September 2018

INDEPENDENT PRACTITIONER TODAY

The

In this issue

Benefit from being betimes

There are big advantages in filing your tax return early, an accountant explains P14

Put your best face forward Expert advice on what to avoid when creating your vital website P27

By Robin Stride

Performance measures for the first batch of 1,000 consultants to be featured on an official website for all to see were set to at last go live as Independent Practitioner Today went to press.

Publication marks a notable shift in openness in private healthcare and is a milestone for the Private Healthcare Information Network (PHIN) which was forced to delay its original plans over the summer.

Efforts to show ‘a meaningful set’ of performance information for a minimum of 1,000 consultants by the end of July were foiled by what it called ‘technological challenges with our platform’.

Some consultants were unable to review and approve their measures as a result, so PHIN fell short of its four-figure target before the holiday period. It was twice forced to extend the data validation window by several weeks.

Chief executive Matt James told specialists after the initial delay: ‘We take responsibility for this and apologise for the frustration which a number of consultants have experienced.’

More consultants were still needed to give the all-clear earlier this month, but the number was said to be ‘very close’ to triggering an Autumn live launch.

With nearly 5,000 consultants having logged in to PHIN’s portal to check information provided by private hospitals, correct errors and give feedback, a spokesman for the data body paid tribute to the doctors involved.

He said: ‘All systems are now “go”. We are starting to see a notable shift in the medical profession towards embracing transparency and this is an indicator to that.

‘We want to thank those leading consultants who are signing up to it and encouraging others to sign up too.

More than 10,000 practitioners have now joined technology specialist Healthcode’s project to support private practice since its launch two years ago.

Healthcode’s managing director Peter Connor said the milestone number of profiles on the Private Practice Register (PPR) meant the company was ‘well on the way’ to producing a game-changing definitive online directory for the private healthcare sector.

He added: ‘I’m confident the rest

will sign up when they see how PPR will support their practice.’

PPR already offers consultants and other healthcare professionals a straightforward path into private practice by streamlining applications for private medical insurer recognition.

Practitioners complete just a single online form covering all the necessary information and select the insurers they wish to register with for recognition.

They can highlight their clinical

Matt James, head of the Private Healthcare Information Network

September sign-up

to improve the data available on healthcare.’

Mr James said: ‘There has been a huge, positive shift from the sector towards greater transparency, and we are thankful to those consultants who have supported this process already.’

‘And we want to encourage other leading doctors to engage in the process, review their data and look ➱ continued on page 4

expertise and access Healthcode electronic billing and secure messaging services to help their practice management.

PPR is tipped to be an industrywide resource as private hospitals use it to enhance communication and efficient working with doctors and insurers.

Doctors will use it as a secure gateway to apply for practising privileges – eliminating the repetitive paperwork usually involved.

➱ continued on page 4

In this issue

is your practice ‘all systems go’?

Jane braithwaite’s second article in her practice management series looks at what it systems you need to run your private practice efficiently and at the processes you must streamline P16

doctors are doing for themselves a consultant experienced in equity participation schemes reviews the options for doctors interested in investing in their own healthcare service firm and offers advice P18

transparency is clear to see transparency isn’t an ambition; it’s a reality that will drive consistency in patient-reported outcome measures and quality of care for patients, says prof carl philpott Philpott P23

editorial comment

Here to help you get on

Helping you keep on top of things and to prepare for change has always been one of our key aims here at Independent Practitioner Today

Every month there are yet more demands on your time. In this issue, we highlight a range of new requirements or developments needing independent practitioners’ attention and consideration.

These include checking and signing off your Private Healthcare Information Network (PHIN) data, chasing pension statements to avoid a shock tax hit and – for those who have not done it yet – evaluating whether to sign up to Healthcode’s Private Practice Register (PPR).

All this and more mean some business basics can get overlooked for longer than they should be.

So we would draw your attention to two other issues we fea­

Bupa’s bid to make cover affordable dr Luke James, the newly appointed medical director of the UK’s leading medical insurer, sets out his focus for the future, including bupa’s relationship with consultants P32

ensure patients know your terms With the requirement for greater fees tranparency and recent General data protection regulation, many independent practitioners would do well to review their terms P34

When saying goodbye to staff recent employment law changes are particularly relevant to employers managing negotiations and the financial entitlements of departing employees, a lawyer advises P38

ture this month that for many readers will be worth sorting sooner rather than later.

We are regularly surprised to find some practitioners soldiering on without an online presence. And those that do have a website are often forgetting to keep it up to date, do not use their photos or display a seemingly permanent ‘website under construction’ message.

Why not give your website a health check, using our feature on page 27 for some excellent suggestions to help you showcase your practice better and attract patients.

Then there is your tax to think about. As our article on page 14 points out, getting ahead now with your tax affairs will save you much hassle next January. Another tax factor to consider is the looming ‘Making Tax Digital’ project (page 46): ‘the biggest shake­up in the tax system since self­assessment’.

Business dilemmas: Preserving privacy when publishing a medico-legal expert explains the importance of anonymising cases in medical publications P44 doctor on the road: Welcome to augmented reality our motoring correspondent dr tony rimmer takes a look at the new mercedes-benz a-class P50

Profits focus: earnings all pumped up our unique benchmarking series looks at the financial fortunes of cardiologists P52

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

SUBScriPtion rateS

£90 independent practitioners. £90 GPs and practice managers (private & NHS). £210 organisations. Save £15 paying by direct debit: individuals £75 (organisations £180). to SUBScriBe – USe SUBScriPtion form on Page 24 or email: lisa@marketingcentre.co.uk Or phone 01752 312140 Or go to the ‘Subscribe’ page of our website www.independent-practitioner-today.co.uk chief sub-editor: Vincent Dawe Head of design: Jonathan Anstee Publisher: Gillian Nineham at gill@ip-today.co.uk Phone: 07767 353897

Get NHS pension quote now to avoid tax shock

By edie Bourne

Thousands of doctors could face a shock tax hit unless they actively now request their pension statement for the 2017 ­ 18 tax year from their NHS pensions agency.

That is the urgent message from specialist medical financial advisers Cavendish Medical to Independent Practitioner Today readers who have health service jobs.

The ‘annual allowance’ limits the amount of tax ­ free pension savings which can be accrued each year to £40,000. Pensions agency letters each autumn detail doctors’ annual pension contributions for the preceding tax year – but only if the doctor has ‘deemed growth’ in their pension pot of more than that figure.

But – as the firm’s experts have

previously advised – a ‘tapered’ annual allowance for those with adjusted earnings over £150,000 reduces this figure further, down to as low as £10,000 for highachieving doctors.

And the NHS will not issue letters to individuals breaching this particular cap.

Patrick Convey, technical director at Cavendish Medical, warned:

‘Senior doctors may easily breach the “taper” with annual pension growth of more than £10,000 and yet may not even realise, as they will not receive official notification from the NHS. Remember that excess pension savings are taxed at your marginal rate of income tax.

‘Unless you act now, you could discover all too late that there is a substantial tax charge to pay.

‘You should request your own statement as soon as possible – the pensions agencies are not the quickest to respond and you will need to allow time for all the calculations to be checked thoroughly before your next tax submission. Many of the statements we have seen have been wrong.’

HM Revenue and Customs (HMRC) calculates the contributions for a defined benefit scheme such as the NHS very differently to that of a private pension.

These figures are based on the deemed ‘growth’ of the pension in that year rather than the actual contributions, with an allowance made for inflation. The statements are therefore difficult to understand and mistakes can go unnoticed.

Mr Convey said it was easy for

doctors to breach annual allowance caps – either standard or the new tapered version – with a pay rise or clinical excellence award.

‘Don’t forget that any private pension contributions will also count towards whichever level of annual allowance is relevant to you and that your NHS pensions agency will not be aware of them.

‘Note also that those breaching the annual allowance can apply for the NHS to pay the tax charge under “Scheme Pays” in exchange for reduced future benefits.

‘However, this option is not available for those breaching the tapered annual allowance – a further complication to consider.

‘As in all matters financial, forward planning is the key to avoid unpleasant situations and unnecessary tax bills.’

Consultants ‘bullied to agree job plans’

Over half of consultants have had a negative experience in their last NHS job planning meeting – and almost a quarter have experienced related bullying, a survey has revealed.

The BMA found 28% thought inappropriate techniques had been used to get their agreement.

Black, Asian, minority ethnic (BAME) women had the worst experience of job planning, with 39% reporting they were bullied at their last job planning meeting. 81% of BAME women disagreed that job planning was used effectively.

Of all groups whose data was analysed, BAME men had found meetings most antagonistic since electronic job planning was introduced, with 40% responding that they found meetings much more antagonistic.

NHS Improvement produced unilateral job planning guidance last year that directed all trusts to move to electronic job plan systems.

The BMA said: ‘While it is important to note that electronic job planning software is not the cause of bullying during job planning, it has been suggested that the rapid, mandated adoption of the software and the collation of the data centrally may have led to overzealous scrutiny of consultants’ programmed activities (PAs).

‘These results align with trends exposed by the widespread national 2017 NHS Staff survey which showed that bullying and harassment remains an extensive problem in the health sector with 24% of all NHS staff – one in four people – having reported that they have experienced bullying in some way.’

BMA consultants’ leader con ­

sultant anaesthetist Dr Robert Harwood said: ‘While we had heard anecdotally that this was an issue in some trusts, we did not know how widespread it was. These figures are troubling and show that there is a clear issue with bullying.

‘Particularly worrying is the numbers of BAME women who have been bullied during the electronic job planning process. This is unacceptable and cannot be tolerated.’

He said the survey did not explore the consequences of undue pressure or bullying during job planning, but it was not unrealistic to suggest that it might be linked to stress, burn ­ out and early retirement.

The BMA wanted to ensure there was a clear understanding of the issues and people were confident to raise concerns and report problems when they happened.

