Understanding social media
By understanding the various social media platforms you can plan a marketing strategy P12
Your marketing plan plays a huge role in getting you to the top in your field, says surgeon Mr Dev Lall P23
Getting to grips with complaints
Complaints from private patients are rising. A new code of practice launched this month aims to address this P32
then the self-pay market non-cosmetic spend could rise from its current level at around £623m to around £948m by 2020.
A document highlighting key themes of the report, researched and written by chief executive Keith Pollard and his team at www. privatehealth.co.uk, stresses that the role and visibility of consultants is changing and there is now a greater need than ever for them to collaborate with providers to design and deliver self-pay pathways.
It recognises there is a growing trend for consultants to establish a strong personal online and digital presence and says this will have an important future role in influencing patient choice.
be more consumer-focused and encourage loyalty by being imaginative about what could be offered before and after treatment.
‘There are many entrepreneurial consultants who have a very good business brain and that’s a skill they can apply to this market to think from the consumer perspective rather than provider perspective.’
Private Healthcare UK’s research, conducted between July and August 2017, included one-to-one interviews with leading figures in the UK provider market, thirdparty administrators, clinicians and NHS private patient units (PPUs).
information and many published no guide prices.
All commentators agreed the self-pay market had consolidated recent growth and was an increasingly important market sector.
Respondents and interviewees felt the top three drivers of self-pay were NHS waiting times, local marketing campaigns and clinical commissioning group initiatives to manage demand.
The report says patients are voicing particular dissatisfaction at these ploys to avoid placing them on waiting lists when there is clear clinical need.
A £1billion self-pay acute market is now seen as a potential reality in the UK within the next four years – and business-minded consultants are being advised to gear up to take advantage of it.
The rise and rise of self-pay patients is a key feature of a new report out this month which found observers and commentators agree this market growth is between 10% and 20% a year.
According to the Private Healthcare UK Selfpay Market Report 2017, the growth rate is as much as 25% a year in London. But if a straight line growth of around 15% a year is assumed for the next three years,
A researcher told Independent Practitioner Today : ‘The opportunity rests with the consultant to proactively engage with providers.
‘Do consultants have a role to play in ensuring how this market goes? Yes, very much so and, either collaboratively as a group or as individuals, they need to engage proactively at a local level with hospitals.
‘With private hospitals, they need to sometimes make the first move if they have a procedure or specialty or way of doing something – or see a market opportunity. They need to take the initiative.’
She believed it was important to
There was also an online survey of industry participants and collection of self-pay pricing information for the most commonly performed surgical procedures, treatments and higher-cost diagnostics from independent providers.
The company collected and analysed around 6,000 prices for a range of diagnostic procedures, treatments and surgical procedures most commonly carried out for self-paying patients.
Feedback showed the proportion of self-pay income in some PPUs appeared slightly lower than stand-alone units.
Most were found not to highlight self-pay as much as other providers in their promotional
Increasingly restrictive NHS funding criteria in orthopaedics, ophthalmology, gastroenterology, gynaecology and urology was fuelling higher self-pay demand.
One surprise in the report was a finding that 34.6% of respondents said they intended to allocate under 5% of their marketing budget to the self-pay market. But 20.4% said they would commit over 30% of their budget.
Researchers said: ‘This seems anomalous considering most agree the self-pay market is the one most likely to be able to produce growth. This may reflect the mix of respondents.’
n Next month: Don’t miss the key themes from the report that every independent practitioner needs to know
avoid tax limbo residency rules spell tax trouble for doctors working abroad P10
Phones are key to your success
How to manage your phone etiquette to project your professional image P20
will customers find you online? Ways in which you can future-proof your website to match search engines P26
Financial tasks you can’t duck don’t bury your head in the sand – tackle these financial issues now P28
Service fits the bill one of London’s newest clinics explains why it outsourced billing at the outset P36
make your ideas grow an accountant gives guidance for doctors launching a new service or product P39
So the rise and rise of the selfpay patient goes on (see front page). This area of the market is now predicted to continue growing for the next half-decade at least.
The Private Healthcare UK Selfpay Market Report 2017 has highlighted some key areas for independent practitioners to think seriously about if they wish to take advantage of this.
There is a lot that many private practices could still do to attract more self-pay business their way in the coming months.
Like our headline story in our last issue said: ‘Make it easier to go private!’ Entrepreneurial
doctors will be doing just that in their approach to the selfpay patient.
As the report acknowledges, some practitioners and providers have made big progress in tailoring their offering in terms of value and customer service.
But others clearly need to revise their marketing plans to maximise the opportunities and display clear pricing packages.
Latest NHS efforts aimed at slashing GP referrals to hospitals by using medical panels to oversee non-urgent referrals could send more patients on the self-pay route. It is time to make sure they easily find you.
By leslie Berry
Doctors should request their pension statement from their NHS pensions agency without delay to avoid a potential tax trap, specialist medical financial advisers Cavendish Medical have warned.
Each autumn, agencies prepare to send out letters detailing doctors’ annual pension contributions for the preceding tax year, but only if the doctor has a deemed pension pot growth of over £40,000.
This figure is set at the annual allowance rate: the amount that can be contributed each year to a pension while still receiving tax relief.
But a new tapered annual allowance for those with over £150,000 earnings reduces this figure down to just £10,000 for high-earning doctors.
Anyone breaching the annual allowance limit, at whatever level is relevant to them, will pay tax on the excess at their marginal income tax rate.
Dr Benjamin Holdsworth, practising medic and financial planner with Cavendish Medical, explained: ‘Senior doctors whose pension “grows” each year by more than £10,000 could face harsh tax penalties but will be unaware, as only those saving over £40,000 a year are required to receive warning letters.
‘You should request your own statement as soon as possible. The NHS is not the fastest at responding to requests. You will need to allow time for all calculations to be checked before your tax return has to be filed.
‘As it is, every year these letters cause significant concern to recipients because the figures are often very different to the actual amount of money they believe they have put into their pension pot. This is because HMRC calculates the contributions for a defined-benefit scheme such as the NHS very differently to that of a private pension. The figures are based on the deemed growth of the pension in that year with an allowance made for inflation.
‘Not only are the calculations particularly complex but we have come across many letters where the figures are actually wrong. Agency errors can cause substantial headaches because they can impact the amount of tax which needs to be paid.’
If the allowance is breached, the individual can carry forward any unused allowances from the three previous tax years.
Dr Holdsworth said it was easy to unknowingly breach the annual allowance, before considering any pensionable salary increase, due to a statutory pay rise or clinical excellence award. tell US yoUr newS Editorial director Robin Stride at robin@ip-today.co.uk Phone: 07909 997340 @robinstride
to advertiSe Contact advertising manager Margaret Floate at margifloate@btinternet.com Phone: 01483 824094 to SUBScriBe lisa@marketingcentre.co.uk Phone 01752 312140
Publisher: Gillian Nineham at gill@ip-today.co.uk Phone: 07767 353897
Head of design: Jonathan Anstee chief sub-editor: Vincent Dawe Circulation figures verified by the Audit Bureau of Circulations
Private hospitals are to have the benefit of Confederation of British Industry (CBI) expertise to help them on issues arising from Brexit. The backing is as a result of their trade organisation, the Association of Independent Healthcare Organisations (AIHO), joining the industries body under a new trade association category.
Chief executive Fiona Booth said there had been ‘constructive
meetings’ sharing intelligence on Brexit, Government relations, regulation and the industrial strategy. She said: ‘Meetings are planned to cover proposals around immigration policies and continued UK access to EU science and innovation funding. AIHO will be an influential healthcare voice at the CBI, as the CBI has taken a decision to shift its focus away from the NHS procurement agenda.’
The escalating cost of insurance premium tax will likely affect employers’ ability to offer private healthcare, a workplace benefits expert has warned.
Sanlam UK commercial head Elliott Silk said the Government’s decision to increase the tax by 20%, and the fact it had doubled in just over 18 months to 12%, was having a negative impact.
He called on the Government to consider ring-fencing private healthcare from the increase to the tax. ‘Ultimately, a decline in employers offering private medical insurance could have adverse repercussions for the NHS, with private healthcare easing some of the burden on a service already operating at full capacity.’
The Association of Medical Insurers and Intermediaries (AMII) has postponed a second petition against insurance premium tax rises on private health insurance until the body feels ‘confident in the longevity of Government’. Its first petition closed early as a result of Parliament disolving in preparation for the general election and all votes cast were lost.
AMII chairman Stuart Scullion said if it began a second petition now, it would have a period of six months from launch to achieve the 100,000 signatures required to see insurance premium tax debated in Parliament.
‘Importantly, we would not be able to re-commence a second petition until Parliament has reestablished the Parliamentary committee who oversee and approve government petitions. However, having also consulted with our intermediary and corporate members, as well as intermediaries and providers who are not currently AMII members, the consensus is that there is too much political uncertainty.’
By robin Stride
Accountants have warned that the net is tightening on high networth individuals in the medical profession who were persuaded to try and save money using tax avoidance schemes.
They say HM Revenue and Customs (HMRC) believes consultants and dentists are the biggest users of these financial arrangements, which are regarded by tax officials as outside the spirit of the law.
Courts ultimately decide the legality of these vehicles but, as we reported in March 2015, tax inspectors have used new powers to demand millions of pounds worth of unpaid taxes.
The ‘pay now, dispute later’ policy has reportedly hit some doctors with unexpected six-figure bills in unpaid tax, plus penalties and interest.
HMRC revealed it has now collected more than £4bn in the crackdown on people who have used a tax avoidance scheme.
Over 75,000 accelerated payment notices (APNs) have been issued to people under inquiry for tax avoidance since the rules were introduced in 2014.
Specialist medical accountants Stanbridge Associates said HMRC had reported that it had enjoyed
ray Stanbridge: the specialist accountant says Hmrc is being increasingly aggressive to doctors
significant success in the courts in attacking tax avoidance schemes, estimating it won eight out of ten schemes it challenged, with many more settling prior to litigation.
Director Ray Stanbridge said the payback requirements on consultants was proving a significant drain on cash flows.
HMRC would consider a payments plan, but accountants believe inspectors are generally unsympathetic to what they believe are higher earners not ‘playing by the rules’.
Mr Stanbridge added: ‘For those consultants who “own up”, the inspectors are likely to be sympathetic. But we are seeing signs they are being increasingly aggressive
towards consultants whom they regard as being unco-operative.’
HMRC said it had now issued APNs on all the schemes under investigation when the new rules came in.
The High Court has confirmed that HMRC had won another judicial review of the APN regime – its sixth victory in six reviews.
HMRC collects an average of £38,400 each day from people in avoidance schemes who are required to pay their disputed tax up front. The average bill for large companies trying to avoid tax is £6m, while for individuals and small corporates it is £74,000.
David Richardson, director general for HMRC’s Customer Compliance Group, said: ‘The vast majority of people play by the rules and pay their taxes on time – people who try to do otherwise place an undue burden on everyone else.
‘APNs have helped level the playing field by changing the economics of avoidance.’
People receiving an APN have 90 days to pay or make representations if they think it is incorrect. HMRC upholds 90% of decisions and challenges every tax avoidance scheme it becomes aware of and is investigating more than 600 schemes and 80,000 users.
See our website version of this story for more information
Consultants submitted record numbers of electronic bills in the first six months of 2017 as more practices migrated from traditional paper invoicing to a ‘fast and secure’ online bill submission option.
The number of private consultants adopting Healthcode technology to charge private medical insurers for their services has
grown by 54% in the last three years.
Non-hospital providers submitted 46% of the total number of bills between January and June this year.
Healthcode’s boss Peter Connor said the service was an efficient and convenient way for consultants to charge and optimise cash flow.
He said: ‘Invoices are validated on submission to Healthcode, so they know straight away that their invoice has met the insurer’s rules and is ready to be processed.
‘They also have the reassurance that Healthcode’s system is encrypted to internet banking standards, so this method of submitting invoices is more secure than post or email.’
By Leslie Berry
Hopes are high that doctors will find the medical revalidation experience far more useful in future.
The independent sector has backed a GMC plan to improve it by making it a more positive and meaningful experience for private practitioners and responsible officers (ROs).
Parties are committed by March 2018 to:
Give doctors and ROs clearer guidance on what is required from them for revalidation.
Support and strengthen processes for doctors working in multiple settings, in particular across the NHS and private practice.
This includes making sure appraisal covers a doctor’s whole scope of practice, that organisations are sharing relevant information and clarifying how designated bodies are expected to support doctors.
Offer more specific advice on how doctors should gather representative feedback from colleagues, including how those colleagues should be selected, making sure this is as robust and helpful as possible.
Identify how to make the patient feedback process easier and more valuable, seeking feedback from doctors and patients.
Create a simple and accessible way to explain the purpose and benefits of revalidation to patients.
Develop a proportionate way to monitor revalidation to make sure it continues to meet its objectives.
Medical royal colleges and faculties will update their guidance on revalidation to clarify what are GMC requirements and what are their own recommendations for best practice.
The Department of Health in
England will also lead a review of the RO regulations, aimed at establishing a connection to a designated body for some groups of doctors that don’t ordinarily have one and making sure only organisations with robust governance arrangements are able to oversee a doctor’s revalidation.
GMC chief executive Charlie Massey said the body’s talks with doctors’ representatives focused on what was needed to make improvements, without adding additional cost or burden.
He said: ‘We need the continued commitment from a wide range of organisations to make revalidation a better experience for doctors, especially at a time when they are under ever-increasing pressure.
‘Revalidation is integral to assuring patients that we regularly confirm that a doctor remains fit to practise. Our focus now is continuing to work with other organisations, getting their feedback and input, as we act on commitments set out in this plan.’
The Revalidation Oversight Group (ROG) – successor to the Revalidation Advisory Board – is chaired by Mr Massey and includes representatives of all four UK health departments, the BMA, training bodies and employer and patient representatives.
