How to hang onto your precious employees
Jane Braithwaite on how to improve staff retention P14
What Bupa is doing to go green James Sherwood outlines the insurer’s efforts to become a net zero emissions business P26
By Robin Stride
Staffing problems could hamper consultants’ and private hospitals’ ability to take advantage of a surge of patients aiming to bypass NHS waiting lists by paying for their own treatment.
A survey from market analysts LaingBuisson’s database – which includes hospitals, clinics, individuals, managers and clinicians –has found high confidence in the market, with over 55% of respondents forecasting self-pay market growth of 10-15% in the next three years.
And according to Private Healthcare UK, although most demand continues to be in London and the South-east, interest in private healthcare is rising consistently across all regions.
But market experts fear the staffing crisis, highlighted by Independent Practitioner Today last month, could severely hit hopes of a self-pay boom.
Liz Heath, author of the new fourth edition of LaingBuisson’s Private Healthcare Self Pay UK Market Report, warned: ‘The challenges around staffing are a real
Talk defuses conflict Dr James Thorpe explains how good communication can cut negligence claims P24 In association with
concern given that they impact all aspects of private healthcare services.
‘Adding additional operating theatre sessions, for example, may not be as simple as it used to be.
‘The theatre may be available, but getting it fully staffed may be an issue. At a time when all indicators are suggesting greater demand for all private services, whether self-pay or insurance-funded, this is a real worry to everyone we’ve spoken to across the sector.’
flexible approach and focusing on efficiencies in clinical pathways and service delivery, but this will need a genuinely collaborative approach between consultants, clinical specialists and providers.’
Her concerns were echoed by Ted Townsend, author of LaingBuisson’s Private Acute Healthcare Central London report, who told a digital conference called to launch his publication that there were continuing worries around staffing.
The trend towards greater spending on health and well-being continued through 2021 and into 2022, according to the self-pay report. People are privately funding their care, but there is more interest in private medical insurance too.
LaingBuisson reports: ‘NHS waiting lists are the most commonly cited reason for the growth in awareness and interest in self-pay. However, the interest is not only in the elective surgical procedures most often associated with this market.
independent healthcare pathway afterwards.’
NHS demand management strategies are also fuelling interest in private initial consultations and diagnostics.
It says these relate mainly to restrictive funding criteria in orthopaedics, ophthalmology, gastroenterology, gynaecology and urology, where there has been a noted increase in interst in self-pay inquiries – ‘though how many convert to business is another question’.
‘Pull factors’ include greater priceing transparency and access to payment plans, which make it easier for people to choose to go private.
The report says some private hospital groups have harmonised their prices nationwide and some NHS private patient units are making information and prices more visible. This gives consumers greater confidence to invest this way in their health.
Specific services, such as vein clinics, day surgery clinics and ophthalmology providers are meanwhile offering competitively priced services based on their efficiencies and economies of scale.
She told this journal: ‘One of the solutions may be adopting a more ➱ continued on page 4
‘People are increasingly turning to private GPs, diagnostics and consultants to expedite treatment, even if they do not remain on an
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EDITORIAL COMMENT
Nine years on from its last revise, the GMC’s Good Medical Practice handbook is getting a welcome update.
Currently, the planned wording is out for consultation (see story on page 8). So we recommend all doctors and the organisations representing them to read it and respond, as it provides a foundation for how they work and what is expected of them in future.
As the GMC says, the document it is not a set of rules, but forms ‘the bedrock that helps guide ethical practice in a world of increasingly complex medicine’.
And that foundation is often the reference point for lawyers prosecuting or defending anxious doctors facing rising levels of complaints and inquiries into their behaviour, be it from patients, hospitals where they practise and, increasingly, clinician colleagues.
Legal experts at the Medical Defence Union (MDU) are among
The challenge to find new patients
As private healthcare experiences rapid change post-Covid, marketeer Simon Marett looks at how this presents new problems for private doctors P18
those currently scrutinising what they see as ‘significant changes’ plus some additions.
This is because, as a central tool used by the GMC in its fitness-to-practise processes, every paragraph and every single word in the document matters.
As the MDU’s Caroline Fryar comments: ‘Regulations, sets of rules and guidance documents must be compatible with the realities of doctors’ daily working lives and support them to get on with the job of safely caring for patients.’
Included for the first time, it is no surprise to see, is a duty for doctors to act, or support others to act, if they become aware of workplace bullying, harassment or discrimination, plus zero tolerance of sexual harassment.
Make sure you get no surprises in the final document. You have until 20 July to check out the changes. Find out more at https://tinyurl.com/3n37b8hp
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Will there be a boom in treatment abroad and more overseas patients travelling to the UK as we return to normal after the pandemic? P20
What it means to be a director
So what are your risks as a company director? This report from Hempsons lawyers Justin Cumberlege and Alison Oliver may surprise you P28
Boost your cash collection
As part of Medical Billing & Collection’s celebration of 30 years in the sector, Simon Brignall continues to highlight 30 key area you need to master P32
Investors need to mind the gap
We should pay more attention to the gap between what a fund earns and what an investor makes, says Ben Holdsworth of Cavendish Medical P34
Help people to access private care
Independent Healthcare Providers Network boss David Hare shows how it is stepping up work to ensure patients can benefit from private care P42
PLUS OUR REGULAR COLUMNS
Business Dilemmas: He’s stalking his partner
The MDU’s Dr Kathryn Leask answers a doctor’s query about reporting an angry patient to the police P36
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Accountant Ian Tongue looks at the areas where keeping adequate paperwork is essential P38
Doctor on the Road:
An electric vehicle ahead of its time
Our medical motoring correspondent Tony Rimmer is impressed with the Hyundai Ioniq 5 P40
By Edie Bourne
NHS Pension Scheme members exceeding the annual allowance in 2019-20 made up a third of the total number of pension tax breaches.
At least 34% of individuals who breached the annual tax-free pension savings limit belonged to the health service scheme.
The news brought a renewed call for an urgent Government review to reduce unfair tax charges on doctors.
The number of senior doctors
affected could be even higher because more than 18,000 GPs had still not received their 2019-20 annual allowance statement by 31 January this year, so are not yet included in the numbers.
In the tax year 2019-20, the total value of pension contributions reported as exceeding the annual allowance was £949m – an increase from £819m in 2018-19.
Patrick Convey, technical director at specialist financial planners Cavendish Medical, said: ‘These
Consultants in independent hospitals treated more insured patients during the first three months of 2022, compared with the same period before the pandemic, according to new billing activity data.
Healthcode, the official clearing organisation for private medical invoices, recorded a rise in the number of unique patients in billing data to 133% of 2019 levels for outpatients and 103% for admitted patients in March 2022.
Insured activity overall exceeded 2019 levels across all regions and medical specialties in the first quarter of 2022, reflecting the extent of the sector’s turnaround, since the low in May 2020.
The company’s managing director Peter Connor said: ‘Two years after lockdown was first imposed, Healthcode’s latest data shows that independent hospitals are back to doing what they do best:
providing high-quality care for patients in need across the UK and relieving the pressure on the healthcare system.
‘Healthcode operates at the heart of the independent healthcare sector and it has been impressive to see everyone pull together to help the national effort during the pandemic.’
See statistics on the right
figures show perfectly how medical professionals are more likely to breach the annual allowance compared to other professionals.
‘The very nature of the NHS scheme means it is all too easy for pension growth in a year to be higher than the tapered or standard tax-free savings limits.
‘We are seeing many senior doctors who are forced to retire early because it would make no financial sense to stay longer. This, of course, has a detrimental effect on staffing
levels at a time when the NHS is facing substantial backlogs.
‘Other professions such as judges have witnessed overhauls of their pension tax rules in recent years and it is obvious the NHS scheme needs further review too.’
The annual allowance limits the amount of tax-free pension savings which can be accrued per year to £40,000.
For higher earners, the ‘tapered’ annual allowance applies which can be as low as just £4,000.
Hospital billing activity surged ahead of 2019 across all UK countries, particularly in England and Wales which did not dip below pre-pandemic levels at any point.
In March, volumes were at an all-time high: England (131%); Scotland (119%); Wales (122%) and Northern Ireland (158%).
Activity largely exceeded 2019 levels across England, with London, the North West, East England and the West Midlands recording high volumes throughout the first financial quarter.
January was quieter in the East Midlands, North-east, South-east, South-west and Yorkshire and the Humber, but levels had bounced back by March, exceeding 2019 by more than 20 percentage points.
Yorkshire and the Humber saw the biggest turnaround, from 94% of 2019 levels in January to 141% in March.
Activity levels rose above 2019 in all but one of the top hospital specialties. Both pathology/haematology and radiology recorded more than double 2019 volumes in March 2022 (211% and 202% respectively).
Orthopaedics and trauma is still the number-one hospital specialty in terms of billing activity and exceeded its 2019 performance in February (111%) and March (123%). Analysts say the Q1 activity levels suggest the specialty has effectively recovered from the pandemic’s adverse effects.
Within hospital settings, outpatient activity was quicker to recover after lockdown measures were relaxed and activity has been consistently higher than 2019 levels for some time. Meanwhile, admitted care activity has been edging closer to pre-pandemic levels and by March 2022 was 5% higher than in the same month of 2019.
By Robin Stride
A wide range of factors are influencing patients to choose to go down the increasingly popular self-pay route.
For older generations at the core of self-pay activity seeking orthopaedic and eye treatments, many have had longed-for holidays curtailed in 2020 and 2021.
Now they are telling providers they have chosen to pay for a joint replacement or cataract removal because they want to get on with their ‘adventure before dementia’.
LaingBuisson consultant Liz Heath said many of them had built up a lot of savings or had a nest egg that was not earning
much money for them – or had not been until recently – so they had chosen to make personal spending decisions weighing up all the different factors.
There were people in this demographic who had generous pensions, still indexed-linked, and savings and assets in property and were choosing to spend some of the money after ‘weighing up their own well-being and uncertainty’.
She told private healthcare operators and other interested parties at a Zoom seminar not to underplay the value of the uncertainty.
‘If you know your operation is going to be in three months, then you can plan around that. If you don’t know when your consulta-
tion, your pre-op assessment or your operation is going to be, for many people that’s one of the big decision-making factors and they are weighing that up against the cost of treatment.’
Another factor affecting decisions to pay for private treatment was the ability to spread the cost of treatment, the meeting heard.
In many cases, self-pay treatment costs could be spread interest-free over a reasonable period.
Mrs Heath added: ‘We know from what providers are telling us that a number of people are choosing to do that. Even if they could afford to pay up front, they are choosing to spread the cost because that suits their own per-
sonal spending and budgeting situation.
‘There are a number of factors at play. I don’t think the economic situation has hit big time yet, but I think we do need to be aware of it as a factor over the next year or so.’
She advised the sector to be mindful that the whole system was not quite back where it was pre-Covid.
‘We do not have all the consultants back doing the full scope of private practice yet; we are nearly there, but consultants returning to private practice – as PHIN’s (the Private Healthcare Information Network) research has illustrated – there has been a bit of a lag in some specialties particularly.’
Mayo Clinic Healthcare in Portland Place, London, is adding inherited cardiac condition services including advanced imaging and electrocardiography (ECG) and genetic testing and counseling to its offering.
Improvements in cardiac imaging and ECG technology and the development of genetic screening and genetic counseling are helping physicians and families work together to identify and manage the conditions.
Genetic counsellors help families understand genetic testing and its implications. Sometimes family members come to the clinic together for testing and counseling.
Mayo cardiologist Dr Elijah Behr said: ‘Sometimes there can be a taboo or anxiety around discussing inherited medical conditions within families.
‘Genetic counsellors help break these barriers by having that conversation.’
The LaingBuisson self-pay report warns that although private providers are keen to return to service their core private patient segments, there is still the possibility of private sector capacity being used by the NHS to reduce waiting lists.
Mrs Health reported continued optimism for the future of the selfpay market, but said it was unclear about the scale of growth going through 2022 and 2023, although early indications from some large providers were ‘very positive’.
‘While the inability to spend money on holiday and leisure activities in 2020-21 meant that people had money in their pockets which they chose to spend on health and well-being, current inflationary pressures, the wider geo-political situation and the opening up of society following the pandemic may serve to stifle growth.’
Doctors Clinic Group (DCG) has acquired Soma Health to add into its occupational health arm along with existing provider, Maitland Medical.
The acquisition is part of an ongoing growth strategy led by its chief executive
Dave Mezher ( right ), former Vitality deputy chief executive.
He said: ‘Our ambition has been to create a healthcare services platform that can provide occupational health along with primary, secondary and other health services to our individual and corporate customers.
‘With the addition of our new partner, we are well on the way to becoming a leader in this space and to use the skills and experience in the respective teams to drive leading-edge healthcare solutions and offer everyone the opportunity to put their health first.’
Originally named London Doctors Clinic (LDC), the GP chain was launched in 2014 to provide convenient GP appointments to London commuters, tourists and business travellers.
In 2022, the business expanded its offering from face-to-face primary care to include secondary care, telehealth and occupational health services.
Its primary care business operates from 23 clinics in central London, the South, Manchester and Birmingham.
They offer extensive secondary care and consultant services as well as working with partners across the country for services such as imaging and diagnostics, physio, dermatology and orthopaedics.
DCG also has a comprehensive telehealth offering including international video services.
London Doctors Clinic is the trading name for clinics in London.