Bma consultants’ leader dr robert Harwood, a consultant anaesthetist

Reassurance from new Aspen owners

By Robin Stride

The new United Arab Emirates (UAE) owner of nine private hospitals in England and Scotland has told Independent Practitioner Today it greatly values its doctors and ‘lays significant stress on their clinical capabilities’.

NMC Healthcare UK’s message came after it acquired 100% of Aspen Healthcare’s equity from US operator Tenet Healthcare for an enterprise value of only £10m.

A spokesman said: ‘The company recognises that the more skilled the clinicians, the better the patient experience, aptly reflecting NMC’s motto of “Every patient counts. Every employee matters”.’

Aspen’s facilities include:

 Cancer Centre London;

 The Chelmsford Day Surgery Hospital;

 Claremont Private Hospital, Sheffield;

 The Edinburgh Clinic;

 Highgate Private Hospital;

 The Holly Private Hospital, Buckland Hill, Essex;

 Midland Eye, Solihull;

 Nova Healthcare, Leeds;

 Parkside Hospital, Wimbledon.

The sale means Tenet now has no operations in the UK. NMC, with facilities in 17 countries, said its acquisition gave it a very cost-

Dr Tony Lopez, chief executive of Incorporated Health Ltd

effective means of rapidly introducing its fertility services to Aspen hospitals.

It added: ‘NMC’s management sees significant opportunity for driving margin and earnings growth at the newly acquired facilities. However, while capital expenditure is planned for the Aspen facilities, NMC does not currently intend to invest in other non-fertility based healthcare facilities in the UK.’

Dr Tony Lopez, chief executive of Incorporated Health Ltd, said: ‘As a 25.5% shareholder in the new molecular imaging depart -

ment of Parkside Hospital’s Cancer Centre London unit in Wimbledon in partnership with 20 consultants and Aspen Healthcare, my company is unclear what NMCs’ plans are for the new fixed facility PET CT scanner – Aspen group’s first in the UK – planned for the first quarter of 2019, but intends to complete the installation.’

NMC said Aspen was particularly recognised in orthopaedics and oncology, representing half of the company’s revenues.

‘Both segments remain highly underserved in the UAE, thus offering the dual benefit of knowledge transfer as well as potential for patient referral to NMC’s own international facilities when the required medical treatment is unavailable in the country.’

NMC, among the top four healthcare operators in the world by market capitalisation, has been listed on the London Stock Exchange since 2012 and is a FTSE100 index member.

Tenet announced plans over a year ago to sell some US hospitals – and the UK operations it bought only in 2015 for $215m – to cut debt.

A number of potential buyers showed interest but Aspen’s eventual sale figure has come as a big shock to consultants.

Eminent boss for register project

Healthcode has appointed Fiona Booth, former chief executive of the Association of Independent Healthcare Organisations (AIHO), to help transform technology use in independent hospitals. She will oversee the launch and development of the Private Practice Register (PPR) [see page 1] and consult with hospital groups and industry representatives to

ensure the programme meets their needs.

Ms Booth said she was excited about PPR’s potential to redefine the administration of practising privileges, procedure credentialing and adverse incident recording.

She said it directly addressed the challenge of governance and demonstrated how seriously everyone in the sector took patient safety.

Fiona Booth, former boss of AIHO

PHIN to sign up all docs who admit

PHIN boss Matt James said his organisation would continue working with hospitals and consultant bodies to ensure all consultants with a private practice supported the initiative.

PHIN said it recognised the project so far was a unique process of reviewing and validating data covering over 750,000 episodes of admitted care delivered across the UK each year, and this would take time to get right.

The project is working towards publishing performance data for all the estimated 14,000 consultants admitting patients privately. Measures range from patient satisfaction and reported outcomes through to adverse event rates.

Next year, PHIN aims to publish fee information for a wider group of consultants, including those who see only outpatients.

PHIN was tasked with its work following a long-running private healthcare inquiry by the Competition and Markets Authority.

A growing chorus is calling for greater transparency and, if acted on, this will help improve the quality of care for patients and drive patient safety, a leading doctor writes in this issue.

Prof Carl Philpott, honorary secretary of ENT-UK, says: ‘I am deeply encouraged by the momentum now starting to build in driving transparency in private healthcare.

‘In the work I do with ENT-UK, and acting as professionalism lead at Norwich Medical School, it is clear that for the next generation of healthcare professionals, transparency in performance data and patient health outcomes data will be commonplace.’

He adds: ‘As transparency takes a significant step forwards through the publication of initial consultant performance data in private healthcare, it will be up to us to continue to make transparency a reality’.

 See page 23

➱ continued from front page

➱ continued from front page

London to get new private hospital

By Charles King

Another new private hospital for London is on the way.

Nuffield Health’s £60m 48-bed new facility, scheduled to open in 2021, will be its only hospital in the capital.

It will specialise in cardiac surgery, cardiology and general surgery.

The charity is renovating the dilapidated former pathology and residential staff quarters buildings at London’s oldest hospital, St Bartholomew’s, Smithfield.

It will be physically and operationally independent from Barts Health NHS Trust, which runs St Bartholomew’s Hospital, and staffed entirely by Nuffield Health.

The development, promoted as the only independent hospital in the City of London, will have four operating theatres and 28 consultation rooms.

Nuffield chief executive Steve Gray said: ‘This is an exciting development for London. We will be working alongside one of the largest heart hospitals in Europe and some of the very best consultants.

‘By connecting up with our existing fitness and well-being clubs and the numerous workplace well-being facilities we run in London, we can provide more people with consistently excellent, personalised care in a modern setting.’

The arrangement provides Barts Health with a multi-million-pound

revenue that it will invest back into NHS services and also retains the historic building’s original façade.

Barts Health NHS Trust chief executive Alwen Williams said: ‘This is an excellent opportunity for our patients to directly benefit from private patient activity at Nuffield Health, as we invest surpluses generated to the trust back into our NHS services.’

Buildings on the site have been out of operational use for many years. One of these became a cult location for fans of the BBC series Sherlock adaptation after the fictional detective leapt to his ‘death’ from the former pathology building in the final episode of the second series.

Mental health help for employers

The Royal College of Psychiatrists has produced a special pack of mental health information for employers and employees covering the most common range of conditions such as depression, anxiety and sleeping problems.

New taxman powers are condemned

A tax specialist has attacked a proposal for tax officials to be allowed secret access to taxpayers’ bank accounts in a range of new measures being suggested to crack down on tax evasion.

David Redfern, director of DSR Tax Claims, called it an unreasonable invasion of taxpayers’ privacy and urged HM Revenue and Customs (HMRC) to reconsider this proposal.

A policy document suggests allowing HMRC access to taxpayers’ banking information to see if the correct amount of tax has been paid.

Mr Redfern said although HMRC was correct to crack down on tax evasion, it was overreaching its powers with this proposal.

He added: ‘HMRC already has the right to access the financial information of taxpayers and can request an Information Order should the evidence deem it necessary. But, to allow HMRC to have secret access to financial information is an alarming suggestion and is a further step towards eroding the civil liberties of UK taxpayers’.

HMRC had said it believed these powers would be used only for a few hundred cases per year and so shouldn’t cause much concern.

It is accepting comments on the proposal until 2 October.

New director for Spire Nottingham

Andy Davey is the new director at Spire Healthcare’s £65m Nottingham hospital.

The pack also covers serious mental illness such as schizophrenia, bipolar disorder and personality disorders.

College president Prof Wendy Burn said: ‘It makes sense for businesses to look after the mental health of their employees.

‘It can make a real difference if they have the right information to

There is also information on seasonal affective disorder, obsessive compulsive disorder, post-natal depression and mental health in pregnancy, self-harm, and eating disorders such as anorexia and bulimia.

hand, if they can say to an employee who is experiencing a mental health issue “we understand”.

‘And it can make a difference if they are able to support, and are able to direct that person to the right place, where they can get the best advice and help.’

Employers can find details of, and order copies of, the information pack at www.rcpsych.ac.uk/ employers.

The unit has 42 private en-suite rooms, 11 day-case beds, 4 theatres including a hybrid theatre, endoscopy suite, on-site MRI, CT, X-ray, ultrasound and mammography, physiotherapy, pharmacy and 300 free car parking spaces.

He said: ‘We are the only CQC Outstanding private hospital in Nottinghamshire and the services and consultants that work with us, combined with this state of the art facility and superb staff, are second to none.’

Nuffield chief executive Steve Gray and the disused former pathology block at Barts Hospital (left)

Brain surgery robot UK first for Harley St

By Olive Carterton

The Harley Street Clinic has notched up a UK first with its introduction of the new minimally-invasive neurosurgery technology, Visualase, to treat patients with complex and aggressive brain tumours.

HCA Healthcare UK said this pioneering technology offers hope to a significant number of patients with difficult-to-access brain tumours who are refused conventional surgery because it is considered too harmful to the surrounding healthy tissue, leading to lasting brain injury.

Neurosurgeons using this new equipment can target, treat and monitor using large-screen monitors which superimpose real-time MRI images of the brain tumour, resulting in greater success rates.

The minimally invasive proce-

Compiled by Philip Housden

Poole’s inpatient PPU closes

The trust’s private patient activity has been based on the six-bed private inpatient ward, Cornelia Suite, opened in 2012.

In the first full year of trading, the trust achieved income of £2.4m at 1.3% of total trust revenues. But latest annual accounts show revenues in 2017-18 were down £114,000 and 5.7% year on year, at £1,897,000 and 0.9% of trust total income.

A spokesperson said: ‘In recognition of lower than anticipated bed utilisation, we have made the difficult decision to cease providing the inpatient element of our private services from August while options are explored.

‘Affected ward staff have been

dure also reduces infection risks, requires shorter hospital stays –typically one day compared to five to ten days after open brain surgery – improves recovery time for patients and reduces scarring.