Plans will implement recommendations in Sir Keith Pearson’s report last January: Taking Revalidation Forward.
Dr Chaand Nagpaul, BMA council chairman, said: ‘We see this action plan as an opportunity to reduce the burden that revalidation imposes on doctors.’
But he said the association would continue activation to relieve the unnecessary burden that revalidation sometimes placed on doctors.
independent Doctors Federation (iDF) Responsible officer Mr ian Mackay explained that the plan, agreed by the Revalidation oversight Group (RoG), was organised into six work streams. each covers a priority area from Sir Keith pearson’s report, taking Revalidation Forward:
1
Making revalidation more accessible to patients and the public
2
Reducing burdens and improving the appraisal experience for doctors
3 Strengthening assurance where doctors work in multiple locations
4
Reducing the number of doctors without a connection – ‘not uncommon’ in the independent sector, according to Mr Mackay.
5 tracking the impact of revalidation
6 Supporting improved local governance
Mr Mackay told independent practitioner today the iDF had agreed to audit the impact of revalidation for a cohort of 500 connected doctors. also, the Revalidation Forum of the association of independent healthcare organisations (aiho) was interested in participating in two subgroups: ‘Making revalidation more accessible to patients and the public’ and ‘tracking the impact of revalidation’.
he said the target date for completion of the various actions varied considerably. Some such as ‘more case studies to help doctors with patient feedback’ was expected next month (october), but the audit was expected to take a year.
Mr Mackay, who represented the independent sector as a member of the RoG, said the GMc was keen to get doctors’ input. those with questions or wanting to get involved in a specific area should contact takingRevalForward@gmc-uk. org.
Organisers have changed the name of a new international healthcare event at Earl’s Court, Olympia, next year.
The Private Healthcare Show 2018 – billed as a showcase for doctor entrepreneurs and private clinics – has been re-named the Future Healthcare UK, international exhibition and conference.
Organisers said the switch followed the signing of a partnership with Turret Media to bring its Future Healthcare Middle East event to the UK.
UK event director Dawn BarclayRoss said she expected the 13-14 March event to attract 4,000 attenders from 65 countries with exhibitors from 25 countries.
Turret Media chairman Richard Hease added: ‘Creating these events in both Abu Dhabi and the UK will attract innovators, entrepreneurs, thought leaders, key buyers and investors, policy and decision-makers in healthcare from all over the world.’
Come and see us at CCR Expo
Come and see Independent Practitioner Today on our stand (J110) at CCR Expo, the UK’s largest event for medical aesthetics at London Olympia on 5 and 6 October.
The show unites surgical and non-surgical professionals and runs alongside two complementary events: the British Association of Aesthetic Plastic Surgeons’ (BAAPS) Annual Scientific Meeting and Practice Manage ment Expo 2017.
Sessions at the latter aim to help visitors looking to set up their own clinic or refurbish their current premises.
They include: ‘Would you like to be the best practice, best doctor and win more patients?’, ‘Patients are a virtue – how to keep them returning’, ‘The impact of the forthcoming general data protection regulation on medical practice’ and ‘The facials and retail skincare market sectors – how to compete profitably.’
Details at www.ccr-expo.com
By Robin Stride
City Psychology Group (CPG) has secured a £150,000 investment –mostly from medical consultants – and has announced it is gearing up to increase its range of services.
Clinical director and consultant psychologist Dr Michael Sinclair told Independent Practitioner Today: ‘Investors have seen a growing market in the private sector and it is starting to boom. We’ve built a brand over the years and they want a part of it.’
CPG, a London-based pioneer and front-runner in the independent psychology sector, was established over ten years ago by him and chief operating officer Raoul Barducci.
With clinics in The City (Liverpool Street), Canary Wharf and Harley Street, it provides services to a growing number of occupational health departments serving some of the city’s leading banks and legal firms, as well as to both independent and NHS consultants and GPs.
Expansion to an additional venue is anticipated next year and there are plans to open more clinics across the capital.
CPG said it aimed to develop existing services and increase its range of general and more specialised services, specifically its occupational health and well-being programmes, psycho-oncology and cardiology psychological support services and its chronic pain clinics.
It was also reacting to meet the increasing demands of the selfreferred and self-funding market, the online service-users market and the cosmetic surgery industry.
Observed Dr Sinclair: ‘I think people are more amenable to psychological intervention and input – it’s much more acceptable these days to have therapies and psychological support.
‘And I think GPs are increasingly open to referring to these services. Patients are waiting six months to a year to be seen in NHS.’
He said the current team of 20 clinical and counselling psychologists, self-employed contractors,
Dr Cliff Bucknall has taken over as HCA Healthcare UK’s chief medical officer following Dr Chris Streather’s departure to a new job as The Royal Free Hospital’s chief executive.
The new incumbent worked with the company for many years as a cardiac consultant at London Bridge Hospital and more recently was the cardiac medical director, leading the development of cardiac care across HCA’s UK facilities. He has been at the forefront of laser lead extraction and biventricular pacemaker implantation and is a regular speaker at conferences and courses worldwide.
His additional appointments have included Royal College of Physicians’ representative on the BSI Standards Committee, cardi-
cardiologist Dr cliff Bucknall
ology adviser to Metropolitan Police and specialist adviser to the NICE Interventional Procedures Programme.
HCA boss Mike Neeb described Dr Bucknall as ‘a huge asset’ to the company and said he had been instrumental in driving its cardiac services’ excellence.
collectively had a wealth of expertise in providing the latest advancements in psychological assessment and intervention.
CPG offers psychological treatment for the full range of mental health problems (mild to severe), psychological testing, neurocognitive rehabilitation, specialised
child and adolescent mental health services, parenting and family work, and medico-legal work. It also runs workshops and training events for doctors – for their continuing profession development – and for other health practitioners, corporate executives, the general public and patients.
proton partners international has won formal planning permission to build its third oncology centre in england. the £35m cancer treatment centre is to be at the new £1bn paddington village, part of Knowledge Quarter Liverpool. it will provide an ‘all-encompassing cancer service for patients’, offering proton beam therapy. conventional treatments are expected next year and proton beam therapy in 2019.
By a staff reporter
The largest indemnity body has revealed an 85% successful defence rate against medical claims closing last year.
But it said doctors and patients were still enduring considerable stress and anxiety because claims were made under an ‘outdated and adversarial legal system’.
MDU chief executive Dr Christine Tomkins said UK doctors continued to provide standards of care among the best in the world, yet claims remained high.
‘We are still seeing far more claims than we did in 2012 and the proportion where the doctor’s actions were not negligent has also risen. This doesn’t serve anyone well – doctors or patients.
‘The costs for the MDU of carefully investigating a case and satisfying the claimant’s lawyers there is no case to answer are significant. On top of that, when we do pay compensation, the size of awards are still rising unsustainably.
‘Claims for £10m or more are no longer unusual. The recent drastic drop in the discount rate [used to
Optegra Eye Hospital Group has been named by healthcare platform Doctify as its ‘Top Rated Eye Hospital’.
The company and its 90 consultants got the highest number of positive reviews on the UK health website, compared to other ophthalmic hospitals or clinics.
At the time of writing, consultant ophthalmic surgeon Mr Alex Shortt at Optegra Eye Hospital London was the highest reviewed surgeon.
He said: ‘With all healthcare, recommendations of individual surgeons and hospitals are invaluable. And I think even more so with ophthalmic surgery, as eyes are so incredibly precious to us,
and so, naturally, patients can feel particularly apprehensive about treatment.’
Doctify created its new award system to acknowledge and celebrate the healthcare providers most reviewed by patients. Doctify.co.uk, where people can search for medical specialists, compare patient reviews and book online, acts as a platform to connect medical specialists and patients.
Co-founder Dr Stephanie Eltz said patient reviews reflected outstanding service from Optegra surgeons and staff. ‘Optegra doesn’t shy away from asking their patients for feedback and this transparency is exactly what healthcare needs.’
calculate future long-term compensation payments] to -0.75% has made matters very much worse.’
MDU chairman Dr Peter Williams said the current legal system had encouraged a dramatic increase in the number of claims being brought. For the minority of claims where compensation was paid, the sums were rising beyond doctors’ ability to pay for them.
‘This has led to some doctors having second thoughts about taking on higher-risk activities. Others express reservations about entering specialties where indem-
nity is so expensive relative to their income. This is worrying, particularly when standards of clinical care remain high and there is rightly more emphasis on risk management.’
He said it was ‘abundantly clear’ that the numbers of claims and size of compensation awards were connected to changes in the civil justice system, rather than to doctors’ performance and professional standards. Change was needed and the MDU was advocating a system that was fair and proportionate for all parties.
BMI boss Jill Watts is leaving BMI after three years to return to Australia ‘for family reasons’.
The chief executive will stay in post until the financial year end, the company said.
She will be replaced by medically qualified Dr Karen Prins, who takes over next month after 20 years of senior management experience with BMI Healthcare’s majority shareholder, the Netcare group in South Africa.
family accident earlier this year and my mother’s deteriorating health, I have decided to return to Australia at the end of the year.’
BMI said Ms Watts had built a strong leadership team and had continued to grow the business and protect margins during challenging market conditions.
Ms Watts said: ‘This has not been an easy decision to reach and it is with a real sense of regret that I have resigned from my position.
‘Unfortunately, due to a serious
Netcare chief executive Dr Richard Friedland said: ‘We will obviously be sad to see Jill depart, but we both respect and understand her reasons for doing so and while we thank Jill for her significant contribution, we wish her well on her return to Australia.’
Nearly one in five UK adults is considering private healthcare options to avoid long waiting times in the NHS, according to a survey.
A study of 2,000 UK adults for PharmacyOutlet.co.uk found this figure rises to 25% among 18- to 34-year-olds and goes up to 28% in London.
If these figures were reflected
nationwide, it would translate into 9.2m UK adults actively thinking of going to see a private doctor. Six in ten believed the quality of NHS care would decline in the next five years due to funding cuts. The ‘nationally-representative’ study by the online pharmacist also found 61% had little faith in the Conservatives’ ability to protect and improve the NHS.
Scorpions – rock you like a hurricane
guns n’ roses – Sweet Child O’ Mine
Ted nugent – Just What The Doctor Ordered
The Doors – Break On Through (To The Other Side)
The rolling Stones – paint it Black
led Zeppelin – Whole lotta love
Queen – We Will rock you
AC/DC – Back in Black
eric Clapton – Cocaine
Jimi hendrix – The Wind Cries Mary
By Charles King
Rock is the most popular type of music listened to by surgeons while operating (49%), followed by pop, classical music, jazz and R&B.
As many as 90% of surgeons worldwide play music in the operating room, with the majority preferring playlists over albums.
Nearly a third have over five playlists on rotation, according to research conducted by healthcare professionals’ social networking service Figure 1 on behalf of music podcast and video streaming service Spotify.
Doctors reported that music relaxes and calms them in the oper-
ating room, helps improve mood and focus and breaks tension when there are quiet moments.
One surgeon stated: ‘It calms the nerves and improves staff morale.’
Another said: ‘At times it keeps the room mellow and co-ordinated, and at other times it keeps the pace up.’
Musical selections are not just up to the medical team, as many surgeons also reported they take requests, with patients having a say about the soundtrack if awake.
One doctor said: ‘We do C-sections where the patients are awake. If they have a preference, we go with what they want. If not, we have fun with it and play
Surgeons have raised new concerns over the unregulated use of dermal fillers fuelled by social media publicity.
The British Association of Aesthetic Plastic Surgeons (BAAPS) warned of unethical marketing of aesthetic treatments to under-18s and said many clinics enticed young patients on social media where they knew they would not face consequences from the Advertising Standards Authority (ASA).
According to a WhatClinic.com poll, 42% of web traffic to lip augmentation pages were from the 18s24s. Clinics surveyed denied they would provide lip filler to under-18s but most would do for under-21s.
The survey credited an increase in demand to the impact of social media and reality television, echoing the sentiments of BAAPS which has urged for stronger regulation of dermal fillers and other non-surgical treatments.
It said dermal fillers remained unregulated in Britain – ‘meaning anyone wielding a syringe can order them off the Internet and have a stab at a lucrative career’.
Yet two out of five surgeons saw patients presenting with complications stemming from the treatments in 2016.
BAAPS said: ‘While the ASA will not allow clinics to advertise cosmetic surgery as prizes or to make
misleading claims in adverts, they admit that they do not have the resources to police social media –resulting in a murky grey area where lip fillers are frequently used by unscrupulous practitioners to encourage new clients for non-surgical treatments, which are often performed in unsterile, non-clinical environments, in people’s homes or even the local pub.’
Former BAAPS president Mr Rajiv Grover said if the Government failed to intervene, then he questioned what was to stop ‘cowboys and amateur injectors’ from lining their pockets by offering dermal fillers to anyone, irrespective of their age?
Aesthetic Business Transformations Ltd, providers of resources to help private aesthetic professionals grow their practice and increase profits, has been officially recognised as an accredited provider with the Continuing Professional Development Standards Office. Boss Pam Underdown said: ‘The world of aesthetic medicine is constantly changing, with increased competition opening
daily. I am delighted to see a growing number of aesthetic professionals are now acknowledging marketing and business skills are just as critical to their success as their clinical skills.’
“name that tune” from old TV shows, old songs, etcetera.’
Survey participants reported that music was turned down during critical points in the surgery and when there were complications.
Figure 1, a global knowledgesharing platform for healthcare professionals, surveyed select registered users of its free mobile app throughout June 2017.
Nearly 700 surgeons and other healthcare professionals from 50 countries and the UK were represented.
But it isn’t all sweet music. See our Business Dilemma advice on page 42 responding to a row about a choice of music in theatre
Aspen Healthcare’s Claremont Private Hospital has been awarded an overall ‘Outstanding’ rating by the Care Quality Commission (CQC).
