Why cash isn’t risk-free
A profile of The Royal Marsden Hospital and its private care service P32
See
The law has changed to give employees greater flexibility to take time off to care for loved ones P36
By Robin Stride
New figures signal a boom in work for thousands of doctors in private practice from patients with private medical insurance (PMI).
Market analysts have revealed demand for private health cover –including insurance, health cash plans and dental cover – has hit its highest levels since the launch of Independent Practitioner Today in 2008.
They report ‘considerably faster’ market growth than historic norms with an annual rise of 6.1% between 2020 and 2022, compared to average annual growth of 1.7% between 2008 and 2019.
LaingBuisson said there was ‘surging demand for private health cover as access to NHS services continues to deteriorate’.
Its Health Cover UK Market Report 19th edition puts the overall value of the health cover market in the UK at £6.7bn at year-end 2022 – up £385m on the previous year.
Private medical cover, including private health insurance, accounts for 80% of the total market value at £5.3bn.
Report author Tim Read observed that growth was being led by company-backed schemes, which might suggest an increased awareness of the impact of employee ill-health on a business – and possibly frustration at the
impact an inaccessible NHS was having on productivity.
He said: ‘Investing in a product that enables people to see primary or secondary care specialists when they need to, rather than having a take a day off work hoping for an appointment, is no longer necessarily seen as a perk but as something critical to ongoing business success.’
Despite a real terms fall in overall market value, the broader picture for the health cover market was ‘positive’.
Mr Read believes higher subscriber numbers after the pandemic should translate to overall growth in market value as background inflation declines.
‘LaingBuisson’s analysis shows a longer, deeper relationship between the length of the NHS waiting list and demand for health insurance. The pandemic may have driven increased demand, but it is misleading to suggest it is the cause of it.
Cover will continue to grow ‘Demand began to increase in 2018, as the NHS waiting list began to rise out of control. This suggests that without substantial inroads into making NHS-funded care accessible within acceptable time-scales for patients, health cover products will continue to grow in demand.’
Mr Read added: ‘There is a long way to go before coverage reaches
levels last seen across the UK population since the 2008 financial crash, but it is the first time there has been sustained growth in the sector for more than 15 years.’
A rising trend of insurance claims in 2022 meant premiums were set to rise, but these are yet to feed through to price increases.
But LaingBuisson warned these were expected to rise ‘above historic increases in the near future’.
The number of individuals taking out their own health insurance has also been increasing.
Private medical cover pays for around half of private hospital and specialist treatment in the UK. Two-thirds of private medical cover is funded by employers as an employee benefit. Individual PMI
The analysis shows a longer, deeper relationship between the length of the NHS waiting list and demand for health insurance.
TIM READ, author of LaingBuisson's Health Cover UK Market Report, 19th edition
policy-holders pay the other third.
Rising demand for other forms of health cover means health cash plans are valued at £461m, dental capitation programmes (£688m) and dental insurance (£180m).
A total of 4.2m people were subscribed to medical cover schemes, but with policies often covering more than one person, 7.3m people had private medical cover, the highest for 14 years.
Market penetration among the rising population was below 2008 levels – 10.8% of the population covered compared to 12.3%.
LaingBuisson said its analysis of the NHS waiting list showed a relationship between medical cover subscriber volumes and the median wait time on the NHS.
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Email: robin@ip-today.co.uk
What made the news in May 2014
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new P10
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Time runs out for certifying kit
Certificates on medical devices run out this month as the EU deadline for switching over to a new system expires. What does it mean for doctors? P14
When patients sue their radiologist
Dr Claire Wratten and Greta Barnes analyse clinical negligence claims notified by MDU radiologist members and give advice on managing risk P16
Private care must heed NHS lessons
Record dissatisfaction levels with the NHS suggest opportunities for those in private practice, but signal a warning if private doctors get too busy P19
The consumer voice on health tech
Understanding customers’ attitudes and how they feels about healthcare is central to the way Bupa’s plans its services, says its medical director P22
Business Dilemmas: Oxygen is being used improperly
Dr Vassiliki Kavadas discusses what to do if a patient has been supplied with home oxygen without a scrip P42
Start a private practice:
What are the tax implications of working abroad
Accountant Richard Norbury on some of the common tax ramifications when going abroad to work P44
Doctor on the Road: Fun in bucket loads
If you have got petrol in your veins, then Tony Rimmer reckons you should get hold of the Mazda MX-5 P48 www.independent-practitioner-today.co.uk
Not all private units can do critical care
Increasing demand for private healthcare brings with it some more risks for doctors in private practice, warn MPS medico-legal experts P26
Let professionals do the heavy lifting
Partnering with a professional medical billing service can streamline your practice’s financial processes, optimise revenue and ease admin burdens P28
Value of updating ethical standards
Dawn Hodgkins of the Independent Healthcare Providers Network reflects on what the GMC’s new ethics standards mean for the private sector P41
By Edie Bourne
Doctors who have used financial advisers and accountants to help them to navigate the complexities of their pension ‘McCloud remedy’ can now recover some of the cost of receiving that help.
The ‘Cost Claim Back Scheme’ has just been launched for NHS Pension Scheme members affected by McCloud, formally known as the ‘Public Service Pensions Remedy’.
The McCloud remedy aims to recompense NHS scheme members deemed to have suffered age discrimination when the 2015 pension scheme was introduced.
Those members now have the option to receive their original
benefits from the 1995 or 2008 scheme for the seven years of the ‘remedy period’, which runs from 2015 when the new pension scheme began to 2022.
Guy Beck, senior financial planner with specialists Cavendish Medical, explained: ‘Like most things concerned with the NHS pension, the rules surrounding McCloud are complex and many doctors have been, quite rightly, seeking expert advice from professionals who can help them make the best decisions for their situation.
‘It is therefore great news that the Government is giving some financial assistance – albeit minor – to help to cover the cost of understanding what McCloud means
Prospective private patients are being promised an easier time when seeking information about others’ experiences in independent hospitals.
A new initiative from the Private Healthcare Information Network (PHIN) will now make it more straightforward for hospitals to give it this information.
Greater transparency is needed by providers and doctors to comply with a long-standing – but hard to deliver – order from the Competition and Markets Authority (CMA).
PHIN is collaborating with the iWantGreatCare/Top Doctors (iWGC/TD) patient feedback platform to move things forward and give hospitals support for the collection and submission of patient satisfaction data.
The iWGC platform is reckoned
to provide a simple and accessible way for hospitals to collect the mandated PHIN patient feedback questions, and it will submit that data directly to PHIN on their behalf.
PHIN chief executive Dr Ian Gargan said: ‘We know patients value the experiences of those who have undergone procedures before them. So we are keen to do whatever we can to help providers submit their patient feedback data, so that we can help patients make more informed choices.
‘Working with iWGC/TD on this initiative provided a great opportunity for us to create a new avenue for data submission and reduce the burden on hospitals.’
Email cma.compliance@iwantgreatcare.org or visit https:// europe.topdoctors.co.uk/iwgcphin-collaboration.
and what their best course of action might be.’
The NHS Cost Claim Back Scheme covers not only professional advice but also direct financial losses or tax losses incurred because of the remedy.
Doctors are hooked on social media, with 80% of a survey’s respondents using it and 78% doing so at least once a day.
A survey of 1,797 Medical Defence Union (MDU) members found the most popular channels were Facebook (75%) with Instagram and YouTube both at 54%.
Non-users’ reasons included privacy concerns (56%), the implication social media might have on their professional life and not having enough time (both 37%).
The research follows new GMC guidance entitled Using social media as a medical professional. While social media can be a great tool for medical profession-
The limit to claims for using an accountant is £1,000 including VAT and for using a financial adviser it is £500 including VAT.
Mr Beck told Independent Practitioner Today : ‘There is a sizeable application form to complete in order to make a claim and a tenpage rulebook.
‘Different forms are required for each professional service, so if you are claiming for accountant and adviser costs, you will need to produce two forms, which can be downloaded from the NHS Business Services Authority website.’ Go to https://cms.nhsbsa.nhs. uk/sites/default/files/2024-01/ Remedy%20cost%20claim%20 back%20form%20%28V1 %29%2020240110.pdf
Dr Catherine Wills, deputy head of advisory services at the MDU
als to connect with others, the GMC emphasises that doctors’ conduct should justify patients’ trust in them and the public’s trust in the profession.
MDU deputy head of advisory services Dr Catherine Wills said: ‘It is unsurprising that so many doctors engage in social media; social media platforms have become woven into the fabric of many people’s lives.
‘However, doctors aren’t like regular members of the online community; they can be held accountable by the GMC for things they post, like or share.
‘Consequently, it’s important for medical professionals to “think before they post” and to always remain professional and maintain patient confidentiality.’
Reports by Robin Stride
Private GPs have come out strongly in support of their NHS colleagues’ pay plight which is forcing them to drastically reduce drawings and to make tough business decisions.
The increasing financial pressure on health service GPs means increasing numbers are contemplating a move to private practice.
Independent Doctors Federation (IDF) GP committee chair Dr Shaima Villait told the group’s AGM about the effects of the last
‘unstable’ year for those in the health service.
She said: ‘19,000 GPs and GP registrars took part in the BMA referendum on whether to accept the GP contract changes made by the Department of Health and Social Care and NHS England at the end of March 2024. 99.2% voted “no”.
‘Talks are now underway on the next steps. Our NHS colleagues are overwhelmed, burnt out and have lost faith with the NHS, which has
The IDF’s commitment to quality is evident in its robust appraisal system, according to its Responsible Officer Dr Alexandra Harkins.
It has received full compliance in external quality assurance checks by healthcare intelligence and quality improvement service CHKS.
IDF appraisers are maintaining their expertise through annual training days and bi-monthly sessions and a new training course is being launched for them.
Dr Harkins told the meeting the IDF revalidation team had shown a commitment to compassion, support and fairness. Remote appraisals have proved popular. 857 appraisals were completed in the last year and 603 were done remotely.
Dr Alexandra Harkins
She said the IDF’s stage 1 support service had effectively resolved several complaints, demonstrating the team’s dedication to supporting doctors.
The federation’s appraisal form will be revised to match up with the GMC’s revised Good Medical Practice
resulted in an increase in GPs joining the independent sector, either entirely or part-time.
‘At the IDF, we are here to support and provide information to help them navigate the process of setting up their practices and we are actively trying to engage with them.’
She said the federation needed to ‘be out there and market’ to get more private GPs to join. There were 323 GP members of the IDF, but a lot more working privately
Alexander, an orthopaedic shoulder surgeon, is the new president-elect of the IDF and will take over from Dr Phil Batty when he finishes his three-year stint in the post next April.
The Independent Doctors Federation, which has the same initials as the Israeli Defence Force, is to consult with members as it considers a name change to avoid being misunderstood.
If it goes ahead, then this would
be its third name in 15 years. The group was founded in 1989 as the Independent Doctors Forum but adopted its present title in 2009.
‘Independent Doctors Network’ is the new proposal.
Members would be asked to con-
who would benefit from the services provided.
One of the difficulties for the group was it did not know how many private GPs there really were now. She said: ‘Unfortunately we have no idea how many private GPs there are in the UK. The BMA doesn’t know, the Care Quality Commission can’t tell us.’
Livestreaming will make future AGMs more accessible for private doctors nationwide.
President Dr Phil Batty, eager to see the organisation become the ‘go to’ body in the independent sector, commented that it was perceived as a group for those within easy reach of the M25. He reported an expansion of the ‘excellent staff team’ to improve communications and events, and announced plans were going ahead for IT infrastructure upgrades to improve user experience.
sider the pros and cons of changing the name at a time when it is increasing its offering to consultants and GPs while embarking on what it considers will be a longterm campaign for changes in the private medical insurance industry.
Dr Batty said the IDF was supporting members through education, networking, advocacy and professional development, ensuring their perspectives shape the organisation’s path.
Members’ well-being and mental health were being prioritised with 24/7 support systems in place and the number of events was being doubled.
Foot and ankle surgeon Mr Andrew Roche, specialist committee chair, announced the IDF has been receiving ‘lots of good evidence’ to support its PMI campaign ( Independent Practitioner Today, April 2024, front page). He explained the effort aims to establish a fair fee structure, eliminate the fee-assured status imposed by insurers and advocate for independent oversight to safeguard doctors’ and patients’ interests.
The Federation has employed a team from RPP Impact Advocacy ‘to challenge the status quo of stagnant fees, limited treatment options, and the resultant diminished patient choice due to opaque practices’. The campaign will seek national media coverage.
Mr Roche reported that the insurance industry had caused stress in his own practice and often influenced critical decisions, such as patient referrals for physiotherapy – ‘a partnership I hold in high
GPs want to have say in revamp of
The IDF’s GP committee has been engaging with the Department of Health to ensure independent GPs have a smooth pathway and process under the new mandatory medical examiner system. This was due to be rolled out in England and Wales in April, as we went to press, to provide independent scrutiny of deaths and to give the bereaved a voice.
Committee chair Dr Shaima Villait explained there were two key elements of the new process. Firstly, all deaths that are not to
Mr Andrew Roche
regard for patient rehabilitation.’ Independent GPs are backing the campaign.
IDF GP committee chair Dr Shaima Villait complained that although they were not affected in the same way, they had seen part of their expertise taken away by insurers who would not authorise work from some consultants
be referred to a coroner will require formal review by the medical examiner before the medical certificate of death can be completed.
Secondly, the medical examiner will want to speak to relatives about any concerns they may had about the care provided to their loved one, and will be able to explain the cause of death as stated on the medical certificate of cause of death (MCCD).
Dr Villait said the Medical Examiner Office would have access to an interpreter service as well as Language Line for families needing an interpreter.
But, unfortunately, the lack of data available on the number of GPs working in the independent sector was a limiting factor.
Her committee is talking with local authorities and the Care Quality Commission to help gather accurate information.
I get more and more patients coming back to me saying “Sorry, that consultant is not recommended”. “He’s not on the list” is what I’m told; they don’t know why that consultant is not on the list.
DR SHAIMA VILLAIT
Chair of the Independent Doctors Federation’s GP committee
whom GPs had advised their patients to see.
She said: ‘They would prefer us to refer via an open referral pathway. We are working with our secondary care colleagues to change this to ensure patient choice is recognised.’
Dr Villait told the meeting: ‘Our patients come to see us because
they trust us to refer them to people that we know, whom we trust, whom they trust us with.