The Visualase technology, developed by healthcare innovator Medtronic, delivers laser energy to target and destroy brain tumour cells by heating the unwanted tissue. It is administered through robotic device ROSA (Robotic Stereotactic Assistance).

Mr Ranjeev Bhangoo, consultant neurosurgeon at The Harley Street Clinic and part of London Neuro surgery Partnership, said the acquisition of Visualase was a significant moment for the clinic and the treatment pathways its surgeons were able to offer their patients.

‘This technology offers another option for patients who have

retained and continue to work within the surgical division and the private patients’ office team remains in place, tasked with identifying and creating new ideas in this area, and supporting our ongoing private outpatient and day case services.’

Poole’s recent experience contrasts with that of Royal Bournemouth where private patient activity is growing.

As the two trusts are working on plans for merger, this may provide the best opportunity for private inpatient services to be kick-started on the Poole site in the future.

Improved complaints system

NHS PPUs are being reminded that the Health Service Ombudsman will not deal with complaints from their private patients.

For this reason, the long-established independent sector equiva-

exhausted all other treatment possibilities. A very significant number of brain tumour patients are refused surgery because surgery will damage surrounding tissue, and Visualase is now a new alternative we can offer these patients’.

Harley Street Clinic consultant neurosurgeon Prof Keyoumars Ashkan said: ‘Visualase technology brings together laser-assisted brain surgery with robotics through a keyhole approach.

‘Precision of the laser delivered under real-time MRI control allows safe treatment of brain tumours in locations previously

lent, the Independent Sector Complaints Adjudication Service (ISCAS), has stepped into the gap.

PPUs are being encouraged to subscribe to ISCAS, with access to its resolution process, including final adjudication by an independent expert to give a result binding on both patient and provider.

The emphasis is upon finding what went wrong and putting it right. Any goodwill payments to patients relate to the inconvenience suffered. There are no charges to a patient

PPU part of winter planning

East Kent Hospitals University Foundation Trust will use spare capacity in its Spencer PPU at the Queen Elizabeth, the Queen Mother Hospital, Margate, for NHS planned surgery to free up space for emergency patients.

The trust said it did not expect

considered not possible to treat. The accuracy of robot integrated in the work flow is essential for directing the laser beam to exactly where it is needed in the brain.

‘The minimally invasive keyhole nature of the whole process allows fast recovery from the therapy with minimal length of stay in the hospital. Visualase will benefit patients with a range of neurological and neurosurgical disorders, especially those with epilepsy or brain tumours.

‘We are delighted to be the first in the UK to make this therapy available to our patients.’

this to affect the private patients service or the income from this.

In the first six months of 2018, the trust cancelled 359 planned operations – the highest number in the South-east.

The 2017-18 trust annual accounts record a dip in private patient revenues last year, down £635k to £2.7m, a fall from 0.66% of turnover to 0.52%, the lowest since 2012-13.

PPUs can successfully run a ‘mixed model’ if they protect private patient demand and proactively ‘pull in’ NHS planned cases in line with usual case mix and ward team skills. Mixed model business cases deliver surpluses that fund more onsite bed capacity that can ease winter pressures.

Philip Housden is a director of Housden Group. Read his feature article on page 36

PPU watch

Neurosurgeons Prof Keyoumars Ashkan and Mr Ranjeev Bhangoo

The Visualase technology superimposes real-time MRI images

Media advice calls rise

By Robin Stride

Doctors are being advised to be switched on to the potential downsides of taking part in the surge of new publicity opportunities offered by electronic media. Defence body the Medical and Dental Union of Scotland (MDDUS) says it frequently receives calls for advice about engaging with media producers and these types of calls are on the rise.

It suggests doctors should think carefully before agreeing to take part in broadcast/social media, check details of any proposal care-

fully and ensure the activity complies with GMC guidance.

If doctors also have an employed contract, the union advises they should check with their employer before agreeing to participate.

Doctors’ queries with the MDDUS include the following common scenarios:

 Requests to participate in online channels with real-time comments on popular TV programmes. Producers often are just looking for a personal view but in the context of being a medical professional;

 Contributing to online blogs or publications, not directly related

to professional practice, but which would state professional qualifications;

 Patients with complex histories who agree to be ‘followed’ for a documentary. Media bosses want GPs and consultants involved in their care to be filmed during consultations and interviewed about the patient’s condition;

 Requests from friends to add clinical content to a blog about a medical condition.

MDDUS medical and risk adviser Dr Gail Gilmartin said medical and dental professionals were not forbidden to take part in any of these activ-

More recruits for clinic at forefront of ‘salary’ trend

Six more consultants have joined Schoen Clinic London, the new private spinal and orthopaedic hospital that is giving specialists a salaried option.

They are consultant spinal surgeons Mr Stewart Tucker, Mr Hanny Anwar and Mr Alex Montgomery, plus consultant orthopaedic surgeons Mr David Sweetnam, Mr Ali Abbasian and Mr Giuseppe Sforza.

Around 100 London GPs, physiotherapists, osteopaths and chiropractors plus private medical insurer representatives took the opportunity for a champagne reception and preview of the Wigmore Street hospital ahead of its opening.

Guests toured the facility including the outpatients department with ten consulting rooms and two minor procedure suites, three lam-

inar-flow theatres, day-case suite and 39 ensuite bedrooms.

A diagnostic suite with MRI, CT and X-ray, and onsite physiotherapy department with 4D scanner, isokentic and spinal strengthening equipment are also housed in the new hospital.

The hospital offers a new model for employing consultants on a full-time or part-time basis, as well as welcoming consultants who wish to practise independently.

Mr Sweetnam joins as head of department, bringing with him over 20 years’ experience as a highly specialised consultant and a passion for the non-surgical management of knee conditions.

London adult and paediatric spinal surgeon Mr Tucker also joins as one of the clinic’s senior consultants and heads of department. He will work at Schoen Clinic

alongside his NHS post as clinical lead at Great Ormond Street Hospital for Children.

Mr Montgomery is also a consultant spinal and orthopaedic surgeon at St Bartholomew’s and Royal London Hospitals where he established its Spinal Unit.

The hospital said Mr Anwar was unique in having been fellowship trained both in orthopaedic and neurosurgical spinal surgery.

Mr Abbasian brings experience from his NHS practice at Guy’s and St Thomas’ NHS Foundation Trust where, as one of the largest and busiest tertiary referral teaching hospitals in the country, he regularly accepts referrals from other orthopaedic centres.

Mr Sforza specialises in arthroscopic shoulder surgery and the rehabilitation of shoulder and elbows.

ities but it was essential to remember that anything they do is judged against professional standards.

Doctors should remember that the GMC places great emphasis on maintaining public confidence in the profession and takes seriously any doctor’s activities which could bring the profession into disrepute.

Where patients are directly involved, their informed, documented consent is essential.

Doctors are advised that if anonymised data is used, or filming occurs in a medical setting, to beware of inadvertent confidentiality breaches.

Nuffield links with cancer care provider

International cancer care provider GenesisCare and Nuffield Health have signed a new partnership to provide oncology diagnosis, care and treatment.

The alliance will co-design and implement cancer care pathways for patients in the UK, including expanding existing operations and improving access in underserved regions.

They will explore opportunities to invest in advanced oncology technology, the latest treatment techniques and diagnostics and other holistic services.

Aldo Rolfo, GenesisCare’s executive manager of Europe, said: ‘The partnership will enable us to lead the way in innovation and open up access to the latest medical technology for people with cancer.’

One new treatment that will be available through the partnership is SpaceOAR hydrogel, a new intervention that helps to reduce the side-effects of radiotherapy treatment for prostate cancer.

This innovative, minimally invasive, procedure implants a biodegradable water-based hydrogel prior to prostate radiotherapy significantly reducing the radiation dose to other nearby tissues.

Surgeons Stewart Tucker, Hanny Anwar, Alex Montgomery, David Sweetnam, Ali Abbasian and Giuseppe Sforza

Brain clinic grows its trials services

By Leslie Berry

Pioneering brain and mind clinic

Re:Cognition Health has expanded its international clinical trials services for Alzheimer’s disease and other related cognitive conditions into the US.

The new centre in Fairfax, Virginia, will provide access to the best healthcare and treatment options for people living with, or at risk of developing, Alzheimer’s disease and other causes of memory impairment leading to dementia.

Re:Cognition Health was encouraged to open in the US due to the success of its UK operation where the clinic is recognised as a leading centre for recruiting patients onto clinical trials for Alzheimer’s disease.

The company is a leading centre for international final phase clinical trials, changing the future for those with memory loss and other symptoms of cognitive impairment.

Chief executive and medical director Dr Emer MacSweeney said: ‘We are delighted to be expanding our Re:Cognition Health centres into the US, giving the opportunity for more people

to gain access to the most advanced treatments available, worldwide. We look forward to offering patients the very best care and access to new emerging treatments.’

Dr James Bicksel, who will lead the clinical trial team, said opening a new clinic for clinical studies for Alzheimer’s disease was a very positive step for the future in fighting this disease.

‘Our patients will have the opportunity to be involved in clinical trials of the next generation of emerging medica -

tions while receiving outstanding medical care by a team of cognitive experts.

‘We are very much looking forward to making a difference to the lives of people in Virginia and Washington DC.’

Re:Cognition Health is a member of the Global Alzheimer Platform (GAP) Foundation, which is establishing a standing world-wide trial-ready platform to drive quality, efficiency and innovation in clinical trials, seeking to reduce clinical testing cycle times by two years or more and to

‘Cautious optimism’ for the future

Chief executive and medical director Dr emer macsweeney said: ‘With every study conducted, we understand more about the disease and become closer to finding a successful treatment and ultimately a cure for alzheimer’s disease.

‘however, we must make an early, accurate, diagnosis and act quickly to have a chance to change the future.

‘With the introduction of new biomarkers to detect evidence of alzheimer’s disease at its earliest stage, there is reason for cautious optimism that new generation medications will delay progression of disease and also boost cognition.