By Agnes Rose
A new animation aims to make it easier for mystified patients to seek and find private healthcare.
It has been launched by the trade body representing private hospitals and clinics in response to the growing numbers of people looking to pay privately for opinions and treatments.
The Independent Healthcare Providers Network (IHPN) teamed up with the Patients Association to develop the animation and a leaflet for the public to better understand how to get and pay for private healthcare.
This includes:
How to access private healthcare;
Mixing and matching NHS and private healthcare;
How to choose a private doctor or healthcare provider;
How to pay for private healthcare.
The animation will be promoted by members of IHPN who deliver both NHS and privately funded patient care.
Patients are also being encouraged by the IHPN and the Patients Association to make use of the Care Quality Commission and Private Healthcare Inform ation Network websites, which provide details on the quality and safety of
independent healthcare providers in England.
IHPN chief executive David Hare said: ‘With increasing numbers of people choosing to pay privately for healthcare – including those who would never have previously considered doing so – it’s vital that the public have access to simple, impartial information on the basics of how private healthcare works and what options are available to them.
‘We are therefore delighted to have worked with the Patients Association on developing these new resources for patients with everything they need to know about private healthcare – helping support people to make the best possible decisions around their treatment.’
Patients Association chief executive Rachel Power added: ‘We have always believed patients should be able to exercise choice when it comes to treatment.
‘When people are considering private healthcare, it’s important that they understand how they access it, how they choose any hospital or provider and how private care will fit in to care they receive from the NHS.’
See the leaflet at www.ihpn.org. uk/wp-content/uploads/2022/03/ Private-patient-animation.pdf
See David Hare’s article on p42
The Independent Healthcare Providers Network’s five-minute video to help the public access private healthcare is available to watch at www.youtube.com/ watch?v=OGzSBiYIUeo
Recent polling conducted by Savanta Comres for IHPN found that nearly half (48%) of people agree they would consider private healthcare if they needed treatment.
Over one-in-five people (21%) said they are likely to use private healthcare in the next 12 months. But despite rising interest in private healthcare, polling by Savanta Comres found a significant proportion of the public was unsure of how to access or pay for private healthcare.
More than one-in-three people (37%) are unaware it is possible to ‘mix and match’ private and NHS healthcare, such as by paying privately for a scan and then having an operation through the NHS.
Two-in-five people (39%) did not know it is possible to speak to their NHS GP about accessing private healthcare.
Savanta ComRes interviewed 2,245 UK adults aged 18+ online between 4-6 February. Data were weighted to be representative of UK adults by gender, age, region and social grade.
By Olive Carterton
The Competition and Markets Authority (CMA) is cracking the whip to try and speed up its demands for publication of information about private consultants and hospitals for potential patients.
An agreed plan targeted for completion by the end of next month (June) is being worked on by a Private Healthcare Information Network (PHIN) forum to deliver full compliance with the competition watchdog’s legal order, made eight years ago, by June 2026. The Private Healthcare Market Investigation Order 2014 requires the performance measures of private healthcare facilities, and independent consultants’ performance measures and fees, to be published by PHIN.
Full compliance was expected by 30 April 2019. But CMA markets and mergers executive director
David Stewart accepts full compliance has been more complicated than anyone – including the competition body – first thought it would be.
In an open letter to consultants and hospitals, he declared he appreciated the challenges brought by the pandemic. But he was now determined the parties should press forward to complete the implementation phase ‘and to deliver the benefits to patients that will flow from better quality healthcare information’.
After attending a PHIN partnership forum, he said he was encouraged at its support for the CMA’s priority which is to ensure private patients receive the benefits arising from the order’s full implementation.
He wrote: ‘I now expect the rest of the industry – private healthcare providers and private consultants – to also match that commitment.
The competition watchdog is considering what action to take against consultants and hospitals ‘who have not engaged properly with the order’
‘As the content of the strategic plan will directly affect all private healthcare providers and private consultants, I urge you to engage with PHIN about your current compliance status and any actions required.
‘PHIN members’ portal can be found here: https://portal.phin. org.uk.’
Consultant representative groups, insurers and stakeholders will be given opportunities over the next few months to contribute to the ‘roadmap’.
Mr Stewart said the CMA would actively review progress and require a written monthly update
from PHIN and was also likely to attend relevant meetings.
He added: ‘This will allow the CMA to intervene where progress on agreeing a suitable plan does not meet the CMA’s expectations. We also appreciate that there is a need to ensure that smaller providers are also meeting their obligations under the order.
‘In this context, over the next year, the CMA will, in addition to supporting the agreement and implementation of the plan, be taking stock of what enforcement action, if any, needs to be taken against market participants who have not engaged properly with the order.’
The Federation of Independent Practitioner Organisations (FIPO) fully backs the CMA’s aim to address the information deficit for patients contemplating treatment in the independent sector.
In a letter to the competition watchdog, the doctors’ body chairman Mr Richard Packard agreed the profession had concerns about the CMA’s mandate being unfulfilled after eight years.
He wrote: ‘We are not surprised that you acknowledged in your letter that both the CMA and PHIN had found that the task of delivering on the report’s mandate more complex than expected.’
But he warned that the escalating costs of providing
information to allow patients independence in their decisionmaking was becoming disproportionate.
And it was unlikely to be effective in the manner in which it had been pursued so far, he said.
‘PHIN has recently approached FIPO to help frame their strategic plan to deliver the solutions to the problems highlighted by the CMA’s investigation. We at FIPO had previously made the CMA aware of our concerns in this regard.’
choose their treatment pathway was to be at the centre of the remedies. But FIPO had pointed out to the CMA on many occasions that this is becoming increasingly difficult.
He continued: ‘This has been brought about by constraints imposed by private medical insurers, who pay for the majority of care provided.
‘Surely, a key feature of a free market is the absence of coerced transactions or conditions on transactions?
experience and will be writing at greater length to update the CMA on current PMI developments, which disincentivise consultants and distort competition and remove the ability of patients in the private healthcare sector to exercise the personal choice for which they have chosen to pay.
‘It is all very well having information about consultants and hospitals if as a patient you cannot make the choices suggested by that information.’
Mr Packard reflected that an improved ability for patients to
‘FIPO is fully supportive of the aim of enabling patients in achieving the best healthcare
The CMA responded that it was looking into consultants’ complaints that patients’ ability to choose their treatment pathway was being constrained by private medical insurers.
By Robin Stride
What unused medical supplies are lounging in your cupboards that could usefully be sent to Ukraine?
That’s the challenge being made to doctors as part of an appeal by the International Christian Medical and Dental Association (ICMDA) which has raised over £310,000 so far for much-needed medical help in the war-torn country.
Shipments of medical supplies and drugs have been delivered to a warehouse run by the Christian Medical Association of Ukraine (CMAU), where they are then distributed to front-line doctors.
Donations have flowed in from around the world via national affiliated groups and individual doctors.
A new rehabilitation centre at AECC University College, Bournemouth, represents a £4.5m investment in facilities, works and specialist healthcare equipment.
Opening in September, it will provide an even broader range of clinical and rehabilitation services to the current offering which includes specialist MRI, ultrasound, X-ray, physiotherapy, a breastfeeding clinic and first-contact physiotherapy.
Clinical services will include physical and sport rehabilitation, speech and language therapy, occupational therapy, dietetics, and podiatry.
The college works with private providers, the NHS and the Dorset Clinical Commissioning Group and its facilities include an open upright MRI scanner, one of only six in the country.
Vice-chancellor Prof Lesley Haig said the development would make it a national leader in health sciences education and care.
The proceeds are being used to resource and support doctors, dentists and other healthcare professionals providing medical care and aid to those affected by the war.
Medical supplies are sourced from pharmaceutical companies and wholesalers and dispatched through a newly established supply chain to the CMAU in Lviv.
Dr John Greenall, associate chief executive of the UK’s Christian Medical Fellowship (CMF), said: ‘We know there is a huge surplus of medical material in the UK. Every ward, theatre and surgery has cupboards full of supplies that are no longer useful here.
‘We encourage members to seek permission to send these items to Ukraine through this appeal. This is the moment to make something that might otherwise go to waste
make a difference and help save lives.’
The appeal has made direct grants to support the evacuation of international medical students, provide aid for refugees and procure supplies for Ukraine from Poland.
Doctors and medical staff around the UK have been sourcing and sending surplus and redundant stocks of medical supplies from hospitals and healthcare providers.
ICMDA chief executive Dr Peter Saunders called the response from doctors and dentists ‘heart-warming’.
He said: ‘Their generosity has meant that we can obtain muchneeded medical supplies and get them to where they are most needed.’
Dr Rudi Migovich, president of the CMF’s counterpart in Ukraine, said: ‘We have civilians with chronic health needs and hospitals in the war zone that urgently require medical supplies. There are good hospitals and good doctors and nurses here, but they need help with medical materials.
‘What has been sent so far is making a real difference and will save lives here, but we need more. Thank you to everyone who has contributed.’
Details of the appeal can be found on the ICMDA website https://icmda.net/ukraineappeal/ or email ukraine@icmda.net.
The CMF is an interdenominational organisation with over 5,000 doctors, 900 medical and nursing students, and 300 nurses and midwives.
A new Newmedica eye health clinic and surgical centre in Norwich has been officially opened four months after it began seeing patients.
The ceremony at Lakeside 200 on the Broadland Business Park (South) was delayed due to the pandemic.
Nuwan Niyadurupola, Mr Narman Puvanachandra and Mr David Spokes
Six local partners run the clinic – operations director Karen
and five consultant
one day a week.
By a staff reporter
All doctors are to be given new duties to tackle toxic cultures that threaten patient safety and staff retention under GMC plans to update its core ethical guidance.
The regulator has launched a 12-week consultation on the content of its new Good Medical Practice handbook.
Last updated in 2013, the guidance outlines the professional values, knowledge and behaviours expected of doctors working in the UK.
The updated draft follows months of working with doctor, employer and patient representatives, as well as other stakeholders, and the GMC says it reflects the issues now facing practitioners in modern healthcare workplaces.
Included for the first time is a duty for doctors to act, or support others to act, if they become aware
Consultant ophthalmologist Prof Richard Gale, president of the Medical Ophthalmology Society UK, has joined eye clinic Newmedica Grimsby.
He specialises in treating wet macular degeneration and his study into the condition has brought in millions of pounds of research funding to the region.
Prof Gale, who has been named Researcher of the Year by the National Institute for Health Research, said: ‘Newmedica has always been proud of its partnership-working with the NHS and now, because the pandemic has caused a backlog of surgery for
of workplace bullying, harassment or discrimination, as well as zero tolerance of sexual harassment.
The draft guidance also responds to doctors’ calls for greater clarity on their use of social media.
A new duty makes clear that they must not use digital communications channels to mislead, and they should ‘make reasonable checks’ to avoid doing so.
For the first time, the guidance –which will also apply to physician associates and anaesthesia associates when they come under GMC regulation – proposes 12 commitments. These include to:
Make the care of patients my first concern;
Demonstrate leadership within my role and work with others to make healthcare environments more supportive, inclusive and fair;
Provide a good standard of prac-
sight and other procedures on the NHS, we are pleased to be able to assist with its waiting lists.
‘Wet macular degeneration has no cure. However, treatment can help slow its progress. Partial recovery of a patient’s vision is possible if they start treatment early enough, so we are glad to be able to see patients quickly, saving them considerable discomfort, inconvenience and giving them better outcomes.’
tice and care, and be honest and open when things go wrong;
Ensure my conduct justifies my patients’ trust in me and the public’s trust in my profession.
In all, the draft updated Good Medical Practice runs to 16 pages. It provides detailed guidance for medical professionals covering areas including ‘working with colleagues’, ‘working with patients’, ‘professional capabilities’ and ‘maintaining trust’.
GMC chief executive Charlie Massey said: ‘Good Medical Practice is not a set of rules, but it is the bedrock that helps guide ethical practice in a world of increasingly complex medicine.
‘This update is designed to reflect the type of fair, inclusive and compassionate workplaces we all want to see, and that are good for doctors as well as for patients.
‘There is a lot of evidence of the
damage bad workplace cultures can do to patient safety and, ultimately, to the UK’s ability to retain the healthcare professionals it needs. Toxic cultures can also spread online, undermining public trust in the medical profession.
‘It is important our guidance reflects the reality of what doctors face and the cultures many are working in, and that it supports them to be able to do the best for their patients and for their colleagues.
‘We want this guidance to be relevant and helpful now and for years ahead and, to achieve that, we need to hear from those who will use it. That is what this consultation is all about.’
The GMC’s consultation on the draft updated Good Medical Practice runs until Wednesday 20 July. Find out more, including how to get involved, go to https://tinyurl. com/3n37b8hp
Five eye surgeons have opened a new OCL Vision clinic in Elstree, Hertfordshire – the first opened by the company outside London.
Featuring four treatment and consultation rooms, it is the latest addition to the fast-growing healthcare cluster in the town’s Centennial Park.
The clinic will offer consultations with two ophthalmic surgeons who already operate private clinics in Hertfordshire: laser correction specialist Mr Allon Barsam and Ms Susan Sarangaopani, who specialises in cosmetic and reconstructive surgery.
They are joined by Ms Sally Ameen, who will perform cataract surgery and glaucoma treatment, and retinal specialists Mr Chien Wong and Ms Rabia Bourzika, who
will also perform cataract surgery. OCL Vision began with three surgeons three-and-a-half years ago and now has ten.
