August 2020

INDEPENDENT PRACTITIONER TODAY

The business journal for doctors in private practice

In this issue

We’re coping with Coronavirus

Consultants at an eye hospital group tell how Covid-19 has changed the way they work P12

Heed the ‘Oracle of Omaha’ Is Warren Buffett the exception which proves the rule? Dr Benjamin Holdsworth on how hard it is to beat the market P24

Put yourself in the shoes of your patient

page 14

Adapting to new ways

David Hare discusses the adjustments private doctors will need to make to live with Covid-19 P30

Under the new proposals, eligible pension members will be given a choice about which set of pension scheme benefits they would prefer for the ‘remedy period’

‘Hugely complex’ pension remedy

By Robin Stride

Doctors forced to move to the 2015 NHS Pension Scheme will be compensated under new proposals which will remove the age discrimination judged to have arisen by the Court of Appeal.

When the 2015 pension scheme was introduced, older members –within ten years of retiring – were allowed to continue with their final salary schemes in the 1995 or 2008 sections.

But, in 2018, the Court of Appeal found this to be discriminatory against younger members in a case brought by judges and firefighters. The Government is now seeking to redress this discrimination across all public sector pension schemes in a move expected to cost £17bn.

In association with

Under the new proposals, eligible pension members will be given a choice about which set of pension scheme benefits they would prefer for the ‘remedy period’ which is between 1 April 2015 to 31 March 2022. They may choose their previous 1995-2008 scheme benefits or their 2015 scheme benefits.

The Government has now launched a consultation to ask members whether they would prefer to make this choice at the end of the remedy period or when they take their benefits on retirement.

Patrick Convey, technical director for specialist financial planners Cavendish Medical, said: ‘This is an extremely complicated situation which will leave some non-medical industry insiders scratching their heads.

‘The NHS pension calculations are already fiendishly complex and now we may have to amend the last five years of tax calculations and annual allowance payments.

‘Many will be wondering how their eventual benefits will be impacted by refunds – for instance, if they have used Scheme Pays to cover tax charges – or their new status if they had deferred membership because of substantial annual allowance limits.

‘The implications for those impacted will be wide-ranging. Doctors should not have to face these important choices without expert advice. Only with detailed discussions can informed decisions be made.’

The Government’s consultation will close on 11 October 2020.

Doctors face three options for pensions

The exact form of remedy will not be known until a while after the consultation closes on 11 October 2020, so there is no action to take until the final form of the solution is put forward – unless you wish to respond to the consultation questions.

James Gransby, of RSM UK Tax and Accounting Ltd, told Independent Practitioner Today it appears affected doctors will be asked in 2022 to decide whether to:

 Maintain the status quo for the benefits they have been building up between 1 April 2015 and 31 March 2022. This will be the default option applied on their behalf if they do not state their preference;

 Make an irrevocable choice to switch from the reformed scheme they have been contributing to, to their legacy scheme, for that period. This is known as ‘immediate choice’;

 Defer their decision on whether to make the sw itch until retirement. Then they will receive more information about the financial implication of the decision. This is known as ‘Deferred Choice Underpin’.

He said: ‘Knowing which option is right for you will mean becoming informed on the topic, or paying someone else who is, to help you make the best decision.’

➱ continued on page 8

TELL US YOUR NEWS. Contact editorial director Robin Stride

Managing your cash flow security

Our Accountant’s Clinic series on the building blocks of accountancy reaches the letter ‘M’ – for managing your cash flow security P10

Email: robin@ip-today.co.uk Phone: 07909 997340 @robinstride

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EDITORIAL COMMENT

Signs of things picking up

Slowly, oh so slowly, the outlook for private practice may be showing encouraging signs.

Last month’s issue aimed to help you get into the recovery position and as these strange days go by, there is increasing evidence of more frustrated independent practitioners at least beginning to get back to some aspects of their work.

Our story opposite reports a welcome increase in insurerfunded healthcare and, for some consultants at least, there has been a gradual return to face-toface outpatient consultations and the releasing of some private hospital theatre capacity.

Medical Billing and Collection, for instance, has recorded a steady rise in activity from the lowest point in the lockdown some three months ago.

But opinion is divided, with some consultants in private practice very upbeat while others threaten to throw in the towel and retire.

The fear of a sooner-thanexpected second wave of Covid19 is one of many factors restraining progress.

So the London Consultants’ Association’s (LCA’s) appeal to the Competition and Markets Authority (CMA) to intervene and allow private hospitals to waive or significantly reduce charges for secretarial/administration services and room rentals – which can amount to over £80,000 a year for full-time independent practitioners – will be backed by many of our readers.

Would the LCA’s suggested fix kick-start the widely paralysed private market back into life?

With so many consultants unable to take holidays this August, it is a good time to find out.

We are around this month, too, so decided to produce this unprecedented extra issue to keep you informed at this critical time. We hope you enjoy it.

Check our website weekly for updates.

Visiting hospital locked in chains

Surgeon Mr David Sellu, convicted for the manslaughter of a patient – later overturned – describes being treated as ‘a very non-private’ patient P19

A good way out of this

As healthcare opens up again to private patients, Simon Brignall discusses the importance of self-pay in ensuring your practice recovers P22

Advice on probationary periods

Lawyer Julia Gray examines the purpose and operation of probation and suggests how it can work most effectively in independent practice P26

Caught in a tug of love

A paediatrician with a private practice is caught in the middle between a child’s waring parents. Dr Kathryn Leask gives medico-legal advice P29

Circulation figures verified by the Audit Bureau of Circulations

Figures show activity is beginning to increase

By Olive Carterton

Hopes are high for continued growth in the private healthcare sector this month following a slow upturn in business over the last few weeks.

A steady increase in activity for insurer-funded healthcare has been noted by Healthcode, the UK’s official payment clearing organisation, particularly in oncolgy where volumes returned to pre-crisis levels a month ago.

Staff at Medical Billing and Collection (MBC), which partners with more than 1,300 consultants, groups, clinics and hospitals across all specialties, also reported in the middle of July that they were beginning to see the private healthcare sector start the process of opening up to meet demand.

Simon Brignall, director of business development, told Independent Practitioner Today this was through a gradual return to faceto-face outpatient consultations and the releasing of theatre capacity by private hospitals.

Writing in this issue (page 22), he says: ‘Our data indicates that the low point in activity was the first week of May and subsequently there has been a progressive increase in activity, which is reassuring to see.

‘Recent reports suggesting that NHS waiting lists could hit 10m patients by year end, up from the current 4.2m number, will likely

mean that there is a large demand for private healthcare from patients who are not prepared to wait.’

With self-pay the growth sector in private healthcare in recent years, he recommends independent practitioners review how they manage these patients in order to improve their cash flow and help it recover as quickly as possible.

Healthcode data shows activity levels for June 2020 were 47% that of the same period in 2019 and this trend continued into early July (48% of July 2019). But it said this was ‘a significant advance’ on the monthly activity level for May 2020, which was just 29% of that 12 months before.

At the same time, this is a mixed picture with geography and specialty proving to be important factors in the rate of recovery across the sector since the end of lockdown.

HERE ARE HEALTHCODE’S HEADLINES FROM JUNE’S ACTIVITY:

COUNTRIES AND REGIONS

 In June 2020, England operated at 48% the level of 2019 while Scotland reached 31% and Wales 20%. By contrast, the equivalent figures in May 2020 were 29% for England, 24% for Scotland and 13% in Wales.

 The West Midlands region bounced back strongest, achieving 65% of 2019 levels in June, compared with 43% in May. London also rallied, achieving 55% of the activity in level of the previous year.

SPECIALTIES

 For oncology, the activity level in June was 99% of that in June 2019. Next was pathology/haematology, which was at 75% of 2019 levels, while the equivalent figure for radiology was 54%.

 ENT was at the other end of the scale, operating at only 19% of 2019 level, while physiotherapy was 23%. Orthopaedics, traditionally a strong area for PMI-funded treatment, only recovered to 25% of its expected level.

ADMITTED vs OUTPATIENT CARE

 Overall hospitals activity has recovered to 40% of previous levels. Within hospital settings, outpatient activity has recovered more strongly, returning to 42% of its 2019 figure, up from 24% in May.

 By contrast, admitted care activity in June was only at 32%.

However, this is an improvement on the May figure of 21% and Healthcode anticipate this will continue, based on recent levels of the consultant activity.

Managing director Peter Connor (right) said: ‘Since private providers were given the green light to resume treatment, everyone has been working hard to deliver high-quality care to patients.

‘As a result, we saw an increase of approximately 50% in activity in June compared with May across the sector, albeit there were still considerable variations. Reassuringly, that positive trend continued into July, which supports our view that this growth is sustainable and the independent healthcare sector is already well on the way to recovery.’

Pay award is labelled ‘a slap in the face’

A 2.8% general uplift in pay for consultants’ NHS work, backdated to April and payable next month, has been criticised by the BMA as ‘a metaphorical slap in the face’. Its consultants’ leader Dr Rob Harwood said the Government had put billions of pounds into business and industry to help keep

the economy afloat during the pandemic but had shown unwillingness to do the same for those on the pandemic’s front line.

‘Many of the most highly skilled doctors in the NHS have seen their pay whittled away year on year with minimal or no pay rises –with many having suffered a 30%

real-terms pay cut over the last decade.

‘This was the perfect opportunity for the Government to show it values our doctors and give them the pay they deserve.’

The value of both national and old style local clinical excellence awards (CEAs) are frozen.

Dr Rob Harwood, chairman of the BMA’s consultants committee

Simon Brignall of Medical Billing and Collection

Union carps about Covid

By Leslie Berry

Surgeons’ and anaesthetists’ trade union The Confederation of British Surgery (CBS) has hit out at ‘fake news’ that healthcare workers are dying at the same rate as the general population during the pandemic.

Consultant plastic surgeon and CBS founding member Mr Mark Henley said it was a fallacy which kept getting amplified ‘as if this was somehow a relief’.

He said: ‘Health workers have historically, in fact, much lower death rates but this has climbed by a staggering 26% in just a few months. The fact that we have not lost anyone in some of the specialties considered to be most at risk – for example, anaesthetists and intensivists – is fantastic, but it only reinforces the fact that the rest of the health team is simply not adequately protected.’