‘Unfortunately, we are not able to do that as much as we used to, our hands are being tied, and this is actually taking away our skills set and taking away our patients’ rights and choices.
‘And I think, as private GPs, this is something we really do have to stand up for. I don’t know how many of you have been affected by this, but I get more and more patients coming back to me saying “Sorry, that consultant is not recommended”. “He’s not on the list” is what I’m told; they don’t know why that consultant is not on the list.’
She was then having to search to find a consultant who had the right credentials for the patient –and most of the time she did not know any of them.
A benchmarking toolkit has been launched for the IDF’s GP members.
The federation has partnered with the NHS Benchmarking Network to enable members to use it anonymously to help improve their practice outcomes and their quality of patient care.
IDF GP committee chair Dr Shaima Villait said: ‘We have chosen three clinical and one nonclinical metrics using NICE guidelines and following NHS practice patient questionnaires.
‘Although this seems daunting at first, it is important to remember the reasons for carrying out benchmarking, the date of which can also be used for practice audits. This toolkit will be a member ben-
efit throughout membership with no additional cost to members.’
The IDF wants as many practices as possible to participate so its project is successful and has reminded GPs this is to be a mandatory requirement by the CQC in England.
Dr Villait said benchmarking helped practices improve and monitor quality, efficiency and patient experience – and assisted professional development.
‘Benchmarking is often thought to consist simply of comparing indicators, but it is a tool based on voluntary and active collaboration within clinics to ensure the best quality of care can be provided to patients as well as for practice improvement.’
By Agnes Rose
A new £5.5m clinic has opened its doors to patients and is offering doctors in a range of specialties the opportunity to apply for practising privileges.
Spire Healthcare Abergele Clinic in Clwyd aims to give patients across north Wales faster access to a wide range of surgical treatments and diagnoses.
Fifty consultants were awarded practising privileges to begin with, but now the search is on for other specialists to join them.
Spire Healthcare’s group medical director Dr Cathy Cale told Independent Practitioner Today: ‘The opening of the Spire Healthcare Abergele Clinic provides more people in north Wales and the surrounding regions with access to high-quality and personalised healthcare at a time that suits them.
‘The new clinic also provides GPs and experienced consultants the opportunity to expand their private practice.
‘Key specialties not fully recruited to the clinic include dermatology, gynaecology, urology, general surgery, pain management and hand and wrist surgery.’
The clinic, in Abergele’s North Wales Business Park, is the first of a network of new community clinics from the provider.
Surgeons expect to deliver up to 1,500 operations annually to
patients who do not require an overnight stay.
People will have access to diagnostic scans, women’s and men’s health treatments, pain management, as well as orthopaedic, dermatological and urological treatments.
Ophthalmic treatments are also soon to be made available at the clinic.
It was formally opened by entrepreneur, philanthropist and Spire shareholder Steve Morgan CBE, accompanied by the group’s nonexecutive director Debbie White and chief executive Justin Ash.
Spire said the opening represented an important step in broadening its services, giving local people fast access to outstanding personalised care in their own community.
The Abergele clinic is part of a network of new Spire clinics being developed to complement its 39 hospitals across Wales, Scotland and England.
Its Abergele investment is in addition to the £11.4m Chesney Court Outpatient & Diagnostic Centre at Spire Yale in Wrexham, Clwyd, which opened in February 2023.
Spire Healthcare Group has sold its leasehold hospital Spire Tunbridge Wells to the Maidstone & Tunbridge Wells NHS Trust for £9.975m.
For around six months after the transaction it will manage the unit on behalf of the trust, continuing to provide treatment to both private and NHS patients.
Spire Tunbridge Wells, rated
‘good’ by the CQC, comprises 28 beds, ten consulting rooms for the 130 consultants operating at the hospital, two operating theatres and an endoscopy suite.
In 2023, the hospital generated revenue of £12.7m and earnings before tax of £1.1m. Leasehold rent incurred during the period was £0.4m and net cash generation,
New guidance from the Information Commissioner’s Office (ICO) aims to support healthcare organisations to ensure they are transparent with people about how their personal information is being used.
The UK data protection regulator hopes this should provide regulatory certainty about how people can be properly informed.
Under data protection law, people have a right to know what is happening to their personal information provided in confidence to trusted practitioners.
Anne Russell, head of regulatory policy projects at the ICO, said: ‘Being transparent is essential to building public trust in health and social care services.
‘If people clearly understand how and why their personal information is being used, they are likely to feel empowered to share their health information to both access care and support initiatives such as medical research.
‘As new technologies are developed and deployed in the health sector, our personal information is becoming more important than ever to boost the efficiency and public benefit of these systems.
‘With this bespoke guidance, we want to support health and social care organisations by improving their understanding of effective transparency, ensuring that they are clear, open and honest with everyone whose personal information is being used.’
excluding working capital movements, was £0.7m. Capital expenditure in the year was £0.4m.
The group said it remained committed to growth and took ‘a consistent and proactive approach to portfolio management’. It now operates 38 hospitals –19 freehold and 19 leasehold properties.
See PPU Watch on opposite page
The guidance aims to help organisations understand the definition of and assess appropriate levels of transparency. It also provides practical steps to developing effective transparency information.
Following a public consultation earlier this year, it incorporates feedback from health and social care organisations across the UK. Check out Independent Practitioner Today’s important feature on this subject in our June issue, published on 11 June.
By a staff reporter
Consultants are being reminded they can now use a new portal to help them when submitting data under the Competition and Markets Authority’s (CMA’s) Private Healthcare Market Order.
The Private Healthcare Information Network (PHIN) gateway, which became available last month (April), contains several new features that have been designed with consultant feedback
Compiled by Philip Housden
Which NHS trust will buy a private hospital next?
Maidstone and Tunbridge Wells (MTW) has become the latest NHS trust to acquire a small hospital from the independent sector (see story opposite).
RUH Bath’s Sulis Hospital has shown how such acquisitions can work successfully to deliver improved NHS capacity and access – and enable a positive income stream from private patient services development.
But similar takeovers of private patient capacity in King’s Lynn and Crewe have not seen equivalent growth in private patient revenues.
All the incumbent hospital chains having a mixed bag of ageing estate are facing increased competition from new market entrants.
This offers a generational opportunity for the NHS to acquire already built capacity and inherit a skilled workforce at a time when capital is so constrained. So where will be next?
MTW’s chief executive Miles Scott sees his purchase as an exciting opportunity: ‘It will enable us to develop planned procedures and diagnostic services and I am
in mind to improve the way the portal works and the benefits it brings.
Anne Coyne, PHIN’s consultant services manager, said: ‘Its enhanced functionality makes it easier for consultants to use, both to comply with their requirements under the CMA Order and to maximise the benefits they can get from their data.
‘This will help to increase compliance rates, meaning that more and more information is available to
patients looking to have a procedure carried out in the private sector.
‘We are grateful to the many consultants who have helped us during the development process and will continue to work with all consultants to provide the support they need.’
PHIN said the improvements were based on feedback provided by consultants, and included:
1. The ability to nominate a delegate to upload and verify data and produce reports;
delighted this investment will benefit patients across our communities.’
Additional facilities will increase NHS capacity and enable MTW to do more procedures for long-waiting patients across Kent and Medway.
After a transition period of around six months, some NHS patients will access care at the Spire Tunbridge Wells site. The new facility will free up capacity at both Maidstone and Tunbridge Wells hospitals and additional patients will be seen at those sites.
Spire Tunbridge Wells employs 173 staff and work will begin on the transfer of their employment to MTW. It currently treats both private and NHS patients and, during the transition, Spire will continue to run the hospital and patient care as normal.
MTW will work with the Spire
2. The addition of insurer fees;
3. The ability to review and update specialties;
4. A new data overview report showing all data PHIN holds on a consultant.
The portal is available to consultants now at https://portal. phin.org.uk
The entrance of Spire’s Tunbridge Wells Hospital in Kent
team to expand the use of the facility for NHS patients during this period and once the transition has completed, the management will be taken over by MTW.
Will MTW now grow private patient services on site to complement the Wells Suite at Tunbridge Wells Hospital? The trust’s private patient income was only £1m (0.15% of all income) in 2022-23, being a fraction of the £7-8m and 2% a year achieved a decade ago.
Moorfields Eye Hospital private care director Andrew Robertson is part-retiring after nearly five years at the trust.
Under his leadership, Moorfields Private has opened new outpatient services, signed a partnership with the Cleveland Clinic, and joined the London Specialist Hospitals partnership.
He also oversaw Moorfields Private Eye Hospital’s response to the commercial and service challenges of Covid-19 and, when elective surgery was placed on hold, redeployed staff to help with the response in London.
Record revenues of £40.8m were delivered in 2022-23, up £3.6m and 9.8%, and private patient incomes hit a new high of 15.4% of total trust income last year.
Mr Robertson told Independent Practitioner Today: ‘Over my career, I have managed a number of private hospitals. Moorfields Private has been like no other – a worldrenowned centre of excellence for ophthalmic care, which invests perhaps the most I have ever seen in state-of-the-art equipment and technology.
‘I am proud to have added my own contribution to a truly firstclass institution, especially through the opening of our clinic in New Cavendish Street, the heart of London’s medical district.’
Mark Bounds, most recently regional director south for Ramsay Health Care, has been appointed to succeed Andrew on an interim basis.
Philip Housden (right) is director of Housden Group commercial healthcare consultancy
By a staff reporter
Bupa has extended its partnership with mental health platform JAAQ (Just Ask A Question) to continue expanding its mental well-being offering to customers by focusing on preventive healthcare.
The partnership aims to tackle the health engagement challenge through personalised, easy-tounderstand, expert-led advice online, increasing access to clinical advice early, when needed, via the JAAQ at work platform.
Bupa doctors already feature on the site talking about men’s health and women’s health, and others
will provide information on a range of new topics over the coming months.
Insight from the latest Bupa Wellbeing Index shows 45% of people rate their mental health as neutral or poor, and mental health services are now some of the most widely used benefits, with counselling services (24%) and mental health apps (23%) two of the top three most used health and wellbeing benefits by employees.
mation easily and alongside all their other health and well-being services from the insurer provided within one app.
Alex Perry, Bupa UK Insurance chief executive, said: ‘These days so many people turn to social media for health advice, but it’s often hard to know what’s credible and can be trusted.
The Independent Sector Complaints Adjudication Service (ISCAS) has highlighted an increasing number of complaints being made by private patients about consultants’ secretaries.
These were among a noticeable increase in complaints, which it thought were perhaps due to increased activity and patient expectations, discussed at a meeting with insurers.
The JAAQ and Bupa content will be integrated into the Bupa Touch app for the first time later this year, allowing customers to access infor-
‘Our clinical expertise alongside JAAQ’s engaging video technology means our customers can access this expert information in a clear, jargon-free way on a range of mental health topics which many may feel reluctant to speak about.’
Waiting times and poor communications were among other gripes.
Complaints involving consultants’ secretaries were considered to be due to secretaries ‘protecting busy consultants’.
A new ophthalmic clinic has opened in Essex, dedicated to providing NHS cataract surgery for patients across the county.
Optegra Eye Clinic Colchester aims to provide care for thousands of people, observing that, with one-in-three adults being diagnosed with a cataract ,there is much demand for treatment.
Colchester surgeon Mr Mahmoud Radwan, who has joined the company to lead the surgeries, said he was looking forward to all the advanced technologies available:
‘I thoroughly enjoy helping people to see well again. There is nothing better than the first post-
operative day when we take the patch off and our patient can see again. It’s magical.
‘It is a pleasure restoring patients’ sight so they can enjoy amazing vision, especially after cataract surgery.’
Richard Armitage, NHS director for Optegra Eye Health Care, said: ‘We are opening clinics in a series of new locations, and Colchester is the first of our new clinic openings in 2024. We are delighted to be supporting existing ophthalmic services in the area.’
The clinic commits to treatment within six weeks of referral by an optician or GP.
Pay discontent among doctors working in the UK is a key reason why many are considering working abroad.
The financial consideration is highlighted in independent research for the GMC which found that other factors were feeling undervalued, a lack of progression
opportunities and disillusionment with the UK’s healthcare systems.
More than 3,000 doctors took part in the survey and, when asked how likely they were to move abroad to practise medicine in the next 12 months, 13% answered ‘very likely’. A further 17% said they were ‘fairly likely’.
GMC figures show around 4,000 doctors who gave up their licence to practise or left the medical register in 2023 gave ‘going to practise abroad’ as one reason for leaving.
A third of leavers were returning to a home country, 9% for ‘caring responsibilities’. High numbers also migrate into the UK.
Dr Latifa Patel, chair of the BMA’s representative body, said when doctors under pressure saw adverts for better pay and working conditions, plus improved lifestyle and sustainable work-life balance on offer overseas, many would find it an offer they felt they could not refuse.
By Douglas Shepherd
Doctors are being promised ‘a more flexible and compassionate approach’ to their regulation under new GMC guidance.
Case examiners and other fitnessto-practise decision-makers are being allowed to close complaints they are called in to investigate.
The GMC has announced that decision-makers will now be able to weigh the full circumstances of a concern earlier in the fitness-topractise process to assess the overall risk to public protection and public confidence in the profession.
This means some concerns may not need to be investigated or referred to a tribunal.
Anthony Omo, the regulator’s general counsel and director of fitness-to-practise, said that the updated guidance was in the interests of both patients and doctors.
He explained: ‘We know doctors find being under GMC investigation very stressful and it is important to us to do all we can to minimise that.
‘This more flexible and compassionate approach to regulation is tailored to the risk posed by each individual case.
‘The changes will avoid unnecessary investigations where the doctor does not pose a risk to public protection or to the public’s confidence in the profession.
‘Complainants can also find the
process difficult. This more proportionate approach will see matters, where there is no risk to the public, dealt with more swiftly.
‘Patients can still have confidence that public protection is at the heart of all our work.
Dishonesty and violence are serious matters and we will continue to investigate concerns and, where appropriate, refer to a tribunal.’
The GMC says changes to the medical regulator’s Guidance for decision-makers when violence and dishonesty may represent a lower risk to public protection are part of its commitment to assure fairness in its processes through more efficient and proportionate investigations.
It said: ‘Concerns that fall under the guidance are those that are minor in nature and did not impact patient care.
‘Allegations of violence and dishonesty which raise a risk to public protection, including where there is a history of repeated behaviour, will continue to be investigated.