Founding partner Mr Barsam said: ‘Specialist centres of excellence like our Elstree clinic are the future of eye surgery and, over time, we expect more highly skilled surgeons to join us.’
Compiled by Philip Housden
NHS trusts across England are being encouraged by NHS England/Improvement (NHSE/I) to ‘actively explore and develop opportunities to grow their external (non-NHS) income in the new financial year’.
Its Revenue Finance and Contracting Guidance for 2022-23 says NHSE/I will work with them to ‘identify and scale up NHS export opportunities and support development of private patient opportunities to generate revenue.’
The guidance, updated on 13 April, accompanies the planning rules published in December 2021, which set out the health service’s priorities for the 2022-23 financial year.
This should be no surprise, because increasing the amount of commercial income is reflected in the aspirations of the NHS Long Term Plan.
The private patient market is worth around £7bn a year, of which the NHS generated preCovid £675m in 2019-20, falling back 44% to £380m in 2020-21.
As highlighted many times in Independent Practitioner Today, most recently last month – see ‘How to Boost PPUs’ on page 44 of our April digital issue – it is estimated the NHS share of the private patient market in England could be increased by up to £1bn a year while also ensuring alignment with core NHS services.
This can be achieved by:
Setting a national framework, enabling collaboration between trusts across regions and Integrated Care Systems (ICSs);
Cross-pollinating already successful examples that build on the strengths of leading trusts, such as identifying the higher morbidity and complex insured patients, often by default treated by the NHS for no charge.
Through such joined-up thinking and working the NHS, it could become a notable brand in this sector.
Of course, as press coverage has shown, these changes must be achieved in a way that reflects the sensitivities and political aspects of delivering private health services within a publicly funded health environment.
What is clear is that the NHS is currently in no position to divert workforce capacity to increasing its private healthcare business over the capacity already existing within hospital providers.
This means the real focus needs to be on substitution. Many patients with private health insurance cannot utilise this if they require procedures that many independent hospitals are unable to provide, such as ITU or very specialist equipment.
Additionally, insured patients are admitted to hospitals via the non-elective pathway into an NHS-funded bed and therefore are not able to utilise their insurance policy, particularly for non-complex surgical interventions.
In both these examples, the taxpayer is subsidising the insured sector at a time when public funding is stretched.
Enabling trusts to work together is the key and NHSE/I recognises this in its guidance stating that trusts will still be expected to grow non-NHS income ‘where appropriate’ while core NHS services should continue to be the ‘focus and priority’.
In picking up these themes, Chris Bown, most recently chief executive of London North-West University Healthcare NHS Trust, told Independent Practitioner Today: ‘It will be important, I believe, that ICSs fully consider what this guidance might mean for their systems as part of the overall recovery programme.
‘There are clearly risks if not implemented well, but we must not dismiss this guidance, as there are opportunities for the NHS – for example, financial – and its patients through greater choice.’
NHS England said in a statement: ‘Work continues with systems and organisations on financial plans for 2022-23.’
A new private GP service has been launched by Sulis Hospital Bath, the NHS-owned ex-Circle Hospital acquired by Royal United Hospitals Bath NHS Foundation Trust last year.
The hospital provides services for private and NHS patients across
Bath, Bristol, Somerset and Wiltshire and has 28 en-suite bedrooms, 22 day-case and five ambulatory care beds, nine consulting rooms, four operating theatres, endoscopy, cardiology and intervention suites.
Private patient revenues of
£585,000 were reported for 202021, down 34% from £882,000 the previous year to only 0.16% of total trust revenues.
But this total can be expected to increase significantly in the forthcoming 2021-22 accounts due to be published in the summer.
NHS England says it will support trusts to develop private patient opportunities to generate revenue
University Hospitals of Leicester (UHL) has finally published annual accounts for 2019-20.
These were delayed from June 2020 when it became clear there was a £46m hole in its 2018-19 financial position, meaning it was unable to sign off the next year’s accounts.
The publication finally enables a full picture for NHS trusts private patient revenues for that year. UHL reports income of £2.8m, which is £298,000 up on estimates used in analysis I have reported in this journal.
This income is 0.3% of the Trust’s total revenues and fully in line with those from the previous six years dating back to 2013-14, which have always been between £2.8m and £3m.
The annual accounts for 202021 are yet to be published but according to a trust spokesperson it is anticipated these and the annual report will be ready in the summer.
Philip Housden is a director of Housden Group
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Private doctor entrepreneurs at the heart of a massive project to grow a hospital of the future in the ‘garden of England’ have secured the funding they needed to go ahead.
Building work on the £80m Kent Institute of Medicine and Surgery (KIMS) scheme, which was expected to bring private work to scores of independent practitioners, got underway after doctors finalised a £34m deal with Clydesdale Bank.
Corporate and private investors, including around 100 clinicians, were providing £46m in cash and personal guarantees for ‘one of the UK’s most advanced surgical hospitals’, due to open in early 2014.
KIMS, being built on a seven-
acre site close to the M20 near Maidstone, would provide care across multiple disciplines and aimed to expand into a ‘centre of excellence’.
More than 200 clinicians had signed up for practising privileges, but KIMS medical board chairman Dr Tony Hammond said: ‘We are absolutely open for clinicians with high levels of skill and practice commitment to come and join us.’
Asked about potential risks to doctors investors, Dr Hammond said: ‘In the light of previous failures, we’ve structured it to ensure nobody is over-exposed and investments are nested very safely within the financial structure.’
The increasing numbers of independent practitioners who are using social media to promote their businesses are being invited by the GMC to give their views on new draft guidance on what is expected from doctor ‘tweeters’. Standards expected of doctors do not change because they are communicating through social media rather than face to face, phone or email, said the doctors’ watchdog.
GMC chief executive Niall Dickson said: ‘These forms of communication can be incredibly useful, but it is important that the
standards of behaviour and respect for others which are expected from doctors in the “real” world are observed online.’
Senior doctors were advised this year could be the best time to take advantage of contributing more to their current pensions while tax relief was at the 50% rate.
The Chancellor had announced in the Budget that the top income tax rate, payable on £150,000 earnings or more, would fall from 50% to 45% from April 2013.
Tax relief on pension contributions for earners in that tax bracket would therefore fall to the same level, so financial planners said pensions savers should make the most of the higher relief before the following April.
Contributions to tax-free pension pots were then £50,000 a year.
A private GP reported a worrying outbreak of ‘textitis’ in the consulting room.
Dr Martin Scurr, a former
Independent Doctors Federation chairman, said patients were increasingly sending texts during a consultation.
Writing in his weekly Daily Mail column, he said the texters, invariably young, appeared quite happy and oblivious about sending a text while seeing the doctor.
The mobile health (mHealth) market was ‘set to take off’ due to private and public impetus to modernise and streamline the sector, according to a new report. Business intelligence researchers GlobalData believed the rapid emergence of mHealth technology would revolutionise future healthcare delivery and management by saving lives and reducing the economic burden imposed by rising chronic conditions such as diabetes, obesity and hypertension.
TELL US YOUR NEWS
How about making the news today? Independent Practitioner Today is always keen to hear from doctor entrepreneurs willing to share their stories in private practice – and from independent practitioners embarking on the journey.
Contact our editorial director Robin Stride at robin@ip-today. co.uk
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TRAINEE SURGEONS must be given an opportunity to operate in the independent sector as well as the NHS.
As consultant surgeons, we can all look back and recognise that some of the best training we had was in the operating theatre.
That is not to decry all the other significant and educationally rich learning events, but as surgeons we are happiest in the operating theatre. A happy trainee is both eager and receptive.
Over recent years, and most acutely during the recent Covid19 pandemic, operating theatre exposure has decreased for surgical trainees.
During the pandemic, many elective procedures were paused entirely and large numbers of surgical trainees were even taken out of the acute operative setting to be redeployed to much-needed support for the Covid effort.
A recent GMC report 1 showed that more than half of all UK surgical trainees have not been able to compensate for their lost operative training. Furthermore, 25% have been unable to gain the necessary operative competencies to progress to their next stage of the curriculum.
This is borne out by a Joint Committee on Surgical Training (JCST) finding 2 that in excess of one million elective training opportunities were lost as a result of the Covid-19 pandemic.
Of note, trainee logbook case numbers in cardiothoracic surgery dropped by 60% and those in ENT by 30%. This will result in longer training periods and ultimately in consultant workforce shortages as trainees will require extra time to meet their competencies.
It is, therefore, imperative that every operating opportunity is available to trainees, with appropriate supervision.
As NHS elective cases are still recovering and many are being
BY MISS FIONA MYINT, Vice-president, Royal College of Surgeons of England
diverted to the independent sector, trainees should be given training opportunities in the independent sector.
In particular, when an NHS patient has an operation in the private sector and a trainee is sent along to ‘assist’, there is no reason why that trainee cannot be the primary surgeon under consultant supervision just as would have occurred if the operation were performed in an NHS hospital.
Indeed, in September 2020, during the pandemic, the Independent Healthcare Providers Network (IHPN), Health Education England (HEE), NHS England and the Confederation of Postgraduate Schools of Surgery (CoPSS) came to an agreement to support the independent healthcare sector in training the next generation of medical professionals.
More than 4,000 trainees have had the benefit of some training under this arrangement. Long may it continue.
However, implementation of this agreement has been patchy. Some independent-sector hospitals clearly see the bigger picture and have accommodated surgical
As NHS elective cases are still recovering and many are being diverted to the independent sector, trainees should be given training opportunities in the independent sector
College of Surgeons of England showed that 30% of BOTA members did not feel confident to take on a consultant post because they lacked operative experience.
They may seek fellowships after gaining their Certificate of Completion of Training, thus further impacting on the consultant workforce in the next few years. Increased mentorship of new consultants will become the norm. There is often a fine line in balancing the pressures of service and training, but the equation can incorporate both NHS and independent-sector operations; it may be easier to balance with such a broader view.
training on their operating lists, providing similar support to that which is found in NHS hospitals.
Morale is low in the NHS at present, not least among the many trainees who have lost training opportunities.
There is burnout in doctors and the ‘Completing the Picture’ survey, looking at why doctors are leaving the NHS, showed that 27% of those who had left the profession had done so due to burnout and stress.
As trainers, we can do our best to create a positive training environment. We can be innovative with simulation and new methods of teaching, but from our own experiences we know that hands-on practical operating taught us well and boosted our own morale.
If we cannot make the most of every training opportunity, we run the risk of letting morale drop further, increasing anxiety over gaining competencies and having trainees reach the end of their training with their operative confidence in the balance.
A recent survey undertaken by the British Orthopaedic Trainee Association (BOTA) and Royal
HEE has facilitated the process, having published a clear pathway for trainees holding a valid National Training Number to attend NHS operating in independent hospitals. Indemnity is covered by NHS indemnity. It is much the same process but in a different building.
It is important that we look hard at the present to prepare for the future. There are shortages in the workforce which will impact on safe and efficient patient care.
To reach our ultimate aim of good patient care, we will need well trained and happy surgeons. Thus, in the present, we must ensure that every training opportunity is utilised both in the NHS and the independent sector.
Miss Fiona Myint is a consultant vascular surgeon and vice-president of the Royal College of Surgeons of England
1. GMC, ‘The state of medical education and practice in the UK’, December 2021
2. Joint Committee of Surgical Training, Association of Surgeons in Training, British Orthopaedics Trainees’ Association, Confederation of Postgraduate Schools of Surgery. ‘Maximising training: making the most of every training opportunity. 2021’ www.jcst.org/key-documents/
Doctors’ businesses must now build on the flexibility and adaptability to change skills they have had to work with over the past two years and continuously develop new ways of working to maintain a sustainable future, advises Julia Burn (right)
THE WORLD has gone through many significant changes in the past two years and businesses have had to adapt and change to enable them to continue.
As a result of the pandemic, there is a lot of pressure being put upon businesses in all sectors of the economy. This is mainly driven by the speed at which we are all being affected by inflation, where the cost of living for every individual has and will continue to increase significantly.
In my view, the next area for all doctors’ businesses to concentrate on is sustainability and reviewing the practical steps that management can implement to ensure everything runs satisfactory to continue for the future.
Sustainability now means more than just the environment; it includes environmental, social and human impact of businesses.
The employee market in all industries appears to be incredibly fluid and businesses in all sectors of the economy will need to keep pace with their competitors. Recruiting and retaining high-calibre staff will become ever more important. This will mean boosting
employee support and well-being, including things like flexible working patterns, mental health support. Diversity and inclusion will be just as important as ensuring salary packages remain competitive with the market.
Continuous review of staffing levels is required, and efficient and timely recruitment is needed to ensure the existing workforce is not overstretched.
Smaller practices may choose to collaborate with other similar-sized businesses so that they can share services, and therefore costs, and enable themselves to offer a wider range of benefits to their staff.
Training and re-training may also be key. The pandemic has taught all business that they need to be able to quickly adapt to change, whether that is keeping up with the PPE regulations, isolation rules, accessing new Government support measures or smarter working, where part of an employee’s role has been moved to working from home.
Some roles have had to adapt and this may have created an element of retraining and change of job role for certain employees.
Succession planning, especially where people have taken stock about their life during the pandemic and decided to take their life in a different direction, may also have become a hot topic of conversation.
Exit strategies may take a major part in a company owner’s plan. This will mean it is even more important to maintain up-to-date financial management information including cash flows and forecasts.