Huge rise in team consults via

video

Consultants have seen a ten-fold rise in the use of a new remote video consultation platform used to treat patients in the UK and abroad during the pandemic.

The number of meeting minutes delivered by Bupa Cromwell Hospital specialists using the service shot up from 3,600 in March to 39,000 in June.

Hospital director Philip Luce said: ‘We introduced Visionable for virtual patient appointments at the very beginning of the Covid-19 pandemic so they could continue with their consultant appointments and adhere to social distancing and travel guidelines.

‘Many of our consultants are now using the platform, with more seeing the benefits and joining each day.

‘Although lockdown measures

The CBS has also criticised ‘jingoistic ‘warlike’ language’ that has been used to described health workers caring for Covid-19 patients.

Dr Eleanor Roberts, a plastic surgery trainee in Glasgow, said warlike metaphors were unhelpful: ‘These metaphors of healthcare workers “going in to battle” or “running into bullets” normalises fatalities. These clichés also imply that these events were unforeseeable and therefore impossible to prepare for.

‘We have an opportunity to review policy decisions and prepare for the likelihood of another wave of Covid-19. The PPE provided

must be adequate and suitable for each healthcare worker, their task and the environment. NHS and social care must be provided with equal resource and interrogation, including workplace incident investigations, as industry handling hazardous substances.’

CBS members point out that healthcare workers do not go to work every day with the intention of giving up their lives and potentially that of their loved ones.

One observed: ‘During the Ebola outbreak – a much more deadly disease – there was not a single casualty amongst UK clinical teams. There is no reason why we seem to be accepting of the fact that the – so-called – “front line” is somehow sacrificial; they are most certainly not ‘collateral damage’ for the greater good. There are hospitals in other countries with appropriate PPE measures whose medical staff have not suffered so much as one Covid-19 infection’.

are beginning to ease, we know that a service like this is still going to be incredibly important for patients to access healthcare professionals safely and securely from their homes.

‘The service is of particular benefit to our numerous international patients, enabling them to access London-based clinicians.’

The healthcare-specific system is accessible via an app and connects doctors with patients and peers, allowing them to securely share patient records and hold international multidisciplinary team meetings by sharing screens, audio and video streams.

Consultant oncoplastic breast surgeon Mr Giles Davies said: ‘Virtual consultations have been incredibly beneficial to patients, especially those who are going

through or recovering from cancer treatment and are deemed clinically vulnerable, which means that reducing trips to the hospital is essential.

‘The technology is secure and easy to use and we are able to share our screens with patients, so they are able to see any images or test results.

‘The patients receive a full report following the appointment and details of their treatment plan, if needed.’

Visionable chief executive Alan Lowe said: ‘We expect to see significant continued uptake of video conferencing technology as healthcare learns from its “pivot to digital” during the coronavirus pandemic and seeks to embed its benefits in the services of the future.’

College calls for a database on implants

The Royal College of Surgeons of England is urging the Government to act on recommendations made by Baroness Cumberlege, following her independent review into the use of pelvic mesh and other technologies.

The Independent Medicines and Medical Devices Safety Review makes a series of recommendations in its report First do no harm Among them is a recommendation by the college last year to create a central database to collect key details such as the patient, the implanted device and the surgeon. College president Prof Derek Alderson said at the root of some of the problems was a failure to properly monitor implants and devices, so any trouble from their use could be picked up swiftly.

‘An individual medical professional might have seen just one or two cases of problems with an implant over a number of years, but with system-wide monitoring, problems could and should be picked up much sooner. The Bill going through Parliament should be used to implement this particular recommendation without delay.’

A remote multidisciplinary team meeting using the Visionable system

Mr Mark Henley

London market recovery

By Robin Stride

Private healthcare in London is bouncing back following months of the pandemic and the future looks ‘pretty rosy’.

That was the upbeat message from a leading consultant speaking at webinar conference called to consider the outlook for the independent sector in the capital.

Prof Julian Teare, medical director of One Welbeck – founded on the history of the largest operator of surgery centres in the world, Amsurg – reported a rapid return of activity.

He told the LaingBuisson meeting: ‘So what do I feel about the future? I feel very positive. I think that private healthcare in central London is bouncing back quickly. I

International market could recover later this year . . .

Hopes that international recovery in the private healthcare market would start later this year were expressed by Ted Townsend, author of the LaingBuisson London Private Acute Healthcare Market Report

He thought the backlog of private medical insurance work would soon return to normal, selfpay would probably lag – could providers convert inquiries? – and that the NHS private patient units were vulnerable.

think consumer confidence is coming back quickly and I think there is going to be an awkward period of time with the contract negotiations until we can work out how we support the NHS, but for private healthcare I think the future looks pretty rosy.’

The gastroenterologist said doctors were very keen to return to NHS and private work and now was the time they should be cracking on.

The frustration for physicians was they were not doing their work in either the NHS or private sector due to uncertainty about a second wave.

Three-quarters of his practice had returned. A lot of people were coming back and happy to resume face to face. In central London, he had seen a gradual loss of the fear seen two months previously.

In the medium term, over the next two years, he considered the macro-economic outlook was ‘more downside than upside’. World recovery hopes assumed patient confidence, no second wave, no bad winter flu season, and no Covid outbreak in a private hospital.

For the long term, Mr Townsend foresaw more pressure from insurers for pathway management to contain costs.

Consultants might be more interested in employment due to lower risk to their incomes, he said. ‘A lot of consultants have said I might just retire now. For me to catch up on what I was doing is going to take a long time; I’ll just take an employed contract for the last five years of my career and then I’ll retire.’

Talking of the challenges and scale of the problems, he said the NHS Confederation expects NHS waiting lists to grow from two million to ten million. Healthcare services were operating at around 60% of capacity and uncertainty about a second wave affected planning.

Cancer Research estimated 2.4 million were awaiting screening, 23,000 cancers had gone undiagnosed during lockdown, and there had been a significant reduction in presentations to A&E with heart attack and stroke.

The private sector’s pandemic contract with the NHS would allow kick-starting activity, but there were concerns over utilisation of private capacity as the two contrasting services aligned and got used to new ways of working.

Although doctors were currently quiet, they were keen to resume their private practices, he told the meeting.

People would seek private healthcare when they could not access the NHS and he thought there would be a rise in both private medical insurance and selfpay patients.

Asked why Welbeck declined to sign the NHS agreement, he said the partnership signed up like everyone else to the original heads of terms and wanted to offer its activity to four NHS hospitals. But ‘after two months we’d seen no patients’. ‘So, collectively, we thought we would far rather be seeing and treating patients and getting on with our work, so we declined the contract.’

. . . but return will be slow

A hospital group boss warned it will take a long time for business to return to normal.

Rob Anderson, chief executive of Aspen Healthcare, reported that central London had been empty, with significant underused capacity in the NHS and independent sector.

The independent sector had done a fantastic job supporting the NHS, but lots of private consultants had not worked for three to four months.

Mr Anderson ( left ) said the whole debate around the NHS’s role in the new world, how it would manage waiting lists and its procurement would undoubtedly have an impact on individual hospitals.

Restarting elective care was slow and complicated and the sector needed certainty about what it was and was not able to do.

The industry needed to understand what the insurers’ response would be: ‘The private medical insurers haven’t really been able to deliver an effective service for a period of some months. I am sure there are an awful lot of patients out there who are unhappy with that. The response can’t be simply to put up premiums.’

Prof Julian Teare, medical director of One Welbeck

Go easy on doctors, says defence body

By a staff reporter

The burden of medico-legal investigations on doctors needs to be minimised as complaints processes and other probes resume, the Medical Defence Union (MDU) has warned.

GMC investigations, NHS complaints procedures and Ombudsmen’s complaints processes resumed last month, having been on hold during the pandemic.

The Medical Practitioners Tribunal Service (MPTS) also opened its doors for fitness-to-practise tribunals at the start of August.

Dr Caroline Fryar, head of MDU advisory services, said with the easing of lockdown, more services were resuming and complaints and referrals to regulators could return to pre-pandemic levels.

PPU

WATCH

The medical defence body is working with those responsible for regulating and investigating complaints to ensure their procedures continue to take account of the extraordinary circumstances of the pandemic and the fact that it is still not business as usual.

Dr Fryar said: ‘Many of the difficult conditions, constraints and added pressures facing doctors will continue for a long time and the impact of the pandemic on the physical and emotional health and well-being of healthcare staff could be felt for many years to come.

‘In a survey of 250 MDU members , including GPs and consultants, 70% of respondents said their stress and anxiety levels had deteriorated since the beginning of the pandemic. And the long-term

Compiled by Philip Housden

health impact on front-line workers, which some have compared to post-traumatic stress disorder, is not yet fully understood.

‘Some patients, their relatives and carers have continued to make complaints during the last few months. The MDU’s members reported to us 500 patient complaints since the start of lockdown on 23 March.

‘Some of these complaints have the potential to become clinical negligence claims, which is why it is also vital the Government acts to ensure all NHS healthcare professionals are exempt from Covid-19related litigation, and the additional distress it inevitably causes.

‘The MDU has been liaising with a number of bodies, including the GMC, MPTS and the Professional

Standards Authority, discussing the quickest and fairest way to address the backlog of investigations and reminding them that conditions are far from ‘normal’ and unlikely to be so for a long time to come.

‘It’s not business as usual for our members and it’s reassuring to see this acknowledged and, we hope, taken into consideration by all who whose business it is to hold them accountable.’

She said the MDU owed it to every one who had made such enormous personal and professional sacrifices to continue to try to minimise the impact on them of unnecessary investigations.

PPUs bounce back from Covid-19

The Royal Marsden weathers Covid-19 storm

Although travel restrictions and fear of Coronavirus has stopped patients travelling from overseas into the UK, the specialist cancer hospital earned £22m from private patients in the April, May, June quarter, trust board papers reveal.

The Financial Times recently published annual accounts show that private patient income in 2019-20 was £132m, up 10.8% from £121m the previous year.

It is the highest in the NHS, comprising 19% of all English trusts’ private income and 36.3% of total trust revenues.

Although these recent results are below plan and 2019-20 levels by 33% (£11m), they represent a healthy relative performance given the wider declines in the central London private patient market.

Activity is beginning to recover with a £1.2m increase in revenue in June and early July referrals returning to January 2020 levels.