‘The GMC engaged with patient and doctor representatives, including medical defence organisations, who provided feedback on the changes and whether it would be proportionate to investigate certain concerns.’
Examples of concerns that, under the updated guidance and if there were no aggravating factors, would no longer need to be investigated include:
A doctor giving false details to a market research company in order to qualify for free products;
A doctor pushing a colleague out the way following a heated argument.
The guidance came into effect on 4 April. More information can be found on the GMC’s website.
Consultant ophthalmic surgeon Mr Mike Adams has been appointed Optegra Eye Health Care national NHS Training Lead to manage and increase training across the group.
His job firstly involves overseeing training at Optegra Eye Hospital, Guildford, Surrey, and he will work with junior doctors in the group’s other UK hospitals, who are taking part in a recently launched fellowship scheme.
He will support teams nationally from an educational perspective, liaise with NHS trusts to finalise placements and be responsible for clinical governance.
Mr Adams said: ‘I am here to help with structure for training and to be a clinical contact for trainees and consultants at hospitals. We want to create a streamlined process whereby we can offer a single touchpoint.’
Junior doctors interested in gaining experience with Optegra should email optegra.training@ nhs.net.
All independent sector providers such as Optegra are obliged to train junior doctors on at least 11% of cases to keep their commissioning positions.
Mr Adams spoke more about the training opportunities: ‘Although private sector support has helped
to reduce surgical wait times, which is a great success, it means that a high percentage of cataract cases are now completed by independent providers, so naturally there are fewer cases within the NHS for junior doctors to work on.
‘We want to offer training in the
same way as the NHS would, so if someone is a trainee in an NHS hospital and there are not enough cataract procedures, they can approach their educational supervisor and ask for a placement at their nearest Optegra.
‘We offer high-volume cataract lists across 12 of our 13 UK hospitals and clinics. We are keen to welcome trainees to all our sites and are proud of the way Optegra works. We have first-class facilities and excellent surgical outcomes, so why not pass those skills on and ensure a high supply of surgeons for the NHS or Optegra itself in the future?
‘Along with our varied training offering from the Fellowship to continuing profession development events, we are fully committed to meeting our financial and ethical responsibilities.’
Mr Adams joined the eye hospital group last January and specialises in cornea and cataract cases.
A look back through our journal’s archives of a decade ago reveals that although times change, some issues are not so new
Bupa was set to push private hospitals to cut their prices by at least 15% in the wake of the competition body’s long inquiry into independent healthcare.
Announcing the move to consultants and GPs at the BMA’s private practice conference, the insurer vowed it would use the money saved to give insured patients better value and to grow the market ‘for the benefit of all participants’.
The insurer said it would chase significant reductions from hospitals found by the Competition and Markets Authority to be charging ‘excessive’ rates and profits.
A spokesperson said: ‘It is an absolute priority of ours to address this – and to secure the agreement of current and future
private hospital owners for significantly lower fees.’
The amount would vary by hospitals group, but in some cases the insurer wanted a 15% cut or more.
Explaining the 15% figure, the insurer added: ‘This has been carefully calculated based on the relative pricing of some of our hospital providers compared to others – for example, where some hospital operators charge significantly more than others, with no evidence of better quality or patient outcomes.’
A Government think-tank sparked fears that doctors could lose thousands of pounds under a new pensions shake-up.
It called for the tax-free lump sum payable upon retirement to be removed and said there should be a reduction in tax relief for higher-rate taxpayers.
The Centre for Policy Studies’ report, ‘Retirement Savings Incentives’, urged the Government to scrap the tax-free lump sum and replace current tax relief levels on pensions with a 33% flat rate for all savers.
While this move would benefit basic-rate taxpayers who received only 20%, senior doctors were among those who would face a substantial cut from their tax relief of up to 45%.
Specialist financial advisers Cavendish Medical said it
remained to be seen whether the proposals would become reality –‘removing the tax-free lump sum would be a bold move for any politician so close to the general election’.
Hundreds of independent practitioners working in Spire Healthcare’s 38 private hospitals were unclear about future plans for the company.
Consultants had been hearing rumours of possible buyers for the group, but parent company Cinven declined the chance to comment on a possible sell-off.
Spire Healthcare had been expecting to have to sell some of its hospitals as a result of the competition inquiry into private healthcare.
But, before the final report a month earlier, it knew it had escaped this threat, saying it welcomed recognition it was not anti-competitive.
Plans to develop new initiatives to promote the ‘Harley Street’ and ‘London’ brand to overseas patients took a step forward with a further meeting for interested parties.
Twenty representatives of leading medical businesses in the area met for follow-up talks following a sell-
out summit meeting which created support for the project.
The initiative aimed to combat growing overseas competition around the world which was hijacking thousands of potential patients who might otherwise have come to see doctors in the UK.
Anaesthetists claimed that higher fees paid to some surgeons for operating on NHS patients in private hospitals were likely to exceed many other ‘inducements’ to consultants being banned in the wake of the competition inquiry.
The Association of Anaesthetists of Great Britain and Ireland hit out over payments in its response to the Competition and Market Authority’s investigation into private healthcare.
AAGBI president Dr William Harrop-Griffiths said: ‘An increasing volume of elective NHS surgery is being performed in private hospitals as a consequence of the Health and Social Care Act 2012.
‘But some groups of consultants are being paid substantially higher hourly rates for treating NHS patients in private hospitals, and we believe this acts as an inducement to bring lucrative, privately-funded work to those hospitals.
‘This is an abuse of public funds that adds many millions a year to NHS costs.’
QI have been a substantive consultant for almost three years and have been considering transitioning from the NHS to focus solely on private practice, due to the growing demand for self-pay procedures in the on-going current climate.
What do I need to consider before making the leap?
tackle a very common question they are increasingly asked by consultants
AMoving a surgical or medical practice over fully from the NHS into the private sector requires careful consideration and there are multiple key factors to take into account before making the decision.
1 Plan ahead
Unless the switch is to one of an employment model contract offer with a hospital group, then a phased approach is usually the least risk-orientated approach.
It provides a safety net in the
event of the private practice taking longer to develop than anticipated.
Create a transition plan addressing demand, financial stability and personal readiness, such as financial commitments to support a young family or other individual circumstances.
2 Consider a phased approach
It is common practice among consultants to initially reduce programmed activities (PAs) within their NHS base and replace those sessions within private practice.
This gives them time and space to focus on developing a private practice, with the assurance of an income from the NHS until such time that a further reduction in PAs becomes a more viable option.
3 Financial considerations
When a consultant does decide to fully transition, it is
essential to analyse the financial implications of leaving the NHS and relying solely on private practice income.
Consider revenue potential and operational overheads to run a private practice, in particular professional medical indemnity costs. It may well take more time than anticipated to establish a steady patient base in the private sector, so ensure the practice is financially viable and capable of supporting income needs without the stability afforded by NHS sessions.
4 Legal and regulatory considerations
Review contractual obligations with the NHS, licensing requirements, insurance and compliance with healthcare laws and regulations.
Ensure you are prepared to navigate the complexities of operating
in a private practice, which can be onerous and financially challenging.
Evaluate the demand for selfpay procedures in the specialist area. Assess the competition, patient demographics and local market trends.
Is there a sustainable demand for this service and how prepared and well-positioned is the practice to capture and divert a significant share of the market?
Develop a detailed plan that includes steps for notifying patients, managing referrals, updating contracts and securing necessary resources for private practice.
Set aside a budget to support these objectives in addition to protecting time in the diary on a regu-
lar basis to enable and revise the plan.
Transitioning from the NHS to private practice will present a level of risk, so it is important to consider not only financial risks, but reputational and regulatory risk factors too.
Include these risks and plans to mitigate challenges and uncertainties associated with the transition.
Consider the impact of your decision on patient continuity of care and access.
Does this decision align with long-term goals and personal values and ethics?
Will private practice continue to deliver the acuity of mix and diversity of patients?
Consider revenue potential and operational overheads to run a private practice, in particular professional medical indemnity costs
Take time to reflect on your professional satisfaction and fulfilment of working in the NHS versus the private sector.
The decision to transition from the NHS to the big leap of being solely focused on private practice should be based on a careful consideration of all the factors.
Evaluate options, seek advice from trusted colleagues and make a decision that aligns with your personal goals and values.
Sue O’Gorman is director of Medici Healthcare Consultancy. Website: www.medicihealthcareconsultancy. co.uk. Email: sue@medicihealthcareconsultancy.co.uk.
Hannah Browning is director of Beyond Excellence Healthcare Consultancy. Website: www.beyondexcellenceconsultancy.co.uk. Email: info@beyondexcellenceconsultancy. co.uk.
All currently valid Medical Device Directive CE certificates are set to expire this month, marking a critical juncture for EU and UK medical device manufacturers.
This date holds significant weight, as the EU Commission had anticipated all manufacturers with products on the EU market to transition to the new Medical Device Regulations CE certificate, yet this expectation has not been universally met.
For consultants and GPs, staying informed about these changes to the device regulations is vital to ensure patient safety and compliance, says Tautvydas Karitonas (right).
Here he explores the recent updates to the regulations and provides practical guidance on what consultants and GPs need to do before the deadline
What are the Medical Device Regulations (MDR)?
The MDR encompasses a comprehensive set of laws and guidelines governing every stage of a medical device’s life cycle.
From design and development to testing, manufacturing, labelling, marketing and post-market surveillance, the MDR ensures devices meet stringent safety and efficacy standards.
The regulations have two primary goals: safeguarding the health of patients and users while ensuring the efficient operation of the internal market for medical devices.
To achieve these aims, and in light of issues identified with the previous regulatory framework, the regulations set out a more robust system of conformity assessment.
This system ensures the quality, safety and performance of devices available in the EU market.
A medical device is a broad category that includes various instruments, apparatus, implants, software and related articles intended for medical purposes.
Whether it is a simple bandage, blood pressure machine, urine sample container or a more complex surgical instrument, pacemaker or
artificial implant, each device plays a crucial role in patient care.
Understanding the MDR
The Regulation (EU) 2017/745, also known as the MDR, was initiated to create a stronger system for evaluating the conformity of medical devices in the EU market.
It has been effective since 26 May 2021, superseding the previous medical device directives. The transitional period was set to extend until the 26 May 2024. However, due to a lack of capacity among notified bodies and manufacturers’ insufficient readiness to adhere to the MDR’s more rigorous requirements before the transition period ends, the European Commission deemed it necessary to prolong this deadline. This extension, though, is contingent on certain conditions to ensure only safe devices for which manufacturers have already initiated the transition to the MDR are granted the extra time.
In light of the issues related to Notified Body* capacity, the only options to stay in the market are to hold a valid MDR CE certificate or to obtain an extension to current Medical Device Directive CE certificates.
This can only be accomplished through an MDR-certification application with a notified body.
The situation is reminiscent of a real-world Thanos snap – when the character in the film Avengers: Infinity War turns half the population of the universe into dust by snapping his fingers – representing a grave risk to our healthcare system, as a considerable number of devices are vulnerable to this risk.
Imagine this: if a manufacturer fails to comply with MDR requirements, their products could be rapidly withdrawn from the market, leading to potential shortages that affect patients who depend on essential devices such as pacemakers or diagnostic tools.
This impact goes beyond patient care, imposing additional costs on healthcare providers as they struggle to find alternative, potentially pricier devices.
Furthermore, non-compliance damages the reputation of manufacturers and suppliers, undermining trust among healthcare providers, patients and the general public. This erosion of trust can lead to widespread implications, harming businesses and destabilising the healthcare ecosystem.
Considering the UK, which represents 12.1% of all medical devices sold within the UK and EU and is home to the NHS – the larg-
est device consumer – the stakes are exceptionally high.
The NHS’s struggles with supply chain issues during the Covid-19 pandemic have underscored the critical importance of robust, near-constant monitoring of supply chains to ensure a consistent supply of compliant medical devices.
The imminent risk of shortages is not hypothetical but a real threat, emphasising the urgent need for pro-active planning and risk mitigation strategies. This regulatory environment casts a significant shadow over medical device research and development.
Despite the UK’s medtech sector being one of the fastest-growing globally, the heightened focus on regulation and compliance is diverting resources away from innovation, potentially hindering advancements in critical areas like orthopaedic implants or diagnostic equipment development.
Increasingly, manufacturers are compelled to prioritise regulatory compliance over pioneering product development, potentially decelerating the rate of progress.
It is pivotal for UK medical device manufacturers and healthcare organisations to ensure they are fully equipped for the MDR deadline.
Manufacturers must guarantee their devices comply with the stringent requirements set by the regulators, while healthcare organisations should have extensive plans to mitigate both immediate and long-term supply chain disruptions.
Navigating these regulatory hurdles with flexibility and a dedication to innovation is vital for preserving the health of the UK’s medical device sector and, by extension, the overall healthcare system.
Consultants and GPs rely on safe and effective medical devices every day. To safeguard patient safety and ensure accurate diagnosis or treatment, they must utilise devices that have undergone proper CE marking and regulatory scrutiny. Understanding market developments and preparing accordingly reinforces this commitment to patient care. Here is what you can do.
Verify that all your medical devices bear a valid CE mark, ensuring compliance with regulatory standards.
It is necessary to have all the relevant information from your medical device manufacturers or supplier to ensure you are using fully compliant medical devices.
Labels should clearly indicate conformity with regulations and standards. Remember, CE marking is not merely a check-box exercise – it is a vital assurance of device safety.
The GMC states that doctors must take the same care when recommending medical devices and digital health tools as they do when issuing traditional prescriptions.
As with prescribing medication, it is important to ensure that any medical device or digital health
tool you recommend is safe, indicated, effective and regulated so that any risks are mitigated. It is the responsibility of the manufacturer or supplier of the devices to ensure they have regulation approval. However, it is important for GPs and consultants to ensure these checks have been done before recommending or using the devices with patients.
2
Collaborate with manufacturers.
If you own clinics or use supplied devices, engage with manufacturers and ensure they are MDR-ready. If they are not, it might be that you need to look for other suppliers who are, as any devices that do not meet the MDR could be taken off the market.
3
Stay informed.
Regularly monitor updates related to MDR. Attend webinars, workshops and conferences to understand the latest developments.
* A notified body is a conformity assessment body designated in accordance with the applicable legislation, which performs thirdparty assessment activities to certify products before being placed on the market.
Notified bodies must operate in a consistent, fair, non-discriminatory, transparent, competent, independent and impartial manner.