Inspectors liked the emphasis on patient care, with staff often going ‘the extra mile’ and they paid tribute to a focus on quality and strong leadership team.
Nuffield Health has won the Private Hospital Group of the Year award at the Health Investor Awards.
The accolade recognises outstanding contribution to healthcare in the last year through innovation and excellence in healthcare products and services.
In the fifth in our series examining new GMC confidentiality guidance, Dr Kathryn Leask (below) explains how best to handle the media if they contact you
The rise of ‘fake news’, 24-hour news channels, social media and countless national and regional newspapers, coupled with an increase in press articles about alleged medical wrongdoings, can make being contacted by a journalist a daunting experience.
so how can you best deal with the media if they contact you? What should you do and what can you say?
The initial contact Journalists will usually make initial contact by email or telephone, although some have been known to use different tactics such as posting a note through the letterbox of the practice or individual involved.
i f a journalist contacts you, remember to stay calm and politely ask them to leave their name, contact details and the name of the organisation they
work for, stating that you will respond to them later.
Most journalists will be happy with this and it allows time to gather their thoughts and prepare a response.
Planning a response in their confidentiality guidance on responding to the media, the GMC acknowledges that ‘doctors are sometimes criticised in the print or broadcast media or on social media by their patients’.
While patients may be able to say what they wish and make detailed and often hurtful allegations in the media, doctors must always consider the duty of confidentiality that they owe to their patients.
The GMC specifically states that ‘you must not put information you have learned in confidence about a patient in the public domain without that patient’s explicit consent. You should usually limit your public response to an explanation of your legal and professional duty of confidentiality’.
With this in mind, the MDU often advises members to say no more than ‘i cannot comment due to my duty of patient confidentiality’.
Once the response is agreed, some doctors find it helpful to write it on a piece of paper and place it prominently near all the
practice phones to remind everyone who answers what to say if a journalist calls.
The practice may also wish to agree that one member of staff such as the practice manager will deal with all press inquiries.
sometimes, a journalist may ask for a comment ‘off the record’; however, there is nothing to prevent a journalist from using this information, and they often will.
i t is good practice to assume that anything said to a journalist will be used and never to say anything that deviates from the planned response.
Occasionally, you may be able to give more information in a prewritten press statement, although this is extremely rare. even if it is possible to do so without breaching patient confidentiality, it is wise to consider whether you wish to.
After all, it is impossible to know who else the journalist has spoken to, what other information they have and what angle they plan on taking with their story and so it can be difficult to judge how the information you give will be used.
Furthermore, even if you provide a statement to a journalist who uses it in a respectful manner, there is nothing to stop another journalist using it at a later date and perhaps with an altogether different angle.
With this in mind, it is best to say as little as possible.
The more you say, the more chance there is for it to be interpreted negatively.
A positive story sometimes, a journalist will want to research a story where there has been a positive outcome for a patient or where a celebrity has mentioned being treated at the practice. i t is touching to know that a patient has been so pleased with their care that they have contacted a journalist.
e ven so, it is important to remember that patient confidentiality cannot be broken and a practice should still not confirm that someone is a patient or comment on their condition or care without express permission.
Usually, press interest in a story will usually be short-lived, only lasting for a day or two. Despite its short lifespan, attention from the media can be very stressful for you and the wider team.
We recommend you seek advice from experts who deal with such calls everyday. At the MDU, our press team specialises in the media and responds to press inquiries on behalf of our members each day.
Dr Kathryn Leask is a MDU medico-legal adviser
Residency rules spell tax trouble for doctors working abroad. Melanie Thomas (right) of specialist medical accountants Hall Liddy explains how to avoid being stuck in ‘tax limbo’
Few doctors leaving the UK to work overseas full-time would think to keep a log of the hours spent on the job or the days they take as leave. Yet without recording details like these, they risk problems with the taxman.
t he new rules on residency –which came into force in 2013 and determine whether or not an individual is resident in the UK for a tax year – are so complex that it is often difficult to determine someone’s status without knowing the full details. there is a whole range of factors to take into account when deciding on residency status and, in many cases, it can be down to the hours and dates worked.
It is, in fact, possible to be contracted to work 35 hours per week but still fail the test, depending upon the amount of leave taken.
Unfortunately, many doctors are unaware that they need to keep records until they come to complete their tax return and find they do not have all the information they need.
Why does residency matter?
An individual’s residency status is fundamental to UK tax and determines whether income is taxable in the UK, especially when considering income from overseas.
In general, if you are considered to be resident in the UK, you will pay income tax on your worldwide income. But if you are not resident, you will only pay tax on your UK income – you won’t pay UK tax on your foreign income.
What do the rules say?
the new rules were introduced in 2013 with the aim of bringing greater clarity on residency status.
t he automatic overseas test is considered first, followed by the automatic UK residence test. For the record, here is the brief version of each – minus the small print!
You are automatically non-resident if you:
spent fewer than 16 days in the UK – or 46 days if you have not been classed as UK resident for the three previous tax years; or...
work abroad full-time – averaging at least 35 hours a week – for at least a complete tax year and spent fewer than 91 days in the UK, of which no more than 30 were spent working.
A working day is more than three hours. You must also have no significant breaks from overseas work.
You are deemed to be automatically resident if:
You spent 183 or more days in the UK in the tax year; or...
Your only home is in the UK and you spent at least 30 days there in the tax year; or...
You work full-time here – on average at least 35 hours a week without significant breaks – over a continuous period of 365 days.
If you leave partway through a tax year, the year may be split between the period you were resident and non-resident. t his involves further complex rules to claim split-year treatment.
do problems arise?
Although the new regime gives greater certainty, in practice, many doctors do not fall into one clear category or another and, in these cases, there is a host of factors to take into account to determine their tax status.
Our advice is to log the hours and days you work and take as annual leave, sick leave, paternity leave or any gaps in your employment, plus the dates you spend back in the UK
this is determined by the ‘sufficient ties test’, which considers both the number of days spent in the UK and the extent of the doctor’s ties in the UK.
What do doctors need to do? our advice is to log the hours and days you work and take as annual leave, sick leave, paternity leave or any gaps in your employment, plus the dates you spend back in the UK. Also log details of work hours carried out while you are here and then get professional help to submit your tax return. It is also advisable to keep a proportion of your income aside just in case you fall back into the UK tax net, particularly if you are working in an unstable job. we are not aware of many inquiries from HM revenue and c ustoms (HM rc ) in relation to individuals’ residency status. But that may change. It could be that, in a few years’ time, HMrc starts to look back and challenge nonresidents’ tax returns. so it is important to determine your tax status correctly and have the supporting evidence or it could come back to bite you.
Melanie Thomas is a medical accountant with Hall Liddy
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The predominant rule of thumb with social media is ‘be where your audience is’. We know they are out there on social media, but where? And how do we find them and engage with them?
Jane Braithwaite (below) says the starting point is to develop a good understanding of the various social media platforms and the demographics of their users so that you can begin to plan your social media strategy using the right channels
LargeLy speaking, clinics and doctors will be targeting consumers, not other businesses, so we should be looking at the platforms where the consumer audience is most likely to be.
so, this month, we are focusing on the various social media platforms and the suitability of each, looking at the U k market rather than globally.
social media marketing is widely considered to be the most cost-effective marketing method, so it’s an area private doctors should be using.
The social media market within the Uk is mature and there have been no new competitive entrants in the last year. The ‘big three’ are recognised to be Facebook, Twitter and Linkedin, but instagram and pinterest are making inroads into the market share.
i will consider each of these platforms in turn to show how each is used with a view to helping you to decide which are right for you.
: Has the largest user base –approaching 3 5m U k users, which is roughly half the Uk population;
: 70% of U k users log in daily;
: i t has an even split of male/female users.
These statistics have remained consistent over the last year, making Facebook a very appealing platform to utilise. With statistics that put the proportion of over18-year-olds in the U k using Facebook at 78%, it’s clearly a platform that allows communication with most of the population in one place.
There is a sense that Facebook is less well received by the younger population, but, in fact, the largest demographic using Facebook is in the 20 to 29 age bracket. Broadly speaking, Facebook has the widest
and largest cross-demographic outreach of any of the platforms.
For many reasons, Facebook is an excellent platform for business marketing and should probably be considered the primary social media platform for doctors and clinics.
Be aware, though, that the number of people who view your post on Facebook is very low at 10%.
The good news is that paid advertising is really cost-effective and we can target the audience when using paid adverts.
When designing your business page, it’s worth thinking broadly about what audiences are interested in and will respond to; could an educational approach appeal to them? For example, this could be a page about orthopaedic surgery which creates useful, expert information rather than one which is solely promotional.
in fact, taking an approach that is purely promotional is likely to put off potential followers. social media users want to be informed and engaged and will react negatively to hard selling.
Facebook can be used with a sense of fun. it is appropriate to be more informal than other platforms and you can add a touch of appealing humour to your posts. a nother strong feature of Facebook is the ability for patients and associates to leave reviews of your service. This customer feedback can be incredibly powerful and you should encourage patients to leave reviews for you. you need to invest time responding to reviews and comments and thank people for taking the time to review you.
The ability to respond to your client base almost immediately is also very powerful.
Facebook is also very useful for clinics and doctors who run events and speaking engagements. so, in summary, we are recom-
mending the use of Facebook very highly, especially paid advertising.
:Has 21m Uk users – a slight increase on last year;
:But take note, not all these users log in daily: many dip in on a weekly or even monthly basis.
Linked i n is the world’s largest professional network and doctors could consider their profile on Linkedin to have the same impor-
tance as their website in terms of providing a profile describing their background, education and areas of interest.
Most of our patients will be on Linkedin and may use it as means to check out doctors and clinics. Linked i n invests considerable effort in ensuring their results come very high on internet searches. if a patient searches your name on google or another search engine, the Linkedin results fea-
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ture very highly and your Linkedin profile will be easily found.
Linkedin allows you to create a personal profile and a business page for your clinic or practice. i t is much easier to drive activity from your personal profile, but it’s important to have a business page too. Linkedin also has numerous groups for you to join and engage with.
For doctors and clinics who choose to use Linked i n to share information, then good quality content is essential. This is a professional platform and, while some people use it as a social platform, most users frown upon this type of activity and believe it should be kept to Facebook.
Linkedin offers paid advertising and you may feel this suits your clinic or practice, but we would suggest that you are probably better investing time and money into Facebook. The main reason for this is that most Facebook users log in daily, whereas Linked i n users dip in and out on a weekly or even monthly basis.
One specific application where Linkedin can be very powerful is recruiting staff.
in summary, we would suggest that all doctors and clinics have a presence on Linkedin, both a personal and business page and these should be very professional. Time should be invested to respond to connection requests and comments on a weekly basis.
a decision to use Linkedin more proactively for marketing will depend largely on your area of specialty and the patients you are looking to appeal to. i n most cases, we would suggest it is not the best platform for marketing.
facebook is our number-one recommended platform for private doctors and clinics. it gives greatest reach through all demographics and users view the content daily
: Has 15m users, which is approximately 45% of Uk adults;
: 62% of users have an income of over £48k;
: 37% login daily.
Twitter has a slightly larger user base than instagram and it boasts a younger demographic, with 64% users aged 18 to 29 years.
Many individuals use Twitter to keep up with news and information in their areas of interest. For example, Twitter is a very effective way to find immediate reactions to an event – for example, the U k election and the awful tragedies in London.
When you are watching a live TV programme or sports event, Twitter will give you an immediate sense of people’s responses and views.
Twitter is a fast-moving stream of content, which means that, like Facebook, it offers a more casual interaction with users. in terms of marketing, Twitter can be used to share your brand and personality with your audience. Using good-quality, curated content on Twitter can drive users to your website to find out more information.
Twitter is a more specific demographic than Facebook and it appears private hospitals do better on Twitter than private doctors and clinics simply because they have a bigger, more diverse audience.
your Twitter strategy needs to include engaging with other relevant clinics, associates and users and starting a conversation with them.
it is not as obvious to use effectively as Facebook. The practice of following others and the use of hashtags requires somebody who knows how the platform works and you would be advised to engage an expert to ensure your time and money is invested wisely.
: Has 14m Uk users;
:
46% of users have an income of over £48k.
Hot on the heels of Twitter in all senses, instagram boasts a more visual user experience, with 29% of adults using i nstagram and 64% of users aged under 30.
instagram can be very helpful to drive brand awareness. i t’s a highly visual medium and requires original, attractive content every day of the week.
p hotos are great and some accounts do very well with created visuals such as quotes and infographics, but, generally speaking, content can’t be repeated on instagram as it can be on Twitter and Facebook.
i nstagram is less demanding than Twitter and Facebook in terms of posting – once a day is fine – but great visual content is hugely important.
ideally, you want to create a situation where other bigger Twitter users ‘like’ and ‘retweet’ your posts to help you gain a wider audience.
Clinics which run, or are involved with, regular events are likely to be more successful on Twitter too because of the nature of the platform. you can use Twitter to build up excitement about an event and particularly on the day of the event itself.
Like Facebook, Twitter is a lowcost advertising platform.
Twitter could be a very useful part of your marketing strategy especially if your patients – and therefore your audience – is in the younger demographic.
so, for many doctors and clinics, it’s just not feasible to run an i nstagram account due to the nature of the specialty. There will be differences between clinics and private doctors – cosmetic surgeons and clinics providing beauty treatments could find an audience on instagram, for example – but it’s more unlikely that knee surgeons would.
i nstagram as a platform is unlike the others because you can follow, like and comment relatively privately compared to Twitter and Facebook. Use of instagram is limited by the lack of a retweet facility or the inclusion of links. you will see many posts stating ‘link in bio’ to try to overcome this weakness.
instagram does provide a paid advertising option and you will see these paid posts in your feed labelled as ‘sponsored’. if instagram is the right platform for you, then this can be very effective. instagram is a great marketing tool for those of us who offer a
visually appealing service. ‘Before’ and ‘after’ shots of cosmetic treatment and weight-loss programmes are numerous. But for many of us, producing appealing images daily may be prohibitive.
pinterest is quite different to the other platforms and is used more as a personal tool rather than a social media tool. it has less than 15m Uk users and less than 15% log in daily. a key difference is that pinterest has a strong female bias.