Shams Maladwala, managing director at The Royal Marsden Private Care, told Independent Practitioner Today: ‘Now that lockdown has eased, we’re pleased to see an increase in both NHS and private referrals, as it means more people are seeking help for signs and symptoms of cancer rather than waiting.

‘The Royal Marsden has become a Covid-protected hospital, enabling us to provide as much treatment as possible in an environment where patients can feel safe.’

As we have previously reported, the trust continues to invest and new private facilities are due to open in Cavendish Square in 2021.

Royal Free leads NHS private unit re-openings

Hadley Wood Hospital (HWH) is a day surgery site located in Barnet, north London, and part of the Royal Free London Private Patients Unit. The private facility is used by over 100 consultants from the trust for insured, self-pay and also NHS waiting list work.

Facilities at the ten-bed unit include two operating theatres, endoscopy, minor ops, six consulting rooms and diagnostic imaging.

Robert Thornton, PPU finance and commercial manager, said: ‘The hospital has great support from the trust encouraging the PPU to restart our business and HWH reopened for private patients in the second week of June.

‘In fact, our private business is now growing faster than it was before the pandemic.’

Prof George Hamilton, PPU medical director, said HWH implemented rigorous infection protection control measures and protocols, complying with NHS guidance to the highest level, and treated urgent NHS cancer twoweek-wait patients throughout Covid-19 – even in the height of the pandemic.

The recently published 2019-20 annual accounts show that the trust earned £20.3m in private patient revenues last year.

Although this was down £2.4m and 12.3% on the previous year, the reduction is understood to be mainly due to the impact of Covid19 in March.

Philip Housden (right) is managing director of Housden Group

Dr Caroline Fryar, head of MDU’s advisory services

Patients want virtual consultations to stay

By Leslie Berry

Virtual consultations are here to stay and are strongly supported by the public, according to a survey. It found over half the population are now comfortable with the idea of talking to their GP by phone or video.

And 61% would either prefer to keep seeing their doctor remotely or would like to at least have the option of remote appointments.

A nationwide survey of 1,049 people by Consumer Intelligence for health insurance provider

Equipsme found that 37% would like the option of a remote consultation, depending on the condition, while 24% would always prefer remote appointments due to convenience or a desire to continue to minimise journeys.

Younger people showed a higher preference for remote consultations, with only 35% saying they would still prefer to see their GP in person – rising to 45% of those aged 55 and older.

The research found that lock-

The London Clinic has a new head of finance

The London Clinic has appointed Gerard Smith as chief financial officer to replace retiring CFO Simon Reiter.

He arrives from Sermo, a global social network for physicians focused on improving patient outcomes.

Chief executive Al Russell said: ‘Simon leaves us on the back of some record breaking results for the charity in 2019. Gerard can now build on this strong platform and is a fantastic fit for us. He also joins

down led to a positive first experience of a remote consultation for many.

Equipsme said over a quarter of people in the UK have now had a remote consultation and for 79% of them it was the first time they had seen a doctor in this way. 86% rated the experience as good or very good.

The company specialises in health care plans for small to medium-sized enterprises and selfemployed businesses, and remote access to a GP 24/7 is one of the most popular benefits it offers. Its service is delivered by Medical Solutions with a team of doctors.

Chief medical officer Dr Chris Morris said: ‘Clinicians now understand that 70%-80% of their care can be delivered without seeing someone face-to-face – and that this is not only an acceptable way of consulting with people but offers many benefits.

‘With the remote approach, more doctors can work from home, and surgeries with lots of consulting rooms may no longer be needed.

at an important time as we rebuild private healthcare while supporting the NHS through the Covid-19 pandemic.’

This means rather than spending money on infrastructure and facilities, budget can be freed up and spent on other essential areas.’

Equipsme managing director Matthew Reed said: ‘Digital healthcare, including phone and video consultations, has been growing steadily but slowly over the last 20 years. Under the circumstances of the last few months, it’s exploded. What we’ve seen is a revolution in how medical care is delivered, and it’s clearly been a revelation to large number of Brits.

‘People have realised they can get practical help and advice for basic health conditions quickly and easily from the comfort of their own home – fitting it in around their working and family lives. While there will always be some people and some ailments that require face-to-face care, remote consultations have proven to be effective, efficient, and perhaps surprisingly popular.’

 Consumer Intelligence online survey conducted 19-22 June 2020 with 1,049 adults in the UK

Pandemic sped up private doctors’ drive to digitalise

Covid-19 has accelerated companies’ digital communications strategy by a global average of six years and by 5.3 years for the UK average.

A survey by Cloud communications platform Twilio found 96% of UK decision-makers believe the pandemic sped up their company’s digital transformation and, of these, 66% said it did so ‘a great deal’. For healthcare the figure was 74%.

Previous inhibitors to innovation have been broken down during the pandemic, with four in five UK respondents saying that Covid19 increased their budget for digital transformation, of which 36% – more than any other country sur-

veyed – said that it increased ‘dramatically’.

UK bosses report easing of barriers such as: lack of clear strategy (37%), getting executive approval (35%), reluctance to replace legacy software (35%), lack of time (33%).

Twilio spokesman David ParryJones said: ‘In the UK, we’ve observed how businesses have rapidly modernised in response to the pandemic. This has affected everything from the ways in which businesses talk to their customers, to how their workplaces function.

‘We’re seeing how digital technologies are being used to completely re-imagine the business landscape.’

CMA urged to help kick-start sector

By Robin Stride

Private consultants were this month awaiting the outcome of an appeal to the competition watchdog to intervene to enable them to return to work treating a huge backlog of patients.

As we reported on our website on 28 July, they appealed to the Competition and Markets Authority (CMA) to allow private hospitals to waive charges for secretarial/ administration services and room rentals – which can amount to over £80,000 a year for full-time independent practitioners.

The CMA made these charges mandatory four years ago after a long-running investigation into private healthcare which identified ‘market distortions’.

But the London Consultants Association (LCA) argues that the private market would be kickstarted back into life if these fees could be waived or significantly reduced by private hospitals and clinic operators.

The LCA believes most would do so because ‘they should see this as a way to ensure their own longterm survival’.

Independent hospital administrators are said to have informed the LCA they are reluctant to allow any concessions for fear of falling foul of the competition regulator.

The LCA says key to restoring the market is to get the private medical consultant back to work.

This will open the front end of the service and would start the process of patient investigation and referral to get the paralysed market moving once more.

The association tells the CMA: ‘Consultants cannot keep staff on furlough forever and they cannot rely on savings, which will eventually become depleted.

‘Again, the fear is that many consultants will not return to private practice.’

In its statement to the watchdog, it said: ‘Although independent hospitals have now agreed to start taking private patient admissions, there are still significant restrictions and consultants are reluctant to restart their practice due to the overburdening cost and the risk involved.

‘A number of consultants are reported to have taken early retirement, whilst others have fur -

loughed support staff, relying on savings or spousal income. The situation remains grave.

‘For a consultant to restart a practice, they must commence reemploying their secretaries and installing administration once again. Many consultants have utilised virtual consultations, but are reluctant to restart face-to-face consultations in view of the limited number of patients wishing to be seen in clinics.

‘The cost of hiring a consulting room – chargeable by the private hospitals – in addition to their other overheads makes the return to normalcy unviable.

‘Independent hospital administrators have informed the LCA that they are reluctant to make any concessions for fear that they will fall foul of the regulator. Moreover, private medical insurers – for example, Vitality – are reducing re-imbursements for virtual consultations, further reducing the incentive to return to practice.

‘Currently, independent hospitals are not seeing any real return of private patient admissions into their hospitals and clinic room usage is reported to be very lim -

ited. There is a paralysis in the market and these prohibitive restart costs are another barrier preventing a return to a normal private healthcare market.’

The LCA said two costs normally borne by the consultant were secretarial/administration services and consulting room rental. But if these charges could be waived or significantly reduced by the private hospital or clinic operator, then this would give the impetus and support to get the consultant back to work with some confidence and the market would be restarted.

It called for a CMA review to consider a uniform easing of regulation so private hospital operators can decide about waiving or significantly reducing these charges over a period of one year. The LCA believes most would, as they should see this as a way to ensure their own long-term survival.

Get advice to stop falling into pension tax trap

Mr Gransby added: ‘Part of the equation to enable this would be to ensure you have up-to-date Pension Savings Statements from the Pensions Agency. But, beware, as these are often not provided in a timely fashion and may contain errors, so get them checked before making your decision.

‘An adviser can do this for you or calculators such as the Tony Goldstone BMA calculator are an invaluable source.

‘For those who have incurred annual allowance tax charges in any year since 2015, then the

“immediate choice” route will generate a recalculation of those growth figures.

‘Where more tax is owed, there is a four-year statutory time limit for reassessing tax – the current tax year plus four full tax years preceding. Any tax payable outside of this time-frame would not need to be paid, which could be beneficial for some.

equivalent of the excess tax paid with respect to all years of the remedy period.

‘Where too much tax was paid –the Government will refund the

‘It is therefore imperative that the numbers are crunched so that you know which of these scenarios applies to you, as otherwise you may be walking into a tax trap, or inaction may mean that you miss out on a rare opportunity to claw back some of the tax that was taken from your pocket in recent years.

‘However, choosing the ‘imme-

diate choice’ route may not be as advantageous as waiting until retirement to make your decision and so don’t let the allure of a tax refund cloud your judgment.

‘Those who have started drawing their pension since April 2015 will be entitled to switch schemes for the remedy period.

‘Advice should be taken as although a switch may result in a higher pension, some people’s circumstances may make them worse off by switching due to other benefits worsening – such as pension provision for an unmarried partner, where relevant.’

Dr Mark Vanderpump, co-author of the LCA letter to the CMA

➱ continued from front page

James Gransby of RSM UK Tax and Accounting Ltd

Major London unit starts post-Covid rehab service

By a staff reporter

HCA’s The Wellington Hospital has launched a post Covid-19 rehabilitation programme – the first of its kind in the UK’s private healthcare sector.

The service offers patients tailored care from a multidisciplinary team including consultant physicians, psychologists, physiotherapists, speech therapists, occupational therapists and dietitians.

Patients will have access to The Wellington Hospital’s complete range of assistive technologies, rehabilitation gyms and hydrotherapy pool.