To ensure this, notified bodies competence is assessed by a National Accreditation Body and awarded accreditation against the applicable regulation and harmonised standards such as EN ISO/ IEC 17021 Certification of management systems and EN ISO/IEC 17065 Product certification.
Tautvydas Karitonas is managing director of Test Labs, a medical device testing laboratory for global compliance. Go to https://testlabsuk.com
Dr Claire Wratten and
Greta Barnes
analyse clinical negligence claims notified by MDU radiologist members and provide advice on managing risks
CLAIMS ARE less frequently made against radiologists than some specialties the MDU covers for private practice – but they remain relatively common and compensation payments can be substantial.
Managing known risks linked to clinical negligence claims is important both to protect patients and to reduce the chance of a claim being successful.
The most common reason for a claim was a missed or incorrect diagnosis.
It is generally alleged that if an abnormality had been reported promptly and/or correctly, and then investigated appropriately, the patient would have received treatment more quickly, reducing the period of pain or extent of symptoms experienced, the extent of treatment required and/or disability. It may be alleged that the patient died because of the delay.
The majority of missed diagnosis claims involved a missed tumour. Depending on the length of delay and stage of the malignancy, the alleged consequences ranged from minimal to severe physical disabilities or avoidable or hastened death.
For example, in one case it was alleged the patient would have avoided an above-knee amputation and, in another, that they would have retained their vision.
A claim was also made following an alleged delayed diagnosis of meningioma; the damages agreed were over £600,000, comprising primarily a claim by the patient’s family for dependency on the patient’s income following his death.
The MDU successfully defended over 60% of claims against radiologists identified in this series that followed an alleged delayed diagnosis of malignancy.
In some claims where fractures were missed, the impact was minimal, restricted to a longer period of discomfort, because the same treatment would have been required in any event.
For other cases, the oversight
In one case, it was alleged the patient would have avoided an above-knee amputation and, in another, that they would have retained their vision
resulted in worsening of symptoms, more significant impact on the patient’s day-to day function and additional or more complex treatment being required.
Some also caused deterioration into a separate condition – for example, a case where a missed skull fracture resulted in development of a brain abscess.
Over 70% of claims in which it was alleged that a fracture was missed were successfully defended.
However, one case, in which it was alleged that a missed fracture meant that the patient required a total knee replacement, resulted in payment of a five-figure sum because of the reduced mobility suffered by the patient and resultant care needed prior to correct diagnosis and following the remedial surgery, that could have been avoided.
There were several cases in which it was alleged that there was a delayed diagnosis of an abnormality of the spinal cord, resulting in neurological damage.
In the vast majority, the diagnosis was cauda equina syndrome, but other diagnoses included spondylolisthesis or arteriovenous malformations. Only 20% of these claims were settled on behalf of the reporting radiologist.
A similar number of claims related to an alleged failure to diagnose an intracranial abnormality on imaging. The diagnoses that were alleged to have been missed included cerebral aneurysms, subarachnoid haemorrhage and ischaemic stroke.
A few delayed or missed diagnosis claims related to infections, where
it was alleged that radiology was incorrectly interpreted and that an infection was missed.
The infections included osteomyelitis, septic arthritis, TB, arachnoiditis and necrotising fasciitis, and only one of these claims was settled on behalf of the reporting radiologist.
In these cases, it was alleged that the claimant had suffered a postoperative complication and concerns were raised regarding the reporting of post-operative imaging, resulting in a delay in diagnosis and treatment of the post-operative complication.
Examples include perforation following a gastric band and loosened pedicle screws following spinal surgery.
Radiologists carry out a huge range of different procedures, any of which may result in complications being suffered by the patient.
The range of complications identified in this analysis included infections or haematomas following a biopsy, complications related to coiling of intracerebral aneurysms and nerve injury following nerve blocks or intra-articular injections.
Almost 70% of claims were successfully defended.
There were relatively few claims following issues with medication and the majority of cases were following administration of a drug to which the patient was allergic, although there was a claim following contrast-induced renal injury.
There were a large number of claims that didn’t clearly fall into a particular category, partly reflecting the wide range of imaging reported on by radiologists.
For example, missed meniscal tears on MRI scanning of the knee, missed renal calculi, missed congenital abnormalities on antenatal scans, missed aortic dissection, failure to diagnose ruptured breast implants and missed foreign bodies.
➱ continued on page 18
This analysis is based on over 230 claims brought against consultant radiologist MDU members working in the independent sector.
Approximately three-quarters of these claims were successfully defended, with no payment made to the claimant.
The aim of a compensation payment is to restore the claimant and/or their dependents to the position they would have been in had the negligence not occurred.
When large payments are made, much of the settlement is comprised of funding the future care of seriously injured patients or to compensate them and/or their dependants for loss of earnings and/or pension.
The average damages payment was £77,500, but there was a very large range.
Alleged delayed diagnosis of malignancy was the most common reason for a claim against a radiologist being settled.
Damages paid to the claimant in these cases varied widely, from just over £1,000 for delayed diagnosis of an Ewing sarcoma, to almost £1m for a failure to identify an incidental malignancy on an ultrasound, resulting in a delayed diagnosis and thus a missed chance for curative treatment.
When a compensation payment is made, the paying party is also responsible for settlement of the legal costs incurred by the claimant in bringing the claim. The amount sought for claimant costs increases with the length and complexity of a claim.
However, even in a relatively straightforward claim, these costs
Delayed diagnosis of malignancy
Post op
Intracranial lesions
Missed fracture
Spinal cord lesion
Delayed diagnosis of infection
Miscellaneous
Medication-related
Procedure-related
can be considerable and can exceed the amount of damages paid to the claimant.
In several cases analysed, the legal costs paid exceeded £100,000, with the largest payment being over £700,000.
The MDU incurs costs investigating and negotiating settlement of claims that settle, but in addition, costs are incurred in the successful defence of a claim – for example, due to instruction of independent experts, solicitors and barristers.
In the claims against radiologists that were successfully defended, the defence costs were often significant – for example, over £180,000 in a case that was won at trial.
These figures demonstrate the need for radiologists to have appropriate indemnity arrangements in place, as even lower-value claims can result in payment of a total sum for damages and legal costs that is considerable.
Quite apart from the financial implications, it can also be very distressing to find out that a patient is bringing a claim against you.
If you face a claim, you can rest assured that the MDU’s specialist claims handlers and medico-legal advisers will be there to support you. They understand how stressful the claims process is.
We will defend claims whenever possible and involve members in the conduct of their cases throughout. If a case requires settlement, we will always obtain your express consent to do so.
Dr Claire Wratten (right, top) is senior medical claims handler and Greta Barnes (right) is senior claims handler at the Medical Defence Union (MDU)
Claims involving radiologists often focus on a few key areas such as delayed or incorrect diagnosis. However, there are some common risk factors, which, if managed appropriately, can help to reduce risks.
These include:
Referring to the GMC’s guidance on consent and other relevant guidelines such as those from NICE. Consent should be obtained by an appropriate member of the team and, ideally, by the radiologist undertaking the procedure.
Confirming that the patient is aware of the risks, benefits and complications of the proposed procedure as well as other therapeutic options. These should be carefully documented.
Even in a relatively straightforward claim, legal costs can be considerable and can exceed the amount of damages paid to the claimant
Supporting information such as patient leaflets can help patient understanding. The use of these should be documented in the records.
Considering the patient’s past medical history, medication history and allergies before administering pre-procedural medication and contrast media.
Obtaining access, where possible, to previous imaging.
Offering a chaperone to patients undergoing any intimate examinations – for example, pelvic ultrasound.
Having a system in place to verify the right site with the patient undergoing treatment and to crosscheck information provided against the referral.
Ensuring appropriate handover to recovery staff for interventional procedures or those under sedation.
Assuring that interruptions in the reporting room are kept to a minimum.
Ensuring robust procedures are in place for communicating results to relevant parties to ensure appropriate and prompt follow-up and treatment.
Being aware of the organisation’s procedures for reporting unexpected findings or those needing urgent investigation and consider contacting the referring doctor directly.
If things go wrong, be open and honest with the patient by providing an explanation of what has happened and the likely short- and long-term effects of this. Say sorry and get advice from the MDU. Consider whether the incident triggers the organisation’s duty of candour requirements.
If you are reporting imaging via a third-party company, ensure that you are aware of the contractual arrangements in place regarding indemnity should a claim arise out of your reporting, even if the patients are NHS patients.
Record dissatisfaction levels with the NHS suggest opportunities for those in private practice, but signal a warning too. Leslie Berry reports
‘WE PUT the patient at the centre of everything we do.’
Commonly trotted out by private providers’ PR teams eager to impress, this catchphrase can easily be dismissed as ‘a statement of the bleedin’ obvious’.
Cynical recipients hearing the slogan for the first time could be excused for responding with: ‘Oh, really – how impressive. So what else is your service aimed at then?’
Putting patients at the centre of it all is a well-meant target, but when it comes down to it, the experience can be vastly different.
Public satisfaction with the NHS has now fallen to the lowest level ever recorded, according to analysis of the latest British Social Attitudes survey (BSA) published by the think-tanks The King’s Fund and the Nuffield Trust.
For the first time in the survey’s 41-year history, under a quarter of people are satisfied with the way the NHS is running. Satisfaction previously peaked in 2010, when seven out of ten people reported being satisfied.
Overall public satisfaction with how the NHS runs now stands at 24% – a fall of five percentage points from the previous year. Since 2020, satisfaction has fallen by 29 percentage points. Dissatisfaction is also at an alltime high (52%).
The survey, carried out by the National Centre for Social Research (NatCen) in September and October 2023, is seen as a goldstandard measure of public attitudes in Britain.
Nearly three-quarters (71%) of respondents who were dissatisfied with the NHS pointed to long ➱ continued on page 20
waiting times for GP and hospital appointments as one of their top reasons for dissatisfaction, followed by staffing shortages (54%), and a view that the Government spends too little on the health service (47%).
Deteriorating public attitudes to the NHS, which only four years ago was receiving huge cheers and weekly standing ovations from a
grateful pandemic-hit nation, demonstrate how opinion can so quickly change.
And there is a warning to heed in there for independent practitioners and their teams – as well as an opportunity.
Private healthcare for many years enjoyed the fruit of its proponents’ promise: ‘Affability, availability and ability’. But work-
Doctors in private practice should have their finger on the pulse about the real concerns patients have with the current challenges within the NHS around, for example, increasing wait times
life balance issues for a new generation of private doctors are increasingly important for them. At the same time, consumers demand more from every organisation and person they buy from. Increasingly, they want excellent service for their money but can find themselves on growing waiting lists for private appointments. Independent Practitioner Today
Question asked: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’
2023 sample size = 3,374. This question was not asked in 1985, 1988 and 1992. ‘Don’t know’ and ‘refusal’ responses are not shown. In 2023, these response categories were selected by 0.41% of respondents. Data has been carefully weighted to minimise differences due to the change in methodology from 2020 onwards
has highlighted other problems they experience too – such as struggling to get their phone calls to clinics answered, and frequently finding the ‘patient journey’ hard to navigate due to administrative red tape.
This journal’s ‘Troubleshooter’ columnist, practice management consultant Sue O’Gorman, of Medici Healthcare Consultancy, believes independent practitioners would do well to consider the BSA survey’s findings and implications.
She says the report clearly highlights the dichotomy of people’s emotional connection with the NHS compared to the service they now struggle to receive and the growing frustrations borne from these challenges.
‘Private healthcare has always set itself apart by offering patients “choice”; where they are seen, by whom and when. This is in contrast to a system where patient choice is becoming rapidly de”patient centralised” and eroded, particularly post-Covid around accessing primary care.
‘From a commercial perspective, doctors in private practice should have their finger on the pulse about the real concerns patients have with the current challenges within the NHS around, for example, increasing wait times.
Market opportunity
‘The self-pay market continues to grow with greater numbers of patients considering paying for their treatment. Despite their political biases, they want access to timely primary care, diagnostics, treatment plans and interventions.
‘Put bluntly, continued dissatisfaction with the NHS creates a potential market opportunity for private healthcare providers to truly “put the patient at the centre of everything we do”.’
Interestingly, nearly half (48%) of the public indicated they would be prepared to pay more for their care by saying they would support the Government increasing taxes and spending more on the NHS.
Public support for the founding principles of the NHS, which marked its 75th anniversary in 2023, remains as strong as ever.
The overwhelming majority of respondents expressed high levels of support for the principles when asked in 2023 if they should still
apply: that it is free of charge when you need it (91%), primarily funded through taxation (82%) and available to everyone (82%).
Consistent with previous years’ surveys, when asked what the most important priorities for the NHS should be, the top two cited by respondents were ‘making it easier to get a GP appointment’ (52%) and ‘increasing the number of staff’ (51%).
Improving waiting times for planned operations and in A&E were chosen by 47% and 45% of respondents respectively.
The survey also measures public opinion on specific NHS services. The think-tanks’ analysis reveals that public satisfaction with GP services – historically the service with the highest levels of public satisfaction – now stands at 34%, the lowest level recorded since the survey began. Since 2019, satisfaction with GP services has fallen by 34 percentage points.
Public satisfaction with inpatient services is at a historically low level (35%) as is satisfaction with outpatient services (44%). 31% said they were satisfied with A&E services, up one percentage point on the previous year.
Dan Wellings, senior fellow at The King’s Fund, called the results ‘depressing but sadly not surprising.’
He believes the NHS is now in uncharted territory. ‘The size of the challenge to recover it is growing more difficult with each passing year. Ahead of the upcoming general election, political leaders should take note of just how far satisfaction with this celebrated public institution has fallen.’
Jessica Morris, fellow at The Nuffield Trust, says political parties should be frank and realistic about the challenges ahead of them if they are to turn things around.
‘Despite such low levels of satisfaction, the public continues to back the principles underpinning the NHS. The public has not fallen out of love with the idea of a publicly funded, free-at-the-point-ofuse NHS, but they are losing confidence that it will support them and their loved-ones in the best possible way when they need it.’
See Sue O’Gorman’s ‘Troubleshooters’ feature on page 12
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THE IMPACT of genomics, digital technology and artificial intelligence (AI) on healthcare – and in particular cancer care – were explored in recent issues of Independent Practitioner Today by my colleague Dr Tim Woodman, medical director of policy and cancer services at Bupa.
Trying to understand customers’ attitudes towards things that do not yet exist may seem like a bit of a shot in the dark.
But we have been able to infer future attitudes based on what is currently available – and by providing descriptions of possible future solutions.