The content on p interest, like i nstagram, needs to be very appeal ing. Users choose their interests and are fed posts that are likely to appeal to them.
i t is hard to see how this platform would be used in a private medical setting.
Conclusions
at this point in time, Facebook is our number-one recommended platform for private doctors and clinics. i t gives greatest reach through all demographics and users view the content daily. But remember that paid advertising is essential.
i t’s vital to be present on Linkedin and to have a very professional personal and business profile. Linked i n can be used to share good-quality content, but we would not advise investing in paid advertising.
Twitter can be a great way to create a community, to engage with others and potentially to drive more visitors to your website if it’s used properly. i t’s harder to use effectively than the other platform, so getting some expert advice is essential.
instagram is best used to build brand awareness and will only suit those of us who can continually produce appealing content.
p interest may be relevant to a small group of doctors or practices but, in our opinion, holds narrow appeal.
Finally, once you have decided which platforms will work for you, ask yourself this question: ‘Why would someone follow me on Facebook/Twitter/instagram?’
Can patients find you online? See page 26
Jane Braithwaite is managing director of Designated Medical
Who is your target audience? consider gender/age/location
create your objectives. What do you want to achieve using social media and how will you measure your success?
Which platform or platforms will appeal to your audience? facebook has the widest reach, but other platforms may suit your needs better
consider paid advertising, especially if using facebook
Use linkedin and remember to create a personal profile and a company page
When you create your platforms, maintain a consistent look and feel in line with your brand
What will interest your audiences? start to write a content plan. organise who will be responsible for providing content on an ongoing basis. This is a significant factor
content creation and curation. develop a plan for content that is relevant to each platform. remember to take a different approach with each platform. facebook is more casual than linkedin
engagement. create your community by following and engaging with key influencers
and finally, take time each month to review your progress. What have you achieved? measure your success against your objectives
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‘Here to help. Not to judge.’
Having progressed from hospital doctor to management consultant, it is now Dr Michelle Tempest’s mission to get more doctors involved in the management of healthcare to help guide positive change from within. Dr Tempest (above) tells her story to Independent Practitioner Today
NothiNg caN replace the journey of being a front-line doctor.
t he camaraderie of medical school, the 100 hour weeks as a junior doctor, the long nights on call, the specialty training and those very distinctive hospital smells.
Every day is an honour and a privilege, every patient unique. h owever, the number-one concern for our future health and social care system is staffing.
Recruitment and retention of staff is fast becoming an anathema for both public and private sectors in both hospital and community settings. Locums are in
high demand and the number of junior doctors rejecting higher specialty training has sky-rocketed.
i am one of the statistics who left the front line; for me there was no single light-bulb moment when i decided to hang up my stethoscope.
in fact, my personal journey was a very slow cross-taper of careers, working part-time in management consultancy at candesic, and parttime as a liaison psychiatrist for more than a decade.
i t was in a different era when career paths were inflexible and gaining experience outside the
No matter which career path doctors choose, it is obvious there is no longer a conveyor belt career progression
hospital walls was hardly ever spoken about, let alone done. But the future generation of doctors has diverse opportunities beyond rigid rota systems and can contemplate career options spanning from entrepreneurship to big pharma. this article considers embracing the choice to be a management consultant.
management consultancy
For so many doctors, the title ‘management consultant’ conjures up pejorative connotations, most leading to the question: ‘will they borrow my watch to tell me the time’?
Sadly, many clinicians have witnessed ever younger management consultants coming in and out of their hospital, promising so much in terms of cost savings, mergers and restructures, while contributing little change to front-line care struggles.
however, until you have walked in the shoes of good consultancy teams who put both head and heart into delivering benefits for patients, clinicians and businesses should put their cynicism on pause.
it’s actually my personal plea to get more doctors involved in the management of healthcare to
help guide positive change from within.
Management consultancy is a broad term covering everything from strategy, change management, financial, it, human resources and operational improvement.
to be a strategy consultant, you need to deeply understand the market and be able to think outside the box to help solve your client’s problems, even in politically-laden environments.
You also need to clarify and predict how the future will be different from the past, spotting the opportunities for improvement
and growth while keeping in mind cost savings and efficiency. to do this, you need to work long, hard hours to collect raw data, analyse it in a way that makes sense for the healthcare economy, and present the data in a logical and clear way to deliver the impact and change required. thankfully, there are plenty of transferable skills that doctors have that are relevant for management consultancy. they are:
a n innate knowledge of the healthcare economy and how to communicate;
a passion for care and under➱ p18
standing of the care pathway. at the end of the day, the business and economics will only ever make sense if the product delivers high-quality, patient-centred care;
Knowing how to do the right thing, even if this goes against the populist cacophony of thinking and lobbying.
Doctors also have a special work ethic. the gives them:
t he ability to communicate complex ideas and academic knowledge in plain talking language;
t he enjoyment of working in close knit teams and knowing how to inspire the best from your team mates;
a love of evidence-based data and a rigorous focus on outcomes;
Knowing how to work to a deadline even if that means working late and weekends.
Doctors are also open to continuous learning and creativity. this allows them to:
Sadly, many clinicians have witnessed ever younger management consultants coming in and out of their hospital, promising so much in terms of cost savings, mergers and restructures, while contributing little change to front-line care struggles
The doctor’s dilemma i am often contacted by disillusioned doctors stuck in the belief that they are nothing more than a cog in a wheel, not valued as an individual.
Managers and politicians of the past have often used the mantra: divide and concur. as soon as the team spirit is broken, individuals can become dogged by anger, bitterness and in-fighting.
as a result, many doctors are left in a quandary, wondering whether they should leave their profession after so much personal sacrifice to get there.
i t is likely that independentsector providers will want to be early adopters of technology, driven by more consumer-focused patient customers.
☛ Home care: With primary care apps such as Babylon, Push Doctor, Doctor c are anywhere and econsult, it is only a matter of time until more specialty interaction is delivered online.
Be inquisitive. No clinician can make a diagnosis without asking the right questions. Business can be very similar;
Find creative ways to create impact, and make the change fun;
Develop and keep up with new knowledge to progress the industry and profession.
Yet it can be during this feeling of self-doubt that the strategic mindset should come into full force.
there is an opportunity for doctors to join forces with management to bridge the divide between forward-thinking healthcare providers and develop new technologies, new partnerships and expand into emerging markets. there is a need for everyone to become more outward-thinking to solve the increasing demand tsunami of patients living longer with more long-term conditions.
Key strategic challenges will be faced during this journey and team-working will become ever more important.
in the past, doctors often left it late in their career to become business-savvy.
Some waited until they had stepped into a board-level position. o thers found their feet by developing their own business during the transition between N h S work and developing their own private list and private income stream.
h owever, management skills will become paramount much earlier in the doctor’s career path and here are some examples of why:
☛
Big data: h ealthcare is changing. For example, a research team at the University of Nottingham has recently created artificial intelligence to predict which patients will have strokes and heart attacks within the next ten years.
although use of big data is still in its infancy, there is no doubt that such new businesses will need the guidance of experienced clinicians.
With such transformations come opportunities, not just for lawyers and data security experts, but also for clinicians to lead by example on what can be treated by smartphones, alongside the internet of things (iot). this market has the potential to expand globally.
☛ Flexible working: to retain medical staff on the front line, working patterns are going to have to become more accommodating.
Medical staff may be enticed by a career portfolio. the most forward-thinking providers are likely to encourage the next generation of clinicians, often eager to help yet buried under N h S bureaucracy, to come and solve managerial quandaries.
i n fact, hca i nternational h ospitals recently announ ced a step in this direction, with junior doctor ‘Fellowship for Future’ programmes.
Summary
No matter which career path doctors choose, it is obvious there is no longer a conveyor belt career progression. Businesses and clinicians will have to work hand in glove to answer the complex questions of how to prepare providers for the future.
to be future leaders and solve problems, management consultancy experience will help. a s with anything in life, you write your own story and your destiny is in your hands.
So if any of you want to get involved in management consultancy or want to learn some new skills, please feel free to drop me a line. Do not choose complacency; choose hope and have faith that together we can make a change.
Dr Michelle Tempest, is a partner at Candesic, a bespoke health and social care consultancy: www.candesic.com
A well-crafted phone call can speak volumes about a practice: how well it is run and how it treats its patients. It projects the overall image and professionalism of the practice, says Stephanie Vaughan-Jones
PeoPle will often call a practice before stepping foot in its reception area. This goes for new inquiries and existing patients alike, so it is worth investing the effort to make sure the clinic’s call handling is done to the best possible standard.
The most successful approach to call handling is to place the importance on the caller, not on whoever is taking the call. The objective is to ensure that the caller hangs up happy.
The first step to well-crafted calls is to, quite simply, answer the phone. This may sound obvious, but so many practices will let calls go unanswered and even be unaware of the sheer number of calls they are missing.
Most people will give up on a call if it isn’t answered within six rings, so make sure that calls are answered promptly, but take care not to rush the conversation. even if you’re busy at the front desk or office, hurrying the call will make the patient feel that they are not valued by the practice. So give them your full attention.
Give a good greeting
A recent survey by Moneypenny discovered that most people find the salutation which consists of ‘time of day, company name’ is the most professional greeting for a business or organisation. Saying
Even though the patient can’t see it, smiling immediately makes you sound as if you have a friendly demeanour
just the practice name can come across as curt or even aggressive, so a ‘good morning’ or ‘good afternoon’ sounds much more welcoming.
Stating your name to the caller will help them feel at ease during their inquiry and help them start a conversation.
Smile while you speak
How you talk and the tone of your voice will set the tone of the conversation and also how the patient reacts during and after the call. e ven though the patient can’t see it, smiling immediately makes you sound as if you have a friendly demeanour. This is because the tone of your voice is sharper and clearer, so you will be easier to understand. i t’s also nearly impossible to be miserable while smiling, so if you have a difficult caller, a friendly tone will help to appease them.
Keep it concise
The chances are that your patient has a limited amount of time to spend on their call to you and wants their query dealt with quickly, efficiently and in a polite manner.
You have probably less than six seconds to decide how best to handle their call, so keep it quick. Ask them specific questions that will help you to come to a conclusion as to how best to proceed. Do you need more information? Do you have to get back to them?
Get all of this information without dragging the call out with too much conversation.
Speak without slang
Nothing says ‘i’m unprofessional’ more than using slang or poor language when speaking with a patient during a phone call. words such as ‘cheers’ or ‘uhhuh’ or ‘see ya’ should be avoided. And never ever swear. o nce it’s out there, you cannot take it back.
Keep calm with contentious callers
i t’s unavoidable, from time to time a patient will get in touch with a bee in their bonnet and you will find yourself on the end of the phone with someone giving you grief.
w hatever happens, however upset they may be, you must remain calm. Getting upset or angry yourself will only exacerbate the situation. instead, take a deep breath and let them vent their problem for a few moments. You will find that once they have their initial anger out of their system, they will be much more likely to work with you to resolve the situation.
i t pays to listen to them carefully so you understand exactly what the situation is, and repeat key points back, if necessary, to make sure you have the clearest picture.
Arrange to call back if a patient calls with a query and you are not able to resolve it straight away, say so and organise a time when you can call them back.
And make sure that you keep that call. even if you haven’t been able to resolve the issue, getting in touch and updating them on the progress can significantly take your customer service up a level.
Next month: What are your calls saying about your practice? Why ‘mystery shopping’ helps, where/what touchpoints to check and what to look for
Stephanie Vaughan-Jones (right) is channel manager at telephone answering specialist firm Moneypenny
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So how do you really get to the top in your field? Surgeon Mr Dev Lall claims your marketing plan plays a bigger role than many realise
networking meetings; you must not ‘obviously or excessively’ promote your practice; there’s no need/you must have a website; paid-for advertising is ‘unacceptable’; AdWords is/isn’t a waste of time. And so it goes on.
Confusion, disinformation and uncertainty seems to be the rule rather than the exception.
And, in this article, i’m going to stir up a bit of controversy and talk about how to become the top dog in your field.
The first thing i want to say is that what i am referring to throughout this piece is how to become the ‘go-to guy’ in your specialty when it comes to your private practice.
What i am not talking about is how to become a recognised expert in your specialty.
The latter requires years of effort, working with other recognised experts in the field, publish-
Expert status when it comes to academia is almost always a long time coming and almost always is a label bestowed upon you by other acknowledged experts in the field.
Becoming the top dog when it comes to private practice is an entirely different matter.
First of all, it has nothing to do with either clinical acumen or academic pedigree. Sure, competence is a must – hopefully that’s a given – but you don’t need any great level of expertise beyond that.
Secondly, it is almost entirely under your own control. You do not need to ‘serve your time’ or await to be anointed by a senior member of the brotherhood. ‘Top dog’ is a status you create and claim for yourself. And it is entirely under your control.
Thirdly, time. Pre-eminence in private practice is a position you can claim in as little as a matter of months. The speed you achieve it is limited entirely by your own hard work and application.
And finally, in academia you tend to progress through the ranks in a step-by-step manner, climbing the ladder of expertise one rung at a time.
not so in private practice. it is entirely possible to leap-frog all the other clinicians in your area: to literally jump from the bottom of the ladder to the top in one giant leap.
Yes, it is a big, bold claim, but it is easily proven: just look around you and you will see many examples of ‘ordinary’ consultants with ‘ordinary’ levels of knowledge and experience who very significantly out-earn more senior and academically/clinically able consultants in their own field.