The tailored programme is designed to ensure a successful recovery for any patient who has battled Covid-19 and is now experiencing long-term effects, from those who were able to safely selfcare at home to those who required admission to critical care.

Current research suggests one-in20 Covid-19 patients will experi -

ence long-term symptoms for at least a month, with those who required intensive care worst affected, the hospital said.

Long-term effects may include cardiovascular and musculoskeletal deconditioning, pulmonary embolism, mobility and balance issues, and mental health issues such as depression, anxiety and post-traumatic stress disorder.

With 36 intensive care beds and access to specialists in cardiac, pulmonary, neurological and renal care, the programme’s operators say it is able to support postCovid-19 recovery in the most complex and high-risk cases.

The hospital is also home to the largest private rehabilitation centre in the UK and offers expertise in rehabilitation of patients with complex neurological injuries and conditions.

During the pandemic, The Wellington Hospital has supported the NHS through sharing vital resources and expertise, diagnostics and time-critical treatment.

Bupa launches at-home cardiac check service

Bupa UK Insurance has launched a new rapid cardiac assessment service to all its insured customers.

The service has been introduced amid growing concern from cardiologists that thousands of people may be putting themselves at greater risk of long-term heart damage having delayed seeking medical help during the pandemic.

At the height of the lockdown, the insurer reports it saw a 60% drop in customer requests for an initial consultation with a cardiologist compared to the same period last year.

Similarly, the British Heart Foundation reports that the num-

ber of people attending hospital with a suspected heart attack has halved during lockdown.

Bupa UK Insurance chief executive Alex Perry said: ‘During the current crisis we know that some people have been reluctant to come forward to get symptoms checked, which could lead to serious health problems in the long-term.

‘Our rapid cardiac assessment service provides reassurance for patients who may be anxious about seeking help, offering fast access to specialist diagnosis from the safety and comfort of their own home.’

The service, which has been successfully piloted in London, offers

Chief executive Eric Reichle said:

‘In the months since the pandemic began, The Wellington Hospital has performed nearly 2,500 procedures without a single post-operative positive Covid test.

‘With more than 20 years of experience in providing complex acute rehabilitation, our exceptional team of clinicians are ideally placed to offer patients the highest

customers a video consultation with a cardiologist within 36 hours of contacting a specialist triage team – much faster than the usual time to arrange a face-to-face appointment.

If further investigation is needed to support a diagnosis, the latest ECG and blood test kits can be sent direct to a customer’s home and a follow up video consultation arranged at no further cost to discuss the results and next steps.

Dr Ravi Assomull, a consultant cardiologist who has been sup -

level of expertise through the next stage of their recovery in our new medical rehabilitation programme.’

Claire Dunsterville, director of the hospital’s rehabilitation services, said the aim was to build patients’ confidence and help recovery in a safe environment surrounded by a vast team of rehabilitation experts.

porting patients with the rapid cardiac assessment service, said: ‘Patients with heart palpitations benefit particularly well from this, as the whole pathway can be conducted exclusively at home with a full diagnosis and management plan reached in a timely fashion.

‘The convenience and clinical robustness of these investigations suggest that these may have a lasting role even after the threats from the Covid-19 pandemic recedes.’

The new cardiac service is part of Bupa’s enhanced range of remote health services. Through Bupa From Home , customers can get advice from nurses on everyday health concerns, treatment from GPs, physios, mental health therapists and fast access to diagnosis and treatment for critical conditions such as cancer and mental health.

Alex Perry, head of Bupa UK Insurance

ACCOUNTANT’S CLINIC: THE BUILDING BLOCKS OF ACCOUNTANCY

to of top tips

is for managing your cash flow security

Julia Burn continues with her A-Z of top tips. This month she turns

SOME OF the UK Government’s schemes to help businesses in the pandemic offered instant relief to businesses, while others were just a deferral of liabilities.

As independent practitioners return to their practices, they will need to manage a host of requirements, including social distancing rules and flexibility with their employees, who may require support particularly with childcare requirements.

But the major area that they need to think about is cash flow.

Doctors will still have bills to pay even though their level of income will not be what it previously was.

Many will find that it takes a long time to reach previous levels of income. Costs to the practice may have been scaled down, but there will inevitably still be some that need paying.

Consideration should be made as to whether changing your accounting period could have cash flow benefits.

Most of the impact of Covid-19 was felt in April and May, with the sharpest contraction of the UK economy ever recorded. For many, that will be in the 2020-21 tax year.

But changing accounting periods could allow some of these losses to be captured in the current

to ‘M’

period being assessed for tax and should be considered to reduce the tax liability on previously generated profits.

The Government has provided automatic deferrals of VAT payments due from 20 March 2020 until 30 June 2020, so for those doctors who are registered for the tax, this means this is not payable until 31 March 2021.

Automatic deferral

It also deferred the income tax selfassessment payments for the selfemployed, due on 31 July 2020, to 31 January 2021. This is also an automatic deferral.

But although these measures offer positive cash flow benefits, the payments still remain due, although the liability is being deferred until a later date.

Some will have been able to put money aside for personal tax liabilities and VAT, while others may not have had funds available to do this.

It is imperative for your business to have a clear understanding of your cash flows and liabilities due over the next 12 months, as the historic ebb and flow of cash will be different. It is likely there will be hardship for some in quarter one of 2021, a period when all the cur-

rent Government support measures will have ceased.

I recommend that if you have funds available, you should pay your liabilities now.

Don’t put yourself into a situation where you have even bigger liabilities to pay, such as where the self-assessment payment on account becomes payable at the same time as the final payment or more than one VAT quarter becomes payable at the same time.

Spread the impact

The next few months could be used to make regular payments on account against these liabilities so you spread the cash flow impact.

As the future of businesses are uncertain, and the ongoing effect of the pandemic cannot be accurately anticipated, your liabilities

could fall due for payment at a time when you potentially have less money available. And we may have to endure a second spike of the virus later in the year.

Practitioners also need to forecast very carefully what they think they will be earning. This will help them estimate their tax liabilities and factor these in when budgeting for the future.

Getting a practice up and running again could be costly in terms of keeping both patients and staff safe by applying all the measures stipulated by the Government, but additional equipment such as screens and extra personal protective equipment should be claimed against business expenses.

Julia Burn is a senior manager at Blick Rothenberg

HOW PRACTICE IS CHANGING

We’re coping with Coronavirus

Seeing the way forward: Consultants at specialist eye hospital group Optegra tell Independent Practitioner Today how Covid-19 has impacted on their work and changed the way they do things

LOCKDOWN PROVIDED an opportunity for specialists at Optegra Eye Health Care to review and reflect, streamline processes and launch a new approach to consultations, as well as plan how to keep patients and staff safe once lockdown was lifted.

Like others, the private hospital group supported the alreadystretched NHS by assisting with emergency care throughout lockdown and with cataract referrals once the doors re-opened.

Mr Amir Hamid, consultant ophthalmic surgeon and medical director for vision correction

‘We have spent a great deal of time and effort during lockdown to review how we work and how we can further increase safety for patients and staff in the face of this new virus.

While it has been challenging not being able to actually operate – after all, we surgeons love nothing more than being in theatre – it has provided an opportunity to pause and reflect.

We have a strict and rigorous regime in place now to keep patients and staff safe

As a result, we have thoroughly analysed and streamlined the patient pathway for our vision correction patients.

An essential element of that –and a direct response to Covid-19 – has been the launch of virtual consultations. This has allowed us to continue to work with existing and new patients even during lockdown, to respond to questions and carry out initial consultations over the phone or internet.

Our intention was very much to reduce the amount of time any individual patient would attend hospital once the doors are open.

So by running all the ‘conversation’ element of the consultation virtually, considering their symptoms, their hopes for their vision, their medical history and so on, we can then have a brief physical consultation for their actual medical eye checks once doors open.

Breathing space

This has allowed us to continue to engage and respond to patient needs – and a positive has been allowing some ‘breathing space’ for patients, so they can really have time to consider all their questions ahead of making decisions on their ophthalmic treatment.

In addition to this new and engaging way of working, we have continued to provide emergency care. For example, our Yorkshire hospital – based in Bradford –entered into an agreement with three local NHS trusts to open its facilities for consultants to perform sight-saving procedures.

Optegra Yorkshire provided NHS care to support local people with vitreoretinal conditions such as retinal detachment and macular hole.

And now that lockdown has lifted, the majority of our hospitals are working with the NHS to provide cataract treatment and help reduce the backlog of patients who were unable to access care in recent months.

In addition, we have been working closely with individual Optegra consultants and our Eye Sciences research department to share knowledge and assist with continuing education and training for our colleagues in the ophthalmic community.

This has included a series of six cataract webinars, information for patients on vision correction options and even a webinar with futurist Dr Patrick Dixon on the impact of this pandemic on the ophthalmic community.

Some of our individual consultants returned to the NHS front line to offer their support and expertise at the peak of the pandemic.

Since the Covid outbreak, the first major change within ophthalmology was for all non-urgent work to be cancelled and so colleagues such as Andy Turnbull were redeployed to an NHS intensive care unit where he became part of the team caring for patients critically ill with coronavirus.

As for the way forward, we have a strict and rigorous regime in place now to keep patients and staff safe.

This includes contact ahead of visiting the hospital to ensure patients do not have any symptoms of Covid-19 and that they or family members are not isolating.

From temperate checks on arrival with a contactless thermometer – for patients, staff and all visitors – to hand sanitiser throughout the hospital, social distancing, clinical staff in PPE, deep cleaning of all equipment, and minimal patients in the hospital at any one time – patient and staff safety is the core priority.’

Unfortunately, we have seen some patients losing sight for fear of Covid-19

‘I have been redeployed to the intensive care unit at Royal Bournemouth Hospital, where I am part of the team caring for patients critically ill with Coronavirus. This has been physically and emotionally draining.

Full PPE is essential and we wouldn’t want to be without it, but wearing it for many hours in a fast-paced, stressful environment, without being able to rehydrate or go to the bathroom is exhausting.

Seeing the grim reality of Covid19 for patients and their families –who have to remain in isolation and are not allowed to visit – is harrowing. We have been warned of the risk to ourselves not only of contracting the virus, but also of burn-out and even post-traumatic stress disorder.