Following a comprehensive literature review, we worked with market research company Ipsos who carried out a survey of 300 participants in the UK, Australia and Spain1 to gain further insight. What we found can be broken down into five key themes.
How do health insurance customers feel about new technology and what matters to them?
Understanding the attitudes and perceptions of our customers and how they feel about healthcare is not only fundamental to the way we operate, but the way we plan our services, writes Bupa’s Dr Robin Clark
Consumer attitudes generally vary across and within generations and other population segmentations, highlighting the need to deliver products and services that are personalised to these groups’ needs.
Opinion on how care is delivered, where and by who, varies. People are generally open to using technology to support their health and wellbeing.
But there are differences and variations when respondents are asked about specific uses of healthcare technology.
Average opinion suggests respondents were generally open about the use of technology to support their health and wellbeing.
However, there appeared to be strongest openness for the 35-44 age group followed by the 25-34 and 45-54 age groups in what seemed to be a U-shaped relationship between openness to using health tech and age.
The strongest sentiments were in the middle age groups and weakest in the youngest and oldest. One potential explanation is that the middle age groups may prioritise time and convenience more highly – due to work or childcare commitments, for example – and so may be more open to using health technology.
Presence or absence of one or more chronic conditions is also a factor to consider.
There are also some differences in expressed preferences by gender, which highlights the importance of consumer segmentation when designing or running healthcare services and interventions.
People’s excitement for future facing developments varies, and they seem to be most excited about AI and least excited about the metaverse.
The rankings are fairly consistent across demographic and user groups such as country, age, gender, medical conditions, private healthcare cover status and tech products usage.
There is greater excitement for genetic testing in those who identify as female, which could be due to awareness of risk-associated variants linked to some high incidence cancers among females.
Over-65s may be more likely to have already had a genetic test as part of existing tests or treatments associated with their care. Therefore, their higher ranking could reflect their existing familiarity.
When people were asked why AI excites them most, the key themes in their responses related to it outperforming humans, offering improved access and speed, helping to tackle resource issues, and predicting poor health and disease.
In general, customers trust products and services that rely on AI as much as, or more than, those that rely on people. 1 And in healthcare, there is a positive perception of AI due to availability, ease, and potential to improve efficiency and lower costs of healthcare services.
Concerns, however, included lack of trust (data privacy), safety, digital maturity, and the idea of full automation.3 Factors impacting the acceptability of AI within healthcare include: age, IT skills, preference for talking to computers, perceived utility, positive attitude and perceived trustworthiness.
The metaverse was consistently ranked lowest as an exciting topic
➱ continued on page 24
although respondents who said they were very knowledgeable on this topic ranked it fourth out of the seven topics rather than last.
The other six were:
AI;
Genetic testing;
Robotics;
Telehealth and remote care;
Wearable and connected devices;
Big data.
Respondents who reported higher understanding of the metaverse were the most likely to enter a fully immersive virtual environment to meet healthcare professionals.
While this finding is unsurprising, it does add to the content validity of the data collected. It can highlight the importance of education when it comes to the adoption of new health technologies but could also be an example of selection bias.
The use of virtual reality (VR) in healthcare is being explored for things like pain management and patient education and involvement. And in the future, VR may be used to engage and deliver therapeutic interventions. Beyond VR is healthcare delivered in the metaverse.
In the future, consumers may be able to consult with healthcare professionals in the metaverse and receive ‘hands-on’ care owing to developments within haptic touch.
Appetite for the metaverse within healthcare is mixed and there is not yet a comprehensive understanding around consumers’ willingness and sentiment towards receiving care or interacting with the metaverse for their health and care needs.
Consumers want to know more about their health risks and intend to take preventive action. There appears to be good appetite to understand health risk, but preferences are likely to be highly personal and specific to the individual. They will also depend on the nature of the health risk being disclosed.
People see value and are interested in tools and technologies, such as genetic tests, which support the prediction of disease and understanding of health risk.
Respondents overwhelmingly
In the future, consumers may be able to consult with healthcare professionals in the metaverse and receive ‘hands-on’ care owing to developments within haptic touch
indicated that they would take positive and constructive action after finding they were at increased risk of developing a health condition. This supports the value and need for healthcare organisations to continue investing in the prediction of diseases and ill health.
Evidence4 shows that:
73.8% of people are happy to receive information about their risk for diseases with available medical treatment (for example, some types of cancer)
72.6% are happy to receive information about their risk of diseases for which only preventive action can be undertaken (for example, heart disease)
69.6% are happy to receive information about the effects of lifestyle (for example, smoking and weight) on their risk of a medical condition.
As treatments and interventions to prevent disease and improve longevity advance, there will likely be increased appetite from consumers to know their health risk so they can act to keep themselves well and in good health, for longer.
There is a growing need and opportunity to support customers with chronic condition management through the use of innovative technological solutions, encouraging self-care and a preventive approach.
Healthcare consumers with chronic conditions favour convenience – and individuals with a reported mental health condition seem to be more in favour of innovative technological solutions. This includes using digital tools to support their mental health, and other innovative solutions to help detect and alert users to a decline in mental health status, such as smart speakers and software that can detect changes in mental health through voice and typing patterns on a laptop, tablet or phone.
In general, people with chronic disease experience a significant improvement in their quality of life and ability to self-care after receiving nurse-led telerehabilitation, when compared to a conven-
tional in-person rehabilitation service. However, preferences vary greatly and depend on a range of different factors.
Current limitations of telehealth offerings like telerehabilitation include technical issues, limitations on carrying out procedures that require physical contact, and security breaches and should not be overlooked.
Evidence also shows that patients with greater physical disabilities resulting from chronic conditions like cardiac diseases, chronic respiratory diseases, and stroke are less likely to comply with a telerehabilitation programme than their counterparts experiencing less functional disability from conditions such as hypertension, diabetes, and cancer5.
Unsurprisingly, our research found that speed, access to quality care and convenience were ranked as the highest motivators for using telehealth.
In our research, consumers ranked their doctor or other healthcare professional, hospital and health insurer as the top three that they would share their health data with, and they are viewed as trusted.
Trust and transparency around data and how it is used are important drivers of data sharing and should be incorporated into a healthcare organisation’s brand.
According to our research, the top three things that an organisation can do to increase customer willingness to share their health data are:
Demonstrating how the organisation keeps data secure (and evidencing this)
Being transparent and upfront with how data is accessed and used, and
Helping consumers understand how sharing health data benefits their health.
However, trust is just one component of a good relationship between consumers and providers.
Consumers were also found to put emphasis and value on personal touch when asked about their thoughts towards certain developments such as robotics within healthcare. For example:
Consumers ranked their doctor or other healthcare professional, hospital and health insurer as the top three that they would share their health data with, and they are viewed as trusted
‘The personal touch can’t be replaced.’
Conclusion
Digital tools and technologies will support the future of healthcare. However, healthcare professionals and organisations must ensure that the quality and nature of relationships between consumers and providers is strengthened by their use, and not weakened.
Consumers must be brought along on the journey to make sure that these tools and technologies are a success.
If they have insufficient knowledge or understanding of the tools, or the tools are not appropriately integrated into current healthcare systems and processes, this presents a risk to their adoption.
1. Our survey, in January 2023, included additional quotas for age, gender, selfreported health condition and private healthcare cover.
2. Why digital trust truly matters. McKinsey, September 2022
3. Chew HSJ, Achananuparp P. Perceptions and Needs of Artificial Intelligence in
Health Care to Increase Adoption: Scoping Review. Journal of Medical Internet Research, 14 January 2022
4. Caroline Brall, Claudia Berlin, Marcel Zwahlen, Kelly E. Ormond, Matthias Egger, Effy Vayena. Public willingness to participate in personalized health research and biobanking: A large-scale Swiss survey. 1 April 2021
5. Lee AYL, Wong AKC, Hung TTM, Yan J, Yang S. Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. Journal of Medical Internet Research, 2 November 2022
Dr Robin Clark is medical director for Bupa Global and UK Insurance
DRIVEN BY historically long NHS waiting lists, more and more people are accessing healthcare in the private sector through medical insurance or self-funding.
Waiting list initiatives are also resulting in some NHS patients being referred to private providers for treatment, funded by the NHS.
Here are some of the statistics:
News reports suggest nearly 500,000 new customers took out private health insurance in 2022 with three of the largest insurance companies in the UK.
Self-pay admissions are down from their record post-pandemic peaks, but are still approximately one third higher than pre-pandemic levels.
A record 820,000 inpatients and day-case patients were treated in 2022 in the private sector, with data from 2023 on track to exceed this again.
According to a recent market update from the Private Healthcare Information Network (PHIN), the top five procedures undertaken in the private sector in 2023 were: cataract surgery, chemotherapy, diagnostic upper-GI endoscopy, diagnostic colonoscopy and primary hip replacement surgery.
In a poll published in 2023 by the Independent Healthcare Providers Network, the most common factor for people deciding to use private healthcare was being unable to get an NHS appointment quickly enough, with 46% of all respondents citing this.
The Institute of Fiscal Studies recently published a report predicting that it is very unlikely that NHS waiting lists in England will reach pre-pandemic levels by December 2027, even in a best-case scenario.
So with the above in mind, it seems unlikely that the increasing number of people turning to the private sector for elective treatment and procedures is going to relent in the near future.
This increase in volume, together with a likely increase in more complex and more frail patients seeking to undergo a procedure in a private hospital, will present additional factors for doctors in private practice to consider.
In the vast majority of private hospitals, there are significant differences in HDU and ITU resource and capacity compared to NHS hospitals, as well as differences in the level of resident junior doctor cover and senior cover out of hours.
The Royal College of Surgeons of England (RCSE) provides helpful guidance on this in its document Working in the Independent Sector. It advises that the consultant performing the procedure will usually be responsible for the care of the patient, including ensuring they receive appropriate postoperative management.
The college also states that surgeons should be satisfied that ‘operations are performed in a facility that is appropriate for the level of risk involved in the procedure.
‘Facilities should be appropriately staffed and equipped to manage possible complications and emergencies and sufficient protocols should be in place for managing complications and emergencies that may arise during the procedure or in the immediate postoperative phase.’
This will be a case-by-case con-
As the volume of patients seeking to undergo procedures and treatment in the private sector increases, there is the potential for frailer patients and those with complex comorbidities to present and seek treatment in this setting too.
More complex private patients add an extra element of risk to their management in the private setting, which needs to be considered.
These considerations include the suitability of the facility for the patient in the event of them developing a complication related to their comorbidity and the proximity to higher levels of care in an NHS facility, including transfer arrangements and times.
Consider whether further information is needed, such as from the patient’s NHS records, with their consent, to accurately assess their suitability for a procedure in that private setting, particularly with direct self-referrals.
Privately practising surgeons should include in their discussion with patients any limits of the care available in that private hospital setting, such as the level of critical care provision and staffing cover.
Discussions should be carefully documented in the medical records together with the clinical justification for undertaking the surgery privately and the appropriateness of doing so in this setting in each patient’s case.
If there is uncertainty about the patient’s suitability to be operated on in the private setting, then this should be discussed with others at that facility, including the medical director.
Giving consideration to these wider elements of private care could help avoid a GMC investigation, criticism at an inquest or even a claim of clinical negligence.
Ensure you have appropriate and adequate indemnity protection for the types of work you are carrying out, so you can seek assistance with a range of medico-legal matters.
sideration dependent on the individual circumstances and risk factors for each patient and the individual facility where the procedure would take place.
A recent Healthcare Safety Investigation Branch investigation into surgical care of NHS patients in independent hospitals highlighted the same factors.
In Good Surgical Practice , the RCSE advises that surgeons working in the private sector should
‘make clear to patients the limits of the care available in any independent hospital used, such as the level of critical care provision and the qualification of the resident medical cover’.
It also advises that surgeons must make arrangements for the continuity of care of private inpatients.
If the surgeon is not personally available in the postoperative period, formal arrangements must be made with an alternative, named and suitably qualified person in the event the patient expe-
riences complications outside normal working hours.
These arrangements should be made in advance, where possible, and made known to the patient and relevant staff at the independent hospital.
Like the consent process for the procedure itself, this exchange of information is a crucial part of the explanation and dialogue between the surgeon and the patient.
Several inquests and GMC matters investigating incidents have questioned whether a private hospital was an appropriate setting for the surgery and postoperative management based on the individual patient’s condition and comorbidities.
In our hypothetical case study, 78-year-old Mr A was keen to have his total hip replacement surgery carried out privately due to the NHS waiting list.
He approached Miss B, a consultant orthopaedic surgeon, directly as a self-paying patient with no GP referral. Mr A had a history of a previous coronary artery stent, COPD which he described as well controlled, osteoarthritis and chronic kidney disease stage three.
He was not aware that the private hospital did not have high dependency or intensive care facilities and this was not discussed by Miss B.
She and the anaesthetist Dr C reviewed Mr A pre-operatively, but did not have access to Mr A’s NHS records, where there was more detailed information regarding his COPD and kidney function.
Mr A’s hip replacement went smoothly and he returned to the ward. But 24 hours later, the resident medical officer (RMO) was called overnight to see Mr A due to a raised temperature and increased secretions.
Mr A was prescribed antibiotics
for a suspected chest infection and Miss B was updated by phone.
The next day, Miss B was caught up with her NHS practice. The RMO was busy covering the wards and managing another sick patient, but was able to briefly review Mr A amongst this. He appeared relatively stable, and antibiotics and IV fluids were continued.
That night, Mr A became profoundly hypoxic, hypotensive and oliguric. The RMO called Miss B who discussed Mr A with the oncall medical and orthopaedic teams at the local NHS trust.
Mr A became increasingly confused and his blood pressure remained low despite all wardbased interventions.
An ambulance was called for an urgent transfer and Mr A was eventually transferred to the NHS hospital the following morning.
He was diagnosed with a chest infection, sepsis and acute kidney injury. Mr A was admitted to the intensive care unit with multiorgan failure, where he sadly died three days later.
Mr A’s family submitted a complaint to the GMC regarding Miss B.
They alleged she had failed to identify he was too high-risk a patient for surgery in the private hospital without the necessary critical care facilities should a postoperative complication like this arise and that she did not inform him of the lack of these facilities.
Dr Beth Walker (below, left) and Dr Sophie Haroon are medico-legal consultants at Medical Protection
Partnering with a professional medical billing service can streamline your practice’s financial processes, optimise revenue and alleviate administrative burdens. And it allows you to focus on delivering exceptional patient care, says Derek Kelly
In today’s dynamic healthcare environment, efficient billing practices are essential for the financial health and success of medical practitioners and organisations.
