of an act of terrorism’.
The GMC’s Confidentiality guidance states: ‘Some laws require disclosure of patient information’ for
purposes including ‘the prevention of terrorism’.
‘You must disclose information if it is required by law.’ If you’re satisfied that disclosure is legally required, you should promptly disclose relevant information to the police.
According to the UK Government’s Prevent strategy, there are clearly many opportunities for doctors, nurses and other staff to help to protect people from radicalisation. The key challenge is to ensure that healthcare workers can identify the signs that someone is vulnerable to radicalisation.
As part of this strategy, the Government has also produced guidance containing tips for healthcare professionals who have concerns that a patient or colleague might be at risk of radicalisation.
If you are concerned that a patient may have been radicalised and that you need to disclose information to protect individuals or the wider public from serious harm, it is important to firstly reflect on the factors that make the person vul-
nerable to abuse or exploitation and what aspects of their behaviour give you cause for concern.
The Prevent guidance includes possible warning signs and says healthcare workers should use their judgement in determining the significance of any unusual changes in behaviour.
Next, consider whether raising concerns is a proportionate response, given the ongoing risk to the individual and others. Balance this against the possible harm and distress to the patient of sharing information about them – for example, the implications for their future engagement with healthcare.
However, it is generally considered appropriate to disclose information if a vulnerable person is at risk of abuse, if a patient has confessed to a serious crime or if they pose a risk to the public.
If you decide to disclose information, the GMC says you should ‘tell patients about such disclosures whenever practicable, unless it would undermine the purpose of the disclosure to do so’.
In some circumstances, including a risk of serious harm to yourself or others, such discussions with the patient may be impracticable.
The Government guidance advises that you raise concerns though a local policy, if there is one, and that in the absence of such arrangements you should usually go via the local safeguarding lead, who would contact the local police Prevent lead.
Record the steps you took to discuss the issue with the patient and your justifications if it is necessary to disclose information without their consent.
Additionally, it may be necessary to share safeguarding information with other organisations, such as social services, to ensure the patient receives appropriate support.
Finally, remember to seek advice from your medical defence organisation if you are unsure how to proceed.
Dr Sally Old is a medico-legal adviser at the Medical Defence Union (MDU)
If you have a patient who declines a chaperone during an intimate examination, then what is the best thing to do? Dr Sally Old explains
QI’m a male, private GP who recently had a consultation with a patient who initially declined a chaperone for an intimate examination saying: ‘Oh, that’s OK. I’m sure you’re trustworthy and I’m in a bit of a hurry. Just go ahead.’ I felt uncomfortable with this and explained that I would prefer to have a chaperone present. After further discussion, the patient agreed and the examination proceeded without incident.
I wonder if I could have done anything differently?
ADoctors are expected to use their professional judgement when deciding whether a chaperone should be offered. However, having a chaperone present during intimate examinations can offer reassurance and act as a safeguard for both the patient and the doctor.
The GMC’s guidance, Intimate examinations and chaperones (2013) states that patients, regardless of gender, should be offered a chaperone before conducting an intimate examination.
It says an intimate examination could include ‘any examination where it is necessary to touch or even be close to a patient’ and that doctors should be sensitive to what a patient might consider intimate.
The purpose of a chaperone is to protect the patient’s dignity and confidentiality, offer emotional support at an embarrassing or uncomfortable time and to facilitate communication.
Having a chaperone present during intimate examinations may also help protect a doctor from unfounded allegations of improper conduct.
The chaperone should be a trained health professional who is familiar with the procedure as opposed to a family member or friend, as they may not be considered an impartial observer. However, a friend or family member may be present alongside a chaperone.
Sometimes a patient may insist on not having a chaperone. While this is the patient’s right, it can leave doctors in an uncomfortable position. In such cases, you should follow the GMC’s guidance and explain why you would prefer a chaperone present.
If the patient continues to decline, it may be possible to defer the examination and refer the patient to a colleague who is willing to examine the patient without a chaperone.
However, if the examination is needed immediately, then there may be no other option but to proceed without a chaperone. If this occurs, then you should document the discussion with the patient in the clinical record and why it was necessary to proceed.
Other reasons to defer a nonurgent examination are if you or
the patient want a chaperone, but no one is available or if the patient is unhappy with the chaperone offered – particularly if the patient knows the chaperone, such as in a small community.