There have also been significant changes in taxes which need to be managed; for example, the new social levy, increase in dividend tax, future increases to National Insurance, changes to National Insurance bandings and increased corporation tax rates.
Sustainability now means more than just the environment; it includes environmental, social and human impact of businesses
Inflation is rising and this will not only affect employees but clients as well. It will be important to keep up with the market regarding fees, offerings and staff costs to ensure they remain competitive.
Private practice businesses will need to innovate and find cost efficiencies, as simply passing on price increases to your patients and customers is not a sustainable business model.
Types of products used may determine who your future customers will be. The world is becoming much more socially and environmentally aware and the products used and how they are sourced will inevitably affect future client bases. Businesses need to build on the flexibility and adaptability to change which they have had to work with over the past two years and continuously develop new ways of working to maintain a sustainable business for the future.
See ‘What Bupa is doing to go green’, page26
Julia Burn is a director at Blick Rothenberg and part of the team that advises medical practitioners
Our troubleshooter Jane Braithwaite (below) answers independent practitioners’ frequently asked questions on business matters.
This month:
‘How do I improve staff retention and ensure my team is stable? Recently, I have lost two members of staff and it will take me a long time to recruit and train new team members’
LOSING A MEMBER of staff is always painful and has a significant impact on team performance and the morale of the remaining team members.
When an individual chooses to leave their role, it is natural for their colleagues to feel unsettled and to question their own position within the organisation.
They are also likely to be asked to pick up extra work while a replacement is found and then take responsibility for training and mentoring the new recruit. The whole episode puts immense pressure on the entire team and can have a damaging effect on service delivery.
When the Covid pandemic first hit us, many of us suspected that one of the negative outcomes would be high unemployment. But we were wrong and the opposite appears to be true.
The majority of jobs survived the end of the Government furlough scheme and the fear of a huge spike in unemployment has not materialised.
Vacancies are now at a record high, with some newspapers reporting 1.2m vacancies and a shortage of skilled workers, which is having a drastic impact in many industry sectors, including the healthcare and care sectors.
One recruitment specialist has reported ‘fierce competition for talent’ and there are reports of graduate lawyers being offered starting salaries of £150,000 and signing-on bonuses by employers desperate to compete in this shortage market.
In general, though, average pay rises are not keeping up with the increase in the cost of living, and
Many employees are more highly motivated by other factors such as flexibility, culture, career development opportunities, geographical location and their relationship with their direct manager
been reminded that life is short, and they want to make the most of their time, both at work and in their social lives.
Many are burnt-out by the pandemic and desperately in need of a break to regroup and recover. Most have taken fewer holidays over the last couple of years and this has had a cumulative effect on exhaustion. The well-being of employees should be a major concern for all employers.
while wages are rising, they are not rising as fast as prices. This will lead to more people searching for a new role purely for better remuneration.
Currently, it is so much harder to recruit due to a shortage of available candidates and so replacing staff is much harder and more time-consuming. Retention of key staff is vital to protect our organisations in the current climate.
How do we ensure we retain our employees?
Most managers assume that salary is the major motivator for their employees. While salary is important, especially with the rising cost of living, for many people there are other more significant factors.
Many employees are more highly motivated by other factors such as flexibility, culture, career development opportunities, geographical location and their relationship with their direct manager.
The pandemic has led to many people thinking about what they want from their working lives with a new perspective. They have
The recruitment firm Randstad UK says that, in a typical year, 11% of workers would move roles, but its recent research in a survey of 6,000 workers found that 69% of those surveyed were feeling confident about moving to a new role in the next six months.
This trend is often referred to by the press as ‘The Great Resignation’ and is going to be hard for industries like healthcare, where the prediction is that some employees are looking to leave the sector completely, resulting in a reduced pool of available workers.
If you have had resignations within your organisation, one valuable way to learn why your employees are unhappy is to hold exit interviews with employees before they leave.
An exit interview should be hosted by an individual who is not directly working with the employee so that the meeting can be credibly viewed as confidential to encourage honesty and transparency.
The interview offers an opportunity for the employee to express their reasons for leaving and to suggest ways in which the organi-
sation can improve to retain valuable workers in the future.
A similar approach should also be adopted with all employees to understand what motivates them most about their work, what they are happy about currently and where your organisation is able to improve.
Asking questions like what additional support would benefit them will give you valuable insight into options to improve.
An HR expert will wisely advise you to create the Employment Value Proposition (EVP) for your organisation, to help you with retention of employees and the recruitment of new team members.
Employees’ perspective
As business owners, we spend much time thinking about patients and clients and how we want them to perceive our organisation, but, to create an EVP, we need to think about our organisation through the eyes of our employees.
An EVP states what employees receive in return for the talent, enthusiasm, loyalty and contribution they deliver to our organisations.
Your EVP will give you a competitive advantage in retaining your employees and attracting the best employees to join your organisation.
This is especially relevant to
organisations that do not have the budget to compete with the remuneration offered by larger competitors. You can promote other unique qualities that differentiate your business from your competitors, thus attracting the right talent.
An EVP should provide incentives that reward hard work and create a supportive, inclusive working environment.
Start by identifying all the benefits of working at your company and the unique strengths of the organisation versus its competitors in terms of remuneration, working environment, career progression, learning and development and culture.
This could be done as a team exercise at a workshop-style meeting or through the use of a simple questionnaire sent to all employees.
Covid has changed the face of the working environment and more companies are adopting a hybrid working solution.
Where this is not possible – for example, in many healthcare settings – businesses are providing more flexible working solutions such as job sharing and condensed hours to attract target audiences who value flexibility and a healthier work-life balance.
Opportunities for career progression are also an attractive proposition for high potential
individuals who are looking for challenge and growth.
Many employers like to showcase success stories of people who have risen through the ranks and who have been encouraged and supported throughout their career journey from entry-level positions to senior-level roles.
Examining the company’s policies on training, performance development and promotions will give clarity on the company’s attitude towards career progression and growth and how the company supports this by providing opportunities for learning and development and rewarding good performance management and development practices.
The culture reflects everything from human, social and even political issues. Identifying with the corporate culture can help candidates determine whether or not their values and beliefs are aligned with those of the company.
If candidates share the same beliefs, attitudes, and behaviours as those identified by the company, this gives them some reassurance of a harmonious working environment which could lead to a longer-term working relationship.
Other benefits can also cover
aspects such as financial strength and constant growth, unique services and a strong commercial footing, reassuring candidates in terms of security, stability and longevity.
In each stage of the EVP definition process, consider how the company fares against its competitors in terms of remuneration, working environment, culture, and career progression. This will help to establish the company’s unique selling points against the competition and promote aspects that are more generous or attractive than your competitors.
Creating your EVP will help you identify areas where you need to improve in your organisation and this will lead to increased employee retention.
According to research from Gartner: ‘Organisations that effectively deliver on their EVP can decrease annual employee turnover by just under 70% and increase new hire commitment by nearly 30%.’
If you have any specific questions that you would like answered, please do feel free to get in touch.
Jane Braithwaite is managing director of Designated Medical, whose experts offer bespoke support across accountancy, marketing, medical PA, HR and recruitment
Elsevier Health’s first Clinician of the Future global report reveals current pain points, predictions for the future and how the industry can come together to address gaps. Leslie Berry reports
THOUSANDS OF doctors and nurses from across the globe have revealed what is needed to fill gaps and future-proof today’s healthcare system.
Their views are recorded in new research from Elsevier Health called the Clinician of the Future report, conducted in partnership with Ipsos.
It uncovers just how undervalued doctors and nurses feel and
their desire for urgent support such as more skills training.
Training needs are highlighted especially in:
The effective use of health data and technology;
Preserving the patient-doctor relationship in a changing digital world;
Recruiting more healthcare professionals into the field.
Their voices have been elevated
The Clinician of the Future report was conducted by Elsevier Health
they are being heard will enable them to get the support they need to deliver better patient care in these difficult times.
‘We must start to shift the conversation away from discussing today’s healthcare problems to delivering solutions that will help improve patient outcomes.
‘In our research, they have been clear about the areas they need support; we must act now to protect, equip and inspire the clinician of the future.’
There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past decade, with many saying their jobs have got worse.
One-in-three clinicians are considering leaving their current role by 2024, with as many as half of this group in some countries leaving healthcare for good.
This comes on top of the existing global healthcare workforce shortage, where clinicians continue to experience severe levels of fatigue and burnout since Covid19 was declared a pandemic.
Charles Alessi, chief clinical officer at the Healthcare Information and Management Systems Society (HIMSS), called it a comprehensive report that provides an opportunity for the industry to listen – and act – on the pivotal guidance given by those on the front lines.
The report includes a quantitative global survey, qualitative interviews and round-table discussions with nearly 3,000 doctors and nurses around the world.
in this first global, multiphase research report to not only understand where the healthcare system is following the Covid-19 pandemic, but where it needs to be in ten years to ensure a future that both providers and patients deserve.
Elsevier Health president Jan Herzhoff says: ‘Doctors and nurses play a vital role in the health and well-being of our society. Ensuring
Its data helps shed light on the challenges impacting the profession today and predictions on what healthcare will look like in the next ten years, according to those providing critical patient care.
To ensure a positive shift moving into the future, and to fill current gaps, clinicians highlight the following priority areas for greater support:
Clinicians predict that, over the next ten years, ‘technology liter-
The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past decade, with many saying their jobs have got worse
This may be why global clinicians say a top support priority is increasing the number of healthcare workers in the coming decade.
Clinicians require the support of larger, better equipped teams and expanded multidisciplinary healthcare teams, such as data analysts, data security experts and scientists, as well as clinicians themselves.
THE CURRENT STATE OF HEALTHCARE
Clinicians’ views globally shown in brackets
71% of clinicians believe that more frequent training is required for clinicians to stay up to date with the introduction of new technologies (83%)
Only 35% believe the time they have with patients is sufficient to provide them with good care (51%)
47% are considering leaving their current role within the next two to three years (31%)
acy’ will become their most valuable capability, ranking higher than ‘clinical knowledge’.
In fact, 56% of clinicians predict they will base most of their clinical decisions using tools that utilise artificial intelligence.
However, 69% report being overwhelmed with the current volume of data and the same percentage predict the widespread use of digital health technologies to become an even more challenging burden in the future.
As a result, 83% believe training needs to be overhauled so they can keep pace with technological advancements.
A greater focus on the patient-provider relationship
Clinicians predict a blended approach to healthcare, with 63% saying most consultations between clinicians and patients will be remote and 49% saying most healthcare will be provided in a patient’s home instead of in a healthcare setting.
While clinicians may save time and see more patients thanks to telehealth, more than half believe telehealth will negatively impact their ability to demonstrate empathy with patients they no longer see in person.
As a result, clinicians are calling for guidance on when to use telehealth and how to transfer soft skills like empathy to the computer screen.
Clinicians are concerned about a global healthcare workforce shortage, with 74% predicting there will be a shortage of nurses and 68% predicting a shortage of doctors in ten years’ time.
Marion Broome, professor of nursing at the School of Nursing, Duke University in Durham, North Carolina, observes: ‘While we know that many nurses are leaving the profession due to burnout, we also know that the pandemic has inspired others to enter the field because of a strong desire for purposeful work.
‘We must embrace this next wave of healthcare professionals and ensure we set them up for success. Our future as a society depends on it.’
Looking to the future
Now Elsevier Health says its research findings will be used in initiatives to try and address the gaps highlighted:
Providing an annual Elsevier Health Clinician of the Future pulse survey to ensure these voices continue to be front and centre;
Convening a global coalition of healthcare leaders and institutions to explore solutions at the medical school and clinical practice level;
Exploring the issue of patient empathy in partnership with its research journals and subject matter experts.
Thomas (Tate) Erlinger, the company’s vice-president Clinical Analytics, says: ‘Ultimately, we asked clinicians for what they need and now it’s our responsibility as a healthcare industry to act.
‘Now is the time for bold thinking to serve providers and patients today and tomorrow. We need to find ways to give clinicians the enhanced skills and resources they need to better support and care for patients in the future.
‘And we need to fill in gaps today to stop the drain on healthcare workers to ensure a strong system in the next decade and beyond.’
To read a copy of the report, go to www.elsevier.com/connect/ clinician-of-the-future
18% feel like the importance of their work is appreciated by government officials (30%)
72% believe that big data will be integral to managing population health (80%)
69% believe that technology companies will be key stakeholders in managing healthcare systems (77%)
65% believe most consultations between clinicians and patients will be remote (63%)
68% believe health inequalities will continue to be exacerbated by the use of digital health technologies (DHT) in the future (64%)
41% believe the majority of healthcare will be provided in a patient’s home instead of a healthcare setting (49%)
70% believe patients will be more empowered to take care of their own health (66%)
79% believe patients will have easy access to remote monitoring tools to assess their health and well-being (79%)
60% believe that the relationship between clinicians and patients will be more of a partnership (62%)
86% believe that age-associated conditions will make up most of the patient population by 2031 (84%)
73% believe there will be an increase in co-morbidities among younger patients by 2031 (71%)
70% believe the widespread use of DHT will be a challenging burden on clinicians’ responsibilities (69%)
58% believe they will be experts in the use of digital health technologies by 2031 (67%)
60% believe that telehealth will negatively impact a clinician’s ability to demonstrate empathy with patients (51%)
36% of doctors and nurses are predicted to retire within the next two to three years (21%)
90% believe that being ‘technologically-savvy’ is an important skill in a clinician’s daily role and has increased in importance over the past ten years (88%)
80% say they need to have a greater understanding of the economics of healthcare (83%)
97% believe an ageing population is driving more change across markets (93%)
The private healthcare sector is going through a period of rapid change post-Covid, as Simon Marett (right) discussed in Independent Practitioner Today in April. Here he looks at how this is presenting new challenges for independent practitioners
Marketing has become highly sophisticated over the last ten years and the number of options available to practitioners can be bamboozling
CONSUMER BEHAVIOUR is changing quickly, competition in private healthcare is increasing, and practitioners are now thinking seriously about marketing, often for the first time.