‘Just as research through clinical studies has improved our outlook for numerous diseases, including previously fatal infections and certain forms of cancer, the same action is being taken today for alzheimer’s disease.’

achieve greater uniformity in trial populations.

It is doing that by building large, well-characterised trialready cohorts, a network of certified high-performance clinical trial sites and an adaptive proofof-concept trial mechanism.

The company specialises in the diagnosis, treatment and care of people showing symptoms of cognitive impairment or mental health concerns.

UK clinical services include traumatic brain injury, neurology, children’s neurological conditions and learning disabilites, Alzheimer’s, other cases of dementia, and mental health conditions.

The Re:Cognition Health Clinics UK centres in London, Essex, Surrey, Birmingham and Plymouth are also major centres for international trials of disease-modifying and new symptomatic drugs for Alzheimer’s disease and other neurological conditions.

Plans are underway for continued national and international expansion.

Under 1% pay rise branded ‘insulting’

Paltry pay rises due next month for consultants with NHS contracts have been branded ‘an insult’ by the leader of the BMA.

Dr Chaand Nagpaul claimed the Government had seriously misjudged the mood of the profession with another sub-inflationary pay award.

He said: ‘The Government’s decision to not implement the recommendations of the Doctors’ and Dentist’s Review Body (DDRB) has been compounded by its

unjust decision to not back-date this pay award to April 2018 for hospital doctors.

‘This is wholly contrary to the definition of an “annual” pay uplift. The Government’s headline figures are inaccurate and misleading for doctors, since this sixmonth pay uplift commencing in October effectively halves its value for the year.

‘Far from the Government claiming to lift the pay cap for public sector workers, most doc-

tors will continue to receive an uplift of 1% or less – and appear uniquely targeted in this unfair manner.’

A BMA poll of over 12,000 doctors in England found more than 90% felt the award was unacceptable. A similar number believed morale had worsened as a result.

According to the association, since 2008 doctors had experienced the largest drop in earnings of all professions subject to pay review bodies, with consultants

seeing a 19% fall in pay, junior doctors 21% cent and GPs 20%.

For some doctors the effective pay increase this year will be as little as 0.75%.

BMA Council chairman Dr Nagpaul said with the NHS facing severe shortages of doctors across all specialties, it was vital for the Government to recognise the contribution declining pay had on doctor recruitment and retention and took steps to reverse this.

 More on the BMA, page 10

Dr emer macsweeney, chief executive of re:Cognition health

Marx marks a GMC first

By a staff reporter

A woman doctor is to become the first female GMC chairman since it was set up 160 years ago.

Dame Clare Marx will succeed Prof Sir Terence Stephenson as GMC chairman in January 2019.

She is the immediate past-president of the Royal College of Surgeons of England, the first woman in college history to hold this role.

Dame Clare said: ‘In the 70th year of the NHS and at a watershed moment for a profession under intense pressure, I look forward to leading GMC’s Council

and working with health partners across the UK in protecting patients by supporting doctors.’

She worked as an orthopaedic surgeon at Ipswich Hospital for

mri scanner drops in

Consultants and patients at the London Clinic are the first in the uK to get access to the new siemens magnetom Vida 3t mri scanner, lowered in through the roof for use this month.

Chief executive al russell said: ‘our multi-million-pound investment provides more appointments and comfort for patients and is a key part of strategy to support our consultants in accurate diagnosis to deliver the best health outcomes for patients.’ the new mri suite is located in its purpose-built cancer centre, the Duchess of Devonshire Wing.

over 20 years before becoming associate medical director for appraisal and revalidation in 2013.

Dame Clare is also chairman of the Faculty of Medical Leadership

and Management, but will step down from that role at the end of this year.

She has stood down as chairman of the independent review of gross negligence manslaughter and culpable homicide in medicine, commissioned by the GMC in February 2018.

GMC chief executive Charlie Massey said: ‘In particular, Dame Clare will play a vital role in driving forward our new strategy, which shifts the emphasis of our work from acting when things have gone wrong to continued support for all doctors in the delivery of the highest standards of care.’

Tax deadline looms to admit foreign assets

Doctors with foreign income or profits on offshore assets are being advised by the taxman to come forward before 30 September to avoid higher tax penalties.

A new ‘Requirement to Correct’ law requires taxpayers to notify HM Revenue and Customs (HMRC) about any offshore tax liabilities relating to UK income, capital gains or inheritance taxes.

But HMRC said some UK taxpayers might not realise they have a requirement to declare their overseas financial interests.

Under the rules, actions like renting out a property abroad, transferring income and assets from one country to another, or even renting out a UK property

when living abroad could mean taxpayers face a tax bill in the UK.

From 1 October, over 100 countries, including the UK, will be able to exchange data on financial accounts under the Common Reporting Standard (CRS). CRS data will significantly enhance the taxman’s ability to detect offshore non-compliance.

The most common reasons for declaring offshore tax relate to foreign property, investment income and moving money into the UK from abroad.

Once a taxpayer has notified HMRC by 30 September of their intention to make a declaration, they have 90 days to make the full disclosure and pay any tax owed.

Too busy to deal with stress

Healthcare workers are among the worst in the UK at taking the time to relieve their stress, according to a survey. Half admit they do ‘little or nothing’ to manage their stress levels.

Most of them say this is due to being too busy, the study by learning marketplace Obby.co.uk found. Company co-founder Tom

Batting said: ‘It’s in bosses’ interests to ensure that employees actually do take measures to manage their stress levels – whether that’s communicating how important this is, allowing them flexi-time so that they can attend whatever activity it is that they do to relieve stress, or even providing classes or workshops for the workforce.’

Dame Clare marx is set to be the new GmC chairman

No-deal Brexit ‘would

harm’ health services

By Leslie Berry

Doctors’ leaders have denied they are scaremongering over warnings of potentially ‘catastrophic’ consequences in healthcare if the UK leaves the EU with a no-deal Brexit.

They set out detailed concerns last month in a BMA paper arguing the result would have an alarming impact on the NHS’s ability to deliver care.

According to the report, a nodeal scenario could threaten widespread harm including:

 The future supply of medicines;

 Delays in diagnosis and treatments;

 The rights and status of EU nationals working in health and research in the UK and vice versa;

 Patients’ access to reciprocal healthcare arrangements both here and in the EU.

Dr Chaand Nagpaul, BMA council chairman, said: ‘The consequences of “no deal” could have potentially catastrophic consequences for patients, the health workforce, services and the nation’s health.

‘The UK Government has finally started planning to ensure the health sector and industry are prepared in the short term for a no deal Brexit, but this is too little, too late and, quite frankly, proof that the impact on the NHS has not received the attention it deserves in the Brexit negotiations.

The GP added: ‘Some will say we are scaremongering by warning of the dangers of a “no-deal” Brexit, but this is not the case. We aren’t shying away from being honest about what is at stake for health services if the UK and the EU fail to reach a deal.

‘As experts in delivering health services and providing care for our patients, we have a duty to set out the consequences of leaving the EU with no future deal in place.’

Dr Peter Bennie (main image) and Dr Chaand Nagpaul (inset)

Dr Peter Bennie, chairman of BMA Scotland and a consultant psychiatrist, believed doctors were ‘increasingly alarmed’ by failure to get a deal which would work to the benefit of patients, the medical workforce and health services across the UK and Europe.

‘This new paper on a no-deal Brexit describes the consequences of such a scenario as “catastrophic”. This isn’t a warning we make lightly.

‘For example, without a deal, we risk losing quick and effective access to medical radio-isotopes, that are vital for diagnosing particular diseases through nuclear medicine imaging techniques, treatment of cancer through radiotherapy, as well as palliative relief of pain.

‘They cannot be stockpiled like other medicines. With the delays and uncertainty this may cause to such vital treatment, it is not hard to see why a no-deal Brexit is such a concern.

‘A no-deal Brexit would also pose risks to supply and regulation of medicines. It would threaten vital health research. It could cut off at source the vital numbers of doctors coming to work in our NHS and bolster the care it provides – at a time when

our workforce is already pushed to the limit.’

At its policy-making Annual Representative Meeting in June, BMA members agreed to call for the public to be given a final

‘This new paper on a no-deal Brexit describes the consequences of such a scenario as “catastrophic”. This isn’t a warning we make lightly Dr Peter Bennie

informed say on the Brexit deal and to reject the notion of a ‘no deal’ given all the serious risks that such an outcome carries.

 To see the full paper, visit www.bma.org.uk/nodealbrexit

ThE EffECT Of A NO-DEAL BRExIT –ACCORDINg TO ThE BMA

In its briefing paper, the BMA outlines what is at stake for health services if the UK and the EU fail to reach a deal on the Withdrawal Agreement by March 2019.

It warns that, in a worst-case scenario, a no-deal scenario could:

 See fewer doctors and other medical staff, at a time when there are already huge shortages of these roles, due to uncertainty over future immigration status and confusion around the mutual recognition of medical qualifications across the EU

 Cause real disruption for almost a million patients receiving treatment for rare diseases, as the UK would be excluded from the European Rare Disease Network

 Cause delays in diagnosis and treatment for cancer patients because the UK would have to source important radio-isotopes from outside of EURATOM

 End reciprocal healthcare agreements which could disrupt patient care and increase insurance costs. ‘If 190,000 UK state pensioners currently signed up to the S1 scheme and living within the EU return to the UK, it could cost the health services between £500m and £1bn per year’

 Weaken the UK’s response to pandemics and increase the chances of diseases spreading as we lose partnerships with key EU bodies, such as the European Centre for Disease Prevention and Control

 Risk the return of a hard border between Northern Ireland and the Republic of Ireland, which could see doctors leaving the profession

A trawl through the archives: what made the news in 2008 IPT

Profits rise due to marketing

Consultants with the fastest growing private practices were defying the credit crunch with a double-digit profit growth in the previous financial year.