It is helpful to have a chaperone
policy for the practice and to publicise the benefits and availability of chaperones to patients. This may encourage patients to communicate their preferences early on so that you can best meet their needs.
Competition and Markets Authority (CMA) enforcement action is being beefed up this year, but a consultant engagement team at the Private Healthcare Information Network (PHIN) is here to help you, says Anne Coyne (right)
Patients tell the Private Healthcare Information Network how valuble they find consultants’ profiles in the PHIN website, especially when they have a photo
WHATEVER YOUR views on the CMA’s Private Healthcare Investigation Order – and we know for many of you they won’t be positive – the fact remains that consultants have a legal obligation to comply with the requirements it sets out.
And the most important of these rules are contained in Article 22: information on consultants’ fees.
The CMA has indicated it is going to step up its enforcement action in 2024, so simply ignoring the order is not really an option.
But the good news is that compliance is a relatively easy thing to achieve and that PHIN’s consultant engagement team is here to help you.
The team has been reaching out to consultants over the past few years and is delighted that nearly 10,000 have now submitted fee information.
And an even greater number have information of one form or another on their PHIN website profiles.
Patients tell us how valuable these profiles are to them, espe
cially when they have extra content, such as a photo.
If you have yet to engage in the process, the team would welcome the opportunity to talk to you at a virtual session or onetoone.
At these, you will be introduced to PHIN and its objectives and meet consultant engagement members, who will walk you through the submission process for your data and answer any questions or concerns you may have.
The virtual sessions are run twice a week, usually at 8am and once at 6pm, and the team is also able to run lunchtime sessions if they fit in better with your work patterns.
Our team is grateful to all those consultants who have given their feedback on the data submission process and PHIN is making changes because of this information.
One key change is that consultants will soon be able to nominate their medical secretary as an approved party to submit data on your behalf.
We are making the required
technical changes to our consultant web portal and are also liaising with the British Society of Medical Secretaries and Administrators (BSMSA) to ensure processes are appropriate and that we can identify any potential blockages or issues to medical secretary involvement. We will offer bespoke training for medical secretaries in due course.
In addition to compliance with the order, we want engagement with PHIN to provide benefits for consultants.
We know that some of you are already using our data in appraisals and revalidations, but want to offer even more.
For instance, we will soon be able to provide you with all the information we hold about you in one easy to access place.
What’s next?
This year we will start to publish information about consultants’ fee arrangement with private medical insurers.
This will cover which companies
This year we will start to publish information about consultants’ fee arrangement with private medical insurers
you work with and whether your fees fall within the insurers’ price range or whether patients will be required to pay an additional fee.
We are also working towards ‘presumed publication’. Consultants will still be able to review and verify the data supplied by hospitals about them for publication, but we will publish data where a consultant has neither verified their data nor raised data issues for review by hospitals.
PHIN, as a whole, is also working on its website this year to make it even more attractive to potential patients – it already gets around 40,000 visitors a month.
This should be an exciting year and we hope that even more of you will be engaging with us. Together we can deliver the order requirements and help patients make informed healthcare decisions.
You can contact the team directly by phone on 020 3823 7518 or by email at consultants@phin.org.uk during office hours (9am 5pm). Outside these hours, please leave a message and we will get back to you.
Alternatively, you can book a virtual session or a one to one using this form: https://bit.ly/ PHINvirtual
Anne Coyne is consultant services manager at the Private Healthcare Information Network (PHIN)
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Competition among consultants was set to intensify as thousands of new entrants into private practice began building up their businesses.
Private healthcare analysts revealed the number of ‘NIPs’ –new independent practitioners –had never been higher.
More than 3,700 doctors had launched a private practice in the UK since 2011 – and numbers were still growing as younger specialists sought to boost stagnant NHS incomes and take on new challenges.
‘NIPs’ numbers had shot up by 60% in just 36 months, rising from 1,008 to 1,612 the previous year.
Figures collated for Independent Practitioner Today by independent sector online solutions experts Healthcode showed a typical
practitioner entering private practice was a male anaesthetist who joined the specialty register eight years previously.
The breakdown of 3,471 consultants entering private practice in the previous three years was:
Anaesthesia 13%;
Trauma and orthopaedic surgery 10%;
General surgery 9%;
Clinical radiology 6%;
Cardiology 6%;
Obstetrics and gynaecology 5%;
Ophthalmology 5%;
Urology 3%;
Paediatrics 3%;
Dermatology 3%. Women remained significantly under-represented.