And many of them grew their practices to outstrip their colleagues’ in a very short space of time.
So how do you go about achieving such legendary levels of private practice success?
Before talking about the details, let me summarise everything in just one word: Positioning. Understand positioning and everything else falls into place.
The key to becoming the ‘top dog’ in private practice is to be seen as the go-to guy in your specialty by both patients and by those who can refer patients your way.
And positioning is entirely selfmanufactured.
To bEcomE Top Dog in yoUR FiElD, consiDER ThEsE sTEps:
promote your private practice in as many ways as possible
To grow your private practice predictably, reliably and rapidly, you need effective marketing. That, i hope, is a given.
But you need to go beyond the basics and do everything you can to maximise your visibility. ideally, you would be found anywhere and everywhere your potential patients congregate.
This is a huge task, but remem-
ber, most of your competitor colleagues do very little, if any, marketing at all. To stand out, all you need do is a little better than them. This is easy because the bar is set so low.
Target your patients
Be aware that saturation of every marketing ‘channel’ out there is expensive and time-consuming.
it is also unnecessary because, in true 80:20 style, you will get a very large proportion of the results you want by targeting your efforts to where the majority of your patients are to be found.
put your face and personality into your practice
People buy products and services from people, not from companies, so even if you have a large practice with several clinicians, someone should be the ‘face’ of that practice.
Think of the vast company that is Apple: to many, Steve Jobs was Apple. Someone needs to be the face of your practice. i deally, it should be you.
become a celebrity
The world is in love with celebrity, and your patients are no different.
Consider any of the doctors on TV; patients are keener to consult with them compared to their colleagues. i t’s ridiculous but true: celebrity sells.
And if there’s one thing that generates celebrity it is exposure. So put yourself out there: get PR, publish ‘opinion’ pieces, run adverts and get interviewed wherever you can.
consider premium pricing
i know that everyone will read this with a sharp intake of breath. Yes, i have heard all the arguments about why it is ‘impossible’ to charge more than your peers: insurance companies won’t pay, you won’t be a ‘preferred provider’ and all the rest of it.
Yet the fact is there are people out there setting their own fees and letting the market decide. And doing very well, thank you.
The fact is that a high price in and of itself speaks of expertise
if there’s one thing that generates celebrity it is exposure. so put yourself out there: get Pr, publish ‘opinion’ pieces, run adverts and get interviewed wherever you can
walk-in clinics to concierge parking to ordering taxis for patients with poor mobility to attend their appointments.
Be nice. More than that, be known for being nice. Like all clinicians, i refer patients to colleagues in other specialties all the time. if i don’t know the consultant personally, i will speak to a colleague or their secretary and ask just this: are they nice?
and authority. And, conversely, people ascribe low value to lowpriced goods and services. This includes healthcare.
One of the best and quickest ways of achieving pre-eminent status is to write a book. it doesn’t have to be some weighty academic tome on cataract surgery or whatever – quite the opposite: a simple patients’ guide to cataracts is far better.
Being an author immediately bestows authority, credibility and expertise upon you. And it really is quite straightforward to do.
While you can’t guarantee results, you can guarantee other aspects of care. For example, that patients will be seen within 15 minutes of their allocated time or that they will get any investigations they need and the results of those tests within 48 hours.
There is always something you can guarantee that matters to patients.
Being visible is not enough: you must be perceived to be better.
Simple ways to achieve this include:
Using testimonials everywhere in all your marketing efforts, your website and your literature;
having a more luxurious practice suite;
Providing services that your colleagues do not.
This could be anything from
Would you see them yourself if you needed to? i f you’re nice, your patients will be happy and far more likely to refer friends or family to you. Their gP will hear about it and it will influence where he or she refers patients in future.
Remember that impressions matter if you want to be the ‘goto guy’, you’ve got to walk the walk and talk the talk. You can’t do it if you look shattered, wear a crumpled cheap suit and your private clinic has threadbare carpets. You’ve got to look the part. And not just you – so has your practice. Are your rooms easy to get to? Are the nurses well dressed and polite? how are phone calls handled? (see page 20). Are messages quickly followed up? All these things create an overall image – for better or for worse.
You may be shocked to realise that becoming top dog in private practice has nothing to do with how good you are as a doctor. You may even be deeply offended by it. And i understand entirely why. if life were fair, the only thing that would matter is your expertise and devotion to patient care. But life isn’t fair. not in the slightest.
The decision you face is: do you behave according to the rules ‘as they should be’ or do you act in accordance with the way the world really is?
As always, the results you get depend entirely upon the choices you make.
Mr Dev Lall (right) is a surgeon who runs private practice consultancy www.privatepracticeexpert.co.uk
How can you ensure your website continues to operate at its full potential for your practice?
Geoff Meakin (below) identifies the changes on the search engine horizon and suggests ways independent practitioners can help future-proof their websites in preparation
According to g oogle, up to 5% of all internet searches are healthcare-related – a massive 12 billion a year.
Like many independent practitioners, you may have already seized this opportunity by adopting an online presence and investing in search engine optimisation (SEo).
Perhaps you’re happy with your website’s performance and have noticed an increase in inquiries and consultations.
However, as the digital revolution unfolds, the ways in which search engines such as g oogle, Yahoo and Bing operate is changing.
With the n HS investing in telehealth applications and the increasing role of telemedicine in general practice, practitioners now have the opportunity to implement virtual consultation technology within their practices.
But while this may present new opportunities, it will also increase competition for healthcare providers.
As travelling time and costs reduce, patients will increasingly shop around for the best consultant, only travelling when necessary.
While this creates new opportunities to cast a much wider net for
your patients, nationally or even internationally, it also brings an increased need for your website to stand out from those of your competitors on this newly widened playing field.
As the popularity of telehealth and online consultations continues to grow, consider whether your website is only targeting patients in your local area, whether you can start targeting other wider areas and how you will differentiate yourself from your competitors online.
Artificial intelligence
Search engines such as g oogle, Yahoo and Bing are now using
artificial intelligence to rapidly learn the various ways users search for information. As this technology develops, it will become possible to provide increasingly detailed and relevant information.
For example, a search such as ‘Private hip surgeons in London who charge less than £8,000 and can operate on me in the next six weeks’ currently returns a plethora of results, mostly irrelevant and others only partially relevant.
But search engines are getting better at identifying the various ways users phrase questions. increasingly, independent practitioners will see potential clients searching for information and services using two, three or possibly more stipulations as in the example above.
Practitioners would be well advised to check the terms people are using to find their website and ask whether all these terms are being suitably catered for.
Voice search is now starting to make a big impact on the way we search for information. Experts claim it will comprise between 30-50% of all search traffic by 2020, with products such as Amazon’s Echo, google’s Home and Apple’s Siri leading the charge. independent practitioners can capitalise on this by including the questions patients may be searching for within the content of their websites. Brief, succinct answers are currently the best approach, as these devices tend to prefer such content.
i n recent years, there has been exponential growth in the use of video online, with Youtube claiming a 100% rise in video consumption year on year.
n ow A r (augmented reality) and Vr (virtual reality) are poised to continue this trend. Both technologies present new, exciting and innovative ways of answering searchers’ questions and providing rich immersive content.
Augmented reality, in which an image is superimposed onto the ‘real’ world, has some obvious benefits in healthcare. Patients can view animated videos to
explain surgical procedures or treatment options.
Similarly, V r enables you to show patients around your beautiful clinic without them needing to leave their home or workplace. this could offer comfort to anxious patients using your services for the first time or, equally, it can provide the opportunity to showcase your state-of-the art facilities. Adopting these technologies on your website now will give you the edge over your competitors.
The rise of adblocking software
t he number of internet users downloading and installing ad blocking software grew by 30% in 2016 to represent a total of 11% of internet users worldwide.
A continued rise will likely see a decline in return on investment for online advertising. Search engines such as google are starting to aggressively penalise advertisers that have poor quality ads and the sites that carry them.
Ensuring that your adverts are of high quality will become increasingly important. i n any case, practitioners should always ensure their websites are performing optimally ‘organically’ without paid-for adverts.
this is far more likely to ensure long-term continued success instead of the quick-fix solution that is often achieved with online advertising.
in June 2016, search giant google announced its goal to help users explore health conditions by providing ‘instant answers’ to symptom related queries.
g oogle is promising to assist users to reach a point where they can ‘do more in-depth research on the web or talk to a health professional’.
this is a clear hint for the private healthcare industry. Websites will need to address health topics in depth and in ways that the brief and succinct ‘instant answers’ will be unable to.
Educating users about when to seek the advice of a health professional is paramount to the strategy of search engines. So a clear ‘call to action’, ensuring patients can contact you easily to book a consultation by phone, email or via your
website is vitally important in converting online visits to customers.
Brain-computer interface
t his technology utilises electroencephalography (EEg) to detect brain activity and communicate directly with a computer.
i t has been in development since the 1970s and is poised to bring about a point when users will only need to think of what they are searching for.
Although widespread use is still a long way off, this technology is already being implemented in healthcare as scientists have been trialling it to enable communication for patients suffering from amyotrophic lateral sclerosis or ‘locked-in’ syndrome.
As this is an emerging technology, it is hard to predict the impact this may have on SEo, but having an awareness of these developments will better enable practitioners to prepare for them.
Health queries and concerns are a huge driver to search engines, and search engines are evolving rapidly to cater for increasingly complex user requirements.
Some of these developments will have a greater impact on websites than others, but one thing is guaranteed: the way we search for and are presented with information will be radically different in five or ten years’ time.
Ask your marketing or web company what it is they see as the future of search behaviour and how they intend to leverage this for your private practice.
if unsatisfied with the answers, a consultation with a healthcare digital marketing specialist may be a worthwhile investment to help future-proof your practice online.
Geoff Meakin is director of healthcare digital marketing specialists SERP Health
Don’t bury your head in the sand. Dr Benjamin Holdsworth (right) spells out the top ten financial issues you cannot ignore any longer
Life is busy. As a doctor, life is arguably busier than most. The temptation to ignore important financial decisions is great and the time available to focus on what needs to be done is short. However, there are key areas that you must consider carefully now – otherwise there is a very real chance that you could impact your future lifestyle.
1 Do you have a retirement plan?
time to think about their future. if you do have a plan, is it still an accurate reflection of your objectives? Has it kept pace with your current standard of living? if you sought advice ten years ago but have not reviewed your financial status recently, it is imperative to check your savings and investments are fit for purpose.
2
Are you on the right pay scale?
One of the most challenging parts of our job is helping people who have left any form of financial planning until they are about to retire or – harder still – after they have retired and finally have the
We encounter many new clients who have been on the wrong pay threshold for several years or have not received contractual pay rises when they were due (see our news story on page 2 of our July/August issue).
They may have had poor advice elsewhere or been advised by a non-medical specialist, which means key details of their medical income were missed.
Are you being paid what you are contractually entitled to?
3
Will you exceed the annual allowance?
The maximum amount of taxrelievable pension contributions you can make each year is £40K. Be wary of any NH s pay rises received through increments, new management positions or clinical exellence awards. i mmediate tax charges of up to 45% can be avoided with good planning.
However, the new ‘tapered’ annual allowance, introduced in April 2016, reduces the cap by £1 for every £2 of income for individuals with ‘adjusted income’ of more than £150,000, with a maximum reduction down to just £10,000 for those earning £210,000 or more.
Note that adjusted income includes not only salary but bonuses, benefits in kind and pension growth, which adds to the complexity of the earnings calculation.
This autumn, the NHs Pensions Agency will issue letters notifying those who have ‘saved’ more than the annual allowance cap for the
last tax year. HMRC bases calculations for pensions’ contributions on the deemed growth of the pension in the year, so the figures they use bear little resemblance to the amount you have actually paid into your pot. Check the sums carefully – many have been wrong.
4 Will you exceed the lifetime allowance for pension savings?
This is the total amount which can be built up in a pension with-
out triggering an extra tax charge. Many doctors unwittingly breach the allowance, paying up to a 55% tax charge on the excess savings when the fund is drawn.
Not surprisingly, the amount of tax revenue raised from lifetime allowance breaches has increased by 80%.
in 2015-16, HMRC gained £36m from savers exceeding pension savings limits compared to just £12m in 2012-13.
Do you know where you stand?
5
Have you protected the value of your pension?
The taxation of pension benefits is a particularly complex area and we see many new clients who have received incorrect pension protection advice.
There are a range of government protection schemes which can help savers restore the value of their pension against lifetime allowance changes. each one differs in terms of qualification criteria.
One such scheme, i ndividual Protection 2016 (iP2016), is now open for applications for those who had pension savings in excess of £1m as at 5 April. Do you have the right protection in place?
6 Are your financial adviser and accountant working together?
When dealing with large sums of money and critical life choices, you need to ensure your professional advisers have the complete
picture of your financial interests as well as competence in the NHs pension.
Make sure your adviser and accountant have the same objectives and work together to ensure opportunities are not missed.
7 Are you confident your practice structure is taxand pension-efficient?
You may well have considered the advantages of trading as a partnership or limited company, but are you really maximising the efficiencies these can provide?
The tax landscape has changed significantly over the last few years and there are now more implications to consider when selecting the best business structure.
Have you overlooked the impact your trading structure has on pension contributions and pension tax? A limited company can contribute ‘pre-taxed’ company income to a pension.
Higher-rate taxpayers can put profits straight into a personal pension rather than taking the income as a dividend.
This applies to any director, so it can be particularly useful to contribute to a spouse’s pension if their lower salary means a higher annual allowance or they do not already have NHs pension contributions to consider.
8 Have you thought about the finances of your family?
Are you making the most of intergenerational planning?
The introduction of pension freedoms now gives universal access to pension funds from age 55. And the ability to pass on pensions’ tax-efficiently on death to family members and other beneficiaries makes pension funding attractive – particularly for some spouses of consultants or where the lifetime allowance and annual allowances are less of a concern.