Marketing is a term that is often misunderstood in healthcare, but it is a vital function for any successful healthcare business or clinic that wishes to grow.
Often the biggest challenge that a clinic faces is finding or acquiring new patients.
Alongside the traditional marketing channels of print advertising, events, sponsorship and direct mail, there is now a multitude of digital channels to consider including:
Digital display advertising;
Social media advertising;
Paid search;
Retargeting;
Digital sponsorship;
Search engine optimisation (SEO);
Email marketing.
All these channels can be good options for healthcare practitioners, and they need to be explored, tested and assessed to find the right blend that works for your clinic.
Here are some of the digital marketing channels and activities to consider:
healthcare service or clinic. This is often done via a customer relationship management (CRM) platform like Mailchimp, Salesforce or Hubspot.
➲
Retargeting – tracking prospective patients that have visited your website previously and placing advertising on their devices that ‘retargets’ them and reminds them of your service.
As this hopefully demonstrates, marketing a healthcare clinic or service is not as straightforward as you may think and it is often worth talking to a reputable marketing consultant or agency for advice before you start.
The risk of diving into marketing without the right level of research or advice is that you can quickly waste valuable budget that does not deliver the results you are hoping for.
In this feature, I will cover some of the main considerations and marketing ‘channels’ that are open to practitioners when they are looking to grow their patient base.
Finding new patients is not as easy as you think
It is not uncommon for a private healthcare clinic to underestimate the time, resources and effort it takes to acquire and build a base of paying patients.
We often get approached by clinics who have gone through the Care Quality Commission application process, hired staff and built the operations and then just expect paying patients to turn up at the door.
➲ Paid search/pay per click (PPC) – spending money on a text advert to appear when someone searches for a type of treatment, condition or clinic that you specialise in. A good option to drive new traffic quickly.
➲ Search engine optimisation (SEO) – investing time, energy and resources in content creation such as blogs, articles and videos so your website appears high up on organic searches. This is not advertising, unlike PPC, but it can take months and even years to see the results.
➲ Digital display advertising – creating a digital advert for your clinic to appear on certain websites to help promote your healthcare clinic or service.
Any good marketing agency or expert should be discussing tracking and return on investment with you and ensuring that for every pound spent, you are generating more than a pound in revenue.
A key point here is that every healthcare clinic is different and competing in different fields of medicine, so marketing activity that may work brilliantly for one clinic may not work for another.
The starting point for any conversation about marketing should always be around what the clinic is trying to achieve and then developing a marketing plan, budget and blend of channels to hit those goals.
But, in our experience, private healthcare just does not work like that, and it takes planning, effort, and investment to build a patient acquisition strategy to attract new patients.
What marketing options/ channels should I consider?
Marketing has become highly sophisticated over the last ten years and the number of options available to practitioners can be bamboozling.
➲ Social media advertising – like digital display advertising, this involves identifying a certain demographic on a social media platform – such as Facebook or Instagram – and paying for your advert to appear on a prospective patient’s feed.
➲ Email marketing –Creating a database of prospective patients – I will cover this in subsequent features – and then emailing them directly to promote your
Next month: the activation aspect of marketing and the various tactics you can use to build a database of prospective patients that you can market your healthcare service or clinic to in the future.
Simon Marett is founder and director at Ellerton Marketing
Ellerton Marketing is providing a free 60-minute business ‘health check’ for Independent Practitioner Today readers and can help guide you through some of the key steps you should be thinking about when it comes to marketing your clinic and acquiring new patients.
The pandemic clearly had a major impact on health services across the globe, diverting resources to treating Covid-19 patients. As we attempt to return to normal, will this result in a boom in demand for treatment abroad? Keith Pollard reports
eases, hospital capacity is still reduced. Covid-19-safe protocols will remain in place for some time to come. Infection control measures in place in most hospitals add time to operating theatre procedures. It is estimated that this, in effect, is reducing theatre capacity by as much as 20%.
It’s not just elective surgery that has been impacted. Dental clinics closed down throughout the pandemic and continue to implement time-consuming Covid-19 protocols. The end result: long waits for routine dental treatment and for more complex treatments such as dental implants.
These factors are not unique to the UK. Patients in many countries are facing delays in accessing treatment within their domestic healthcare systems.
In the US, a McKinsey survey of health system leaders, hospital executives report that they may struggle to address this backlog, given work force availability, enhanced sanitation protocols and reserved inpatient capacity.
An analysis of cataract surgery volumes estimated that the US may face a backlog of 1.1m to 1.6m cataract procedures in 2022.
An opportunity for medical travel?
AS THE pandemic subsides and hospitals begin to get back to the business of treating non-Covid patients, patients are facing major challenges in accessing the healthcare they need or the treatment that has been delayed through the pandemic.
Several factors are driving this pent-up demand. In many countries, Covid-19 patients filled up hospital bed capacity and blocked the provision of elective surgery that would normally be undertaken.
The UK is a prime example of the pandemic’s impact. At the end of
December 2021, the UK’s NHS waiting list had risen to 6.1m.
It is estimated that this could rise to 9.2m, possibly to as many as 10.7m by Spring 2024.
The pent-up demand for treatment does not only include those patients who are already waiting for treatment.
Analysis published by the Health Foundation shows that while UK waiting lists continue to grow, so too does the number of ‘missing’ patients who have not yet been added to the list.
There were far fewer patients referred for routine hospital care than would have been expected based on numbers prior to the pandemic. These ‘missing patients’ will add more pressure to the waiting list.
With the delays in diagnosis of diseases such as cancer, patients are coming forward at a later stage of disease progression.
The more severe form of a disease such as cancer takes longer to treat, requires resource-heavy forms of treatment and is more expensive.
Even as the pandemic pressure
If patients can’t access the surgery or treatment that they need in their own country, under their public healthcare system or state-funded health insurance, will this prompt them to pay for the treatment either domestically or in another country?
The early evidence in the UK is certainly an increase in demand for ‘self-pay’ surgery in the country’s private hospitals.
HCA Healthcare, in London, has seen a 25% increase in self-pay hip and knee replacements and Spire Healthcare has reported a 47% growth in half-year revenues from self-paying patients. Some international clinics are also reporting renewed interest and bookings from foreign patients.
So, if you’re looking to attract overseas patients who are frus -
Success in medical travel is about being focused on what you are exceptionally good at
trated by the delays and the cost of treatment in their own country, here’s what you need to do.
1
Ensure you understand what is going on in your targeted source countries. Do some research:
a) Identify the areas of potential demand. Hips and knees? Cancer diagnosis and treatment? Dental treatment?
b) Understand the geography of demand in the source country. Are there specific regions where demand is high? In the UK,
regional waiting list times are made public on the web. Research the catchment areas around the regional airports that fly direct to your country.
2
Get your pricing right. Remember that cost is a major driver of many forms of medical travel.
a) Make sure you know the price the patient may pay for treatment in their own country.
b) Factor in the costs of travel and accommodation.
c) Ensure that your price point is attractive enough to deliver significant saving to the patient.
d) Offer an all-inclusive package. Don’t surprise the patient with hidden extras.
3 Get the product right.
a) Do you understand and can you meet the language and cultural needs of the patient?
b) Are you providing a comprehensive and supportive service throughout the patient journey –from initial contact through to booking and treatment, then support when the patient has returned home?
4
If there is one thing that patients want, post-pandemic, it is reassurance about quality and safety.
a) Can you provide clear evidence of your expertise? Outcome data? Quality data?
b) Can you convince the patient that you operate a ‘Covid-safe’ environment?
c) Can you provide multiple patient testimonials from similar patients who can support your claims?
5
And last of all, measure your success – or failure.
a) Set some very clear objectives.
b) Make sure they are SMART –specific, measurable, achievable, relevant and timely.
c) And within SMART, focus on specific. Do not try to be ‘all things to all men’ – or to all patients.
Success in medical travel is about being focused on what you are exceptionally good at and on a very clearly defined target group of patients – in terms of disease, source country and demographic.
The next 12-24 months represent some very clear opportunities for medical travel.
The pent-up demand is there. Can international hospitals and clinics ‘strike while the iron is hot?’
Keith Pollard (right) is editor in chief of the International Medical travel Journal, in which this article first appeared
Independent Practitioner Today takes a look inside the UK’s newest private hospital – the 184-bed Cleveland Clinic at 33 Grosvenor Place, London
The eight-storey hospital, with 29 ICU beds, eight operating theatres, a 41-bed neurological rehabilitation ward and around 1,150 staff –including nearly 300 doctors – promises ‘the highest-quality care and world-class patient experience’.
In the US, Cleveland Clinic was among the first to publish outcomes. Since 2004, it has required all clinical specialties to collect and publish comprehensive data every year.
Originally built in the 1950s as the headquarters for an energy company, its London building has been extensively renovated and redesigned.
Throughout the renovation process, the organisation prioritised reducing the facility’s environmental impact, with 98% of the original building’s materials recycled.
It will produce some of its own heat and power through a combined heat and power plant to significantly reduce carbon emissions.
Good communication is essential in ensuring patients receive safe care, but it may also reduce the likelihood of patient complaints and claims if something goes wrong. Dr James Thorpe (right) explains more
WE EACH react differently to challenging situations in life and the same applies to how we react to challenging encounters with patients.
Sometimes these reactions are effective; sometimes they are not and this is true for even the most experienced consultants.
A recent survey by the Institute of Public Policy Research showed that 31% of British adults have found it difficult to access NHS services during the pandemic, with 12% saying they had pursued private healthcare instead .
Private practitioners may therefore be seeing patients who have experienced delays and are frustrated or anxious.
It is important to continually hone and develop communication skills that enable you to consciously choose how you would like to respond to a range of challenges from patients in order to bring about a favourable outcome.
The majority of complaints and claims are not related to the clini-
cal quality of care a patient has received.
A relationship breakdown often occurs before the incident that leads to a complaint. Put simply, when something goes wrong, your patient is more likely to make a complaint or claim if communication is poor.
Claims and complaints data, and international research, consistently demonstrate that patient dissatisfaction with their doctor’s communication fuels the majority of complaints, and poor communication and a perceived lack of caring is instrumental in patients’ decisions to sue.
But is the converse true? Is being a good communicator and demonstrating caring associated with a lower risk of sustaining patient complaints?
The answer is ‘yes’: studies have found that positive communication behaviours increase patients’ perceptions of competence and
decrease their intention to complain or sue.
In addition to continuously perfecting your professional skills, remember to also take time to perfect communication and empathy skills.
It is the combination of both technical and emotional performance that appears to single out the route to ongoing overall excellence as a healthcare provider, and it is essential in reducing the risk of a complaint or claim.
Patients who are kept informed about their condition or the steps being taken to deal with their issue and feel listened to and involved in the care they receive are more likely to comply with the treatment recommended and less likely to complain if things go wrong.
If you think about a situation where you found a patient challenging, did your emotions in this situation affect how you communicated with the patient?
Our emotions naturally influ -
ence our behaviour, which then impacts on the outcomes of these difficult interactions.
Everyone perceives some interactions as ‘difficult’ and a host of interpersonal and situational factors can contribute to the perception of difficulty.
Researchers and educators have come to understand that it is the relationship or the interaction that contributes to the difficulty. It is easy to identify or label a patient as ‘difficult’.
However, research shows how this labelling of a patient affects not only the emotions of the clinician but also their cognitive processes, leading directly to poorer clinical outcomes for these patients. Other potential outcomes from difficult interactions include increased investigations, decreased patient satisfaction and unmet expectations.
We have all seen patients who we knew or suspected were receiv-
A relationship breakdown often occurs before the incident that leads to a complaint. Put simply, when something goes wrong, your patient is more likely to make a complaint or claim if communication is poor
ing over- or under-treatment as a result of interactional difficulties with their doctor.
Of course, this has implications for the individual patient and for medico-legal risk because of the risk of a complaint and/or claim arising from a breakdown in the relationship.
This is why I believe that, regardless of experience, there is value in taking time to examine how you can handle such interactions in the most effective way.
Several skills can be used to ensure you make a good impression with patients. When interacting with doctors, most patients note their non-verbal skills more than they report on other aspects.
For example, you rarely hear a patient saying: ‘Their clinical skills were excellent’. You are far more likely to hear patients reporting: ‘She was very kind and empathetic’ or: ‘He explained the process to me very clearly’. By maximising verbal and nonverbal skills, you are able to exert
some control over the impression patients create. Doctors who are perceived by patients as caring, kind and focused on patient needs can go a significant way to reducing the risk of complaints.
‘Active listening’ is a term that most of us will be familiar with. This involves fully concentrating on what is being said rather than just passively ‘hearing’ the message, and conveying that to the patient using eye contact or smiling.