New work opportunities for independent practitioners looked set to escalate as increasing numbers of private and NHS deals took shape.
Lawyers involved in the discussions revealed that joint projects between the sectors had never looked so promising.
One specialist legal firm said it alone was working on ten transactions, while a second wave in the pipeline could double this number.
Lawyer Jonathan Lisle, of global law firm DLA Piper, said: ‘We are currently acting on a large number of public-private partnerships in
the healthcare sector and we see this as a real growth area – and indeed I personally regard this as key to the successful future of the NHS.’
Surgeons registered frustration and disappointment at a continuing lack of Government controls over ‘cosmetic cowboys’ following a review into the sector the previous year by Sir Bruce Keogh.
The biggest critics were the British Association of Aesthetic Plastic Surgeons (BAAPS), which condemned what it saw as a lack of action in the Department of Health’s response to the 40 recommendations.
Although the Government agreed with most of Sir Bruce’s recommendations, the association’s president, consultant plastic surgeon Mr Rajiv Grover, claimed: ‘It’s business as usual in
the Wild West and the message from the Government is clear: roll up and feel free to have a stab.’
BAAPS complained that the Government’s response in a 22-page report boiled down to very little regulation, in real terms, being implemented.
Mr Grover added: ‘Frankly, we are no less than appalled at the lack of action taken. This review –not the first one conducted into the sector – represents yet another thoroughly wasted opportunity to ensure patient safety.’
Doctors’ working pressures were cited as a key factor in driving them to the top of Britain’s car insurance claims league.
Research from a comparison website revealed they were the most bump-prone drivers, with GPs leading the way and consultants right on their tails.
Gocompare.com found almost a third of GPs had made at least one insurance claim in the past five years.
The proportion of GPs with a claim was not only the highest of any occupation in the UK, but more than double the national average for all professions at 13.12%.
Hospital consultants were immediately behind them with just over 26% having made a claim.
Tax investigations are stressful, costly and time-consuming. Compliance checks are often triggered because information submitted on a tax return is not consistent with information HM Revenue and Customs already holds.
Richard Norbury (right) covers some common issues to consider before you next file your tax returns
IN THIS digital age, tax officials have many sources of information from external sources, including banks and building societies, employers, stamp duty, land tax and information-sharing between foreign tax authorities.
A common error is to think that income from overseas does not need to be included on your UK tax return.
HM Revenue and Customs (HMRC) now receives information about accounts, trusts and investments based outside of the UK from around the world.
Many doctors were either born overseas or have spent time abroad, meaning it is likely that they have financial interests in those countries and if they are living and working in the UK, then tax is likely to be due on foreign income or gains.
The rules can be complicated and also taken into account is the time spent in the UK.
It is very important that you make your accountant aware of any such income or gains so you can get professional advice on whether it needs to be declared on your personal tax return.
Often there are tax agreements between the UK and other coun➱ continued on page 44
tries, meaning you may get credit for tax paid at source, but this does not mean that you should not declare the income, as there may be more tax to pay in the UK if the rates are higher.
Employers have an obligation to submit information to HMRC for all employees monthly under Real Time Information (RTI) rules. Obviously, it is rare for someone to forget to submit their details for their main post, but often doctors will work elsewhere or change jobs, meaning the job you have left should have prepared a P45. If a doctor undertakes waiting list initiative or bank work, then this is sometimes paid on a separate payslip to your main role and a different tax code can be applied to the post.
Care should be taken when disclosing your P60 figures at the end of the year.
Within the NHS, it is common for other posts to be included on your main P60 or it may be the case that you have separate forms for each post.
It is also easy to forget smaller ad hoc payments you may have received from other employers or neighbouring NHS trusts, which could have been some time ago by the time you are filing your return.
This is a complex area and has
HM Revenue and Customs now receives information about accounts, trusts and investments based outside of the UK from around the world
been further complicated by the ‘McCloud remedy’, which will potentially alter the tax charges that have been previously declared. It is important that amounts declared on tax returns are reported correctly.
NHS Pensions often allows for these tax charges to be paid directly from the pension fund via a form called a ‘scheme pays’ election.