Who will receive your pension fund benefits when you die?
Are your loved-ones protected from unnecessary tax charges by considering your inheritance tax position now? Do you and your adult children have up-to-date wills in place?
As busy professionals, it is easy to let these things slip, but if the unthinkable happens, you would not wish to add financial concerns to their emotional burden.
9 Are you taking advantage of your available allowances every year?
Are you using isAs, capital gains and gift allowances, or maximising tax reliefs through annual pension allowances to minimise the duty owed to HMRC? This includes allowances for your spouse and family.
individuals have an annual capital gains allowance of £11,300. This provides significant opportunities for tax-free investment returns every year. At the same time, the reduced annual and lifetime allowances are driving a renewed enthusiasm in isAs as a supplement to pension funding.
They are particularly tax-efficient for higher-rate and additional-rate taxpayers. The is A allowance is now £20,000 per per-
son, allowing a couple to shelter £40,000 a year from future taxation.
10
How are your investments performing?
Do you have expensive older-style funds which are performing badly or no longer adhered to your attitude to risk?
Have you been tempted to go it alone with your investments?
Online fund providers are adept at attracting the ‘DiY investor’ with exciting company information, one-off opportunities and investment experts who can apparently see into the future.
The result is often disappointingly average returns and far too much hard work for the timechallenged doctor.
Who has the energy or inclination to focus properly on their finances after a busy clinic and list? Which doctor can keep up to date with every change to tax and pension regulation?
A skilled professional should do a better job. According to peerreviewed research by asset management company Vanguard, an average investor achieves returns of around 3% more per year with the help of an adviser compared with investing on their own.
The financial landscape is facing constant change and it is therefore vital to dedicate some time to ensure your affairs are in order.
The result will be a stress-free retirement and complete peace of mind that you will enjoy financial freedom in later life.
Dr Benjamin Holdsworth is a practising medic and business development director of Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions.
Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested
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Good complaints management is an integral part of good governance and quality management.
But in a world where the consumer is king and independent healthcare is provided by a huge variety of different entities, clear definition of good complaints management is needed.
t hat is what the i ndependent Healthcare s ector c omplaints adjudication service (iscas) does for its subscribers, who make up 95% of the UK’s independent healthcare providers.
Healthcare is a political battleground and each successive Government must find a new way to prove its unique healthcare offering to the electorate.
down among Whitehall’s lower priorities – but with potential to rise to prominence – is a desire that electors should be able to complain about the private healthcare they have received to a Governmentprovided, impartial, ombudsman.
But this would remove an element of autonomy from independent healthcare that iscas believes would be undesirable. Fortunately, it would also require primary legislation to be passed by p arliament. a nd there is no sign yet in this p arliament that time would be given to such legislation, but change is possible.
Our new code of practice brings super-clarity to the essential process of complaints handling, management
it behoves independent healthcare to take notice of such desires and preempt those it can. so we have consulted closely with the standards followed by the parliamentary Healthcare o mbudsman (pHso), particularly those related to speed of response and evident fairness.
We have been fortunate also to be able to draw upon the expertise of c entre for Effective d isputes Resolution ( c E d R) who have worldwide experience of dispute resolution across many industries.
more impartial Fairness is related to impartiality. to remove any challenge that could be made to its impartiality from independent healthcare providers being members of iscas ltd, the directors have agreed that providers’ status in the company is changed to that of subscribers – so they become consumers rather than members. to demonstrate the impartiality and fairness of the complaints
process in the independent healthcare sector, iscas uses the code of practice for complaints management, a public document widely available to interested parties (see page 34).
Uncomfortable sanctions
i t is a primary condition of acceptance to iscas that providers adopt the code into their own protocols. the code incorporates the requirement that they annually review their complaints management performance against the code, and report the result of their review to us.
nonacceptance and noncompliance would bring external sanctions that we believe would be uncomfortable to the provider concerned and then to the rest of the industry.
iscas ’s latest annual report highlighted a significant rise in the number of complaints about complaints handling by subscribers.
among all the measured heads of complaint, those about incompetent complaints handling rose from an already significant 22% in the last annual report, to 67% (corrected for the longer reporting year) in the current 2016 report. to correct this systemic weakness, we needed to do something to help subscribers strengthen their performance in complaints handling.
We started with a review of how the iscas c ode 2013 has been implemented by providers, seeking the causes of the increased number of complaints against the complaints process itself.
We worked with c E d R, the pHso and providers to construct an entirely new code of practice, effective from this month with a very much strengthened first stage.
the code is expressed in terms of the obligations of all in the complaints pipeline, from first
expression of a patient’s concern to final resolution.
i t brings super clarity to the essential process of complaints handling, in the interests of helping providers towards good governance and quality management. it employs the familiar management round of acting, recording, evaluating, improving, and action.
Experienced medical consultants in private practice, and independent practitioners generally, are sometimes wary of the unfocused complainant. our new code is a framework for effectively handling complaints.
i t has a ‘ s even s teps to Good complaints Handling’ blueprint for actions, starting with empathising and listening and ending with action. there is also a separate policy on handling unacceptable behaviour by complainants, defining what is – and what is
not – considered unreasonable. i t covers self funded patients, treatment paid for by insurance, clinicians with practising privileges, and n H s private patients units. But it does not cover unlawful acts, the m ental Health a ct, financial disputes, clinical negligence, private medical insurance products or nHs patients.
providers will make an annual self assessment of compliance against the standards in the code using a template to be provided by us, and share this with iscas when subscriptions are renewed. i f the provider finds that it is not meeting code standards, it must devise an action plan demonstrating how compliance will be achieved. this will be a condition of subscription renewal.
See ‘What you can do’, page 34
Sally Taber is director of the Independent Healthcare Sector Complaints Adjudication Service
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Step 1: EMPATHISE
This means approaching the situation from the complainant’s perspective.
It might involve
Reassuring the complainant that their ongoing treatment will not be affected by their complaint, or;
Acknowledging the impact on them of the events they have complained about, or;
Expressing sympathy with the trouble or suffering the complainant reports having experienced.
Step 2: LISTEN
This means developing an understanding of their experience from the complainant’s perspective.
One of the most helpful things is to offer to meet with complainants.
Meetings can have several benefits: from showing that the complaint has been taken seriously and demonstrating that the organisation is in listening mode, to clarifying the key matters of complaint, providing an opportunity to resolve concerns early on, and building rapport and trust.
Where complaints investigations are done well, the investigation gets underway swiftly, it has a clear structure and defined scope, and there is a sense of momentum and a defined end.
All relevant parties should be asked to input into the investigation, particularly clinicians.
Another marker of a good investigation is that conflicts of evidence are reconciled, and complainants are helped to understand the relevance of clinical opinion. There should be a robust documentary record of the investigation.
This means making sense of the evidence that has been amassed and the outcome of the investigation. Reflective questions include:
Has the investigation got to the bottom of what occurred?
What further steps, if any, are necessary before a full response can be made?
Which aspects of the complaint, if any, should be upheld?
How can we learn from this?
All relevant parties should be asked to input into the investigation, particularly clinicians
How can we prevent the same problems from happening again?
How well have we managed this complaint?
What might we do differently if a similar situation were to happen?
Step 5: RESPOND
And do so within the specified time-frames – or give reasons why this is not possible and when a full response will be made – and be clear what the organisation has found.
It means demonstrating candour regarding any failings, and being explicit about deficiencies and what should have happened, and any steps taken to prevent the same problems occurring again. Responding also means being clear whether the complaint is upheld, and what that means.
Step 6: REMEDY
Complainants seek a range of remedies, from financial redress
to an apology and assurances that steps will be taken to avoid the same problems happening again. It is important to acknowledge the remedy that the complainant seeks and whether the organisation is prepared to grant it and the reasons why.
Wherever possible, the response should try to return the complainant to the position they would have been in if the events concerned had not happened. Any apology should be clear and unequivocal.
Step 7: ACT
This means ensuring that change happens and that the outcome is communicated to complainants. It is about describing what action has been taken to learn lessons and what has or will be done to prevent the same shortcomings from arising again.
Source: Code of Practice for Complaints Management, by ISCAS, 2017
One of London’s newest clinics, Twenty-five Harley Street day clinic, decided from the outset to go the preventative medicine route for billing and collection. Chief executive Bob Davidson explains
Our clinic aims to become l ondon’s premier day clinic for women and was the brainchild of ukrainian entrepreneur and businesswoman Anna Tigipko.
i was lucky to find myself in the right place at the right time on the lookout for something different.
Having first been sounded out by Anna over a phone call, my first meeting with her took place at her offices in Mayfair. As she set out her vision and then took me around the building at 25 Harley Street, i immediately realised this was it – an opportunity for a fully ‘integrated’ clinic including primary, secondary and tertiary expertise with on-site treatment backed up by pathology and imaging. This is what i felt private patients really needed.
And so my work began. From redesigning the building from an accountancy practice to a private clinic worthy of Anna’s vision, to purchasing equipment for our pathology laboratory, setting up
an advanced imaging suite, designing an ambulatory day-case gynaecology suite, building a detox unit, deciding on our treatments and hiring staff and consultants.
i was aware that the billing and collection side of the practice was one of the major tasks i faced and would be key once the clinic opened.
Having worked in the independent healthcare market for years, i was also aware of the stories of clinics building up backlogs of debt – something i felt we would be wise to look at and ideally address proactively from the start.
The issues i identified as needing addressing were:
Different payment types and having the resources and facilities to deal with each;
r econciliation of payments against invoices sent;
c hasing invoices sent which would include any excesses from insurance policies;
reporting what was happening for both accountancy and management purposes.
i was thankfully aware of the option of outsourcing the billing and collection and the more i considered what we wanted for the clinic, the more i thought it might be the best solution.
Being a high-end clinic based on Harley Street, a big target market for us was always going to be selfpay patients.
That is not to say we are not looking at the private medical insurance and embassy market as well, but the majority of our clients we expect to be always selfpayers. We expect a certain amount of these clients to be international and also patients who will become regular visitors – especially for periods at a time. We found we were able to set up a card payment facility through outsourcing our billing and col-
lection which was immediately appealing, as it meant we did not have to register for our own card reader and it also allowed us to feed this data automatically into other monies being collected. And it proved very cost-effective with a receipt and invoice raised at point of sale.
During my time working in and around Harley Street, i was aware of stories of large debt levels some clinics had let mount.
i was also aware that a big cause of this was not properly reconciling payments received against invoices sent, especially when insurers or embassies would not always make it obvious with their remittance forms.
We felt internally that even though staff could be given this task each week, quite often other things can get in the way. Furthermore, staff turnover does
unfortunately happen. So, again, we felt outsourcing this side of the practice might make sense, as it meant we were hiring dedicated staff to this task and it would also ‘buy’ us continuity of service.
While a lot of our patients – or guests as we prefer to call them –would be self-payers and paying on day of treatment, there would, of course, be those who would pay on account or prior to treatment, especially international patients.
And as we did more insurance work and embassy payments, the resources and facilities to accurately record and chase invoices systematically would be needed.
Much the same as reconciling payments, we felt we could apply resources to do this. But we would still have the issue of hiring the expertise, staff turnover and also the fact that practice management software does not always
allow for this process as thoroughly as some specialist billing company software.
Twenty-five is a big clinic by Harley Street standards, with multiple treatments and multiple consultants. We very much regard this as being a major strength, providing an integrated service with specialists in an array of fields including gynaecology, general practice, dermatology, pathology, imaging, aesthetics and plastic surgery and menopause care.
The reporting we wanted was therefore extensive, including which consultants were doing what work and the divide of facility fees and consultants’ fees.
Again, we felt normal practice management software would not give us the level of detail we were after, so felt outsourcing it to more bespoke software providers who would manage this process
for us seemed a sensible longterm option and from the start.
We considered the pros and cons internally and after a number of meetings with Medical Billing and collection (MBc), we decided to outsource to them and have been very glad we did.
While this will not be for every practice, a big benefit for us is that a headache has been removed.
We found only a small number of staff needed to be trained in how to use MB c ’s own bespoke software module that allows us to take a patient’s payment on the front desk. it was the same with billing information from clinic lists we send the company on either a daily or weekly basis.
All in all, we can concentrate our energies on growing the practice and managing our guests rather than handling this important but often awkward side of the business – dealing with the payments and money.
SPECIALIST MEDICAL ACCOUNTANTS
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Since starting in the mid 1970’s Sandison Easson has continued to grow and is one of the largest independent medical specialist accountants in the UK.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
Sandison Easson acts for medical professionals throughout all stages of their career and has clients in almost every town in England, Scotland and Wales.
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
We provide the usual services you would expect from an accountant such as preparation of your accounts and tax declarations but offer so much more including advice on:
• Setting up in Private Practice
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You must now always demonstrate in your reports that you understand the ramifications of the Montgomery v Lanarkshire Health Board (2015) ruling, warns Michael R. Young
The law is not static and constantly evolves. The Montgomery ruling is a good example of this.
Doctors are used to giving information about the benefits and risks of any recommended treatment to their patients and obtaining their consent. The GMC issues very good guidance about consent.
Unfortunately, the law lagged behind the expected standard of information-giving and consent expected from a clinician by their regulatory bodies. h owever, the Montgomery ruling of March 2015 brought the law and the regulatory guidance into line.
historically, it was up to the clinician to judge how much information they would disclose to a patient (Sidaway v Board of Governors of the Bethlem Royal h ospital and the Maudsley hospital [1985]) and provided the doctor or dentist explained the risks of a given treatment – to the extent that it accorded with a responsible body of medical opinion – liability would not attach.
This is the basis of the Bolam test with which all clinical negligence expert witnesses should be familiar.