Posture can also help in tuning into certain cues, words and emotions in the patient that may indicate distress and other highly charged emotions.
Continually honing your communication skills throughout your career will help in defusing difficult patient interactions, reduce the risk of a complaint or claim and ultimately ensure you continue to provide care to the best of your ability.
Dr James Thorpe is a medico-legal adviser for Medical Protection
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Efforts by private doctors and hospitals to make our planet a healthier place to live are gathering pace. Here, Bupa’s James Sherwood (right) follows his analysis last month on the impact of climate change on our health with a round-up of the insurer’s efforts to become a net zero emissions business
WHILE CLIMATE change is our reality, and it is going to change the way we provide care, we should not let it deter us from taking a more sustainable approach.
We can all make healthy and environmentally friendly behaviour changes that last. At Bupa, we are on a journey to help make a better world. We are committed to doing all we can, environmentally and in our communities, to make a positive difference.
Here are some examples of the things we are doing, which we hope will provide some inspiration.
As a healthcare company, we consider it vital to lead with action in reducing our environmental footprint in delivering healthcare, particularly given the now indisputable links between the environment and human health. That is why we have set a goal to become a net zero business by 2040 across all our operations.
As a first step to achieving net zero emissions by 2040, Bupa has set science-based targets which are aligned to keep global warming to no more than 1.5°c. These targets
will ensure we make transformational progress this decade.
Last year, we worked with the Association of British Insurers on an ambitious climate action roadmap for our industry. As part of this, we are committed to getting our UK-based insurance businesses to net zero for direct emissions by 2025 – and we’re not far off already.
Steps we have taken so far to reduce our impact include: ➲ All our UK operations run on renewable electricity and some on biogas. Our Leeds, London and award-winning Manchester office
buildings are energy-efficient, with an ‘excellent’ BREEAM rating.
➲ Food waste in Bupa care homes and at the Cromwell Hospital is recycled into green energy.
➲ Over the past decade, we have invested £23m in eco-friendly technology including solar power, LED lighting and building energymanagement systems.
➲ Our priority is to significantly reduce greenhouse gas emissions to as close to zero as possible. Until we get to net zero, we will offset any remaining emissions by investing in nature-based solutions.
In the UK, we have supported the UN’s Climate Neutral Now initiative since 2019. Offsetting is done by supporting projects that reduce or remove greenhouse gas emissions from the atmosphere.
We do this by working with One Carbon World, a not-for-profit partner of the UN’s Climate Neutral Now initiative. As part of this, we are investing in reforestation projects in South America and renewable energy projects in India.
To keep up momentum, we will:
Get to net zero in our direct operations by 2030 and across all areas, including our supply chain, by 2040 ;
Work with our supply chains and partners to eliminate carbon emissions and reduce our overall footprint;
Switch our company cars from petrol and diesel to electric and hybrid;
Automate the way we use heat, light and power to improve our buildings’ energy efficiency.
Delivering through partnerships
We are working in partnership with Forum for the Future, Walgreens Boots Alliance and GSK Consumer Healthcare on how health companies can improve both people and planet health, this includes co-authoring the report ‘Driving co-benefits for climate and health’.
We have also joined the wider healthcare community signing the #HealthyClimate prescription letter, calling on governments and policy-makers to act on the current climate and health crisis, and contributed to the World Health Organization COP26 Special Report on Climate and Health.
Driving innovation
We are innovating so we can care for our customers in ways that are
better for them and the planet, including:
☛ Offering customers access to our Digital GP service so they have the option of a consultation by video call. This takes cars off the roads and cuts down on energy use in practices. Our customers rate it highly.
☛ Continuing to add more and more no-travel options for healthcare, including our remote health assessments, physio services and our skin assessment service, where customers are sent specialist imaging equipment to take photos of any skin worries which are then assessed by consultants.
☛ Our charity, the Bupa Foundation, has provided funding for Asthma UK’s WhatsApp service for people experiencing longCovid symptoms.
Last year, we launched our ecodisruptive global innovation challenge, an initiative which brings together three elements of Bupa’s new strategy: sustainability, agile culture and digital transformation.
It saw 126 Bupa employees across the world partnering with about 500 eco start-ups on six challenges:
Reducing carbon emissions;
Improving air quality through greener transport;
Eliminating waste and reducing consumption;
James Sherwood reported last month on how climate change is affecting healthcare
Increasing, restoring or protecting biodiversity;
Making our cities healthier;
Empowering people to improve their health and that of the planet.
The winner was Spanish start-up Circoolar which received the most votes from Bupa’s employees worldwide for its pilot focused on making ethical and sustainable uniforms for healthcare professionals by turning plastic bottles into fabric.
Plastic contributes to greenhouse gas emissions at every stage of its lifecycle, from production to refining and the way it is managed as a waste product. Each uniform prevents waste from 18 plastic bottles ending up in the ocean or landfill.
Circoolar will receive a £200,000 investment from Bupa.
Australian start-up AirSeed, an innovative environmental restoration company, and the UK’s Upcycled Medical, who make textiles from discarded plastics, were the runners-up and will also receive investment from Bupa.
Supporting
Eco-anxiety is anxiety related to our relationship with the environment and the fear of climate change.
Young people, particularly, are worried, depressed and angry about climate change and this is
heightened by media coverage of rising temperatures, forest fires and melting ice caps.
Through The Bupa Foundation, we are investing 1% of our profits into our local communities, including three programmes which have a positive impact on people’s mental health.
We have partnered with Mind to provide funding for online wellbeing resources to support 11-25 year-olds with their mental health, including how to cope with the impact of the pandemic and climate change. This aims to reach 2.5m young people by the end of 2022.
Our free Wellbeing for Educators workshops for school staff has reached more than 3,000 young people and educators who used resources for the Bupa Foundation’s Beyond Words programme, which encourages creative writing to support mental well-being.
Our employees’ Community Committees in Bristol, Manchester, Leeds, London and Staines, Middlesex, support local charities that help vulnerable people by providing grants, volunteering and fundraising for them. They also use volunteering days to support charities of their choice.
James Sherwood is general manager, operations and healthcare management, Bupa
Calling private healthcare companies, hospitals, clinics and doctors – be an inspiration to others and tell Independent Practitioner Today what you are doing as a contribution to becoming a net zero business. Email robin@ip-today.co.uk
So what are your risks as a company director? This report from Justin Cumberlege (far right) and Alison Oliver (right) may surprise you
MANY DOCTORS are forming companies to deliver healthcare services and they carefully consider the risks for the company, and how to insure against them.
But few stop to think what liabilities they are taking on as directors.
Unlike the shareholders, whose risk is the loss of what they paid for the share – or, in a few cases, agreed to pay but have not – directors’ risks are unlimited. If they breach the laws governing directors’ duties, they may end up with fines and even imprisonment.
Directors have the responsibility of running the company for the shareholders and, as companies have become larger, the law has stepped in to ensure they are obliged to protect shareholders’ interests and help potential investors to have confidence to invest in the company.
While this does not apply to the same extent to small private com-
If directors breach the laws governing directors’ duties, they may end up with fines and even imprisonment
panies – those who do not trade their shares on a public stock exchange – many of the laws still apply.
Under company law, every company must have at least one director.
The role of the directors is to oversee the day-to-day management of the company. This includes ensuring that the com -
pany complies with laws and regulations, such as:
Health and safety laws;
Data protection laws; Employment law;
Environmental law;
Anti-bribery and equalities legislation;
Insolvency laws;
Company law – including the records and administrative matters referred to above.
Directors may delegate responsibility for these matters to employees or a company secretary, but they retain overall responsibility for ensuring the company complies with all relevant regulations.
Directors have a general power to make decisions concerning the operation of the company.
How ever, certain matters are reserved under company law to be decided by the shareholders – for example, changing the company name or adopting new articles of association.
In addition, the articles of association, which are the firm’s constitution, might reserve certain matters to be decided by the shareholders –for example, capital expenditure over a certain threshold.
Directors’ duties
Directors are subject to seven general duties under the Companies Act:
1
To act within their powers – Directors must act in accordance with the constitution of the company and only exercise their powers for the purposes for which they are conferred.
2
To promote the success of the company – Directors must act in the way they consider, in good faith, would be most likely to promote the success of the company for the benefit of its members (shareholders) as a whole.
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3
To exercise independent judgement – Directors must exercise their powers independently, without subordinating their powers to the will of others.
4
To exercise reasonable care, skill and diligence –meaning, in the words of the Act, the care, skill and diligence that would be exercised by a reasonably diligent person with:
(a) The general knowledge, skill and experience that may reasonably be expected of a person carrying out the functions carried out by the director in relation to the company, and
(b) The general knowledge, skill and experience that the director has.
Paragraph (b) is subjective; if a director is a qualified accountant, he would be expected to bring those skills to bear on the matters of the company. It does not mean he does the work, but they should integrate the accounts using their skill.
Paragraph (a) is more objective, requiring that all directors must keep up to date with the activities of the company and participate in the decision-making, using the skills and knowledge they have.
5
To avoid conflicts of interest – Directors must avoid situations in which they have or can have a direct or indirect interest that conflicts with, or may conflict with, the company’s interests.
This duty will not be infringed where the conflict is authorised in accordance with the articles. Having a robust conflicts of interest policy is important.
6 Not to accept benefits from third parties –Directors must not accept any benefit – including a bribe – from a third party which is conferred because of their position as director.
7
To declare an interest in a proposed transaction or arrangement with the company – Where a director is in any way interested in a proposed transaction or arrangement with the company, they must declare the nature and extent of that interest to the other directors.
The shareholders may authorise
the directors to do or omit to do something which might otherwise be a breach of duty.
duties
Directors also owe various other duties, such as:
A duty of confidence in respect of the company’s confidential information;
A duty in certain circumstances to consider or act in the interests of creditors.
Directors have particular responsibilities if the company is in financial difficulty. There is a statutory offence under the Insolvency Act 1986 if a company trades insolvent.
Once a director or directors of a company conclude – or should have concluded – that there is no reasonable prospect of the company avoiding an insolvent liquidation or administration, they have a duty to take every step reasonably possible to avoid losses to the company’s creditors.
If, after the company has gone into insolvent administration or liquidation, it appears to the court that a director has failed to comply with this duty, the court can order the director to contribute to make good the losses.
There are also offences of fraudulent trading, where the director carries on the business of the company with the intention to defraud creditors, and misfeasance, defined as the misapplication or retention of property of the company.
If a company is in financial difficulty, directors should take independent advice to avoid the possible personal consequences.
The majority of a director’s duties are owed to the company. In certain circumstances, shareholders may be able to bring a claim on the company’s behalf, and liquidators and administrators may apply to the court to examine whether there has been a breach of duty in situations where the company is insolvent.
Regulators may enforce breaches of legislation against directors.
Remedies for the company and others enforcing breaches of duty on the part of directors include:
Directors must avoid situations in which they have or can have a direct or indirect interest that conflicts with, or may conflict with, the company’s interests
hold certain NHS contracts, and may not be permitted to be a charity trustee.
Companies are permitted to take out insurance to protect the personal assets of directors in the event they are personally sued for wrongful acts, such as acting outside their powers, in managing the company.
However, this insurance would not protect a director in the event that they commit a criminal offence.
Directors may sometimes be asked to provide personal guarantees for the performance of particular obligations by the company. Directors should always take independent advice if asked to provide a personal guarantee.
Injunction – compelling the directors to do or refrain from doing something; Damages – to compensate the affected party for their losses.
If a director is found liable for wrongful or fraudulent trading or misfeasance, they could be required to contribute to the company’s assets, although this is rare in practice. Fraudulent trading is also a criminal offence.
Directors could also be prosecuted for offences under health and safety and other legislation.
A court may make a disqualification order against a person that they shall not, without leave of the court, be a director of a company on the basis that they are unfit for that office.
This would usually be as a result of misfeasance or breach of fiduciary duty or a material breach of legislation.
A person who is disqualified from acting as a director is not eligible to hold other offices as well, like certain public offices or to
Certain people may owe duties as a director even if not validly appointed as such. These include, in particular: De facto directors: a person who assumes the responsibility to act as a director, even if not actually or validly appointed as such; Shadow directors: a person in accordance with whose directions or instructions the directors of a company are accustomed to act. So if you are thinking of having a company controlled by you without you actually being a director, this would not mean you are not liable as a director. Also, you may need to register as a person with significant control at Companies House.
Incorporating a company is very easy but ensuring that you are complying with the obligations of a director should not be overlooked.
Disclaimer: This article is for information purposes only and should not be relied on as legal advice. Neither the authors nor Hempsons will be liable for losses arising from reliance on the information in this article. The article is based on the law of England and there might be variations in other jurisdictions.
Justin Cumberlege and Alison Oliver are partners in the healthcare law firm Hempsons and provide advice to company directors
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As part of Medical Billing & Collection’s celebration of 30 years in the sector, Simon Brignall (right) continues to highlight 30 key areas practices need to master to overcome the challenges to collect their money. Here are his next ten
I often meet with consultants working in private practice who ually or on a mixture of a word processing, diary and spreadsheet
Even when they use practice
based, these are often run on laptops or PCs which are not
ness recovery perspective, because if the device is lost, the software becomes corrupt, the hardware fails and then the consultant’s record-keeping and finances are put at risk, with all that this
When commencing private practice, one of the first things consultants should do is to ensure they have
A vital element of this would involve having a robust auditable system to facilitate the financial processes of the practice. This should include the ability to:
Raise invoices and take 24/7 payments;
Reconcile payments;
Employ a robust chase process, including the ability to follow up on outstanding invoices using a range of communication methods. If you are already in private practice, but currently do not have the appropriate infrastructure in place, then I recommend you put it at the top of your list of action points.