We reported that analysis of early returns for 2007-08 suggested a typical profit rise of 4-5% on the back of a 3% income increase and reduced expenses.

But practices who were seriously marketing were seeing their income up 15% and profits 9-10% higher.

Booming orthopods sell to BMI

A team of orthopaedic consultants who had opened a special private unit just two years previously, joined BMI healthcare.

The Oxford Clinic for Specialist Surgery, a limited liability partnership of 45 consultants, was re-named BMI The Oxford Clinic.

Stalked doctor prompts advice

The case of a male consultant who was the innocent victim of the amorous intentions of a female private patient sparked new advice to specialists from a defence body.

Problems began after he gave the woman his mobile number so she could call him if she had a postoperative emergency.

But his life became a nightmare after the patient made successive attempts to contact him inappropriately.

Although he firmly rebuffed her approaches, he ended up in front of the gMC after she hit back by making allegations. The Council concluded there was no evidence and took no action.

The MDU said the amorous attention might appear harmless, but it was important to take prompt action by explaining sensitively and professionally the attentions were unwelcome.

Earnings are rated by RSM

Doctors were able to assess their relative financial performance using figures from a pay baseline of over 50 specialties.

The comparative index, reported in the Journal of the Royal Society of Medicine, aimed to help them use these 2003-04 figures as a marker to assess the new NhS contract’s impact.

The mean annual total for all consultants, derived from unidentifiable tax returns, was £110,773 (£76,628 NhS; £34,144 private).

Private earnings peaked among the 45- to 49-years-olds (£38,200) while 50- to 54-year-olds earned most from both (£120,548).

Know your profit per patient

An article in Independent Practitioner Today said many specialists did not know how much it cost to see a patient.

The author said: ‘Only when you have a clear picture of how much it costs you to see one patient will you be able to give the right focus and direction to the essential functions of cost control and effective cost/benefit analysis.’

Try Before you Buy…

Investing in a Practice Management System is a huge commitment. That’s why we offer you a FREE 30 day trial to see if our software is right tor you.

The Cost Effective, Secure & Private Practice Management System.

Support is FREE throughout your trial via telephone, online chat or email.

Thinking of moving from your current Practice Management supplier?

• Access anytime, 24/7, on any device

Changing your software may seem daunting and time consuming, but it doesn’t need to be.

• Data backed up in ‘real time’ on the Microsoft Azure Platform

• Clear, user friendly interface

• Go Paperless by typing & importing documents

Talk to our Support team today on 0330 999 3399 and ask how moving to MidexPro can give you a more cost-effective alternative and hear how we can minimise the impact to your practice whilst you move.

One Touch eBilling

•

• Advanced analytical Practice Data available

• Encrypted software to IS027001 standards with Optional 2-Factor Authentication

•

Outstanding UK support via Email, Phone & Live Chat

For a FREE 30 day trial of the system, Please call 0330 999 3399 or email support@midexpro.com

E: support@midexpro.com

T: 0330 999 3399

W: midexpro.com

Sharing OutcOme data

Total transparency is needed to gain trust

I am del I ghted to have the opportunity to write about safety in the sector. anyone who works in healthcare, private or NhS, will tell you that their number-one priority is providing the best possible care to patients.

this means safe, effective, highquality care. that pursuit of quality and safety provides us with a common thread.

In recent months, safety in the private sector has come under increased scrutiny. But scrutiny is no bad thing. In fact, we should welcome it. We have the opportunity to set the record straight. With scrutiny there also comes the opportunity to improve where needed.

With that in mind, we have set up an initiative at h C a to help demonstrate our standards and drive further improvement. It centres on transparency and data.

We believe all patient care in the UK should be measured in exactly the same way – whether NhS or private. Currently, divergence exists which makes it harder for patients and government to compare the care being provided.

CHENIES MEWS

IMAGING CENTRE

SPECIALIST MRI IN THE HEART OF LONDON

• Advanced Cardiac MRI

• 3T Neuro MRI

• MRI for patients with cardiac pacemakers

T: 0203 887 0566

E: referrals@cheniesmews.com

W: www.cheniesmews.com

We believe all patient care in the UK should be measured in exactly the same way –whether NHS or private

that’s why we have launched a campaign for our data to be integrated widely and without exception. t his has innumerable benefits for patients and it also helps demonstrate our record clearly to the general public. t he fact that we can view full patient journeys means we can ensure that all outcomes and interactions can be measured to optimise user experience and healthcare provision. total transparency is essential to form government and public trust. It’s an ambitious campaign and not without its challenges.

The lack of clarity leads to myths and a negative narrative

Without that comparison, it’s harder to really assess the care in the private sector and be reassured of safety standards on a national scale – not just in comparison in one sector of healthcare.

t here are areas of successful alignment. h C a h ealthcare UK was the first independent-sector provider to submit data to the National Institute for Cardiovascular Outcomes Research (NICOR).

Lack of data

But, in some instances, we are restricted from submitting to registries and audits or restricted from interpreting the results. For instance, the Intensive Care National audit & Research Centre, to which we have provided data, does not publish our results.

t his divergence and lack of comparable data has been one of the main thrusts of criticism in conversations about safety in the sector. this lack of clarity leads to myths and a negative narrative.

In the NhS, patient consent is assumed. In the independent sector, consent is required for data to be shared, so patients need to have express written consent. So, for the volume of data that we would need to make a meaningful and comparable contribution, we would need to have exactly the same criteria as the NhS and, of course, this will need to be compliant with the eU’s general data Protection Regulation.

But, as a sector, I think we need to set ourselves challenges and rise to them, particularly on safety.

a s a first step, we would welcome the opportunity to submit to the hospital episodes Statistics data published by N h S d igital and, over time, to all national registries where we meet the participatory criteria to ensure comparable patient data.

t hrough this transparency I hope we will be able to help shift the conversation on from a separate one about the independent sector specifically to a broader one about improvement and shared learning across the healthcare sector more broadly.

 See ‘Transparency is clear to see’, page 23

Dr cliff bUcKNall, chief medical officer, Hca Healthcare UK

A new pathology partnership for your practice

A personal service designed for your practice

We operate our own UKAS accredited and CQC registered laboratory providing all aspects of the cellular pathology services. Since 2007 we have provided world class service to match the specific needs of each and every one of our clients.

Adapting to your exact needs

We know only too well that every doctor needs a pathology partnership that is based on absolute trust and certainty and that can only be established when there is a complete understanding of the unique needs of a particular medical practice. Every practice is different and every practice deserves a pathology service to match!

Seamless setup

Whether we are working for a new practice or replacing another laboratory, our first priority is to learn our client’s business thoroughly. We integrate our services with your needs, taking the pressure off your team

and achieving a seamless transition. We take away the hassle and when required, we will provide a pathology training package for all of your relevant staff.

“It has been an absolute delight to work with the CPS team in setting up our histology service here at One Stop Doctors. One Stop Doctors

Consultant pathologists always on hand

We excel in the speed, accuracy and overall quality of our reporting. Our consultant pathologists are always available to discuss a particular case. They are also available to personally attend MDTs when appropriate.

We always want to provide a higher level of service, a more accessible, more direct service, where for example, we could offer every doctor personal contact with the consultant pathologist whenever it was needed.

“Working with CPS has been a refreshing change. You get an efficient and highly personalised Histopathology service second to none!”

Ray Shidrawi –Consultant Physician and Gastroenterologist

It is why we prefer to work as a close and long term partner and collaborator, helping our clients to provide a world class standard of care for every patient. It’s our culture at CPS.

So, if you are looking to conduct a review of your current pathology partner or are actively looking for a new provider that structures their service specifically for your practice, then call me, Scott Hague on 07741 855 550.

Diagnostic Cytology

Gynaecologic Cytology

AccoUnTAnT’s cLinic

Filing your tax return for 201718 may not be due until the 31 January 2019, but the sooner you get this done, the better, advises Susan Hutter (below). Follow her guidelines for filing a tax return ahead of the January deadline

Benefit from being betimes

Knowledge is king

Filing a tax return may not be top of your to-do list, but the sooner you get going, the sooner you or your accountant can calculate the tax bill. If you don’t have all the funds to hand, then it means you can budget so you can pay the tax bill on time.

Leaving it to the last minute creates unnecessary stress

I’ve known some of the most fantastic medics – acclaimed in their profession – leave their tax bill to the last minute and their stress levels hiked in the final week of January. Not a healthy way to be in the beginning of a new year. Preparing early will take a big

weight off and you will wonder why you didn’t do it even earlier.

Avoid fines

Of course, with a nominal late filing penalty of £100, there will be some who may want to disregard the official deadline. But beware!

This could bring you to the attention of the HM Revenue and Customs (HMRC) for all the wrong reasons. Plus, if your tax bill is not paid by the end of February 2019, you will automatically be fined a 5% penalty of your overall tax bill. Depending on how much you have earned, this could be the equivalent of a nice treat for yourself, a family holiday or even a new car!

You could lose out on professional fee protection if investigated

I can’t stress this next point enough – if you file more than 90 days late and then subsequently find yourself under an investigation with the taxman, you will not be covered by your insurance company for payment of professional fee protection. So file early.

Gathering

the information

In advance of filing your tax return, it’s likely you will have to gather information from third parties; for example, bank and building societies, tax certificates and private rental income statements from managing agents.

While much of the information is available online, there may be some providers where this isn’t possible or where the data only goes back to a certain time period. Planning ahead is wise, not least because who hasn’t had a computer crash or breakdown at a crucial juncture?

Time of the month – get into regular reporting habits

I always impress on my clients that it’s good to keep a spreadsheet of accounts and update this quarterly or, even better, monthly. Try not to leave this to the yearend because the stress will mount as you try and piece together a whole year’s business activity.

And, of course, you run the risk of producing inaccurate records.