Well-being groups have been set up to try and support healthcare workers during this time. I have so much admiration for the nurses and doctors who do this all day every day and I have renewed appreciation for my relatively comfortable day job.’

☞ Independent Practitioner Today is keen to hear from other readers about their experiences while in lockdown and how their work is changing as they resume private practice. Email robin@ip-today.co.uk

Mr Stephen Lash, medical director Optegra UK and consultant vitreo-retinal surgeon

‘Keeping patients safe has been a priority. It’s vital for us to provide as safe an environment as possible given that macular degeneration can result in loss of sight without the regular injection treatments and these patients are at highest risk from Covid-19.

Unfortunately, we have seen some losing sight for fear of Covid19. The challenges have been keeping up with national advice and guidance, as it has continually changed as the situation evolved.

Rethink patient journeys

This difficult time has forced us to think about the use of technology and remote consultations. It has required us to rethink the journey through the hospital, which ultimately moves us away from use of waiting rooms as the norm.

Waiting rooms are there because of inefficiencies in the system and so our patient journeys have to become more regimented, predictable and focused, minimising time spent in the hospital. This is a great thing for patients going forward.

I am doing more consultations over the phone and reviewing images sent by referrers, which is possible in my subspecialty. We are encouraging closer working with optometrists to review postoperative patients in the community and I see this link as critical.

I have been arguing for more responsibility for and closer working with optometrists since leaving the profession to train as a doctor. They are very knowledgeable and have all the kit.

Ideally, we need a national IT framework to link the community with the hospitals to really leverage this relationship.’ 

Mr Andy Turnbull, consultant at Optegra Hampshire

GUIDE TO DELIVERING SUPERIOR PATIENT EXPERIENCE IN PRIVATE PRACTICE

How your patients feel about the care you provide is arguably the most important measure of your success in private practice. It is essential that patients receive good treatment that improves their health, and this is a fundamental and measurable element of your care.

But there are many other factors that influence how a patient feels about your care and it is all these elements that form the patient experience. You want your patients’ experience to be as good as possible.

In her third article in this series, Jane Braithwaite builds on the concept that patient experience is about putting your patients first

Put yourself the shoes your patient

yourself in shoes of patient

I suggest you approach the patient experience through the eyes of your patient and follow their journey

YOUR PATIENT should be at the centre of your patient experience strategy and every interaction your patient has with your practice is important.

Who are your patients?

The best way to ensure you are putting your patients first is to think about the patient’s journey, considering the three stages of before, during and after care. Before we do that though, we should start by discussing who your patients are, so you have a clear view of what is important to your typical patient.

A useful way to make it easier to understand your patients is to create personas. I would recommend creating three different personas and giving each persona a name so you can relate to them easily and use their names when refining your strategy.

Let us take a gynaecologist, which is the specialty that I am most familiar with, and consider one example persona.

Michelle is 36 years old and works for a well-known finance company in the city. Her career is important to her and she has been incredibly successful, in part due to working long hours, travelling frequently and often working evenings and weekends to keep up with such a demanding workload.

Two years ago, she married her partner – who she met on a business trip – after a short engagement. They are both very keen to start a family and thought it would happen naturally, but after two years they are becoming anxious and are ready to seek help.

This persona of our typical patient Michelle is something we

will refer to regularly as we plan our patient experience. As mentioned earlier, I would suggest that you create three personas to represent different patient groups within your practice and consider each one in turn.

Another important factor is to consider your patient support group. When considering fertility, both partners are involved, and our patient experience needs to reflect that and ensure that both parties are looked after well throughout their journey.

So, in Michelle’s case, the experience of her partner will also be important. In other specialties, we may need to consider others too; for example, when treating a patient who is a child, we need to consider the persona of the parent/carer or guardian.

This may also be true in the case of a patient who is critically ill and relying on their next of kin to make decisions regarding their care.

The patient’s journey

Having created your personas, you are ready to embark on the patient journey.

To ensure you put the patient at the centre of your strategy, I suggest you approach the patient experience through the eyes of your patient and follow their journey. You can break the patient journey down into three stages: before, during and after treatment.

In our article last month, we talked about setting your vision, which describes where you want to be and setting your objectives to help you achieve this. Your vision and objectives need to be the fore➱ p16

front of your mind in your next steps. You need to ensure that every interaction a patient has with you is in line with that vision.

To help bring this to life, let us take The London Clinic as an example, which has stated the following as its vision:

THE LONDON CLINIC

Our Vision:

To be the most trusted hospital. Our vision provides the essential foundation for our future.

In all our relationships, trust is the one thing that will give others the confidence that we can achieve something exceptional.

These statements give everyone at The London Clinic absolute clarity and clear direction, defining what is important, and their vision can be used by them to ‘test’ all their decisions regarding processes and policies by asking questions like these below.

 How does this build trust?

 How does this build confidence?

 How does this demonstrate that we can achieve something exceptional?

It is important that you use this same approach applying your own vision to your patient journey.

Before treatment

At some point, an individual becomes a potential patient for you. This is likely to occur when an individual starts to experience symptoms and begins to explore what these symptoms are caused by and how to treat them. This is the start of the patient journey and the start of your patient’s experience.

These days, a patient will probably start to research their symptoms online and may also book an appointment to see their GP, either via the NHS or privately. So, in terms of your patient experience, it is important to ensure you

have considered both potential routes to your practice.

The first scenario of a patient researching their symptoms online is a dangerous situation as we all know.

A slight rash can rapidly escalate into a fear of a critical illness when a patient encounters a bad website.

But, increasingly, there is a wealth of more useful information available online and your challenge is to ensure that your content is easily found by your potential patients searching for their symptoms and that it is written in such a way that your patient can relate to it and finds it valuable.

For many doctors, the objective is to be seen online as a ‘thought leader’ in their specialty and this is achieved by sharing accurate, valid and useful information in a professional manner.

Use your personas to think about your patients’ needs before treatment. Think about our

KEY POINTS

1 Put your patients first and at the centre of your strategy

2 Consider every interact your patients have with your practice

3 Apply your vision and goals to drive your decisionmaking

4 Be clear on who your patients are

5 Create personas and give each one a name

6 Consider each aspect of your patient journey

7 Communication is key

8 Establish a long-term relationship

CHECK OUT OUR BUSINESS DIRECTORY

Independent Practitioner Today now features an online advertising directory to complement our journal and website.

Split into ‘business’ and ‘lifestyle’ directories, they list the services independent practitioners need to run their practices or spend their well-earned money on.

patient Michelle as described earlier. We know she is intelligent, driven and used to being in control of her own life. We also know she works long hours and is likely to do her research out of hours, in the evening at weekends or perhaps while travelling.

Expert opinion

So, Michelle may be searching online from her laptop but is quite likely to use her mobile, and you need to ensure your information presents well in either format. Typically, 50% of website visitors are from mobile devices and many websites are still not optimised for mobile, so this needs fixing quickly. Michelle will want to find expert opinion and will be drawn by factual content that informs her of the options available to her. She will want to research the subject broadly so that she develops the knowledge to take control of her situation. Once she achieves this,

Typically, 50% of website visitors are from mobile devices and many websites are still not optimised for mobile, so this needs fixing quickly

she will be ready to commit to meeting her chosen expert.

There are numerous methods available for doctors to provide information to potential patients. Having a good website is key, with content that is updated and written with your patient personas in mind. You will need to invest in search engine optimisation to ensure your website is listed well by Google in the search results.

The content on your website could include an article on frequently asked questions, a description of the typical patient journey, case studies and testimonials.

You need to consider what your patients want to know. What do your patients typically ask during their first consultation?

You could include an option on your website for patients to sign up to receive your regular updates in the form of a newsletter and this is a good way to start a longer-term relationship with your patient.

A patient gets a real feel for who you are when watching your video, which is very reassuring and will ensure your patient is less anxious about their first consultation

As well as written content for your patients, you can also create videos, which are hugely popular and reassuring for patients.

A patient gets a real feel for who you are when watching your video, which is very reassuring and will ensure your patient is less anxious about their first consultation. In terms of the patient experience, this is a huge positive.

Your relationships with potential referrers, such as other consultants and GPs, are incredibly important and there are numerous ways you can nurture these, including providing leaflets and other collateral that will be of value to your referrers. Have a different set of leaflets to hand out to potential patients.

You could have a section on your website purely for GPs and other consultants to refer to, organise webinars and live events, Covid permitting.

And you could also consider a monthly or quarterly newsletter for your network of referrers which would be different from your patient newsletter.

Other potential sources of referrals could be insurance companies and embassies and, if this is relevant to your practice, it is important to consider these relationships too.

During treatment

Once your patient has decided to book with you, they will have their first human interaction with your practice and they will most likely email or call your practice to make their initial enquiry.

Many doctors are now offering patients the opportunity to book online and, for patients like Michelle, this would be incredibly positive. As we know, she is most likely to be researching online out of normal office hours and so the ability to book her first appointment too is very appealing.

It is at this point of the first interaction that your medical PA will start to build their relationship with your patient, and this is incredibly important.

For every interaction you have with a patient, either during a consultation or planned surgery, your medical secretary may have more than six interactions by phone and by email.

It is imperative that your medical PA is fully engaged in your vision, understands your objectives and manages your patients in a way that supports your vision. Our next article will focus on engaging your team in your patient experience strategy and will explore this in detail.

During treatment, the need for information remains a top priority for your patient. Discussions during your consultation may easily be forgotten by an anxious patient, so a follow-up email or letter with a summary of what you discussed will be beneficial.

Again, you might consider sending articles describing the typical patient journey and frequently asked questions to ensure your patient feels fully informed and in control of their treatment.

Over recent months, the use of video conferencing has grown exponentially, and while face-toface consultations will always be

Most patients will be feeling anxious on their first visit and being treated well on arrival will help to alleviate that anxiety

preferential, you may decide to include video as part of your patient care.

For example, a new patient who is travelling a long distance to meet you may be reassured by an initial video consultation that is both convenient for them and provides a great opportunity for you to ensure your patient feels comfortable with you and commits to a face-to-face consultation. It may also be possible to ‘meet’ patients more quickly by video than in a face-to-face scenario and therefore deliver a greater patient experience, especially for patients who need urgent reassurance.