But navigating the complexities of medical billing can be challenging and often leads to delayed payments, billing errors and administrative inefficiencies.
Let’s explore some of the main
benefits of harnessing the expertise of a professional billing service to elevate your practice’s financial performance.
Maximise revenue and minimise delays
Professional medical billing companies understand the importance of timely reimbursement for sustaining a thriving healthcare prac-
tice. Regular payments are the lifeblood of a flourishing healthcare practice.
By exploiting technology and industry expertise, these services ensure prompt submission of claims and diligent follow-up on outstanding payments.
At my company, Medserv, we recognise the critical significance of getting what is owed in on time.
One of our clients, an esteemed cardiologist, struggled with lengthy payment delays and revenue leakage due to billing inefficiencies.
We were able to swiftly implement a tailored billing solution for this customer, ensuring prompt claims submission and diligent follow-up on outstanding payments.
As a result, she experienced a remarkable surge in revenue and a substantial reduction in payment delays, enabling her to focus more on patient care without financial concerns.
Leveraging technology for billing efficiency
In addition to expert knowledge and support, professional medical billing services leverage software to further enhance billing efficiency.
These solutions streamline the entire billing process, from claim submission to payment reconciliation, reducing manual errors and accelerating re-imbursement cycles.
Our systems can help identify and rectify billing errors or inconsistencies before claims are submitted, lessening the likelihood of claim rejections or denials.
This proactive approach not only ensures smoother revenue cycles but also minimises disruptions to cash flow.
With the constant evolution of technology, companies continuously update their systems to stay at the forefront of innovation. By harnessing this power, practices
Professional medical billing companies understand the importance of timely re-imbursement for sustaining a thriving healthcare practice
can achieve unprecedented levels of billing efficiency, and that ultimately translates into increased revenue and practice growth.
Navigate regulatory complexity with confidence Getting through the ever-changing landscape of healthcare regulations can be daunting. Fortunately, professional billing companies have teams of seasoned billing experts well-versed in regulatory compliance.
Whether its staying abreast of coding updates or adhering to billing guidelines, these services provide comprehensive support to ensure your practice remains compliant and audit-ready at all times.
Enhance practice efficiency Time is a precious commodity in the healthcare industry and administrative tasks can often encroach upon valuable patientfacing hours.
But professional billing companies streamline billing processes, empowering you to reclaim your time and focus on patient care.
From automated claims processing to personalised support from dedicated billing specialists, these services optimise your practice’s administrative workflows, enhancing efficiency and productivity.
An example of a busy oncologist, who was overwhelmed with administrative tasks, comes to mind. The problem was impeding his ability to provide optimal patient care.
We were able to automate cumbersome processes and provide personalised support, allowing him to streamline the practice’s administrative workflows and dedicate more time to patient consultations and treatments.
And this additional patientfacing time also helped to increase the overall practice’s revenue.
Actionable insights are instrumental in driving practice growth and informed decision-making. Professional billing services also offer robust reporting and analytics tools that provide invaluable insights into your practice’s financial performance, payer trends and revenue cycle metrics.
Armed with this data-driven intelligence, you can make informed decisions to optimise revenue streams and drive practice growth.
We are aware that many clients have used Medserv’s comprehensive reporting tools to gain actionable insights into their practice’s financial performance and patient demographics.
Capitalising on this data-driven intelligence, they can implement strategic initiatives to optimise revenue streams and attract new patients, driving practice growth exponentially.
Client satisfaction is paramount for professional billing services. With a commitment to excellence and personalised service, they go above and beyond to meet the unique needs of each client.
From responsive customer support to proactive communication, professional billing companies partner with you every step of the way, ensuring a seamless and stress-free billing experience for both you and your patients.
Partnering with a professional medical billing service like Medserv is about unlocking the full potential of your practice.
With their expertise in streamlining billing processes and optimising revenue, they enable consultants to achieve financial success while focusing on delivering exceptional patient care.
Choosing this path can transform your practice and free up more of your valuable time.
Derek Kelly (right) is marketing manager at Medserv
The free and integrated digital prescribing platform for all private prescribers.
CloudRx take care of the dispensing, payment and delivery of medicines direct to your patients, wherever in the country they may be, for more convenient access to their medicines.
Order prescriptions at the touch of a button to add a whole new level of convenience for your patients.
Simple and fast digital prescribing.
Legal paperless prescriptions, repeat prescriptions and controlled drugs.
Prescriber fees can be charged to the patient if required.
Our API enables frictionless integration with healthcare brands & clinical software including Semble, WriteUpp, MidexPRO, eClinic, Pabau and ClinicYou.
“We were struggling to keep up with the admin side of the prescriptions, not to mention storage for medication to cope with a huge increase in prescriptions. CloudRx immediately took away the strain. Since our partnership we have grown by more than 200% in size. We could not have achieved this seamless scalablity without them.”
– Dr Louise Newson, Newson Health
Risk means different things to different people. Guy Beck spells out the unexpected damage to your wealth from holding cash and eschewing stock markets
TRYING TO explain what ‘investment risk’ is in a short note is a challenge, as it means different things to different people.
To a person with little knowledge of investing, putting money into the stock market can feel like a risky thing to do. After all, they have probably been told, or read, that stock markets are volatile and are therefore ‘risky’ and not for the faint-hearted.
With bank deposits paying a decent return in 2024 compared to recent years, they may be tempted to remain in cash.
To someone who is a more experienced investor and has weathered some tough stock market downturns but has been rewarded with strong overall returns from dividends and share price rises, being invested in the stock market feels less risky than the reckless
conservatism of placing bank deposits.
The problem here is one of timeframes and inflation. In a year’s time, one can be more certain of what your cash will buy you than you can of your stock market investments.
In 20 years’ time, the risk is that you do not have enough in your cash pot to support all the lifestyle dreams and choices that you had hoped for. This could be described as ‘goal risk’ and one that all investors should be focused on.
The chances are that, over longer time frames, cash becomes the riskier asset, as it is less effective at delivering growth in purchasing power than stocks.
Using long-term US data from 1926 to 2023, cash has delivered around 0.3% per year above inflation. US stocks, on the other hand, delivered a little over 7% per year above inflation.
In purchasing power terms, over this 98-year period, 100 US dollars grew to 135 US dollars for a holder of cash, whereas for a holder of US stocks, this turned into 85,300 US dollars.
In fact, cash suffered a 50% loss of purchasing power from May 1933 to December 1951 and it took until October 2001 to recover! That is risk.
Since January 2009, cash has lost 25% of its purchasing power, yet this is only half of the 50% fall in value of the 1930s and 1940s.
Alternatively put, 100 US dollars held in cash in August 1989, is still only worth 100 US dollars today, whereas if it had been invested in equities, it would be worth over 1,000 US dollars in purchasing power terms.
Investing in stocks can be risky from an emotional point of view, as they suffer severe peak-to-
The chances are that, over longer time frames, cash becomes the riskier asset, as it is less effective at delivering growth in purchasing power than stocks
the impact of market specific falls can help, as may incorporating different styles of stocks, such as smaller companies and value stocks and potentially other asset classes such as global commercial property.
trough falls. For example, US stocks have fallen more than 50% on four occasions since 1929, with the worst fall of almost 80% – after inflation – being the Wall Street Crash that started in 1929 and bottomed out in 1932.
It would be hard for most investors to suffer such egregious losses and stay focused on their longterm plan. Yet, those with the emotional and financial capacity to stay invested recouped these losses by the end of 1936.
More recently, the ‘dot.com’ crash of the early 2000s took US equity investors nearly 13 years to recover from. Even this simple example illustrates how multi-faceted risk is.
Investors need to be aware not only of short-term volatility, but also of goal risk, which is materially influenced by inflation risk during the investor’s investment horizon, and the prolonged periods that portfolios can potentially be under water (drawdown risk) once inflation is accounted for.
Helping investors to balance –and where possible mitigate –these risks is an important part of an adviser’s role.
Global diversification to reduce
Allocations to shorter-dated, high-quality bonds can help to dampen short-term volatility and inflation-linked bonds may help to mitigate the risk of inflation to some degree. Understanding what risk really means to you is an integral part of the financial planning and investment process. Your adviser should help here.
‘Risk surrounds us and envelops us. Without understanding it, we risk everything and without capitalising on it, we gain nothing.’
Breakwell and Barnett
Guy Beck (below) is a senior financial planner with Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
Founded
in 1851 as the world’s first hospital dedicated to the study and treatment of cancer, The Royal Marsden is today one of Europe’s leading cancer centres. It employs more than 2,500 cancer specialists and currently sees and treats 60,000 NHS and private patients every year. Philip Housden takes a closer look
THE ROYAL Marsden Private Care is the largest NHS private patient unit (PPU) treating patients from both domestic and international markets.
It delivered income of £162.3m in 2022-23 – 19% up on the previous year – with any private care surplus being re-invested back into the hospital for the benefit of both NHS and private patients.
These revenues are 34.2% of total
trust income, by far the largest proportion in the NHS, but marginally down on the pre-Covid peak of 36.3% in 2019-20.
Indeed, Royal Marsden Private Care incomes represent 25.1% of the total for England NHS trust private patient income.
Pushing the boundaries
Mark Hawken, who was appointed managing director of The Royal
Marsden Private Care in September 2023, says: ‘The Royal Marsden is committed to respond to opportunities and future challenges within the cancer landscape. We continue to innovate and push the boundaries in cancer diagnosis in the delivery of personalised diagnostics treatment and care.
‘Through optimising our use of technology, artificial intelligence and translating our scientific
knowledge, we lead on new innovations such as genomics – which improves faster access, diagnosis and treatment options to improve cancer patient care and outcomes.’
‘Excellent’ facilities and technology
The Royal Marsden Private Care has dedicated private facilities in Chelsea, London and Sutton, Surrey, along with a Medical Daycare Unit at Kingston Hospital and a diagnostic and research-led treatment centre in Cavendish Square in London’s Harley Street Medical Area.
Housed within an Edwardian listed building, Cavendish Square opened its doors in April 2021 and welcomed 2,635 new outpatients from over 35 countries in the first two years after opening. 100% of patients recently rated their care as excellent or very good.
The centre offers private patients fast and direct access to worldleading and research-active consultants to personally oversee every aspect of their treatment plan.
It includes a minor procedure suite and a medical day unit with bespoke treatment bays, along with a full a diagnostic imaging suite including MRI, CT, X-ray, mammography and ultrasound and on-site rapid blood testing.
‘Patients from around the world have benefited from the centre’s brand-new facilities, safe in the knowledge that everything in Cavendish Square is underpinned by The Royal Marsden’s worldleading standards of cancer care,’ explains Mr Hawken.
Private patients treated across all sites benefit from high quality facilities and technology. For example, the hospital is one of a handful of UK centres with an MR Linac.
Located in Sutton, in south-west London, the machine delivers radiotherapy with the guidance of an MRI scanner, which allows treatment to be tailored precisely to patients in real time, with detailed imagery.
The hospital is also equipped with robotic technology including two CyberKnife machines and two surgical robots (a daVinci S and da Vinci Xi), which deliver more accurate and less invasive treatment to patients and were funded by The Royal Marsden Cancer Charity.
Personalised care and research-led treatment
The Royal Marsden’s multidisciplinary model ensures that cancer patients receive highly personalised care.
Up to 35 specialists including surgeons, medical oncologists, radiotherapists, pathologists, nurses and radiologists attend weekly multidisciplinary team meetings (MDTs) to develop tailored treatment plans for each patient and regularly review their care.
The Royal Marsden and The Institute of Cancer Research, London, together are ranked as one of the top cancer centres in the world for the impact of their research and are the only dedicated UK National Institute for Health and Care Research (NIHR) Bio medical Research Centre for cancer.
This emphasis on research means patients often have faster access to the latest drugs, treatments, clinical trials and techniques.
For example, results from practice-changing research studies such as the PACE B trial, led by Prof Nicholas van As, medical
The Cavendish Square treatment centre includes a medical day unit with bespoke treatment bays, along with a full diagnostic imaging suite and on-site rapid blood testing
The Royal Marsden’s multidisciplinary model ensures that cancer patients receive highly personalised care ➱ continued on page 34
As one of the top cancer centres globally, The Royal Marsden Private Care treats patients from around the world and offers a specialist international advocate service.
The multilingual team, which includes Arabic and Mandarin-speaking staff, offer translation services for most languages. They help international patients throughout treatment, from providing admission and consultation support to advice on accommodation and payment enquiries.
To offer comprehensive private healthcare to a wider pool of international patients, The Royal Marsden Private Care recently partnered with renowned specialist hospitals from across the capital.
Through London Specialist Hospitals, the hospital will provide cancer services as part of a consortium of world-leading experts, including cardiology, spinal neurosurgery and paediatrics specialists, offering personalised care packages and comprehensive wrap-around support services, such as culturally appropriate menu choices and prayer facilities.
Mr Hawken concludes: ‘It has been an exciting eight months at The Royal Marsden. I am incredibly proud to work for a world-class cancer centre with a reputation for pioneering innovative research and providing outstanding care and treatment.’
director and consultant clinical oncologist at The Royal Marsden, showed prostate cancer treatment could safely cut radiotherapy treatment time by 75%.
The trial demonstrated that people with intermediate risk, localised prostate cancer can be treated as effectively using fewer and higher doses of radiation therapy delivered over five treatment sessions as they can with lower doses delivered over several weeks.
‘At The Royal Marsden, we are focused on developing smarter, better and kinder treatments for patients across the UK and internationally,’ says Prof van As.
‘Standard radiation treatment is already highly effective and is very well tolerated in people with localised prostate cancer, but for patients to have this treatment delivered just as effectively in five days as opposed to four weeks is hugely significant.’
Innovative partnerships
Thanks to innovative partnerships between The Royal Marsden and commercial industry, the hospital
The entrance to the Royal Marsden Private Care’s treatment centre in Cavendish Square in London’s Harley Street Medical Area
is at the forefront of advances in genomics, with increasingly personalised diagnostic tests, monitoring schemes, and treatments being developed.
This includes a collaboration with Guardant Health, a leading precision oncology company, on the Marsden360 liquid biopsy test.
The blood test provides a comprehensive profile of tumours and ensures patients have another way to access personalised treatment.