Use a skilled/trained bookkeeper

I advise my clients to get the help of a trained book-keeper who is familiar with some of the crucial accounting conventions.

This is not to say your practice manager is not the most efficient and organised member of the team. It’s just that when it comes to numbers, you can’t afford to cut corners.

You don’t need to employ someone full-time – you could outsource to a freelance bookkeeper or your accountant may offer this service.

salaries and dividends

If you trade as a limited company, you will need to get advice around your salary and payment of dividends before filing.

One problem that often arises is

working this out if there are no up-to-date records.

Payments on account

Another reason for consultants to get ahead with accounts is that you may be able to reduce your payments on account for your tax bill if, say, your business hasn’t been so profitable or perhaps you have taken a sabbatical compared to the previous year.

This could make a big cash flow difference and even mean you are due a rebate. Or if you have had a better year with your business than the previous one, then you will need to know how much extra money to put aside for the bill due in January 2020.

 In Susan’s next column, she looks at the questions you need to be asking your accountant

Susan Hutter is a partner at Blick Rothenberg and part of the team advising medical practitioners

WELCOME TO THE NEW PINDROP HEARING CLINIC

Stern advice on property income

please be aware that Hmrc is monitoring far more of those who own another property and are receiving rental income – in the UK or offshore.

Hmrc will be able to cross-reference you against any land registry filings and also by making paye and vat visits to property agents.

it also has close links with overseas tax authorities and so it can and will pick up any information which does not tally with the information you provide on rental income or even capital gains or losses on property disposals.

Some people may think that if expenses for, say, property reparations outweigh the cost of rental income, then they automatically make a loss and will not have to declare, but this is not the case.

remember, if you are found to have ‘omitted’ any information, this could lead Hmrc to opening up an investigation which goes back six years from the current tax filing year. even further, if negligence is proven.

apart from the time that will be taken up and potential stress, you could find yourself having to pay out tens of thousands of pounds if you have not been declaring the information. it’s not worth it – always be transparent.

Offering state-of-the art facilities at 41 Harley Street. After 11 successful years we have moved to a beautiful new purpose-built clinic, designed to deliver the most advanced Audiology services for your patients.

Refer your patients today

• NEW paediatric testing, including visual reinforcement audiometry (VRA) and Oto-acoustic emissions (OAEs)

• NEW specialist-led tinnitus rehabilitation service, equipped for complex cases

• 2 purpose-built Sound Lounges complete with sound field and speech-in-noise audiometry facilities

• Evidence-based hearing aid fittings, using the latest technology not currently available on the NHS

• Full suite of audio-vestibular diagnostic services

• Outstanding aftercare and patient service

Is your private practice ‘all systems go’?

Just because you’ve had the same system since you started doesn’t mean it’s the best one for you now

There are so many facets to running a successful private medical practice. Jane Braithwaite’s (right) second article in her practice management series focuses on the functional aspects. She looks at what IT systems you might need to run your practice efficiently and examines mapping the processes that you must streamline for a well-run practice

As with any business, you will need to give detailed consideration to your it needs. the difference for a private medical practice is the kind of data you will be storing.

You don’t just need to think about the number of PCs you might need as well as printers and other peripherals. Medical records, patient notes, scans, bank details and even recorded phone calls are all considered personal data under the General Data Protection Regulation (GDPR).

Even before GDPR was introduced, there were specific requirements for data storage in healthcare. there have previously been some worrying data breaches by companies who stored patient data unencrypted, and GDPR has added punitive fines to ensure that all companies take the issue seriously. the Nhs’s guidelines on using public cloud services such as Google Drive and my previous article on data should be helpful resources (March, page 20).

You might be wondering if it would be easier to outsource data storage, and this is certainly an option. t here are many companies offering systems that can assist with this as well as with financial management, appointment scheduling and more. these systems can also provide remote access to practice information and may integrate with your other software. healthcare is big business and there are dozens of companies offering solutions.

One main difference between off-the-shelf solutions and bespoke systems will obviously be price. But you must be careful to look beyond the price tag to the implications for your practice long-term.

Many consultants start out thinking they can manage everything themselves with the help of their medical secretary. some will achieve this, but you need to consider what happens when your practice grows.

t he amount of data will grow too, but you might find that your set-up does not scale without significant time and investment. hopefully, you’ve also taken my previous advice on executive information and anticipated this, so necessary changes can be made

Top Tips

 Systems update: Just because you’ve had the same system since you started doesn’t mean it’s the best one for you now. Be open to demos from alternative suppliers and keep abreast of new developments

 Why paperless works: As well as being environmentally friendly, more secure and cost-effective, it will mean that your important documents will always be to hand. And, longer term, you will not have the costly problem of storing copious amounts of paper securely

 Spend to save: There are companies who can advise you on choosing practice management systems or the pros and cons of outsourcing. it’s worth considering what they can do for you

 Use the right tool: specialist software mapping tools such as Microsoft Visio or Lucidchart could work well for you once you’ve captured all the relevant data

 Review regularly: if you’ve been in private practice for some time, chances are that processes can become bloated as tasks and documents are added. Take time to review and see how you can streamline

 Ergonomics matter: processes aren’t always digital. is it as simple as re-organising the office layout or how forms are stored?

 Get value for money: Many businesses only use a fraction of software features – could a little extra training mean you get full use out of the systems you shell out for?

 Resident expert: is there someone on your team with secret streamlining skills or a hitherto hidden passion for processes and iT? Take advantage of their enthusiasm

without disruption to your patients.

Process mapping without making this article seem like Business 101, have you thought through all of the processes that will enable your practice to run optimally?

i’m a big fan of simple solutions, where possible, and an even bigger fan of a paperless office. But these both rely on well thought-out solutions to everyday challenges.

Process mapping means defining your business activities, partly to understand who takes ownership at each stage. this means that you won’t miss important details that could impact on patient satisfaction or business efficiency.

Process maps are visual, as you might expect, and there are plenty of specialist software packages you could use, some of them free. But if you’re looking at processes within a team, starting with A3 sheets of paper is a great way to capture information.

As an example, let’s look at the journey for your patients. Do they come to you via referral by other consultants or directly from your website? h ow are follow-up appointments confirmed? who is responsible for communicating test results and within

what time-scales? try to map every part of their journey from the first contact they have with the clinic to a successful outcome – whatever this might mean for your specialty. You may find the N hs process mapping model helpful for this.

the patient journey is the most important process for your practice, but it’s by no means the only one. what are your processes for finding a new supplier, recruiting a member of staff or carrying out appraisals?

You must ensure the processes you’ve identified and mapped pinpoint who is responsible for each activity and which systems are involved. t here must be no confusion over who arranges for feedback forms to be sent out or when patients are advised of the cost of a consultation.

My motto is ‘mind the gaps’, because i believe that taking care of the details is what ensures a well-run practice. But to take care of the details, you must be very clear on what they are. 

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

PROBLEMS WITH THE TAX MAN?

HMRC tax investigations and disputes create difficult and stressful times.

As an award winning firm of tax experts, our highly experienced partners specialise in resolving problems relating to tax investigations and disputes with HMRC.

To find out, in confidence, how we can help call 0800 734 3333.

‘Here to help. Not to judge.’

Doctors are individually able to hold up to 5% of the financial interest in any share class or options in a private facility or its equipment, directly or indirectly

Doctors are doing it for themselves

The desire for doctors to engage in consultant equity participation schemes is growing, yet still resisted by some. Dr Tony Lopez, founder and chief executive of Incorporated Health, reviews the position and offers advice

Independent practItIoners have experienced a sustained fall in remuneration and, in the wake of the competition and Markets a uthority ( c M a ) Final o rder, some are beginning to invest in medical services.

Following a recent historic public sector pay freeze and declining pension benefits meaning they have to work longer, many doctors are taking advantage of

greater independence, generous Government tax allowances and financial returns, preparing to share in both risk and reward, while not leaving all the ‘upside’ to the hosting facilities.

Cash cows

Many consultants operate using limited companies or limited liability partnerships, often with considerable ‘retained profit’

available for dividends or ‘interests’ for discretionary division among members.

It is not uncommon for these entities to be treated as ‘cash cows’ with no investment in business savings accounts or fund extraction policy, simply awaiting the day of liquidation with a potential 10% entrepreneur’s tax relief many years hence, although there is no guarantee that this govern-

ment relief will even still be available.

Furthermore, an unprecedented number of consultants are retiring from the nHs early, finding themselves in receipt of significant taxfree lump sums yet with a future of likely poor returns from banks and managed investments.

o ften these same consultants wish to maintain clinical practice,

with many simply retiring for 24 hours and planning to continue in clinical practice for five to eight more years.

Yet profit share or dividends in their clinics can continue in perpetuity as long as the equity is preserved, governed by a suitable shareholders agreement.

However, hospitals and clinics have a considerable amount of ‘sunk costs’ and it may be in their interest to deter new entrants internally as well externally.

For example, diagnostic equipment is highly remunerative and it’s not surprising they wish to maintain complete ownership, as this is among the most lucrative parts of private practice.

s ome providers would like to suppress consultant engagement while others are supportive, engaging in ‘consultant equity participation’ schemes.

What is the law?

consultant equity participation is fully endorsed by the cMa Final order which came into law on 1 october 2015; it is financially regulated by UK law and supported by the BMa

doctors are individually able to hold up to 5% of the financial interest in any share class or options in a private facility or its equipment, directly or indirectly.

Interestingly, if there is no overnight stay in a facility, such a restriction may not apply. participants must pay a fair market value for their stake and any profit share or dividends must be distributed pro rata in accordance with their stake.

the order states that a referring clinician is prohibited from requesting, agreeing to receive or accepting any direct incentive from private hospital providers to give preference to their facilities, when treating patients or referring patients for treatment or tests, implicitly or explicitly. these include cash payments for patients referred or tests commissioned.

similarly, private hospital providers are no longer allowed to offer inducements to procure referring clinicians to give preference to their hospitals.

s uch incentives include payments relative to clinical activity, including numbers of patients

Doctors are individually able to hold up to 5% of the financial interest in any share class or options in a private facility or its equipment, directly or indirectly

referred, tests performed or treatment at a particular facility.