Physical environment

When your patient does come to see you face to face, the physical environment in which you meet will also impact the patient experience.

To enhance this, it is important that your PA reconfirms the appointment the day before and ensures the patient has accurate details regarding your location and how to reach it, plus other considerations such as parking.

On arrival at your clinic or hospital, your patient will be greeted by your receptionist and this first impression is important. We all know how it feels to arrive at a reception desk to find the receptionist busy on the phone.

Ideally, your patient will be warmly greeted by a receptionist who is expecting them and welcomes them warmly. Most patients will be feeling anxious on their first visit and being treated well on arrival will help to alleviate that anxiety.

The consultation itself is of the utmost importance and, as a doctor, you know exactly how to

Many other members of your team will also be included in your patient’s care and they need to understand exactly how you want your patients to feel

manage that aspect, so I am not going to dwell on this.

At the end of your consultation, your patient will ideally be feeling that they were listened to and you, as their expert and doctor, have both understood their concerns and agreed a treatment plan that they understand and feel comfortable with.

Whatever the treatment plan involves, each step of the process needs to be designed to ensure that the patient feels in control, has the information they need and feels looked after.

Communication is absolutely key and I believe that, in most cases, over-communicating is better than under-communicating. Again, your medical PA will play a key role in this.

Many other members of your team will also be included in your patient’s care and they need to understand exactly how you want your patients to feel and the patient experience you want to deliver.

After treatment

In most cases, patients will attend a follow-up appointment with you, which is normally face to face. At this point, the patient may be discharged from your care or there may be a longer-term plan; for example, an annual check-up.

In either case, I would encourage you to view each patient as a longterm patient. In the future, they may need further treatment or they may have friends and family who have a need for your services.

For these reasons, I would encourage you to consider your patient experience to be long term and to look for opportunities for continued care.

A regular newsletter will keep your patients informed about the services you provide and potentially new treatments that are available. You might also include articles regarding preventative health.

In your patient’s mind, you are already a trusted expert and so your continued communication is likely to be welcomed. 

Jane Braithwaite (left) is managing director of Designated Medical, which offers business services for private consultants, including medical secretary support, book-keeping and digital marketing

IMPRISONED FOR MANSLAUGHTER

Surgeon Mr David Sellu (below), convicted for gross negligence manslaughter of a patient at a private hospital – overturned on appeal after a 30-month prison sentence –continues describing the saga of how he was treated as a ‘very non-private’ patient while he was an inmate

Visiting hospital locked in chains

THE DOCTOR in the cubicle was a pleasant young woman who introduced herself and asked me to recount my history.

The prison officers saw no reason to leave the cubicle, so I simply ignored them.

She made no attempt to defend my right to confidentiality – a right I insisted on for the prisoner patients I treated from Wormwood Scrubs prison.

This time for my examination, I would need to take off my prison jacket, my shoes and socks and my trousers, and the doctor might want to examine my abdomen and groin as well as my legs. I looked at the doctor first in the hope that she would bar the officers from the examination room, and then at the officers.

Not much was said, but I still

had my outdoor clothes on, including my jacket. The handcuff was on my right wrist, attached to the female officer’s left wrist but with little slack in the link between the cuffs.

The male officer opened his bag of metalwork and extracted a set of handcuffs, but this one was different.

Long chain

It had a long chain about six metres long with a cuff at each end. The male officer commanded me to take my left arm out of my jacket and he attached the new cuff to my left wrist. He then attached the second new corresponding cuff to the right wrist of the female officer.

‘I don’t mean to hurt you, but if you are pinched…’

‘It is not intentional,’ I finished the sentence for him.

He proceeded to remove the first set of cuffs, first from his colleague and then from me, but I was left with the cuff and chain combination I called ‘Duke.’

Both officers were now free to stand outside the cubicle on the other side of the curtain with the chain dangling on the floor.

With my free right hand and a slightly restrained left hand, I managed to remove my coat, shoes and socks and then my trousers and lay on the couch.

The examination was efficient, in my view. The doctor’s brief was to determine whether or not I had a deep vein thrombosis (DVT) and the indications were that I might. One leg was more swollen than

➱ p20

the other; neither was painful, but the worse-affected calf was a little sore to touch and the D-Dimer blood test was a little raised but was in the equivocal range.

The officers insisted on being back in the cubicle as soon as they felt the examination was over in case the doctor gave me any information I was forbidden to know. I was relieved that I was allowed to get dressed first.

Standard treatment

As a DVT could not be ruled out and the imaging department was now closed for routine DVT scans, the standard treatment was to give an injection of the blood-thinning agent tinzaparin and to bring me back when the scanning room was open to do the definitive test.

‘When will that be?’ I asked.

She looked in the direction of the male officer, who shook his head.

‘Well, if it is not tomorrow,’ I

continued, ‘then I would have to have daily injections of tinzaparin until the scan is done.’

I had been warned not to criticise any part of the prison service in front of others, so I had to choose carefully what I said next.

‘Knowing the difficulties in the healthcare centre, I am worried that I may miss my injections.’

‘Leave that to us and we will see what we can do,’ the male officer replied. The tone of his voice was more of a command than reassurance.

I was weighed: 80kg – subtract

five for the cuff and chain – given a tinzaparin injection and ordered back to the waiting room to wait for our taxi back.

Three-and-a-half hours after we first presented to A&E, I was in the back of the same taxi we had taken to the West Suffolk Hospital. Mercifully, I had not encountered anyone I knew professionally from my medical life during the hospital visit.

The male officer got out of the car and took a sheaf of papers and his bag to the gatehouse. Soon after, a female officer emerged from the gate carrying a two-metre pole and she signalled to the driver to get out of the car. The new female officer got into the driver’s side, opened the dashboard, flipped through the contents, looked on the floor, lifted the floor mat and had a quick look inside all the compartments in the car.

She instructed the driver to open the car bonnet. Another quick look. The new officer picked up the pole and slid it underneath the car, put it back on the ground and signed a piece of paper handed over by the taxi driver.

Bemused, I asked the officer I was chained to: ‘What’s all this about?’

‘They are checking for drugs and other forbidden items.’

Cursory check

I thought to myself that this was at best a very cursory check. Surely, if they were going through all the trouble, they could search more thoroughly.

Interestingly, the female officer I was attached to was not searched and I was not to know whether her male colleague had been either. Once we were all back in the car, the inner gate was opened, we drove through and alighted in front of the entrance to reception.

‘One last search before I unlock your handcuffs and take you back to your unit.’

The process completed, the female officer went her way as I walked ahead of the male officer back to Unit 10. She did not say a word to me as she walked away.

The courtyards were empty and as we walked, I inquired: ‘What happens to me now?’

‘I will leave your A&E letter with healthcare and things will be taken care of.’

The day had been stressful and humiliating. As my evening meal, by now very cold, was handed over to me in a polystyrene container, I asked if I could phone home to let my family know what had happened today and that I’d returned to prison without a diagnosis.

‘Lock-up was hours ago and phone calls are not allowed at this time. Make your way to your cell,’ I was told.

At ten o’clock on a Saturday morning, my cell door was pushed open.

‘You have ten minutes to get ready and you are coming with me. I will be waiting in the unit office.’

I knew enough by now though to guess what was going to happen. DVT is an emergency and if suspected clinically, as in my case, it should be confirmed or excluded by venous duplex scan at the earliest opportunity. I knew that scanning units opened on Saturdays and any urgent requests from the previous evening would be dealt with.

This trip was almost certainly going to be to the scanning unit in the imaging department at the West Suffolk Hospital. I had also learned enough about security procedures to realise that I would not be told any of this and, moreover, would be prevented from making any phone calls.

Scanning room

Just after midday, I was called into the scanning room where there was a nurse and a doctor. I was instructed to pull my jeans down – I did not have to take them or my shoes off – and to pull my underpants over to the right to expose my left groin. The officers made no attempt to leave the room.

When the doctor had finished a scan on my left leg, he said there was no clot but there was only fluid under my skin. As the swelling was on both sides, albeit worse on the left, I asked if the right leg ought to be scanned as well. No, the doctor replied; the request form said to do only the left side.

The session complete, I was pleased that I did not have a DVT in my lower left leg but my legs were still puffy. I was then taken to a ward and told a doctor would call when it was my turn.

DEALING WITH SELF-PAY PATIENTS

A good way out of this

As the private healthcare sector continues to open up again to private patients, Simon Brignall discusses the importance of self-pay in ensuring your practice recovers

THE CORONAVIRUS has proved to be extremely challenging for consultants in private practice and has meant they have had to make a lot of difficult decisions over recent months.

At Medical Billing and Collection (MBC), we partner with over 1,300 consultants, groups, clinics and hospitals across all specialties. Our data indicates that the low point in activity was the first week of May and subsequently there has been a progressive increase in activity, which is reassuring to see.

Recent reports suggesting that NHS waiting lists could hit 10m patients by the end of the year, up from the current 4.2m, will likely mean that there is a large demand for private healthcare from patients who are not prepared to wait.

We are beginning to see the private healthcare sector start the process of opening to meet this demand through the gradual return to face ­ to ­ face outpatient consultations and the releasing of theatre capacity by the private hospitals.

The major trend of the last decade was the growth of the self­pay market and we fully expect that this sector will form a significant portion of the recovery.

There have been many reasons for the increase in the demand for self­pay over recent years and here are the major ones:

 NHS

With approximately 10% of the population having private health insurance, this means that when the remaining 90% of the population sees that the NHS is experiencing difficulties, an increasing number of patients will elect to access the private sector.

With headlines in the press suggesting rising NHS waiting lists,

this demand for private healthcare will only continue to increase.

We know that the number of patients accessing acute care has reduced during the Covid­19 crisis, which means these conditions have gone untreated. This will translate into a build­up of more complex problems for the future.



Wealthy elderly patients

Older patients who have benefited from rising house prices are in a better position to access private healthcare than ever before. Combined with greater quality of life expectations, this means that they are much more likely to chose to access private care than previous generations.



Insurance policies

To control the costs of the premiums, insurance companies have amended their policies to include ever­ increasing elements which are not covered by the policy.

This can be for a variety of reasons, including benefit limits, patient excess on the policy, coshare policies – where the patient agrees to pay a percentage of each invoice – and certain procedures being excluded.