The Marsden360 can deliver results faster than traditional tissue sampling which can positively impact outcomes, although it can
be carried out in parallel to tissue sampling.
The test is currently available for some private and clinical trial patients being treated at The Royal Marsden, as well as for a cohort of lung cancer patients enrolled on an NHS England pilot study. The Royal Marsden is currently the only centre providing this testing technology on site.
It is also working with the automation company, Automata, to increase cancer genomic testing capacity through robotic automation.
With Automata’s support, The
Royal Marsden’s Clinical Genomics Service will double its genomic testing capacity through a new robotic sample processing platform and increase patient access to critical genomic testing. The new installation – which is due to be completed this year – will also expand the range of tests the hospital can perform.
Philip Housden (right) is director of Housden Group commercial healthcare consultancy
The Royal Marsden Private Care has dedicated private facilities in Chelsea, London and Sutton, Surrey, along with a Medical Daycare Unit at Kingston Hospital and a diagnostic and research-led treatment centre in Cavendish Square in London’s Harley Street Medical Area
The Royal Marsden Private Care runs a free GP education series including bespoke events and an archive of online resources. The programme provides guidance and advice on the early diagnosis and management of both common and rarer cancers and access to the hospital’s worldleading consultants.
Andrew Marsh, senior GP liaison and corporate manager, says: ‘Our series takes a symptom-led approach to ensure sessions mirror the day-to-day practice of GPs. By providing access to our experts, attendees have the opportunity to hear and ask about the latest advice and insight in cancer diagnosis and treatment.’
Events include half-day GP education days that are run regularly in London but can be attended virtually.
Attendees can network with other GPs, meet consultants,and earn five continuing professional development credits. Smaller, more focused events are also available. This includes sessions hosted by a Royal Marsden consultant across the hospital’s sites, along with ‘lunch-and-learns’ for GPs based in London and north Surrey.
Easson is a firm of truly specialist medical accountants who provide personal and tailored advice to clients.
act for medical professionals throughout all stages of their career with clients in almost every town in England, Scotland and Wales.
cut through the complicated jargon and deliver practical, easy to understand advice.
WE PROVIDE THE USUAL SERVICES YOU WOULD EXPECT FROM AN ACCOUNTANT SUCH AS PREPARATION OF YOUR ACCOUNTS AND TAX DECLARATIONS BUT OFFER SO MUCH MORE INCLUDING ADVICE ON:
• SETTING UP A NEW PRIVATE PRACTICE
• BUILDING AN EXISTING PRIVATE PRACTICE
• BUSINESS STRUCTURES TO PROTECT WEALTH
• BUSINESS STRUCTURES TO MAXIMISE TAX EFFICIENCY
• CLAIMING TAX REFUNDS INCLUDING OVERPAID ANNUAL ALLOWANCE TAX
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New employment law regulations came into force on 6 April 2024, improving the rights of employees and giving them more flexibility. These changes affect parents and carers in particular, allowing them to take leave or request flexible working arrangements to take care of their families without the worry of losing their job.
Lawyer Henrietta Donnelly (left) discusses what these changes mean for independent practitioners and what employers should do to ensure they are following the law and protecting their employees
NEW REGULATIONS relating to maternity leave, adoption leave and shared parental leave extend the previous statutory protections against redundancy for employees, covering pregnancy and a period after returning to work.
Key points of the Maternity Leave, Adoption Leave and Shared Parental Leave (Amendment) Regulations
☛ Employees on maternity, adoption or shared parental leave must be offered any suitable alternative employment opportunities when faced with the possibility of redundancy during their leave period, prioritising them over other employees also facing redundancy.
☛ This protected period has been extended to up to 18 months from the child’s birth/ adoption – or entry into UK for overseas adoptions – for employees on maternity or adoption leave.
☛ For employees taking shared parental leave, the duration of the protected period varies. For those taking six or more consecutive weeks, the protected period is 18 months after the birth, placement or entry into UK. For those taking less than six weeks, the protections only last for the duration of leave.
☛ The new protections apply to new parents returning from maternity, adoption or shared parental leave, and pregnant employees who disclose their pregnancies to their employer on or after 6 April 2024.
☛ If an employee suffers a miscarriage, the protected period lasts for two weeks after the end of the pregnancy, if before 24 weeks. If the pregnancy ends after 24 weeks, the employee is entitled to full statutory maternity leave and the full protected period of 18 months after the date of birth.
New regulations changing how employees can take paternity leave following birth or adoption have also been introduced.
As with the maternity, adoption and shared parental leave, these new regulations will apply to employees taking paternity leave when the birth or adoption is on or after 6 April 2024.
➱ continued on page 38
Key points of paternity leave
➲ The maximum duration of paternity leave is still two weeks. But employees can now choose to take their leave and pay as two non-consecutive weeks, rather than one block.
➲ Employees can take this leave at any time during the first year following the birth or adoption, extended from the previous period of the first eight weeks. This offers new parents more flexibility and allows them to take their leave when it best suits their family.
➲ Paternity leave cannot be taken after shared parental leave. If an employee wishes to take shared parental leave and paternity leave, they must take the paternity leave first.
➲ The notice period required for each period of leave has been shortened to 28 days, providing expectant parents increased flexibility when preparing for this change.
Previous regulations permitted workers to take a ‘fair’ amount of leave to look after their dependents under specific conditions.
However, these limitations pose difficulties for employees who shoulder additional duties as unpaid carers. The Carer’s Leave Regulations 2024 give employees more flexibility to care for their dependents without worrying about work.
Key points of carer’s leave
➤ Employees will have a ‘day one’ right to request unpaid carer’s leave – previously only available after 26 weeks of qualifying service.
➤ Employees can take up to one week of unpaid carer’s leave in any rolling 12-month period in consecutive or non-consecutive periods, from a minimum of one half working day.
➤ Employees must give notice of at least twice the length of the period of leave requested or, if longer, three days. For example, Four days’ notice for two days of leave, two weeks’ notice for one week of leave and so on.
➤ Notice can be given verbally, but it must mention the entitlement of carer’s leave to be valid.
➤ Employers can postpone leave if there is a legitimate
The maximum duration of paternity leave is still two weeks. But employees can now choose to take their leave and pay as two non-consecutive weeks, rather than one block
business reason, but must allow the employee to take the leave within one month of the request.
➤ Employers are required to consult with their employees to explore available options before postponing a leave request.
➤ Employees are not required to provide evidence of their entitlement to carer’s leave.
➤ Employees can bring an Employment Tribunal claim if their employer has unreasonably postponed, prevented or attempted to prevent their request.
The Flexible Working (Amendment) Regulations 2023 (SI 2023/1328) and the Employment Relations (Flexible Working) Act 2023 have introduced additional changes to workers’ rights, giving employees more ability to request flexible work schedules.
The Advisory, Conciliation and Arbitration Service has replaced its code of practice on flexible working requests to reflect the new law.
Key points of flexible work
> As with the new carer’s leave, the requirement of 26 weeks’ service has been scrapped and
employees now have a ‘day one’ right to make up to two requests to change their working pattern, hours or place of work within any 12-month period.
> All requests must be in writing and state that it is a statutory request for flexible working. It must contain the date of the request, the details of the changes requested and the date the employee would like the changes to come into effect.
> Employers must handle requests in a reasonable manner and carefully assess the implications for the employee and the business.
> Employers must decide on a request within two months of receiving it. Once a decision has been made, the employer must inform the employee in writing without unreasonable delay.
> Employers must agree to flexible working requests unless there is a genuine business reason
not to. The business reasons must be one of – or a combination of –the eight potential reasons set out in section 80(G)of the Employment Rights Act 1996.
> Employers must not reject a request without consulting the employee first, to discuss other potential options.
> Though there is no statutory right to appeal a decision about flexible working requests, employers are advised to offer the right to appeal to avoid other potential grievances.
If you work in a private practice and employ workers, you must ensure you are compliant with the new regulations. We recommend you:
Review and update all policies and processes relating to leave, redundancy, and flexible working to reflect the new regulations.
Employers must agree to flexible working requests unless there is a genuine business reason not to.
Provide employees with notice of the changes in writing, clearly setting out their rights and any new procedures they must follow.
Offer employees the opportunity to discuss the changes and ask any questions they may have.
One essential point to note is the difference between the rights of salaried employees and those in a partnership.
If you are a partner in a private practice, your rights are determined by the terms of your partnership agreement.
In light of these changes, we recommend that you review and update your partnership agreement to ensure both you and your business are protected.
Henrietta Donnelly is a solicitor at specialist healthcare law firm Hempsons. If you would like more information on this subject, please email Henrietta at H.Donnelly@ hempsons.co.uk
Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes of free legal advice.
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At the beginning of this year, the GMC published an updated version of its Good Medical Practice, the professional standards for all doctors in the UK, which came into effect on 30 January.
With independent practitioners having now had several months to absorb and take on board the guidance, Dawn Hodgkins (below) gives some of the key reflections from the Independent Healthcare Providers Network (IHPN) about what it all means for the sector
AS I REPRESENT the independent sector where many thousands of doctors work every year, I was delighted to have been invited to join the GMC’s independent advisory forum.
This group helped to shape the GMC’s thinking throughout every step of its review of standards, acting as a ‘critical friend’, constructively challenging positions on key issues, offering diverse views and experiences, and generally to be a good sounding board.
The GMC had clearly thought a great deal about what it wanted the advisory group to do and the role it wanted it to play in shaping the new standards, with a real focus on ensuring the group included people from a range of backgrounds.
These included representatives from all sectors of the medical profession with different levels of experience, from the newly qualified to senior doctors.
It also included equality, diversity and inclusion leaders, along with industry experts and system regulators. Likewise, connection to, or understanding of, the four nations of Northern Ireland, Scotland, Wales and England was also really important when it came to the make-up of the group.
The review’s importance
Looking at the new guidance itself, fundamentally this is about establishing good practice when it comes to the standards of patient care and professional behaviour expected of all doctors in the UK across all specialties, career stages and sectors.
This means doctors working, for example, in the NHS, in the independent sector, in research or in policy or regulation.
Most doctors are committed professionals who work incredibly hard, be that in the direct delivery of care or in other areas, and their behaviours and professional standards are key to creating and supporting cultures where good care can flourish.
So how does the revised Good Medical Practice (GMP) support good care and why is this review so important?
As Independent Practitioner Today readers will no doubt be familiar, there have been a great number of inquiries and reviews that have
highlighted failings in the health and care system.
These are failings that should have been identified and responded to through robust clinical governance – the processes and systems used by healthcare organisations to monitor and improve safety and quality.
From an IHPN perspective, we have done important work in the area of medical governance and oversight and this has been an area of critical focus for us, and for our members, in the last few years.
We have put much time, working with the GMC, Care Quality Commission (CQC) and others, into the Medical Pract itioners Assurance Framework (MPAF), led originally by Sir Bruce Keogh.
This was designed to ensure a more standardised approach to medical governance in the independent sector and ultimately drive up the quality and safety of care for patients.
But this is not enough if the very standards that doctors work to are not sufficiently clear and fail to positively support the right behaviours and standards and allow meaningful discussion when those standards aren’t met.
We also know that when things go wrong, patients and their families have not always been treated with kindness, openness or, at times, fairness.
And we also know that some doctors, particularly those internationally educated and/or women, are more likely to have been treated unfairly.
This tells me that the previous GMP did not sufficiently speak to the clinical governance agenda or the values and behaviours that are essential for good quality care.
So I was pleased to see some key changes in the new GMP standards which address some of the issues I have mentioned, notably:
A stronger focus on behaviours and values that create respectful, fair and supportive workplaces;
A clearer promotion of patientcentred care;
More specific consideration of tackling discrimination;
Championing fair and inclusive leadership;
Supporting continuity of care and safe delegation.
We also know that when things go wrong, patients and their families have not always been treated with kindness, openness or, at times, fairness
Tackling discrimination and supporting fair and inclusive leadership were two areas I found particularly important.
We have to get better at this if we are to support all doctors, along with those who will be on the GMC register working in all areas of healthcare.
With the guidance now already in place for a number of months, it is a good opportunity to look again and ensure that both independent providers and practitioners, including locums, understand the clinical governance arrangements in their place of work and what is expected of them, especially, for example, through induction processes.
Likewise, I would suggest that you ensure all policies and procedures are updated to reflect the new standards and that you identify any gaps between your current policies and procedures and the new standards.
You will also want to ensure your staff members are aware that the new standards seek to create a more respectful, fair and supportive working environment and consider how you might make this a reality.
You also might want to check out the GMC’s handbook on clinical governance aimed at organisations which employ, contract or oversee the practice of doctors in the UK and, of course, the IHPN’s MPAF.
This framework, used by the CQC when assessing independent providers, aims to provide boards with a description of the core principles underpinning effective clinical governance for doctors, focusing particularly on responsibilities outlined in the Responsible Officer regulations.
Independent practitioners pride themselves on their professionalism and desire to learn, grow and continuously improve.
The GMP guidance therefore provides an excellent opportunity to take stock and redouble the sector’s efforts to ensure we continue on this journey and that patients get the very best from us.
Dawn Hodgkins is the director of regulation at the Independent Healthcare Providers Network (IHPN)
Dr Vassiliki Kavadas (below) discusses what to do if a patient has been supplied with home oxygen without a prescription
and risk assessments had not taken place before the oxygen was supplied to the patient and that this had been made so readily available without a prescription.
I feel that there is a greater risk given that the fact that the patient is a smoker and lives alone.
What should I do?
AThis is a potentially awkward situation given the issues at hand which are severalfold.
QI’m a private respiratory consultant who recently saw a new patient with respiratory disease. During the consultation, the patient requested home oxygen, telling me he had tried it before and felt better with it.
However, I couldn’t find a reference to who had prescribed this in the records and there is no mention of home oxygen in the GP referral letter.
I questioned the patient further and discovered that a relative of the patient, also a healthcare professional, had been supplying him with home oxygen cannisters for the last year.
The patient is a smoker and lives alone – although he does receive some support from social services.
Now I am concerned that the required and necessary clinical
There may be a risk of fire to the patient’s and neighbours’ properties because he is a smoker. He may have a clinical need for home oxygen, as he said he felt better having used it over the last year, and not prescribing it to him may lead to a complaint.
Additionally, on the face of it, it appears that another healthcare professional had been inappropriately supplying oxygen to their family member.
In this situation, it may be wise for you to arrange for the patient to be appropriately assessed and refer him to the local home oxygen service.