Furthermore, non ‘low-value services’ including room hire, secretarial and administrative assistance can be neither offered nor received except at a fair market rate and free allocation of shares in an equity participation scheme based on private patient revenue received is disallowed.

restrictive practice clauses, contractual or otherwise, obliging doctors to refer patients to a facility or preventing them referring elsewhere, are forbidden.

Limited general information must also be made available, including hospital website disclosure of participants in equity schemes and data submitted to the p rivate Healthcare Information network.

What do healthcare providers think?

some network hospital and independent providers appear selfish and are resistant. For example, in their submission to the c M a , ramsay Health care UK strongly disagreed with the cMa’s provisional finding with regard to the ‘…beneficial effects such schemes may have on barriers to entry…’ suggesting that financial incentives ‘may interfere with clinical decisions’.

ramsay considered equity partnership schemes ‘rewarded consultants for sending patients to a particular facility and was seen to interfere with clinical decisionmaking to the detriment of patients.’ It has no published consultant equity participation schemes.

s imilarly, t he London c linic stated in its cMa submission that consultant ‘equity incentive schemes, which involved hospital operators, should be unwound’

and ‘if an investor had an incentive to refer patients to a hospital, there was a motive and profit, which should not be allowed’.

However, there is no evidence for this and strict financial audits and compliance governance are in place, notwithstanding the significant regulatory role of the GMc

However, several significant providers are now engaged in joint ventures with consultant groups, with several new projects pending. o thers, like n uffield Health, are understandably more cautious, having experienced ‘failed’ ventures in such arrangements previously.

BMI Healthcare was the most pragmatic in its response to the c M a , and stated that it was in favour of equity participation ‘where consultants were legitimately investing their money, the return was proportionate to the investment, it was a pro-competitive introduction of new services, new techniques or new equipment and the investment was transparent’.

H ca and a spen both have a number of consultant equity participation ventures and Hca felt that ‘leaving room for equity participation in the industry was a useful tool to create investment and create new competition.’

among the insurers, aviva felt such schemes could be beneficial ‘because they provided the consultant with an interest in making sure that the hospital was operating effectively, growing the hospital business, attracting customers and competing effectively’.

consultant investors may wish to share risk as well as reward and by interacting this way, consultants are more likely to tolerate continued downward pressure on specialist fees, as equity returns could outweigh falling reimbursement and rising costs – for example, medical indemnity.

Furthermore, increasing competition and squeezing the cost out of ‘too expensive’ private healthcare may be beneficial to all parties in the value chain, including patients.

What ventures are most suitable?

Joint ventures around new or replacement equipment which are tangible and affordable lend themselves particularly well to such arrangements. diagnostic equipment purchase such as imaging facilities, endoscopy, ophthalmology, neurophysiology and cardiac facilities are good examples. t he groups most likely to engage in such ventures are primary referrers including orthopaedic and other surgeons, neurologists, rheumatologists, cardiologists and radiologists.

For example, BMI Healthcare has a number of joint ventures around complex imaging equipment. Its largest is in Guildford, s urrey, and includes consultant equity participation to own and operate a pet ct scanner within its cancer unit.

Many others have previously been reported in Independent Practitioner Today , including LycaHealth’s MrI unit in canary Wharf (January 2016), t he avicenna clinic in northampton (october 2016) and most recently t he Fortius c linic in c entral London (February 2018).

However, doctors are strongly advised to be cautious when investing in ventures involving expensive new builds or ventures or costly leases and management charges created by hosting partners.

Consultant radiologist Dr Tony Lopez in front of an MRI his firm co­owns with BMI Mount Alvernia Hospital in Guildford, Surrey

some new facilities are costing between £30m-£100m to build and these have to be repaid, which may delay returns beyond their useful time.

What are the costs of funding equipment joint ventures?

For most imaging joint ventures, complex diagnostic imaging equipment can cost between £600,000£2.5m, with additional costs required to modify new or existing space. the costs rise considerably with new builds of course. a typical consultant equity stake for 10-20 individuals would be between 1-3%, requiring an investment of typically between £10,000-£80,000 depending on the project capital value.

What tax reliefs are available?

If structured carefully, it may be useful to seek advanced assurance from HM revenue and customs

to grant either s eed e nterprise Investment s cheme ( se I s ) or e nterprise Investment s cheme (eIs) tax reliefs of 50% and 30% respectively applied at the time of investment.

t he company a nnual Investment a llowance is currently £200,000 in a 12-month period, and can also be claimed from profits before tax on purchased ‘plant and machinery’.

What can consultants do if hospitals resist their financial engagement?

Where an independent sector provider simply resists a reasonable business approach from typically a consultant group, pressure could be bought to bear collectively for detailed discussion to achieve mutual benefit. consultants cannot be forcibly suppressed or rejected in the current financial environment following the cMa’s final report.

Where an independent sector provider simply resists a reasonable business approach from typically a consultant group, pressure could be bought to bear collectively for detailed discussion to achieve mutual benefit

the option remains to create a similar joint venture with a competitor facility in the same location – where possible – or with one of a number of significant well-funded new entrants into UK independent healthcare. It may also be useful to engage an independent adviser with management consultancy and operational experience, with an option for this partner to co-invest rather than charging significant consultancy fees, obviating the awkwardness of consultants negotiating directly with a potentially hostile ‘local’ stakeholder. 

Dr Tony Lopez (left) is founder and chief executive of Incorporated Health (www.incorporatedhealth.co.uk) with over 20 years’ experience as an NHS consultant and independent practitioner, having created several significant joint ventures using CMAcompliant consultant equity participation

Having served healthcare professionals since its inception in 1993, Tax­Link, chartered tax advisers and accountants in Wimbledon, has built a wealth of knowledge and experience in dealing with taxation issues faced by doctors in private practice. Our focus is on tax planning and compliance.

l Tax structuring to suit personal circumstances (LLP, limited companies)

l Solvent liquidations

l Consultant groups and consortia

l Assessment of pension contributions in light of tapering annual allowances

l Ad hoc assistance with HMRC investigations and reviews.

more information and tax­efficient advice, please:

Dear Reader,

Subscribing to Independent Practitioner Today is the only way you can be sure you will see every issue and have the option of reading us online using our special page-turnable edition. Don’t risk missing out. Our personal subscription for doctors and managers is only £90 a year and £210 for organisations. But you can cut this to just £75 and £180 respectively if you pay by direct debit. So take advantage of this offer now for our unique business journal dedicated to supporting you in your private practice. We’re confident your subscription will repay itself many times over!

Editorial director

ApplicATion FoR SUbScRipTion

Doctors, please give GMC No. (see rates listed above)

i enclose a cheque for £ ........... made payable to the independent practitioner Ltd please debit my mastercard/Visa/amex/diners

I encose a cheque made payable to The Independent Practitioner Ltd

Please debit my Mastercard/Visa/ Amex/Diners Card No

r * indicates this item must be filled

i would like to pay by direct debit (please complete all details in box below). don’t forget, it’s £15 cheaper to pay by direct debit; £30 less for organisations.

Instructions to your Bank or Building Society to pay Direct Debits

Name and full address of your bank/Building Society

To: The

Name(s) of account holders

banks and building societies may not accept direct debit instructions for some types of account

post your application (no postage required – UK only) to: independent practitioner today subscriptions department, Freepost, po box 36, plymouth, pL1 1br

Banks and Building Societies may not accept Direct Debit instructions for some types of account

phone: 01752 312140

Fax: 01752 313162 email: lisa@marketingcentre.co.uk or subscribe online at www.independent-practitioner-today.co.uk if you want to pay by card

by writing to your Bank or Building Society. Please also send a copy of your letter to us.

I am deeply encouraged by the momentum now starting to build in driving transparency in private healthcare.

There is a growing chorus calling for greater transparency, from the p rivate Healthcare Information Network ( p HIN), Royal College of Surgeons (RCS) and, more recently, from the now former Secretary of State for Health Jeremy Hunt.

a nd if this is acted on, then increased transparency will help improve the quality of care for patients and drive patient safety.

In the work I do with eNT­UK, and acting as professionalism lead at Norwich medical School, it is clear that for the next generation of healthcare professionals, transparency in performance data and patient health outcomes data will be commonplace.

The professionalism and commitment being initiated now will be even more evident in the next generation of medicine.

With the imminent publication of consultant­level private healthcare performance data beginning two month ago, more validated data about consultants is available to the public than ever before. So, as transparency becomes a

reality, there is a clear and present need to better demonstrate the positive benefits that our procedures provide patients in day­today activity.

p atient ­ Reported Outcome m easures ( p RO m s) enable this through focusing data on the patient experience and being able to build a much stronger picture of the longer­term patient journey.

as pHIN progresses, the collection of pROms data will help drive clinically validated outcomes data starting with private healthcare.

integrating private and nhS

For consultants working in private practice, I believe this means that we can start to measure patient outcomes in a more standardised way and this is a major advancement in creating closer integration between NHS and private healthcare systems.

Hospitals, consultants and procedures can be compared across NHS and private healthcare and opportunities for each to learn can be identified.

But to do this more systematically, we must overcome the notion that collecting p RO m s data creates a perceived added workload, which places resistance in the path of progression.

Health systems do, however, need to work harder at facilitating electronic data capture. This could be as straightforward as providing patients with i p ads, for instance, so they can respond to questionnaires and measurements of health outcomes with the least inconvenience to both the patient and the doctor.

However, we must consider data collection an absolute priority and continue to digitise at all levels. Undertaking pROms data capture more routinely across practices would be a step change in the level of outcomes measurements that we are able to assess across the patient journey and drive much more joined­up thinking.