 Overseas patients

If your practice is based in central London, then this has always been a part of practice life, with patients coming from outside of the UK seeking private healthcare. This area was immediately impacted by the shutdown and the reduction in air travel, but we expect the demand from these patients to return as restrictions continue to be relaxed.

 Mental health

The impact on mental health of the coronavirus and the lockdown is well documented. This sector proved to be more resilient than other specialties, as practitioners were able to quickly transition to remote consultations and I am now hearing from practices that they expect this option to become part of their toolkit in the future.

Self ­ pay typically forms a large proportion of the patient demographic of practices in this field.

It is important to note that, across our client base, the selffunding patient is either the largest or second largest payment source. Some of the practices we manage comprise of 90% self­pay.

From the reasons I have already

discussed, we expect this sector to make up a large percentage of the recovery and so it is important that you maximise the potential of this key area.

Remember, self ­ pay patients benefit the practice because, over a period that has often only seen the steady reduction in fees, this is an area where the consultant has complete autonomy.

Consultants can set their fees purely based on factors such as their experience, the demand for their services and competition. If you have not updated your fees in a while, this could be a good time to conduct a review of your fee structure to ensure you optimise your income.

Managing self-pay

Considering the importance of the self ­ pay sector, it is vital to make sure that these patients are dealt with correctly from both a billing and collection perspective. Unfortunately, in our experience, this is rarely the case and there is quite often a lack of clarity regarding the billing of self ­ pay patients and, more importantly, the collecting of outstanding money.

This often results in the practice having a large amount of outstanding debt, which is either chased intermittently or not chased at all, resulting in debts that can quite quickly mount up to a significant sum of money.

The reasons for this debt can be attributed to many factors, but typically what we see is a lack of robust procedures in place to deal with these patients.

Ask yourself this question: do you know the percentage of your practice that is self­pay and what type of self­pay patients they are? In my experience from conducting reviews of practices, consult­

Credit card? That will do nicely, Sir

ants are constantly surprised about the size of the self­pay element of their practice.

It is vital that your practice has systems in place to deal with each element of self­pay listed below:

 UK self-pay

For UK self­pay patients, you need to have a published price list or to have notified the patient of their fee in advance.

It is good working practice to also confirm both the methods of payments that are available as well as when payment is due, so that the patient will not only expect an invoice but also understands how they are to pay.

At MBC, we have a variety of methods available to offer our clients and these are tailored to the needs of their practice.

Most commonly, we invoice patients after their treatment and this is usually by email that includes a link to our payment portal, which enables the patient to pay 24/7.

We also have the options to invoice patients in advance for treatment, where required, or to

collect payments on the day via our Client Self­pay platform.

When you are invoicing patients post ­ treatment, you will need to put in place a robust system where the patient is chased for payment after an agreed period. Then ensure this is repeated on a regular basis until payment is collected.

Failure to do this is the most common reason why debt levels increase and can lead to cash flow difficulties.



Overseas patients

If you are going to see a patient who is not a resident of the UK, it is even more important to make sure your fees and method of payment are made clear. Once they leave the country, it is extremely difficult to collect what they owe you.

When we deal with these patients on behalf of our clients, we commonly collect money in advance of treatment. Where payment is collected by the hospital, then we raise an invoice to the hospital for your fee. It is important to follow up with the relevant finance department

to ensure these payments are made to the practice – hospital administration can vary.



Insurance shortfalls

Even the most efficient practices find this challenging. And often it is the cause of a significant proportion of their outstanding debts.

This is because most patients do not review the terms of their insurance policy and assume that all costs are going to be met by their insurer; so when they receive an invoice for an outstanding balance not covered by their insurance company, this can come as a shock.

We find a lot of patients will ignore the invoice, thinking that it is either a copy of what has been sent to the insurer or that their insurance company is liable. So it is important to follow up with the patient directly and explain why they have received an invoice.

A large part of what we do on behalf of our clients is liaise between the insurer and the patient to ensure it is clear who owes the money. Some patients will wish to contest this with their insurer, as they believe the latter are liable, and so it is

important that any issues are highlighted as soon as possible to minimise delays.

Once the patient accepts that the money is owed by them, then steps need to be put in place to chase outstanding balances and take payment.

The future

Self­pay has been the growth sector in private healthcare in recent years and as I have highlighted in this article, it is likely to be key to the recovery. It is important that you review how you manage these patients in order to improve your cash flow and help it recover as quickly as possible.

Of course, a good alternative is that you could choose to partner with a billing company which has the expertise and skill set to remove this burden from your practice. 

Simon Brignall (right) is director of business development at Medical Billing and Collection

£ £ $ $ £ Take heed of the ‘Oracle of

$

Is Warren Buffett the exception which proves the rule? Dr Benjamin Holdsworth on how hard it is to beat the market £

IF YOU were asked who you thought was the world’s best investor, you might well say Warren Buffett, the chairman and chief executive of Berkshire Hathaway.

That would not be an unreasonable answer, given he is worth around $71.5bn, give or take a few million for daily market movements.

He is also often held up by those in support of ‘market ­ beating’ strategies as a shining example of their creed. More than 40,000 avid followers attended the 2018 annual shareholders’ meeting, referred to by some as ‘Woodstock for capitalists’ and his style of investing is known as ‘Buffettology’, on which numerous books and articles have been penned.

To us, Buffett is the exception that proves the rule. Although he – via Berkshire Hathaway – owns a concentrated pool of hand­picked companies, he has several traits in common with a more systematic approach, such as an infallible belief in the power of capitalism to create wealth over time, which requires discipline, patience and fortitude to capture.

He is comfortable being different to the market; famously, he avoided tech stocks in the late 1990s because he did not ‘get’ them. He also detests fund management costs that detract from market returns.

Upward march

I have a huge amount of respect for Warren Buffett, but provide an alternative narrative that perhaps simply reinforces how difficult it is to beat the relentless upward march – with some inevitable setbacks – of markets for long ­ term investors.

Buffett has been investing for almost three­quarters of a century, starting early. By 32 years of age, he was worth just shy of $2m. He is now almost 90. His longevity in the game is a major factor in his legendary status.

It might surprise you to know that had he retired early at 60 in 1990, he would have been worth a paltry $3.3bn. In other words, he would have been worth under 5% of his net worth today.

It is worth noting that it has been increasingly hard for Buffett to beat the market. In the early

days, there were fewer research analysts and fund managers in the market and a far higher level of amateurs playing the game. He was the shark in the pool.

Imagine that he had been persuaded to run a mutual fund, not a listed investment holding company.

A manager with such a track record would be justified in charging a 1% fee a year. In the past 24 years, he would not have beaten the market. Even without these fees, Berkshire Hathaway’s shares have struggled to beat the markets in the past decade or so.

Although he will always be remembered for his investing prowess, folksy words of wisdom and his philanthropy – he intends to give away the bulk of his wealth – in our view, his real legacy is his enduring advice to all investors that remains simple and direct:

‘When the dumb investor realises how dumb he is and invests in an index fund, he becomes smarter than the smartest investor . . . most investors, both institutional and individual, will find the best way to own common stocks is through an index fund that charges minimal fees.’

Alternatively:

‘It is not necessary to do extraordinary things to get extraordinary results.’

I could not agree more! 

Dr Benjamin Holdsworth (right) is director of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS.

The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions.

Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.

Probationary periods are not a free-for-all

Have you been getting maximum benefit from probationary periods for new staff? Julia Gray (right) examines the purpose and operation of probation and suggests how it can work most effectively in independent practice

THE PURPOSE of a probationary period is to provide an opportunity to assess the suitability of a new employee and the means to part company with them more easily if they are unsuitable.

A probationary period is advisable for almost any new employee. The main exceptions would be very short-term contracts and very senior appointments.

There are two crucial requirements that need to be met for an employer to be able to take advantage of a probation regime: 1. The terms need to be included in the employment contract and clear to everyone concerned; 2. Managers must properly engage with the process and make a conscious, rational and evidencebased decision at the end of it. The length of probation will depend on the nature of the job and how long it will take to assess the employee’s performance; commonly, it lasts between one and six months. The key feature of the probationary period is that it provides for shorter notice, allowing the employer to terminate the employment contract more quickly – and possibly more cheaply.

Other rights

Other rights under the contract can also be subject to the successful completion of a probationary period; for example, the right to contractual sick pay. If the employee successfully completes their probation, they move to a standard set of contractual rights, including a longer notice period.

A probation clause should set out, as a minimum, how long probation will last, what notice will apply during that period – subject to the statutory minimum – and the implications of passing or failing.

If you would like to have the option of extending the probationary period, the employment contract should provide for that.

It is important the employee understands from the outset the probationary process and what is expected of them. It is good practice to have regular, documented meetings throughout. If the end of probation comes and goes without being addressed, the employee will likely be deemed to have successfully completed it by default.

An employee who has been sacked must have accrued two years’ service before they can bring most types of unfair dismissal claim. By the time notice expires following the end of a probation, an employee will not usually have enough service to bring a claim.

For that reason, many employers opt not to follow their normal policy – or the Acas Code – when they dismiss an employee at the end of their probationary period.

It is important the employee understands from the outset the probationary process and what is expected of them

That approach is not without risk. The minimum service requirement for unfair dismissal claims does not apply to several other types of claim, including claims relating to discrimination and whistle-blowing.

When an employee has been absent for a significant proportion of their probationary period, the manager might have insufficient information on which to base a final decision.

The level of absence itself might act as a deterrence to confirming the post permanently. However, if

an employee fails their probationary period for a reason connected to a disability, maternity or other protected characteristic, then they would have grounds to bring a discrimination claim.

Another chance

Where an employee would otherwise fail their probation due to absence, employers should consider giving them another chance to prove themselves by exercising any contractual right to extend probation.

If you do not have a contractual right to do so, you can invite the employee to agree to vary their contract to provide for an extension, which they might be willing to do if they see it as their only means to keep their job.

If the employee serves – or is paid in lieu of – their notice entitlement, they will not easily be able to succeed with a claim for breach of contract or wrongful dismissal

in connection with that notice entitlement.

But a breach of contract claim of a different type might arise if your disciplinary/capability policy is contractual and you do not follow it.