If a tax return declares that a ‘scheme pays’ election has paid the tax charge on behalf of the taxpayer, then the HMRC is still expecting the money and this is paid over at regular intervals by the pension scheme to HMRC. If for any reason the ‘scheme pays’ election has not been submitted or if the forms have been rejected, then eventually the HMRC is likely to open an inquiry. If you are in any doubt, then you can check with NHS Pensions directly.
It is becoming increasingly common for doctors to work collabora-
tively either in partnership or via an limited liability partnership (LLP). If you are a partner or a member of these organisations, then you should receive details to declare on your personal tax return.
Sometimes when these ventures are new, the amounts are smaller and, because you may not have physically drawn any money out, you may think that there is nothing to declare.
This is not the case, as you will be assessed on the level of profit allocated to you, or your company, rather than the amount drawn and if the figures do not match with the partnership tax return, you are likely to receive a compliance check.
There has been a huge increase in electric car usage and doctors have taken advantage of either the salary sacrifice arrangements offered by the NHS or via their own limited company.
Employers are obliged to report the benefit on a P11d form and it is important that they issue this form to you for inclusion on your tax return.
Doctors and their businesses will often pay employees including family members. It is possible that smaller businesses will not have to operate a formal PAYE scheme, but if the amounts reach certain limits or if the individual is in receipt of another salary or pension, it is a requirement that a PAYE scheme is in operation.
HMRC operates an exemption of £1,000 for basic-rate taxpayers and £500 for higher-rate taxpayers on savings income.
A lesser-known fact is that if you are an additional-rate taxpayer, then you are not entitled to take advantage of these exemptions, meaning all your savings are taxed at the prevailing rate.
The threshold was recently lowered for the additional rate, meaning anyone earning £125,140 or above now falls into this category. This is information that HMRC can access easily, because the banks are obliged to report savings income to them.
It is a misconception that if your outgoings are equal or more than the income received from properties that you do not have to declare anything
HMRC has previously targeted returns that are filed consistently late. Waiting until the last moment to prepare and submit returns increases the risk of error in calculating what is due by dint of them being rushed.
Failure to pay on time is also a red flag, so if you are ever in a situation where the tax cannot be paid in full by the due date, it is best to take advice from your accountant.
Most doctors do not have to charge VAT on their fees due to the healthcare exemptions.
But an exception to this is those carrying out medico-legal work or purely cosmetic work. The threshold to register for VAT is currently set as £85,000 a year and this needs to be reviewed on a rolling 12-month basis.
Failure to register can lead to penalties and VAT arrears from the date that you should have registered.
It has been reported that HMRC has recently formed a specialist team to target the cosmetic medical sector focusing on treatments such as Botox, fillers and facial peels to check whether they qualify for medical exemption from VAT or not.
It is important that you speak to a specialist medical accountant if you are carrying out this type of work.
It is a misconception that if your outgoings are equal or more than the income received from properties that you do not have to declare anything.
Often the largest regular payment made is the mortgage payment to the lender. This can be a mixture of capital and interest and the capital element of the payment cannot be set off against income tax.
Most doctors are higher- or additional-rate taxpayers and cannot claim full tax relief on the interest element either and instead receive a tax credit equivalent to basic rate tax.
Engaging in a tax avoidance scheme or choosing tax incentiv-
ised investments which fail to meet HMRC rules and regulations will obviously increase the risk of an inquiry.
There have been numerous cases where taxpayers are scrutinised because they entered an arrangement that they did not fully understand. Often if it sounds too good to be true, it is.
If you are considering entering a scheme, it is always best to have independent professional advice.
If you have a large fall in income or increased costs that fall outside of industry averages, this may increase your chances of an inquiry.
This is sometimes unavoidable and expected. For example, many private doctors saw private earnings significantly reduce during the Covid lockdown, but to minimise the risk, you should avoid claiming excessive costs in your accounts or against employment income.
To be able to claim costs against employment income, expenses must be wholly, exclusively and necessarily for the performance of their duties.
Realistically, this often restricts expenses claims against employment income to just professional subscriptions.
It is worth mentioning that most accountants will offer fee protection insurance. These policies will often cover the accountancy costs, but obviously not any additional tax, interest or penalties of an inquiry.
While the above are factors in HMRC opening an inquiry, it is important to remember that there are also completely random investigations.