Following Montgomery, the law now generally requires that a clinician must take ‘reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments’.
w hen providing opinion on issues of consent, the expert must consider whether the patient was:
Given enough information to make a decision. This includes being given all the options, including the option of no treatment;
Given information that is rele-
vant to them (the test of ‘materiality’ – see below). Risks should not be merely reduced to percentages;
Bombarded with confusing or technical information; the judgment confirms that this is not considered acceptable.
The key question the expert must ask themselves is: ‘Is there evidence of dialogue, discussion of alternatives, and risk(s) in the clinical records?’
There are, however, three exceptions to the general requirement to inform:
1. If a patient tells the clinician that he or she would prefer not to know the risks.
2. when the clinician reasonably considers that disclosure of a risk would be seriously detrimental to the patient’s health. But this exception should not be abused to subvert the principle of informed consent.
3. In circumstances of necessity, as, for example, where the patient requires treatment urgently but is unconscious or otherwise unable to make a decision.
‘Materiality’ – the quality of being relevant or significant – is to be judged by reference to the individual circumstances of the case and whether a reasonable person in the patient’s position would be likely to attach significance to the risk, or whether the clinician is or should be aware that the particular patient would be likely to attach significance to it.
This requires consideration of the patient as an individual – a risk that is ‘material’ for one individual may not be so for another – and thereby requires a bespoke consent process. as an expert, you must look for evidence of this.
w here does this leave the expert witness? The main difference postMontgomery is that Bolam can no longer be used as a potential defence for issues of consent. In all issues except that of consent, Bolam still applies.
You must also be aware that the Montgomery legal test will be applied to all cases that are heard from the date of the judgment, even if the events of the claim occurred before the judgment – i.e. it will be applied retrospectively.
It is important to realise that Montgomery does not replace Bolam, it merely adds another layer, one that relates solely to the issue of consent.
You must always demonstrate in your reports that you understand the Montgomery ruling.
In a previous article taken from page 67 of my book (see below), I set out how you could demonstrate that you understand the Bolam and Bolitho tests; this will have to be modified to include Montgomery.
I suggest the following wording:
‘During the process of evaluating all of the evidence and information made available to me, and throughout the preparation of my report, I
will remain mindful of the direction of McNair J to the jury in Bolam v Friern hospital Management Committee when reaching my conclusions regarding the issue of liability (the Bolam test) and of lord Browne-wilkinson in Bolitho v City and h ackney h ealth authority. I will also consider the judgment of lord Kerr and lord Reed in Montgomery v lanarkshire health Board (consent).
The questions I will therefore ask are:
how might a reasonable, responsible and respectable body of medical/dental practitioners have conducted themselves?
Can I provide a logical explanation for what was actually done or omitted, knowing all of the facts of the case?
was the patient given enough information to make a decision?
This includes being given all the options, including the option of no treatment.
was the patient given information that is relevant to them (the test of “materiality”)?
was the patient bombarded with confusing or technical information?’
Michael R. Young is the author of The Effective and Efficient Clinical Negligence Expert Witness, price £60 from Otmoor Publishing
the book costs £60, but independent practitioner today has secured discount of a third off for readers, so you pay only £40. listen to the audio content which accompanies the book at this website: www.otmoorpublishing.com/audio. for more information and to order, email stephen.bonner@ otmoorpublishing.com, quoting reference ‘Young/ipt’.
susan hutter (right) gives guidance for doctors looking to broaden their offering by launching a new service or a medical product
aN INCR ea SING number of consultants, GPs and other medical specialists are now looking at ways to provide new services or even launch products to offer patients and clients a fuller offering.
It’s also a good way to increase your annual revenue. For example, some practices now offer alternative and holistic treatments such as reiki, massage and alexander Technique.
Others offer counselling alongside oncology treatment. One dermatologist I know is launching a special line of skin care products and an orthopaedic surgeon has launched specific assisted living aids online for those with disabilities.
Now, having a great seed of an idea is all very well, but how can you ensure this can be financially viable and successful?
Here are my top tips:
➲ If you have created an innovative product that really is a first in the marketplace, make sure you protect yourself from other competitors stealing your ideas by getting the idea patented.
Do make sure you seek expert advice from an intellectual property lawyer.
➲ It may seem obvious, but do revise your business plan or write a new one from scratch to factor in your new requirements. having something on paper is essential if you are looking to get funding or want to be sure how you are going to build the new side of the business over the coming months and years.
➲ If you are launching a new product or service, then you are more than likely going to need additional funding.
The most tax-efficient way of raising money is through the enterprise Investment Scheme. as long as all the shareholders have less than a 30% stake, then all shareholders will get tax relief on their original investment. If they are one of the seed shareholders –who has put in the first £150,000 – then they will get 50% tax relief.
having a great seed of an idea is all very well, but how can you ensure this can be financially viable and successful?
➲ More often than not, it makes sense to set up a limited company rather than a limited liability partnership (llP). Both will provide personal protection to the shareholders of a company or members of an llP from the creditors of the business. But the advantage of a limited company is that you can claim Research and Develop ment Tax credits for anything from developing your website to research needed for a new product or service.
If you qualify for R&D, then you can claim back 230% in tax relief.
➲ In many ways, it is a good idea to separate your new business venture from the main practice or consultancy. If you have other people investing in your business, they could try to take a stake in your existing business.
➲ Your new venture could take off fairly quickly. If you envisage the turnover exceeding £85,000 a year (the VaT threshold), do make sure you take advice about whether you register your business for VaT.
➲ Depending on the type of new offering or service, you should be prepared to invest time and money in the marketing drive. This could mean making sure your website is sufficiently appeal ing and high-calibre to attract online customers.
If you are launching a new product which is targeted across the UK or even further afield, you should look at getting specialist advice and support from marketing and PR professionals, so you get the message out far and wide that you are open for business. See ‘Legal Briefing’, page 40
Susan Hutter is a specialist medical accountant and a partner at accountancy firm Shelley Stock Hutter
‘Look to the future now: it’s only just begun.’ So sang Wolverhampton glam rockers Slade in their famous Christmas hit.
Now, I know it is still probably a little early to be getting ready for Christmas, but these particular words do nevertheless seem an apt way of bringing to a close our series of articles on healthcare startups and the increasing use of apps and technology for delivering health services.
Even in the few months since our first article appeared, things have not stood still, and nor would we expect them to.
t he Care Quality Commission
1
Build in a suitable planning phase: a year or so is not unrealistic – there is a lot to consider and plenty of potential pitfalls, but good planning at the outset will pay dividends later
2 take care when discussing your ideas with possible partners and investors: a confidentiality agreement –sometimes called a ‘nondisclosure agreement’ – provides vital protection against others ‘borrowing’ your plans. And think, too, about properly protecting your intellectual property
3 map out the personal data you will be collecting or passing on to others and ensure that privacy policies and consent forms tie in to this
4
Our popular legal series for doctor entrepreneurs ends with Simon Lee’s ten tips for doctors in the process of – or who are considering –setting up online or app-based healthcare businesses
(CQC) in particular has started publishing its first reports into such healthcare providers and so, in this piece, we look at some of the learning points and warning signs already laid out, as well as offer a reminder of some of the key areas of learning from previous articles in the series.
In March this year, the CQC published advice for people considering using an online doctor, published information on how digital primary care providers are regulated and inspected by the CQC, and issued a joint statement with the
GMC – among others – reminding clinicians and service providers that they still need to follow their usual professional guidelines.
t he CQC’s chief inspector of general practice, Prof Steve Field, was quoted as saying: ‘this might be a new way of working, but the risks and responsibilities need to be understood and action taken in response. As the regulator of health and social care, we will continue to play our part in guaranteeing this.’
Looking at the guidance for those thinking of using an online doctor, the CQC sets out some information designed to reassure patients,
Don’t forget that some – but not all – smartphone apps can count as medical devices and, if they do, you will need to be aware of the relevant regulations
5 online prescribing is a complex area, so take particular care here
6
Any contract formed with a person who isn’t physically with you in the room – including clicking on a website or on an app – is likely to be ‘distance selling’, so you will need to ensure that your terms and conditions take account of this
7 patients will almost always count as ‘consumers’ for the purposes of the law, so make sure your patient-facing documents are clear and accessible
8 Don’t assume that you will automatically own the content of your own website. make sure that this is expressly agreed with whoever designs your site for you
9 Whether the person you work with is ultimately considered an employee, worker, or self-employed can depend on a range of factors which can certainly go beyond whatever label is attached to the documents
10 Keep up to date with the CQC’s inspection reports and guidance, since, as more reports come out, it will be easier to establish what is good practice and help you minimise the risk of repeating the mistakes of others
so it makes sense if you have these issues in mind when both promoting and running your services.
CQC registration, where it is required, is a must, of course, but it is also important to clearly flag your address and contact details, as well as how you will safeguard patients’ confidential information. this links up with our previous articles in the series on data protection and the legal requirements for ‘distance selling’.
Beyond this, there are the parameters for an online consultation – the importance of the doctor verifying the patient is who they say they are, taking a medical history and asking permission to share the consultation with the patient’s GP.
It also touches on online prescribing – see also our earlier article in the series, as well as some further points in the box on the left – and having medical tests done online.
the regulation document is, as you might expect, a more detailed paper and so you should certainly familiarise yourself with it if you have not already done so.
Its full name is Clarification of regulatory methodology: PMS digital healthcare providers , and the section at the end on ‘Additional Prompts for Digital Healthcare Providers in PMS’ is a helpful check list of key questions and prompts.
In turn, this should help you shape your policies and procedures to help minimise the risk of problems arising.
For example:
What protocols are there to identify and verify the patient at the start of the first and subsequent consultations?
How does the provider ensure compliance with appropriate guidance on remote prescribing?
How does the provider obtain/ assess informed consent?
t he last of these is a case in point, as a recent inspection report specifically highlighted that the CQC had seen no evidence of formal training about the Mental Capacity Act 2005 and noted that the provider’s consent policy did not meet the requirements of that Act.
Warning signs
this links to other warning signs in the inspection reports that have been published. Certainly, prescribing is a thorny area (see also our previous article on this in the May issue of Independent Practitioner Today) and care must be taken in this area.
For instance, one service was suspended after prescribing drugs following only a 17second assessment; another had conditions placed on it for prescribing opioid based medicine without proper patient identification systems. And the CQC in a different
matter was concerned about someone being prescribed the narcolepsy drug Modafinil to keep them awake to complete an assignment at work.
these kinds of examples highlight both the importance of having suitable policies and procedures in place and also having a suitable mechanism for checking compliance with them.
Again, quoting Prof Steve Field: ‘As with conventional GP surgeries, online companies and pharmacies are required to provide safe, high quality and compassionate care and must adhere to exactly the same standards. they must not cut corners.’
While there’s certainly plenty to be wary of with this kind of business, there are also lots of potential opportunities and so plenty to be positive about too.
Simon Lee is an associate at legal firm Hempsons
Independent Practitioner Today has joined forces with leading niche 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.
As a survey finds 90% of surgeons listen to music in the operating theatre (see page 7), Dr Ellie Mein responds to a dilemma after a nurse complained that the choice of song was striking the wrong chord
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QI have just witnessed a dispute about the music being played in the operating theatre.
The surgeon put on his playlist as usual, but the scrub nurse, whom he had not previously worked with, complained about the choice of music, as she found it distracting.
She asked that no music be played and commented that music in operating theatres should be banned, as it was ‘medico-legally indefensible’.
In a later discussion, the surgeon explained that, as music was played in theatre by most of his other surgical colleagues, he felt the ‘Bolam principle’ would apply in the event of any claim.
Put another way, if the decision to play music in theatres was supported by ‘a responsible body of medical opinion’, a claim could be defended.
Is this the case?
AThere is a relatively long tradition of music being
played in operating theatres and this was originally intended to benefit conscious patients undergoing surgical procedures.
However, music is now widely played in theatre even when the patient is under general anaesthetic. A 2014 report in the BMJ estimated that music was played in around 60 to 70% of theatres, with the playlist usually having been chosen by the lead surgeon.
This same article stated that approximately 80% of theatre staff felt that music improved communication within the team, enhanced efficiency and reduced anxiety.1
In addition, several studies show that playing music can have a beneficial effect on those who hear it. Some research has suggested that playing music – and in particular, the music of Mozart – can enhance handeye coordination.
And a small study involving 15 plastic surgery trainees also found that when listening to their chosen music the speed and quality of their surgical repairs improved.2 But despite the suggestion that music can improve handeye coordination and thereby enhance performance, there also are concerns about the negative impact of music in theatre.
Findings [of the study] suggested that music could impair communication between team members, lead to increased tension within teams and prolong operative times
When a patient changes their name, it can lead to problems. Dr Sally Old (right) answers a reader’s inquiry
A 2015 study published by Weldon et al in the Journal of Advanced Nursin g 3 used video footage of 20 surgical operations to study the verbal and nonverbal communications between staff members.
Of these operations, 70% had music playing in the theatre, but findings suggested that music could impair communication between team members, lead to increased tension within teams and prolong operative times.
The authors of the study concluded that the decision to play music in theatre should be a collective one rather than being dictated by the senior or operating surgeon alone.
With this in mind, there are various steps that may facilitate the use of music in theatre while avoiding disputes within the team.
A surgeon should check with the hospital being worked in whether there are any policies in place regarding music being played.
The surgeon could check if any of the team had an objection to certain types of music, or any music at all, being played.
If staff are concerned about distractions or interference with communication within the team, these could be mitigated for example, by keeping the volume suitably low.
References
1. www.bmj.com/content/349/bmj. g7436
2. https://academic.oup.com/asj/ article/35/7/858/2589165/ProspectiveRandomized-Study-of-the-Effect-of 3. http://onlinelibrary.wiley.com/ doi/10.1111/jan.12744/ abstract
Dr Ellie Mein (right) is a MDU medico-legal adviser
QI have a patient who has recently divorced and has reverted to her maiden name. She has made a complaint after receiving a series of letters made out in her married name.