That is one reason why it is usually advisable to follow some degree of procedure in dismissing during a probationary period. It also provides an evidence trail supporting your motivation for dismissal; for example, by helping you to refute any challenge that it was discriminatory. Now might be the time to review how effective your probation process is and whether any changes are needed to your current practice.

If you have a practice manager, ask for feedback about their views and experiences, and whether they need any support or training to enable them to make the most of probationary periods. 

Julia Gray is a solicitor with Hempsons

Free legal advice for Independent Practitioner Today readers

Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.

We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.

Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.

Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes’ of free legal advice.

Advice is available on:

 Business structures (including partnerships)

 Commercial contracts

 Disputes and litigation  HR/employment

 Premises

 Regulatory requirements and investigations

Michael Rourke Tania Francis m.rourke@hempsons.co.uk t.francis@hempsons.co.uk

Police want my patient’s data

A private psychiatrist is being ‘chased’ by the police to provide information about a patient, particularly about his mental health and what medicine he takes. Dr Kathryn Leask (right) answers his query about disclosure

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Dilemma 1

Must I acceed to police request?

QI am a private psychiatrist and have been looking after a patient with mental health and drug abuse problems for a few years.

I was contacted by the police this morning and they have asked me to provide information about him, particularly in relation to his mental health and what medication he takes.

This information is for the forensic medical examiner where he is being held in custody. The police have told me that he is alleged to have committed a serious offence. He has been assessed by the doctor and does not have capacity to consent to this disclosure.

Can I provide any information about the patient to the police?

AWhere there is an overriding public interest, sensitive information about a patient can be disclosed without their consent.

Regardless of the crime, this patient is in custody and therefore unlikely to be a risk to anyone else and, as such, it may be difficult to justify breaching his confidentiality in the public interest.

In this case, it is the forensic medical examiner (FME) who has requested the information, presumably so that the patient can be appropriately treated. To do this, the FME will need information about the patient’s medical history and what medication he is currently taking.

The information may also be useful to the police for their own criminal investigation. As the patient does not have capacity to

provide you with consent, as with any patient, you should act in their best interests.

Rather than disclose information to the police directly, ask that the FME contacts you personally so that you can provide him with the clinical information he needs to treat the patient.

The FME will also have a duty of confidentiality to the patient. The information you give should be limited to only that which is necessary for the patient to be treated and made safe.

Careful records

You should make careful records of whom you have spoken to and what their role is and what information you have provided and why. This will be important should you be asked to justify your decision to disclose information later.

Where police ask for information about a patient who is not a risk to others, it would be difficult to justify disclosing information about them without consent. If the police cannot obtain consent from the patient, they may attempt to rely on data protection regulations which would enable you to disclose information under certain circumstances, such as the detection or prevention of a crime, without being in breach of data protection law. However, it does not mandate you to disclose information.

Your ethical professional duty of confidentiality to the patient overrides this. If necessary, the police may be able to obtain a court order compelling you to disclose information. In this case, you should only disclose the information which is referred to in the order.

Your defence body can review a court order for you to advise on its validity and what action it orders you to take.

A paediatrician with a private practice is caught in the middle between a child’s waring father and mother. Dr Kathryn Leask gives her advice

Caught in a tug of love

Dilemma 2

Do I go against mum’s wishes?

QI have been seeing a sevenyear-old child who has severe eczema. He is on several different treatments and spends time with both of his parents, who are separated. The parents do not get on and the child is often stuck in the middle. There are no safeguarding concerns.

The father has contacted me, as he is aware from his son that there has been a change in his medication regime and I have given some advice about allergens. He is due to go camping with his son and has asked for information from his medical records about his condition.

The mother is refusing to update the father in an attempt to stop him taking the child away. On previous occasions, she has made it clear that she does not want any information being passed on to the father.

I can provide the father with the information he has asked for, but do I need the mother’s permission to do this? The father has shown me a copy of the child’s birth certificate on which he is recorded as the father.

AAs the father’s name is on the birth certificate, he will have parental responsibility for the child. This means he is legally entitled to be provided with information about his son.

While you should take any concerns the mother has about dis -

closing information into account, she cannot veto any request from the father.

Ultimately, you should act in the child’s best interests. If the child was at an age where he was thought to be competent to decide himself, he should be consulted about any potential disclosure.

Legitimate reason

In this case, the father appears to have a legitimate reason to request information. There has been a change in the child’s medication regime and specific advice has been given which will potentially have an impact on his health.

If both parents have custody of the child, it is important that they are both aware of any important medical information to ensure their child’s treatment and care is optimal.

It is obviously important to maintain a good relationship with the mother, particularly if she is also a patient of the practice, and therefore it would be a good idea to explain to her that the father is legally entitled to request information about his son and explain what you intend to disclose to the father and why this is in her son’s best interests.

You can reassure her that if there was any information that related directly to her in her son’s records, this would not be passed on to the father.

It is important to clearly document the discussions that take place and the decisions you have made and the reasons for them. This documentation will be important if you are asked to justify your decisions later. 

GETTING BACK TO WORK

Adapting to new ways

David Hare (right) discusses how the nature of clinical care is changing and outlines some of the many adjustments independent practitioners will need to get to grips with in the coming months as we all adjust to living with Covid-19

WHILE THE country has thankfully passed the initial peak of the pandemic, it is becoming ever clearer that until a vaccine is found, we will be living with the impact of Covid-19 for some time.

This ‘new normal’ environment will have significant impacts for both patients and healthcare practitioners. Here are some of the key considerations for all of us involved in independent healthcare as we work hard to maintain high quality patient care.

Firstly, it is important to stress that healthcare is a people business and throughout the pandemic the Independent Healthcare Providers Network’s (IHPN’s) top priority has been to help support clinical staff across the sector to meet the challenges posed by Coronavirus and ensure patients can get the best possible care.

As part of the deal between the NHS and independent hospitals, providers have sought to ensure that clinicians in the private sector can access all the resources available to NHS staff during this time.

This can be seen most clearly with regards testing, which, in the absence of a vaccine, is crucial to keeping both staff and patients safe.

Through IHPN, providers have ensured that independent sector staff have parity of access with NHS staff to both swab-testing for Covid-19 as well as antibody testing which looks at immunity to the virus.

This will be vital given the constant need for testing, with some in the health world such as the Royal College of Surgeons arguing that clinical staff need to be tested at least twice a week to reassure patients.

Equally, it is vital to protect not only the physical health of clinicians working in the sector, but also their mental health.

In what can only be described as the most challenging conditions ever faced by the health service, clinicians are having to cope with ongoing uncertainty about a virus we know relatively little about; in many cases, operating outside their scope of practice, as well as the need to deal with the anxieties around wearing personal protective equipment (PPE).

MPS webinars

At this time, clinical leadership has never been more important and IHPN has been teaming up with the Medical Protection Society to run a series of webinars to give leaders in the sector practical, evidence-based strategies to sustain clinical performance throughout this period and ensure staff are aware, understand and are coping with the rapid changes around them.

Ensuring clinical leaders have the tools they need to support their staff in the new Covid world is even more necessary given the stringent infection prevention and control measures that will now be

Many providers and clinicians are going above and beyond both national and international guidance on infection control

a mainstay in all healthcare settings.

Such measures include staff adhering to social distancing wherever possible in non-clinical areas, with close contact between staff over prolonged periods being at a minimum; for example by:

 Avoiding congregating at cen tral workstations;

 Restricting the number of staff on ward rounds;

 Conducting hand-over sessions in a setting where there is space for social distancing;

 Moving to ‘virtual’ multidisc iplinary team meetings;

 Staggering staff breaks to limit the density of healthcare workers in specific areas.

more remote and digital consultations.

While, for many, this is a positive move, independent practitioners will have to grapple with new processes as a result of this, including around information

And where social distancing measures are not always possible, all staff in hospital are urged to wear a surgical face mask when not in PPE or in a part of the facility that is Covid-secure.

These measures are not easy. But we are proud of the work that is taking place in the sector to ensure the safety of both patients and

quarantine.

So as we move to the next phase of dealing with the virus, IHPN is committed to continuing to support providers and clinicians in the sector to best understand what they need to do to keep themselves and patients safe. 

David Hare is chief executive of the IHPN

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We will be bringing you more weekly news on our website to see you through until our next digital-page turn issue – but here’s a taste of what we’ve got lined up for you next month:

 With pensions much in the news and another shake-up on the way for many independent practitioners who have an NHS pension (see page one and eight of this month’s journal), accountant James Gransby looks at its good, bad and the ugly aspects.

 Surviving complaints and investigations:

1. What to do when a complaint is made in private practice? Dr Gregory Dollman, of the MDDUS, shows some case studies, highlights the pitfalls to avoid and shows how to manage the impact of a complaint

2. The chances of undergoing a GMC investigation during your career are high. In the first of two articles, MDU medico-legal adviser Dr Ellie Mein explains what you need to know for what is ‘a stressful but survivable experience’

 New series: Setting up a medico-legal practice. The first in our new series of five considers ‘why become a medical expert witness?’ Caren Scott addresses myths about the role

 Due to lockdown, we weren’t allowed in the car with him, so our motoring correspondent Dr Tony Rimmer got the Porsche Taycan turbo all to himself. He considers it the best handling electric car on the market and it is one of the fastest. Tony raves: ‘This obviously comes at a cost, but if you want to raise your green credentials and still enjoy all aspects of driving, then there is nothing like it.’

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 Some PPUs are bouncing back, but fears were expressed during a LaingBuisson seminar this summer about their future. Philip Housden shares insights from PPUs’ annual accounts for 2019-20

 In part four of the guide to delivering superior patient experience in private practice, Jane Braithwaite looks at inspiring your teams, retention strategies for the existing team and team-building events

 Accountants Clinic’s A-Z lands on ‘N’ – for ‘new normal’. In these strange times, what does that actually mean day to day and how are we all affected financially? Big issues for independent practitioners are examined: virtual working, managing staff, cash flow management

 In the wake of more consultants being fined for contravening competition law (see story on our website), we called in Hempsons solicitor Michael Rourke for some legal advice

 Cardiologists feature in our Profits Focus benchmarking series

 The life cycle of a private practice

 If you are a long-term investor, then check out Cavendish Medical’s assessment of the impact of the ‘Big Five’ tech companies

 You work hard for it, so don’t lose it. Topical advice from Medical Billing and Collection

 Plus all our usual features, latest news and views

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