At Medical Billing & Collection, we use our own proprietary software, ensuring that even practices we partner with who rely on manual systems now have the infrastructure and functionality of a modern practice.
12 Have an audit trail Whatever system you adopt, you need to ensure the billing for the practice is auditable and accurate so that figures can be easily generated for your accountant.
This will save time and give a sense of comfort should the taxman ever wish to inspect your practice, as these figures will be clear and easy to read.
It is worth noting that Her Majesty’s Revenue and Customs (HMRC) has often targeted the medical sector, as it has had a poor reputation for record-keeping.
13
GDPR
There are not many of you who will be unaware of General Data Protection Regulations (GDPR) or have not had some form of GDPR training. It is important to ensure your practice and any software you use conforms to these regulations. Our systems and processes are fully compliant; our contract includes a data-sharing agreement and our privacy policy is available on our website.
14
Know the state of play
Easy access to accurate and up-todate practice data that can be reviewed using a range of parameters is vitally important.
This is because it is the first link in the chain for many key activities, such as the chasing of outstanding invoices or to allow you to conduct a practice review. If you do not have access to this key data, then you are unable to make any progress in revenue management or make informed decisions about your practice.
IMPORTANCE OF BEING SEEN
15 Ensure you stand out
It is important to review your presence online and ensure that whatever you find puts you in the best light.
Even if you do not have a website, you will find you are probably on multiple sites which may include the hospitals where you work and your Bupa profile. Make sure the information displayed is up to date and ensure you have a professional profile picture. Many studies show patients are more likely to engage when there is a picture of a person they can relate to.
Where possible, and this especially includes on your website, remember your audience is prospective patients, not your colleagues. Tailor your messaging to your patients’ needs rather than as an attempt to impress your colleagues by detailing your CV or a list of your accomplishments.
THE CODE OF INSURANCE BILLING
16 CCSD
Once a consultant has decided on their pricing policy,
As a good rule of thumb, the practice should set the goal of billing within 24 hours of any treatment carried out. This will ensure good cash flow and minimise bad debts
the price of the first code by 40% and add that figure to the price of the first code.
If two codes are used, then multiply the price of the first code by 25% and then add that to the first code.
Example 2. PMI formula – If three codes are used, you take the first code price and add 50% of the second code price and then add 25% of the third code price.
As the invoice is the first step in the revenue cycle process, it is important for a practice to raise its invoices promptly.
they need to ensure they keep abreast of all the changes to the Clinical Coding Schedule and Development group (CCSD) codes applicable to their specialty. There are more than 2,000 procedure codes alongside diagnostic codes to choose from.
Changes to the coding schedules are implemented monthly. There can be replacement codes, new codes, changes to descriptions and the ability to bill multiple codes together.
All of this can also impact on what can be charged to each insurer. Lack of knowledge in this area can often lead to undercharging for procedures or billing problems with the private medical insurers (PMIs) that can delay payment.
Continuing to incorrectly invoice insurers can result in punitive action in extreme cases.
17
Pricing is key
Each PMI can choose to adopt the CCSD schedule in full, in part or choose to use its own coding when necessary. Each has its own fee schedule for each code, and these are also subject to change.
So it is important to keep abreast of the latest fee schedule to ensure you optimise your income as well as to ensure you are not invoicing incorrectly. Persistent billing problems can cause delays in payments and, in extreme cases, derecognition by the insurer.
18
Formula for success
If this was not enough, you need to understand the various formulas that can be applied for each insurer, dependent upon the number of codes used. Here are some examples for the billing of multiple codes: Example 1. PMI formula – If three codes are used, you multiply
Example 3. As in example two, but you cannot charge for the third code.
You also need to understand what codes can be billed together, which is often referred to as the bundling and unbundling rules.
In conjunction with all the above, there are many PMIspecific rules you need to know to bill correctly.
These include, but are not limited to, the following:
One PMI will not allow a followup consultation or inpatient care to be billed within ten days of surgery, as they determine that the CCSD price includes the post-op element of care.
Another PMI will allow followup consultations to be billed without any time limits, but the number of inpatient care days which is included within the CCSD code can differ, depending upon the specific CCSD code performed in surgery.
All other PMIs will allow inpatient care to be billed without any of the above restrictions.
A PMI will only allow certain codes to be billed in conjunction with a follow-up consultation.
Delays in invoicing not only reflect badly on the practice, which can negatively impact the patients view of their treatment, but it also means the practice’s cash flow suffers. Remember that the longer the delay in raising an invoice, the greater the risk it results in a bad debt.
Some insurance companies now have strict time limits – typically six months – in which they need to receive an invoice otherwise they will not pay.
Another advantage of invoicing promptly is that any problems are highlighted earlier, which can often improve your chances of these being resolved.
As a good rule of thumb, the practice should set the goal of billing within 24 hours of any treatment carried out. This will ensure good cash flow and minimise bad debts.
Billing requires accuracy as well as speed. It is important there is a checking process to make sure the invoice is accurate and contains all the relevant information before it is sent to the relevant payment company or patient.
Mistakes made on invoices make the practice look unprofessional and can also lead to losses in income and impact cash flow.
Simon Brignall is director of business development at Medical Billing & Collection, which is celebrating 30 years of partnering with consultants in private practice
We should pay more attention to the gap between what a fund earns and what an investor makes. Dr Benjamin Holdsworth (right) on why percentages are important
IN THE investing world, there are some quirky mathematical outcomes that are worth remembering.
The first is that if an investment goes up 100%, it only has to go down 50% to get back to where it started.
And the second is that if an investment goes down 50% it has to go back up 100% to get back to where it started. It may seem obvious but it is useful to keep in mind.
The past two years have given us quite a few live examples of this maths in action, including Cathie Woods’ innovative technology fund ARKK, an actively managed Exchange Traded Fund (ETF).
ARKK posted a stellar return of around 200% from the start of 2020 to February 2021. Cathie Woods quickly became the darling of US financial media and TV shows.
If we compare that to a more typical robust, diversified portfolio comprising 60% in global equities and 40% in higher quality bonds, which returned in the region of 8% over the same period, we may feel a bit disappointed.
As we have counselled before, there are two sides to the investment coin
FIGURE 1: ‘PEAK’ ARKK (1 JAN 2020 TO 21 FEB 2021)
FIGURE 2: ‘PEAK’ ARKK (21 FEB 2021 TO 12 MARCH 2022)
Yet 8% is actually a good outcome, given that in the first quarter of 2020 the markets fell substantially on the back of the pandemic. (See figure 1)
If we roll on from the ‘peak’ of ARKK to 12 March 2022, we can see the asymmetry in percentage returns in action. ARKK has lost over 60% and is now almost back to where it started the period, despite its 200% rise. (See figure 2)
Over the whole period, ARKK is up 13% and the global balanced portfolio is up 9% (nine), so not much to choose between the two, or is there?
As we have counselled before, there are two sides to the investment coin. One is return and the other is risk. Over the whole period, the ARKK fund is almost four times more volatile than the global balanced fund, which makes it inherently harder to live with.
The other useful lesson to take from this example is that most of the stellar performance occurred when the ARKK fund was relatively small. The 200% performance quoted above assumes that a lump sum was invested on 1 January 2020 and held for the period under review.
Yet the fund only became popular once the bulk of the rise had already happened. A large component of investors’ money was invested at or near ‘peak’ ARKK and has suffered the bulk of the subsequent fall.
Morningstar – a reputable, independent fund research house – has estimated that in the three years to 31 December 2021, the total return (relating to a lump sum invested at the start of the period, otherwise known as a time-weighted return) was around 35% a year in US$ terms.
On the other hand, if fund flows are accounted for, the average investor generated a return somewhere in the region of 10% a year,
Sometimes the ‘tortoise’ investor can feel left behind, but the diversified nature of their portfolio . . . results in a much smoother journey to their destination known as the investor or moneyweighted return.
This 25% or so annual difference between what the investment returned and what the average investor gets back, is sometimes referred to as the ‘behaviour gap’.
Sometimes the ‘tortoise’ investor can feel left behind, but the diversified nature of their portfolio across markets, sectors, companies and other asset classes such as bonds, results in a much smoother journey to their destination.
The highs may not be so high but the lows take less recovering from, reining in the ‘hare’ investor.
This should encourage tortoise investors to stay invested. The mathematics of percentages in investment returns may be quirky, but it is important.
Dr Benjamin Holdsworth is a director of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS.
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions.
Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
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Dr Kathryn Leask (right) describes a troubling scenario with a patient
QA patient attended for an annual health check yesterday, which was arranged by his employer. He was in good physical shape, but when I asked him about his mental health, I was quite disturbed by his response.
The patient said he had been unable to sleep properly since his partner left and was unable to stop thinking about whether she was in a new relationship. He confided that he had followed her back to her new flat from work and was now parking outside at weekends to ‘keep an eye on her’.
I’m concerned his behaviour
will escalate. He seemed consumed by anger. Should I report him to the police?
AThis is a situation where disclosing information to the police may be necessary to protect the patient’s ex-partner.
The big question for you to consider is whether the risk that he might cause her serious harm outweighs his right to confidentiality and the wider public interest in medical care being confidential.
The GMC’s Confidentiality guidance explains that confidentiality is very important for doctorpatient relationships, but it is not absolute.
It continues: ‘There can be a public interest in disclosing information if the benefits to an individual or society outweigh both the public and the patient’s interest in keeping the information
The GMC’s Confidentiality guidance explains that confidentiality is very important for doctor-patient relationships, but it is not absolute
confidential’; for example, to protect individuals from serious crime.
In line with NHS guidance, it says this would usually include ‘crimes that cause serious physical or psychological harm to individuals’ whereas ‘crimes that are not usually serious enough to warrant disclosure without consent include theft, fraud, and damage
to property where loss or damage is less substantial’.
The GMC says that, if you have already decided to disclose information in the public interest, you do not need to obtain consent,. However, you should tell the patient about your intention to disclose the information, unless it is unsafe to do so (para 67).
If you do decide to disclose your concerns to the police, this should only be the minimum information necessary to allow the police to protect the ex-partner. Whether or not you decide to disclose the information, you should document your reasons for your decision and record any conversation that you have had with the patient and police in the notes.
Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union
Dealing with a
non-compliant patient
puts this consultant in a quandary. Dr Kathryn Leask has some suggestions
QI am a consultant physician and have a patient who has been on insulin for several years.
His compliance has never been very good and he has needed a lot of encouragement to ensure his blood sugar is monitored to allow safe dosing and for him to have diabetic reviews. Recently, his engagement with monitoring has deteriorated and I am concerned about whether I should continue to prescribe or advise him that I will not prescribe any further insulin without an up-to-date review.
AIt is important to try to establish why the patient isn’t engaging and whether this is something that can be addressed with some reassurance or advice. Is he having difficulties getting to the clinic or is something else going on in his personal life to prevent him from engaging?
Is he difficult to contact or avoiding calls from you or not responding to written correspondence?
If so, it may be helpful to ask the pharmacist to speak to him when he collects his medication or ask the pharmacist to let you or one of your clinic nurses know when he attends the pharmacy in case you are able to speak to him then.
If you are not able to speak to him when he collects his medication, on the phone or during a home visit, and if you feel he hasn’t previously been given all the information he needs with regards to the risks of his actions, it would be a good idea to write to him.
I recommend that any written correspondence is sent by registered post and preferably signed for, so that there is no question as to whether it has been received.
The patient should be advised about the importance of taking his insulin but also why the monitoring and diabetic reviews are important. He needs to be aware of the risk he is putting himself at if he does not engage with you so that he can make an informed decision.
It is also important to satisfy yourself that he has capacity to make treatment decisions for himself.
Diarise a review or flag the notes so that there is a prompt to revisit matters at future consultations or when the opportunity arises.
With regards to continuing to prescribe without monitoring taking place, you will need to carry out a risk assessment, balancing the benefits and risks of providing treatment unmonitored against the pros and cons of stopping the medication.
The decision reached will depend on the patient’s particular circumstances. You may feel, for example, that the patient’s need
for insulin, even if this is unsupervised, outweighs the risks associated with not taking it at all, especially if he is able to check his own blood glucose level.
If, after taking these steps, the
patient still won’t engage, make sure he knows that he can contact you at any time and put measures in place that will help him to manage his condition himself as safely as possible.
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When dealing with patients, doctors are all used to keeping copious notes, but when it comes to the financial paperwork, they can often be lacking. In many cases, financial arrangements can work themselves out, but if things go wrong, you can quickly be into a costly situation.
Ian Tongue (below) looks at the areas where keeping adequate paperwork is essential in the commercial world
ACCOUNTING RECORDS can take many forms and in recent years there has been a push to use digital packages and store records electronically.
There is nothing wrong with manual records, but changes to the tax system known as ‘Making Tax Digital’ will largely force businesses into keeping electronic records, as more frequent reporting of information will be required.
As a minimum, your system must record:
Income earned;
Income received;
Expenses;
Bad debts.
A private practice should always be run through a separate bank account. For those that are VATregistered, a higher standard of record-keeping is required.