In her complaint, she stated that she had already told our reception staff of her name change during her last visit.
She has threatened to report the practice to the Information Commissioner’s Office for failing to keep accurate and up-todate information.
What should I do about it?
AIt is important to look at how to manage the patient’s complaint, but also how the error occurred. Be sure that all of the patient’s records are amended immediately and make sure that any changes to computerised records have been saved.
In addressing the patient’s complaint, offer the individual a full and sincere apology for the error and reassurance that the computer records have been amended to reflect her preferred name and salutation.
As the mistake may have stemmed from human error, perhaps introduce further staff training as a precaution against a repeat of this situation in the future.
If you decide to implement further training, inform the patient that, following receipt of her complaint, training has been provided to everybody in your private practice to reinforce the importance of keeping patient information up to date.
As well as being a fundamental requirement for all healthcare professionals, accurate recordkeeping is one of the essential standards for
organisations registered with the Care Quality Commission.
Organisations are expected to have ‘clear procedures that are followed in practice, monitored and reviewed, to ensure personalised records and medical records are kept and maintained for each person who uses the service’.
You may feel that this complaint is a useful prompt to review your local procedures.
Sometimes a patient may request that a change of name is applied retrospectively to their entire medical record.
But bear in mind that, while patients are entitled to challenge the validity of records and to have factual errors corrected, medical records need to accurately reflect details at the time of treatment. Consequently, this request cannot be fulfilled. An entry in the patient’s records should not be amended simply because the patient does not like it and such requests need to be handled carefully.
Dr Sally Old is a MDU medico-legal adviser
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Starting out in private practice can be daunting, but preparing well in advance rather than leaving things until you are busier can be very beneficial and help maintain that all-important worklife balance.
Consider these key areas when entering into the work of private medicine.
Use a good secretary
i have spoken at many events for new consultants over the years and one common theme from those consultants that are successful is the importance of a good secretary.
using an experienced secretary
will, no doubt, make your life much easier and allow you to focus on seeing patients, which is where the money is earned.
the first port of call is often your n HS secretary if you are happy with them, and this can work well.
i t is usually best to ensure that they have some experience in private medicine, as chasing insurers and patients for money does not come naturally in the nHS.
Speak with colleagues who have established private practices to see what their secretarial services are, as it can often work well to link up with a colleague and employ a secretary rather than use an ad-hoc self-employed one.
The three ‘A’s
the key to success in the world of private practice can often be highlighted by the three ‘a’s: ability, availability and affability.
the first is a given after all those years of hard work and training, but it is vital for the success of your private practice that you are available to patients in addition to the demanding nHS role and home life.
affability is important, as it is a marketplace after all, and if patients don’t feel that connection, it can limit development, particularly for those with a high proportion of self-paying patients where the all-important word-ofmouth endorsements are vital.
Speaking with colleagues and professional advisers before you start out is really important.
You can often glean key information about the marketplace for
your specialty and geographic area from talking to colleagues, who are, more often than not, open about things.
t his helps you to set expectations on your earnings level and to understand any opportunities that could be on the horizon; for example, retiring colleagues.
Don’t engage an accountant after you have commenced; do it beforehand to ensure you understand your new obligations for running a business and are best placed from the start.
Speaking before commencement will ensure you consider the following key factors:
the tax system;
Key dates and timings;
t he most appropriate trading structure for your circumstances; record-keeping requirements; Practical factors for running a successful private practice.
Pretty much anyone can call themselves an accountant, so it is important you engage someone who is appropriately qualified and has medical experience, as the world of private medicine is very different to other businesses. i always recommend engaging a firm of chartered accountants who are medical specialists.
the self-assessment tax system can seem strange at first, as there is often a very long period of time from earning the money to paying tax to HM revenue and Customs. When the tax does become payable, it can be a shock, as it usually represents one-and-a-half times what you owe for the previous year. it is important that you understand how much to save for tax and stick to it from the outset, as trying to catch up later on can create a feeling that you are working for the taxman.
When starting out, you will need to increase your indemnity cover. When you call your provider, you will be asked how much income you are expected to earn and what sources of income you will have. i t is important to be realistic and review the figures periodically to ensure they are reasonable, as a retrospective charge from an insurer is not uncommon and can really set you back. in addition to specialty loading of premiums by risk, the different types of work performed can also have an impact and it is really important that you clearly separate out any income that is covered by nHS crown insurance or you could be paying excessively.
i t is important that when you obtain your admitting rights, you are proactive in putting the word out. Most private hospitals have
teams to look after new consultants in that regard, but you may have to do some of the leg work yourself, particularly on the selfpayer side of things. a good website and use of social media can be the deciding factor in the digital age we work in. However, there is often little substitute for meeting with groups such as g Ps and building your network of referrers in person.
t here can often be significant benefits to working together in a group, so find out whether this is happening within your area and specialty. not only could working with others provide an enhanced level of private work, it often provides much-needed support and can save costs.
Working together can be simply cost-saving or could go much further to include sharing income and profit, so do your homework,
as it may not be as much commitment as you think.
Don’t do it all yourself
t he temptation can often be to do as much as you can, but if this results in you having less time to see patients, there can be a substantial cost in lost revenue. Consider if you need help. it can be particularly beneficial to use the services of a spouse, which is often tax-efficient as well.
Don’t work for free
Within private medicine there should be a low risk of not getting paid. Before seeing a patient, it is important that their insurer has authorised the procedure and you invoice them at the agreed rate. For self-payers, the policy of paying up front is very common and can limit your exposure to bad debts.
Ian Tongue is a partner with Sandison Easson chartered accountants
It’s like sitting in your own private club! For independent practitioners who can get their driving thrills elsewhere, this Audi ticks most boxes for business and family needs, says Dr Tony Rimmer (right)
As we all know in independent medical practice, it takes a long time and plenty of hard work to build up a reputation for excellence.
However, once reached, this is quite a fragile position to be in. It takes only a mild slackening off or a few publically-aired reports of poor service to threaten this hardfought character.
In the world of cars, premium brand Audi is always looking over its shoulder at competitors like BM w, Mercedes and – most recently – Jaguar, who constantly edge closer with regard to high build quality both inside and out. e very new model is a new challenge and standards cannot slip. w hen Audi released the midsized Q5 sUV in 2009, it seemed like it was taking a big risk. This was a new market sector. would people pay more for a car with the same space as a conventional estate car but with a rugged and more ‘off-road’ appearance? well, lots of people have and it turns out that Audi got it just right. BM w and Mercedes were quick to respond with the X3 and GLC models and we now have the excellent Jaguar F-Pace challenging too (see our May edition).
Audi has released an all-new Q5 that is lighter and more efficient than the model it replaces
However, nothing stands still and Audi has released an all-new Q5 that is lighter and more efficient than the model it replaces. It also benefits from all the newest high-tech electronic equipment that is a must in the world of premium vehicles.
It is available with either a 2.0 litre diesel engine producing 148bhp, 161bhp or 187bhp, depending on the state of tune, or a 2.0 litre petrol engine producing 250bhp.
High-tech equipment abounds and notable features include the adaptive cruise control and the virtual cockpit with head-up windscreen display
For those with a thirst for more performance, there is a 3.0 litre V6 diesel model with 282bhp and the range-topping £51,200 s Q5 with a 3.0 V6 petrol engine producing 349bhp. Audi predicts most sales will be of the more fuel-efficient diesel variants
However, in the current environmental mist of distrust of all things diesel-powered, particularly V w group products, I thought it apposite to review a petrol-powered version of the new Q5. My test car was the £40,170 2.0 TFsi s line with the 250bhp four-cylinder petrol turbo engine. All Q5s have Audi’s Quattro
ultra four-wheel-drive system that, when cruising, allows drive to the front wheels only. This reduces friction and increases efficiency. The s-Tronic dual-clutch automatic box shifts smoothly between seven available ratios.
It is very difficult to make an s UV look stylish, given the upright dimensions, and the new Q5, although benefiting from more angular lines, is not going to turn many heads.
The Audi family front grille is quite imposing and the smart LeD lights give it some individual character.
It is in the cabin that Audi wins most fans and the new car does not disappoint. An excellent driving position, comfortable seats and high-quality dashboard materials make you feel like you are sitting in a private club. Rear passengers get a great deal too. Plenty of headroom and the ability to slide the rear seats fore and aft as well as reclining only adds to the feeling of luxury. High-tech equipment abounds and notable features include the adaptive cruise control and the virtual cockpit with head-up
windscreen display. Be careful though, options are expensive and, like my test car, you can end up paying an extra £10,000 quite easily.
Out on the road, the Q5 immediately impresses with the supremely comfortable and quiet way that it goes about its business.
My test car had the optional adaptive air suspension and although it is pricey at £2,000, it transforms the fidgety ride of lesser models into a limousinelike experience.
You could travel many hundreds of miles in this car without blinking and it is the closest to an Intercity Pullman train than anything I’ve experienced before.
The downside to this smoothness is that, off the motorways, the Q5 is not a great performer on twisty roads. The steering feels numb and body control becomes a bit wallowy. s elect Dynamic mode and unfortunately not a lot changes.
I have to praise the engine though. Despite having only four cylinders and being only 2.0 litres in size, it performs very smoothly and quietly. Although the petrol unit lacks the torque of diesel versions, performance is surprisingly
good. I certainly did not miss the start-up rattle of a diesel engine either.
s o the new Q5 is a supremely well made comfortable and practical premium family sUV. It does everything really well, but does not excite the keen driver.
You will need to look towards top of the range Jaguar F-Pace models and the Porsche Macan to get some dynamic satisfaction from your driving. But for independent practitioners who can get their driving thrills elsewhere, this Audi ticks most boxes for business and family needs.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
An excellent driving position, comfortable seats and high-quality dashboard materials make you feel like you are sitting in a private club
Body: five-seat hatchback suV
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Like a lot of other specialties, cardiologists are having to work harder to get any growth – or even stay still. Ray Stanbridge reports
Our latest unique survey of consultant cardiologists’ earnings shows gross income has increased by about 5.1% between 2014 and 2015.
It rose from £135,000 to £142,000. But costs have increased by about 7.5% between the two years. as a result, profits for the year have risen by about 3.7% from £82,000 to £85,000. this figure is very much in line with our forecast in the september 2016 report.
What are the causes of these changes?
Our view is that, in the long term, cardiology is a growth area and the market is likely to expand. a t the same time, insurers are putting pressures on cardiologists’ fees.
the growth in income is therefore primarily explained by a volume increase in activity rather than a price increase. as with other disciplines, cardiologists are working harder to achieve the same incomes.
Costs have shown some
aveRage INCOMe aND eXPeNDITURe OF a CONSULTaNT CaRDIOLOgIST WITH aN eSTaBLISHeD PRIvaTe PRaCTICe
Expenditure
Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)
increase, particularly with respect of medical suppliers/assistants fees, professional indemnity costs and staff costs – there is a link between family staff costs and the growth in the personal allowance. as we reported earlier, there has been a significant increase over the years in industry insurance costs from the traditional market leaders.
New providers have appeared on the market and, for some, indemnity costs have stabilised and even have shown some signs of a decrease.
Most other costs have remained fairly constant, including ‘other’ – which are primarily advertising and promotion.
What then of the future? a preliminary review of figures for the year to a pril 2016 suggests that cardiologists’ income from private practices has continued to rise.
Changes in the 2015-16 year are, however, seeing the first signs of additional cost pressures resulting from the Competition and Markets authority (CMa) rulings implemented from april 2015. We are still seeing continuing signs of interest from cardiologists in forming groups, but per-
Source: Stanbridge Associates Ltd. RaNge OF gROSS INCOMeS
Some younger consultants are choosing not to enter private practice but rather to undertake additional work through Paye
haps not as much actual activity as we would have anticipated. the london market is perhaps different from the rest of the country and there are distinctive signs of potential consolidation of practices here.
In the country, we are perhaps seeing some signs of other developments – that of growth and employment. some younger consultants are choosing not to enter private practice but rather to undertake additional work through PaYe t he advantages are that a home-work balance can better be planned, defence cover costs can be saved, and room hire/secretarial costs will not be incurred.
expect to see much more of this phenomenon in coming years.
Despite this change, we anticipate continuing growth in the average private cardiology practice over the next few years.
a s we stated in our s eptember 2016 report: ‘Consultants are changing the way they are trad-
ing. For example, there are fewer sole practitioners and more groups and other consultants have incorporated.
‘the significant market changes, including growth of Choose and Book, other NHs expenditure in the private sector and heavy insurance pressure on fees – which has
accentuated from about 2012 –have all had an effect on results.’
t his means that our survey, which has never been statistically significant, is ever becoming more difficult to compile. We are searching for better ways to present data.
Nevertheless, for the purpose of this report, we have retained our old style, trying to make some adjustments to reflect changing market situations and organisational structures.
a s regular readers will know, our survey is restricted to consultant cardiologists who are not in full-time private practice.
Our sample includes those who: Have had a five-year private practice experience;
Have held either a maximum part-time or a ‘new’ consultant contract in the NHs;
are seriously intent in promoting private practice as a business;
earn at least £5,000 in the private sector including Choose and Book but not paid through PaYe;
May or may not have incorporated or be a member of a group.
Next month: ENT surgeons
Ray Stanbridge is a partner with accountancy, finance and tax advisory medical specialists Stanbridge Associates
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Business Dilemmas: advice on closing your private practice, your responsibilities and the issues you need to consider. We also answer a reader’s query about accepting gifts from patients
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a surgeon shows how to sell your expertise – without being salesy
What is your financial adviser worth to you? Dr Benjamin Holdsworth, of Cavendish Medical, explains the added value which comes from engaging a professional
eNT surgeons’ latest earnings come under the microscope in our latest Profits Focus
Business advice from a retiring consultant to a new private doctor
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