As you are being asked to prescribe the home oxygen, you need to be satisfied that the prescription is clinically indicated and that you take account of clinical guidelines for its prescribing from relevant bodies.
Patient’s expectations
The patient’s expectations may be that you will continue to prescribe the home oxygen.
So a clear discussion with him should include not only a recommendation that he stops using the oxygen canister he has at home, explaining the potential risks to not only himself but also to neighbouring properties and people, but an explanation as to why he
mised by the actions of this healthcare professional.
There may be a risk of fire to the patient’s and neighbours’ properties because he is a smoker
has to undergo a detailed assessment before you can safely prescribe it and what that assessment will involve.
Additionally, in line with the GMC’s guidance on raising concerns, you need to consider whether this is a situation where you have a duty to raise a concern, taking into account patient safety which may have been compro -
It may be that this healthcare professional can justify their actions, but that is not necessarily something that you will be able to explore.
As part of your discussion with the patient, it is also worth sharing your concerns in this regard, explaining your duty as a doctor to raise concerns when you are made aware of unsafe practices and seeking consent to disclose the concern to additional individuals. You should make a note of exactly what your concerns are and what action you then take in relation to these.
Dr Vassiliki Kavadas is a phone adviser at the Medical Defence Union
A private GP has concerns for a young patient who asks for contraception. Dr Beverley Ward (right) discusses what she should do
QI’m a private GP who recently had a 13-yearold patient visit the practice to ask for contraception.
She explained that she was in a relationship with a boy, but was concerned that condoms weren’t effective, so wanted to use another more reliable method.
We had a long conversation and I was impressed with her level of knowledge and understanding about methods of contraception. I feel she is ‘Gillick competent’ to consent.
However, she looks younger than her age and I am concerned for her safety, as I think she is particularly vulnerable.
Given the circumstances, should I prescribe contraception and/or inform social services?
AThis is an extremely sensitive and difficult situation and it is important to balance your duty of confidentiality to the patient with your safeguarding duties.
As the patient is 13 years of age, she may be mature enough to consent to treatment or sexual activity. However, it is important to assess this thoroughly and document your opinion in the patient’s records.
Even if you believed the patient was able to consent to sexual activity, she could still be at risk of abuse, depending on the nature of the relationship she was in.
It is advisable to arrange a follow-up appointment with the patient to ascertain whether there was a significant difference in the sexual partner’s age, maturity or power, as well as if there was concurrent use of drugs or alcohol or any bribery, payment or pressure to either engage in sexual activity or to keep the relationship a secret.
If this discussion highlights any concerns, then you should seek consent to disclose this information or consider disclosure without consent in the patient’s and public interests.
Furthermore, it is also worth asking the patient to allow the involvement of a parent or guardian and to discuss this with a child safeguarding lead, documenting any advice given.
The latter discussion could be on an anonymous basis if the patient had not provided consent to disclose her identity.
With regards to prescribing contraception, the GMC makes clear that a doctor can provide contraceptive advice and treatment without parental knowledge or consent to patients under 16 as long as certain conditions are met.
For example, the patient must understand all aspects of the advice, its implications and is very likely to go ahead with sexual activity regardless of treatment, while you must believe it to be in the patient’s best interests and have attempted but failed to persuade them to involve a parent or guardian.
Dr Beverley Ward is a phone adviser with the Medical Defence Union
In many cases, when you move to the UK from overseas, you will be treated as a resident in the UK from the date you arrive. You will then pay UK tax and National Insurance on your UK income.
In the Spring Budget this year, Chancellor Jeremy Hunt announced a reform of the ’non-domicile’ regime from April 2025.
Currently, non-domiciled – or ‘non-dom’ as it is often referred – status allows working in the UK when the permanent home is considered to be outside of the UK. This status allows the income generated outside of the UK to be exempt from UK tax unless that money is brought over here.
If your foreign earnings are less than £2,000 a year and the money is not brought into the UK, then you do not have to make any declarations of the income or non-domiciled status.
But if the income is in excess of £2,000 or the income is brought into the UK, then great care needs to be taken and specialist tax advice should be sought.
If you do not have non-dom status, UK tax is payable on foreign income. This could include interest on an overseas bank account, rent on overseas property or an overseas pension. HMRC now has access to information about accounts, trusts and investments around the world.
It is very important that you make your accountant aware of any such income or gains, so that you can get professional advice on whether it needs to be declared on your personal tax return.
There are often tax agreements between the UK and other countries meaning you may get credit for tax paid at source, but this does not mean that you should not declare the income, as there may be more tax to pay in the UK if the rates are higher.
Many doctors during their careers will be presented with opportunities to work overseas. The length of time you are working aboard and the working arrangements result in different tax consequences under the UK tax system.
Richard Norbury (right) highlights some of the common tax ramifications when working abroad or moving to the UK
AS YOUR reputation builds, you may be requested to see or operate on patients outside of the UK. This would usually be on a selfemployed basis or via your limited company.
These types of arrangement may come in the form of short trips working abroad before returning here.
As a UK taxpayer, you or your limited company are subject to UK tax on your worldwide income and therefore the income generated follows the usual UK tax rules.
However, it may be that the country you are working in also requires some form of tax payment under its tax system. Some countries require that payments made to you or your company have tax taken at source from the payment. This is referred to as ‘withholding tax’.
The good news is that the UK has what is known as double taxation treaties with lots of countries around the world. If there is a
treaty, when calculating your tax liabilities for the year, you are able to deduct some or all the tax paid in the foreign country so that you are only taxed on the higher of UK tax or local tax.
Provided the trip is ‘wholly and exclusively’ in relation to the purpose of your trade, it is likely that you will be able to claim tax relief on some of the costs incurred while travelling abroad.
It is very important to discuss any plans to work outside the UK with an accountant before undertaking any work.
VAT
VAT is a very complex tax. While services provided by doctors’ businesses usually are exempt from VAT under the healthcare exemptions, working outside of the UK can add complexities.
You may also need to consider any VAT equivalent taxes in the country you are working in.
➱ continued on page 46
Although selling your UK properties can be an indication of severing all ties with the UK, it is not a requirement to do so.
Many people leaving the UK will maintain ownership of their UK residential properties and choose to rent them.
In these cases, you will likely be classed as a non-resident landlord –providing, of course, that you are considered to no longer be a UK tax resident. UK tax is payable on the rental income. Providing you have no other UK income, each property owner will have access to a UK personal allowance and basic-rate tax bands on these streams.
In certain cases, HMRC will allow you to report the property income via self-assessment but it may also be the case that it asks the letting agent to deduct tax at source.
It is a common misconception that if your outgoings are equal or in excess of the income received from properties that you do not have to declare anything.
Often the largest regular payment made is the mortgage payment to the lender. This can be a mixture of capital and interest and the capital element of the payment cannot be set off against income tax.
Mortgage interest costs on rental properties is no longer treated as a cost, so instead 20% of the interest paid is used a deduction from your tax liability.
When leaving the UK and considering what the ownership of your main place of residence is, you should also consider capital gains tax implications.
Normally, your principal private residence is exempt from any capital gains tax. However, if you leave the UK and commence renting the property out, when you ultimately sell the property, not all of the gain will be exempt from capital gains tax and you could find yourself with a capital gains tax liability.
The calculation takes into account the purchase price and allowable capital cost incurred during ownership and deducting these against the selling price.
The Principal Private Residence (PPR) relief is worked out by calculating the total number of days you either resided or are deemed to have resided in the property and dividing the total number of days of ownership.
This is then applied as a factor against the total gain, leaving a balance which is subject to capital gains tax.
There is also an obligation to report and pay any capital gain on residential property within 60 days of the sale. The capital gains tax allowance has recently been reduced to £3,000.
The devil is often in the detail when it comes to VAT. It is strongly recommended that you take advice from a specialist VAT advisor before starting any work outside the UK.
Moving abroad
Opportunities may arise for you to relocate from the UK to a different country in the medium to long term.
When you leave the UK, the date you are deemed to have left the UK system depends on a number of factors and whether or not you have severed ties with the UK.
There is no defined description as to what severed ties with the UK means in HM Revenue and Customs’ (HMRC’s) eyes.
However, strong indications of severing ties would be things such as:
Taking a permanent salaried role in another country;
Selling your family home;
Your spouse and dependents moving with you.
If you are deemed to have severed ties with the UK, then you would be able to claim what is called ‘split-year treatment’.
This status means in the tax year that you leave the UK, you are only subject to UK tax from 6 April to the date you leave the UK system.
In plain language, the UK income generated before you left would be subject to UK tax and any foreign income earnt after you left would not be subject to UK tax.
If ‘split-year treatment’ is not applicable, whether you are considered to be a UK tax resident usually depends on how many days you spend in the UK within the tax year – 6 April to 5 April the following year.
Whichever status applies to you, great care must be taken when visiting the UK because the number of days you can spend here once
you have left the UK tax system are very strict.
While it is not tax advice, if you pay for indemnity cover outside of the NHS, you should speak to your indemnity provider to ensure that you have ‘run-off cover’ to cover any claims made against you after you cease UK work.
Ascertaining your tax status when leaving the UK is very complicated and taking advice prior to moving can ensure you understand your tax obligations.
You would also need to consider your obligations in the country you are moving to, especially if you are considering private work that may not be taxed at source. Seeking the advice of an accountant in that particular country would also be highly recommended.
If you do work abroad for a period, then this may offer some tax plan-
ning opportunities in the UK tax system.
This could include drawing dividends from a UK limited company or making use of your pension savings annual allowance in the years you are not considered to be UK tax resident. Care should be taken to ensure this does not cause tax liabilities in other countries.
It is always a good idea to have a consultation with a specialist medical accountant if you are considering working abroad in any capacity so that they can review your overall position and advise you accordingly.
Next month: Maximising your practice profitability. Alec James has some excellent advice and tips for independent practitioners on the big topic of the moment
Richard Norbury is a partner at Sandison Easson & Co, specialist medical accountants
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This pocket-sized sports car is a breath of fresh air in a world dominated by EVs. But it could be a dying breed. If you have got petrol in your veins, then Dr Tony Rimmer reckons you should get hold of one while you can
As
soon
you
MAJOR BREAKTHROUGHS are scattered throughout the history of medicine. Many are still as relevant today as they were on discovery but will have been refined and fine-tuned over the years.
Take penicillin; first identified in 1928 by Fleming and still in use today. X-ray investigation is another; used for the first time in 1895 on the wife of discoverer, Röntgen, it is still used daily on a global basis.
Occasionally, in the world of automobiles, a car comes along as a breakthrough model, that is ‘just right’ and goes on to have a life much longer than expected and has, seemingly, never-ending appeal.
Such a car is the Mazda MX-5. I first drove one in 1990 and on testing this latest 2024 version, it became immediately apparent how little had changed over 34
years. This is a blessed relief and is the key to this Mazda’s longevity: it is a small affordable sports car that delivers fun behind the wheel – in bucket loads.
Since production began, more than one million have been built in Mazda’s factory in Hiroshima, Japan, and over 130,000 have found their way to UK homes.
The current fourth generation car was launched in 2015 and, for 2024, several useful upgrades and tweaks have made it even more desirable.
It is still available as a soft-top convertible, the Roadster, or with a powered solid roof, the RF.
The engine choice has not changed either: two four-cylinder petrol engines. The 1.5litre unit produces 132bhp and the 2.0litre has 184bhp.
And the gearbox remains the sweet six-speed manual box and, in the UK at least, no automatic option is available.
Externally, the lights are all new LED units front and rear, but do not alter the overall appearance of this neat sports car. Inside, there is a new and bigger 8.8inch infotainment touchscreen and the driver’s dashboard is clearer.
The steering has been refined with more directness and driver feel tuned into the electric assisted system.
Mazda’s philosophy with this updated MX-5 is to enhance the oneness with the car and the connection to the road for any driver who gets behind the wheel.
So, has it been successful and can it improve an already brilliant recipe?
For me, slipping into the driver’s seat was like meeting an old famil-
iar friend. The cockpit is neat and cosy with a perfect driving position and all controls falling easily to hand.
Visibility is fantastic even with the roof raised. As soon as you engage the lovely direct gear lever into first and move off, you are aware as to how neat and light this Mazda is.
At around 1,100kg, it is half the weight of most electric cars and only a third of the weight of many of them.
Acceleration is brisk and the chassis provides the driver with constant feedback from all four wheels all of the time. The ride is firm, as you would expect, but not uncomfortable and on smooth roads such as motorways, it allows relaxed cruising.
However, the MX-5 is at its best
The MX-5 is at its best on windy ‘A’ and ‘B’ roads where it quickly shows how brilliant it is as an enjoyable driving machine
Body: Two-seater sports car
Engine: 2.0litre rear-wheel drive
Power: 184bhp
Torque: 205Nm
Top speed: 136mph
Acceleration: 0-60mph in 6.5 seconds
WLTP claimed fuel efficiency: 41.5mpg (combined) CO2 emissions: 153g/km
On-the-road price: £32,835
ing – speeds to get that satisfaction.
Faster, heavier and much wider sports cars like Ferraris and Porsches really need racetracks to get the best out of them.
Having said that, I found that the more powerful 2.0litre version had the right amount of power for the chassis. The 1.5litre engine revs more easily but feels like it has to work too hard to serve up the fun.
night bags, so a weekend away is perfectly possible.
I really enjoyed my re-acquaintance with Mazda’s pocket-sized sports car. In a world dominated by EVs, it is a breath of fresh air.
on windy ‘A’ and ‘B’ roads where it quickly shows how brilliant it is as an enjoyable driving machine. Its relative narrowness is well suited to British roads, too. Like all great sports cars, it has all the close involvement of driver and machine that you get riding a motorbike – but it is a lot safer.
In fact, this Mazda’s trump card is that you don’t need to be doing silly – and potentially licence-los-
The fact that you can drop the hood quickly whenever the sun shows its face is just icing on the cake. I prefer the lighter soft-top roadster because you can push the hood back with one hand and, in my view, it looks better than the RF hard-top.
There is even enough room in the boot for a couple of soft over-
How long it can continue in production is a question I would rather not contemplate. Electric sports cars coming along, like the MG Cyberster, will be faster but they will be bigger, heavier and lack a manual gearbox and be a lot more expensive.
The MX-5 is a dying breed, so my advice to any medic with petrol in their veins is to take the plunge and get one while you can.
Dr Tony Rimmer (right) is a former NHS GP practising in Guildford, Surrey
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