It is also worth noting that many different types of business taxes can be investigated; it is not limited to income tax – other areas of taxation can also be investigated. Next month: Sometimes people can end up with tax liabilities due to rules that may be accidental or uncommon or somewhat hidden. Alec James exposes these in next month’s IndependentPractitionerToday.
Richard Norbury is a partner at Sandison Easson & Co, specialist medical accountants
The ‘biggest car manufacturer you have never heard of’ has launched a direct competitor to the Tesla Model 3. Independent Practitioner Today’s motoring correspondent Dr Tony Rimmer (right) says it’s worth a look
Body: Five-seat saloon
Engine: Two electric motors.
All-wheel drive
Power: 523bhp
Battery capacity: 82.5kWh
Top speed: 112mph
Acceleration: 0-62mph in 3.2 seconds
WLTP range: 323 miles
CO2 emissions: 0g/km
On-the-road price: £48,695
IN THE world of cars, it has been the big companies that have survived and made the most profits. The smaller independent car makers cannot compete and are a rare and dying breed.
Now electrification has come along and even the huge companies have been caught out. They have had to outsource the battery and control technologies to others while they play technological catch-up.
This has put them at the mercy of uncontrollable supply issues among other things. And most of these supplying companies who have had great experience in electronic and battery technology over many years are Chinese.
So it is no surprise that these companies are now offering their own finished products on the UK market and each new model is more impressive than the last.
I recently reviewed the Golfsized Atto 3 from BYD, the biggest car manufacturer you have never heard of, and they have now launched the Seal.
Tesla competitor
This four-door saloon is a direct competitor to the Tesla Model 3, the Hyundai Ioniq 6 and the Polestar 2, so has a tough job ahead of it to steal sales in this lucrative market.
It is available in two versions, both with a 82.5kWh battery.
The £45,695 rear-wheel-drive Design version has a 308bhp electric motor and a potential range of 354 miles.
The faster all-wheel-drive Excellence version has two electric motors producing a combined 523bhp, a range of 323 miles and
The centre console has, in BYD-speak, ‘a dynamic and powerful shape, resembling a seal emerging from the sea’
costs £48,695. The Excellence model has other suspension tweaks to help with the extra performance, which allows the 0 to 62mph sprint to take just 3.8 seconds. It was this version that I drove on test.
The Seal is a smart-looking car with European-flavoured styling. There are enough external design features to make it interesting without being over the top. The interior feels premium, with comfortable faux-leather upholstery and good-quality plastics.
The centre console has, in BYDspeak, ‘a dynamic and powerful shape, resembling a seal emerging from the sea’. Hmm, I am not sure about that, but it looks clear and functional to me.
The large 15.6” infotainment screen is very like that in a Tesla and unfortunately some of the ventilation controls and sound systems are difficult to find in submenus, particularly while on the move.
Passenger space is above average, as it benefits from BYD’s advanced battery construction called ‘blade technology’. Their batteries are
completely Cobalt-free and use lithium iron-phosphate as the cathode.
The physical battery is honeycomb in construction and forms a strong structural element to the whole car. It is thinner than other batteries and also has a protective element in collision safety performance.
Rear-seat passengers get more headroom than competitors, but practicality is let down, like the Tesla Model 3, by the lack of a hatchback.
Tesla buyers had to wait for the Model Y SUV, and BYD will be bringing their SUV version of the Seal to market in the future.
I can usually tell within a couple of miles of driving any test car how it feels from behind the wheel and my initial impressions are rarely altered over time. As a keen driver, I was impressed by the Seal within the first mile or two.
The steering is direct and well weighted, the performance sportscar quick and the ride is tight, composed and comfortable on most surfaces. I did have some fun tack-
ling a few challenging twisty B-roads.
The only comparable electric vehicle that drives as well is the BMW i4, so hats off to BYD for getting the chassis so right. The car feels solid and well-built with a real premium feel – another unexpected bonus.
There are some negatives, of course. Wind noise could be a little more suppressed and the infotainment tech is really not as userfriendly as it should be.
With only its third model to hit UK roads within a year or so, BYD has seriously ruffled the feathers of Tesla and the European brands.
This is, of course, good news for us medics as consumers. More competition means better deals to be had. The default choice in this sector of the EV market has, for a long time, been the Tesla model 3. But if you want something a bit different and that entertains the driver a lot more, you would do well to take a look at the Seal.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
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