HM Revenue and Customs (HMRC) requires you to keep ‘adequate’ accounting records, but does not specify exactly what that means. From a practical perspective, this means that your records allow you to disclose a complete and accurate position of the business.
When starting out in private practice, it is often the case that you engage your NHS secretary, who may carry out private secretarial work for you and other colleagues engaging in private practice.
The same applies to assistants you may work with in the NHS, whom you may also engage to help you in carrying out private work.
Often these arrangements are loose when it comes to formal agreements, the parties perhaps thinking it represents a commitment to have a contract. But a written agreement helps protect both parties from HMRC challenging the status of the arrangement.
Determining ‘status’ is a term used by HMRC and is important, as it looks at whether the terms between two parties are one of employment, self-employment or contracting.
It is often assumed that status is determined by simply agreeing to not be an employee and an invoice being issued by the secretary.
That may be fine based on the circumstances in question, but, conversely, it may be leaving the engaging party with potentially significant risk of financial loss through penalties, interest and surcharges for not operating a PAYE scheme and work-based pension scheme.
A rare but significant risk is a secretary or assistant claiming that they thought you were deducting their tax and National Insurance and they were your employee. This situation can be difficult to navigate and the other party can twist the circumstances to fit their claim, making it expensive to defend. Thankfully, there are provisions to recover tax directly from an employee in this situation.
A private practice should always be run through a separate bank account. For those that are VATregistered, a higher standard of record-keeping is required
The best way to avoid any issues is to use the HMRC check employment status for tax (CEST) tool available on HMRC’s website. This tool asks pertinent questions for determining employment status and should always be discussed with your accountant if anything is unclear.
Related to the above employment status is anti-avoidance tax legislation known as IR35. In more recent times, it has been used almost interchangeably with the term ‘off-payroll working’.
It is not new, as it has been around since 1999, but has largely been an ineffective piece of legislation, as working arrangements are often complex.
IR35 was put in place due to individuals who were largely employees forming limited companies to carry out work which was a tax-saving for the employee and saving National Insurance for both employee and employer.
The use of an intermediary business in this way was targeted by IR35, which has reared its head in recent times, as the risk of getting the status wrong is shared between both contracting parties, which has given the legislation more focus.
HMRC would clearly like to establish an employment relationship, as it creates National Insurance payable, but the vast majority of private practice working arrangements do not fit under this status and are outside the scope of IR35.
The private hospitals have all had to consider their trading relationships with consultants carrying out private work and they will ask you to complete paperwork to allow them to complete a status determination statement, or SDS as it is known.
It is important that you keep all of the relevant paperwork to sup-
port your IR35 status. It is always a good idea to speak with your accountant when preparing your answers to ensure you understand each question.
It is common for consultants to work in groups, which is a popular way of sharing risk, supporting each other and providing opportunities.
Often the group is comprised of work colleagues and friends, which is always a risk to mix business and friendship, so it is extremely important that you set things out formally from the start to avoid any issues later.
The most common way of trading in a group is via a limited liability partnership, but a limited company is also often used.
In the case of a limited liability partnership, a member’s agreement is extremely important, as it sets the scene for how the arrangement will work in practice and covers the important matters such as sharing profit, entry/exit and other key areas.
The equivalent of a member’s agreement for a company is a shareholder agreement which is equally as important.
It can be common for spouses to be involved in private practices in various capacities. Even though it may seem unnecessary to formally document matters, it is always a good idea to have everything set out whether they are employed or you are a partnership or perhaps joint owners of a limited company.
Unfortunately, it is a fact of life that not all marriages last and having something to refer to should the worst happen will save both parties a lot of financial pain arguing matters through solicitors.
Formalising working and financial arrangements is a normal part of running a successful and risk managed business. More often than not, the required paperwork does not take much time or money to put in place but can avoid a lot of potential financial pain. Next month: The life cycle of a company
Ian Tongue is a partner with Sandison Easson accountants
Great design and value make this good-looker impossible not to recommend, says Independent Practitioner
Today’s motoring correspondent Dr Tony Rimmer (right)
A very open-plan dashboard is dominated by two landscape-shaped information screens and physical switchgear is kept to a minimum
TO KEEP up with the latest medical advances, we rely on expert advice and opinions from our peers to utilise modern technology. They give us a steer on how best to use new and unfamiliar equipment and treatments. And it is also little different when choosing a new car, particularly if we are entering the emerging technological world of all-electric vehicles.
There have been many new EVs launched over the last year and professional motoring journalists have been eagerly awaiting their arrival on the manufacturers’ press fleets, ready for appraisal.
Some of them have been more impressive than others, but there is one car that has received universal acclaim from all quarters; the Hyundai Ioniq 5. Is it as impressive as they say? I aimed to find out with my own thorough review.
The South Korean brand has, along with its sister company Kia, been electrifying many of their cars over the last few years with hybrids, plug-in hybrids and some all-electric vehicles.
However, the Ioniq 5 sits on their first ground-up design electric platform. Its KIA sister model, the EV6, sits on the same platform. It is available with a 58kWh battery and single electric motor or a 72kWh battery with a choice of one or two electric motors. Claimed range is between 238 and 298 miles depending on the model. Trim options include the Connect, Premium and Ultimate. The Premium has all the features you would ever really need and represents the best value. My test car was the 72kWh rear-wheel drive Premium version which, at £43,090 and a range of 298 miles, would suit most of us medics most of the time.
The first thing to note is its strik-
ing external design. Its appearance is thoroughly modern and somewhat ahead of its time. It looks like an electric car from the future and Tesla, among others, could learn a few tricks from Hyundai.
Sharp lines on all panels and special LED lighting features makes the Hyundai stand out in a sea of bland SUVs. It looks best in light colours such as the metallic silver of my test car.
What is a surprise when you see the Ioniq 5 in the flesh is that a car that looks VW Golf-sized in photos is bigger – the same size as an ID4.
Inside the cabin, the modern themes continue. A very openplan dashboard is dominated by two large landscape-shaped information screens and physical switchgear is kept to a minimum. I would say that the quality of materials used, such as the plastics and seat materials, is high; better than the usual Ford, Peugeot or Citroen level. The drive selector is located on the steering column like in VW’s ID models and this frees up space in the front footwells for extra storage features.
The three rear passenger seats also benefit from the electric platform: the available legroom and headroom is really impressive and the seats can either slide forward to increase boot space or recline for extra comfort. Boot space is generous, but the floor is a bit high: but at least the re-charging cables can be stored below.
Driving the Ioniq 5 delivers the typical EV attributes of linear power delivery, silence and the feeling of being pushed along by a large velvet-gloved fist.
All-round visibility is great but the lack of a rear screen wiper is a significant omission.
Driving the Ioniq 5 delivers the typical EV attributes of linear power delivery, silence and the feeling of being pushed along by a large velvet-gloved fist
This model, with 215bhp, feels plenty swift enough – particularly since the handling is set up with soft suspension to give an excellent ride. Fast cornering is not this Hyundai’s best attribute; it is best on ‘A’ roads and motorways.
Stick to the 19-inch wheels of the Premium model too; the larger 20-inch alloys of the Ultimate look great but worsen the ride. Regenerative braking power is easily altered between four settings by paddles behind the steering wheel and on its strongest setting allows one-pedal driving.
Rivals at this price point include the VW ID4 and the Skoda Enyaq. But the Ioniq 5 has more of a premium feel and really competes with the BMW iX3 and Volvo XC40 Recharge; both a good £15£20k more expensive.
Tesla’s long-awaited small SUV Model Y costs upwards of £55k and even my current favourite EV, the Audi Q4, cost £10k more.
This is one of the reasons that the Hyundai is so well loved by the motoring press. I was very impressed too. With its great design and great value, it is impossible not to recommend.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Body: Five-seat hatchback SUV
Engine: Sincle electric motor.
Rear-wheel drive
Power: 215bhp
Torque: 350Nm
Top speed: 115mph
Acceleration: 0-62mph in 7.4 secs
Claimed range (WLTP): 300miles
Real world range: circa 250miles
CO2 emissions: 0g/km
On-the-road price: £43,090
Network boss
David Hare
(left) says it is stepping up its work to ensure as
many patients as possible
can benefit from ‘the fantastic treatment delivered by independent practitioners across the country’
CLINICIANS WORKING across the independent healthcare sector cannot have failed to notice the rising demand for their services in the last few years.
There are several factors behind this, from the practical – such as rising waiting times for NHS care – to more subtle behavioural changes.
Indeed, the pandemic has undoubtedly led many people to think more about the importance of their own health and how they can take a more proactive approach to managing their physical and mental well-being.
With these forces at play, many more people are now paying for treatment, including those who never previously would have considered private care.
And in response to this trend, the Independent Healthcare Providers Network (IHPN) is keen to play its role in providing insights on the public’s appetite and knowledge around private healthcare.
We want to support independent practitioners in ensuring as many people as possible can benefit from our resources and we aim to develop new resources to help support the next generation of private patients.
Earlier this year, we commissioned some polling from Savanta ComRes which found that around half (48%) of people agree that they would consider private healthcare if they needed treatment, with one in five (21%) believing that they are likely to use private healthcare in the next 12 months.
These are incredible figures and really demonstrate the growing relevance that independent healthcare practitioners will have in people’s lives in the coming months and years.
Perhaps not surprisingly, those most likely to agree that they
would consider private healthcare are those with higher – albeit not huge – incomes of over £48,000 and traditional ‘ABC1’ backgrounds.
Interestingly, those most open to paying privately also include people from ethnic minority backgrounds as well as younger age groups – notably 18-34 year-olds and 35-54 year-olds.
With younger people used to paying for convenience on everything from Uber to Deliveroo and Netflix, paying for swift access to healthcare is the obvious next step for those wanting a quick test/ appointment or treatment.
Appetite to know
While there is clearly growing demand from all directions, our polling also found there is real appetite to understand more about how private healthcare works, with just over a third of people agreeing they would like to know more about the process.
This is particularly key given some gaps in people’s knowledge about private healthcare.
Our research found that over one-in-three people (37%) are not aware that it is possible to ‘mix and
match’ private and NHS healthcare – for example, paying privately for a scan and then having an operation through the NHS –with two-in-five people (39%) not being aware that it is possible to speak to their GP about accessing private healthcare.
With more and more people considering private healthcare and eager to understand how it works, IHPN recently teamed up with the Patients Association to develop some new resources for the public to better understand how to access and pay for private healthcare.
Working together with a patient focus group, we have produced a new animation to support people on how to navigate private healthcare, looking at issues including:
How to access private healthcare;
Mixing and matching NHS and private healthcare;
How to choose a private doctor or healthcare provider;
How to pay for private healthcare.
This animation is being promoted by members of the IHPN and, alongside the Patients Association, we will also be encouraging patients to make use of the Care Quality Commission and Private Healthcare Information Network websites for information on the quality and safety of independent practitioners and providers across England.
With more people looking to pay privately for their healthcare, this is just the start of IHPN’s journey in helping independent doctors and providers to better understand and support the next generation of private patients.
David Hare is chief executive at the IHPN
Coming in our June issue, published on 7 June:
A Medical Defence Union medico-legal expert presents a detailed analysis of what the GMC’s draft revision of Good Medical Practice could mean for you
Dr Philip Batty, the Independent Doctors Federation’s (IDF) new president, reveals some plans and intentions for the organisation’s next three years. The IDF was founded before appraisal and revalidation to support doctors in private practice and to help each other grow
We take a look at the City of London’s first independent hospital –Nuffield Health at St Bartholomew’s Hospital – where 200 consultants have been granted practising privileges
As entrepreneurial vascular surgeon Prof Mark Whiteley opens his fourth Whiteley Clinic, he reveals how his businesses survived and then grew during Covid. His company aims to open its fifth by the end of 2022 and is recruiting interested doctors and vascular technologists
Our Troubleshooter Jane Braithwaite looks at the big question many doctors who employ their own staff have been asking: ‘Now that my team have had a taste of home working, they all want to work from home more of the time. How do I make this work?’
Sustainability, environmental and governance issues in healthcare: Jamie Foster, a commercial lawyer with Hill Dickinson who specialises in the health and life sciences sector, spells out what it means for private hospitals, clinics and technology providers
TODAY The business
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How to ‘onboard’ new patients – Simon Marett of Ellerton Marketing continues his series to help your medical business grow and advises on how to overcome the major challenge of converting a casual inquiry or first-time visitor to your website to being a fully paid patient
Keep It Legal: What you need to do once you have incorporated as a company – and the consequences of not keeping Companies House filings up to date. Hempsons’ Kirsty Odell and Georgina Hall explain
As the latest LaingBuisson report on the self-pay market is published, author Liz Heath reflects on the sector and whether the optimism expressed by many is founded on evidence of sustainable growth
In our Business Dilemmas series, Dr Kathryn Leask discusses what to do if you have concerns about the standards of care being provided by a colleague and answers a private GP’s question on disclosing information after a patient’s death
While sensitivity and empathy are vital components of managing patient-clinician communication in a disclosure event, listening is the most important. Kirsten Dyer, of the Cognitive Institute and Medical Protection Society Partnerships, explains
Simon Brignall of Medical Billing & Collection presents the third part of his masterclass on how to get your money in
Will the new BMW iX be a doctors’ favourite? Our motoring correspondent Dr Tony Rimmer finds out
And don’t forget to check out our additional news updates every week online
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