Taking the specialty of eNT as an example, there has been much work undertaken to help develop and promote pROms. For example, the Sino­Nasal Outcome Test22 questionnaire (SNOT­22) has been validated and used widely in practice since 2009.

This has proved an effective tool to move beyond simple data

and is of great value to patients and clinicians in understanding care and quality of life improvements.

For nasal obstruction – specifically related to septal deviation – the Nasal Obstruction and Septoplasty effectiveness (NOSe) scale is a validated pROm that, at the time of writing, is going through an implementation process and for which e NT­ UK has confirmed its support.

Furthermore, p HIN will be using NOSe as the pROms performance measure being collected for e NT procedures, and it will later be published for private work.

This is significant because, with the roll ­ out of NOS e across the NHS and private healthcare, this is a great example of a specialty that will have an opportunity to create much stronger integration of pROms data across both NHS and private practice.

p RO m s data undoubtedly unlocks and evidences quality of care experienced by patients, so we must prioritise data standardisation and consistency in collecting this information more routinely.

as transparency takes a significant step forwards through the publication of initial consultant performance data in private healthcare, it will be up to us to continue to make transparency a reality.

We must rally behind this so that future data on pROms can be published and quality of care for patients can continue to be improved.

Prof Carl Philpott is honorary secretary of ENT-UK and honorary consultant rhinologist and ENT surgeon at the James Paget University Hospital and Spire Norwich Hospital Hospitals, consultants and procedures can be compared across nHs and private healthcare and opportunities for each to learn can be identified

Prof Carl Philpott, enT surgeon

MEDICAL RISK SERVICES LIMITED

Switching ‘offers certainty and can avoid future woes’

Amid calls for discretionary insurance cover to be phased out, clinicians are being urged to move sooner rather than later to commercial alternatives. Peter Anderson reports

CLINICIANS ARE being urged to create certainty over their insurance arrangements amid growing calls for the medical profession’s long-standing system of discretionary cover to be replaced.

The debate over insurance was ramped up recently when the NHS Partners Network (NHSPN) – the influential trade body representing independent sector healthcare providers – called on the UK Government to introduce a system of mandatory contractual insurance for all practising clinicians.

The call has prompted key industry players to highlight the benefits of switching to commercial insurance, with warnings that many clinicians are mistakenly envisaging obstacles to transferring that simply do not exist. They also argue that policyholders are potentially storing up problems the longer they stick with their discretionary arrangements.

Roger Houston, co-founder of Medical Risk Services Limited (MRSL), said: ‘The reality for so many clinicians is that transferring to a commercial underwriter would be easier – and would provide much greater certainty – than merely sticking with a mutual.

‘We’ve spoken to doctors and dentists who get stuck on a merry-go-round between mutuals when cover and a broad package of support is readily available in the commercial sector.’

In late May, the NHSPN demanded greater reassurance for patients. In a detailed submission

to the Health Secretary on safety in independent hospitals, it said the Government ‘should consult widely on requiring all clinicians to have mandatory insurance in place as part of their licence to practise’.

It said that, within its contribution to the Paterson Inquiry, it was working to assess what could be done to establish a ‘comprehensive insurance regime’ for clinicians.

‘Lack of public reassurance’

The NHSPN added: ‘We do not believe that a system of discretionary insurance cover for clinicians can provide the necessary public reassurance that if something goes wrong in a healthcare setting that patients will be entitled to compensation no matter what the cause or intent.’

Medical Risk Services Limited, a prominent provider of insurance, advice and services to medical practitioners since 2004, welcomed the NHSPN’s comments.

Mr Houston said: ‘Clinicians

shouldn’t bury their heads in the sand when it comes to insurance. It makes increasing sense for them to switch their insurance voluntarily to the commercial sector rather than holding on and worrying about future changes to Government policy.’

According to Mr Houston, some clinicians are even discouraged from moving to the commercial sector simply because they perceive mutuals’ discretionary approach to settling claims could work against them in the future.

Another huge benefit highlighted by MRSL is that commercial cover can be extended well beyond areas that are traditionally handled by the mutual sector. For example, it said commercial cover could incorporate employers’ liability and public liability right through to diverse areas such as data breach, cyber risks or defence against a tax inspection.

According to MRSL director Chris Cloke Browne: ‘One of the key concerns about a discretionary system of insurance is that

it fails to offer contractual certainty for members. In particular, with clinicians frequently moving from one mutual to another, many are fearful that an organisation might focus its finite resources on paying claims made by existing members ahead of claims raised by its former members.’

He said: ‘This strengthens the argument for moving to a commercial underwriter, which in our view is less risky than merely switching mutuals. Contractual cover is clearly – and broadly – worded, meaning policyholders have certainty on what is and isn’t covered.

Uncertainty is ‘stacking up’ ‘We see a real danger that anyone in business for the past decade – and relying on discretionary cover for that period – has ten years of potential uncertainty to worry about in the event of making a claim. This lack of certainty increases markedly for those relying on mutuals for longer.’

Mr Cloke Browne added: ‘The expertise and experience within the commercial sector mean a policyholder can expect clarity, certainty and peace of mind, with a progressively diminishing threat of past-year claims being declined. The risk of emerging issues for non-paediatric work should have virtually disappeared within five or six years of switching to the commercial sector.’

Another strength of the commercial sector, according to Mr Cloke Browne, is that, in line with mutuals, brokers such as

MRSL can offer a ‘full suite’ of support and expertise, including a 24-hour helpline and access to detailed technical advice.

He recalled a recent complaint made to the General Dental Council (GDC) about a dentist insured through MRSL. The insurance policy in place meant the dentist was covered against potential legal expenses resulting from the patient’s grievance.

However, Mr Cloke Browne said MRSL’s support and technical expertise meant the dentist was advised to delay lodging an insurance claim. Despite requesting notes, the GDC subsequently ruled there was no case to answer, resulting in the policyholder facing no claim, no costs and no impact on their insurance policy.

Clinicians unsure of cover Clinicians’ rapidly and dramatically changing roles have made many practitioners uncertain about the extent of their cover through a discretionary system, according to MRSL.

It noted that practitioners’ work routinely straddled both the NHS and the private sector, with many doctors and dentists now broadening the services they offer well beyond what many would deem their ‘traditional’ role.

Mr Houston recalled: ‘We recently advised a sole trader who joined the growing number of dentists sourcing insurance via MRSL. The dentist needed and received assurances that, in addition to their preventive and routine dental work, other procedures ranging from cosmetic dentistry to skin peels, diathermy, eyebrow lifts and dermal fillers would be covered.

‘We were delighted to put together a tailored package that guaranteed cover for risks that a more conservative insurer may merely have opted to exclude.’

The potential dangers of a practitioner unknowingly being without cover for their full range of procedures is highlighted only too starkly by the GDC’s published standards.

Among its ‘9 Principles’ for members, the GDC insists dentists have ‘appropriate insurance or indemnity in place to make sure your patients can claim any compensation to which they may be entitled’.

It adds: ‘You should ensure that you keep to the terms and conditions of your insurance or indemnity.’

According to MRSL, this highlights the potential dangers of assuming insurance will be in place,

Above: MRSL co-founder and CEO Roger Houston

only to discover an insurer takes an overly conservative view on what falls within its remit.

One of the final concerns for practitioners looking to switch insurer is the potential gaps in cover while transferring to the commercial sector, according to MRSL. However, the company believes the fears are overplayed.

It argues that the switch is realistically no different to the move many members routinely make between mutuals. Mr Houston explained: ‘MRSL also offers defence for policyholders during transition, while older claims that emerge are frequently defensible through arguments on Statute of Limitation and Causation.’

‘‘The reality for so many clinicians is that transferring to a commercial underwriter would be easier – and would provide much greater certainty – than merely sticking with a mutual Roger Houston

‘‘For MRSL, the issue of policyholders having someone to assist their defence is as important as the insurance cover itself.

Mr Houston explained that this was why the comprehensive – and 24-hour – package of support, advice and expertise offered by the company was so important to policyholders and to MRSL itself.

He said: ‘Ensuring a valid claim is paid is essential; so too is knowing there’s someone there at your side when you need them most.’

For further information on MRSL and its services, please telephone 0203 058 3733, email enquiries@mrslenterprise.com or visit www.mrslenterprise.com

More appointments Brilliant service

patients

When Moneypenny looks after your calls and chats.

Practitioners use us because we offer the very best people and technology to deliver the most efficient and satisfying experience for patients. Discover how we will make your practice even more successful. Talk to us today.

Put your best face forward

Many practitioners still rely on their hospital’s website as the only source of information for their practice when they could be offering their patients a great deal more. But just having a website is not enough – it needs to stand out for the right reasons. grant brookes (right) shows what to avoid

yOUR WeBSITe is a key source of information for your patients, as well as those looking to become patients or moving into your local area.

Whether designing your own site or working with professionals, you should keep these costly website sins in mind:

 Font size failure

Fonts which are too large, too small or differentiate too

much across your website look unprofessional. you want your website to be clear and concise. Using a font too small is hard to read online and anything that is difficult to read will immediately put people off and they will click off and look elsewhere.

 poor copy paying for fantastic design is one thing, but what about your content. as a medical expert, you

want to project a professional image, so proof ­ reading everything posted online is essential. your website visitors will be put off by even small errors, so it pays to either invest in professional copywriting or spend the extra time needed to get it right.

 colour and contrast you may have a favourite colour combination, but your website is not likely to be the place

using a font too small is hard to read online and anything that is difficult to read will immediately put people off and they will click off and look elsewhere

to show it off. Certain colour combinations simply don’t work and if you explore examples of good online design, you will see that most opt for subtle colour palettes which allow the content of the website to be easily digested and the navigation to be followed with ease. In the example overleaf, created for dr Stephanie Barrett, you can see how a simple and classic colour palette works, allowing visi ­

a new window on the world: the website of consultant physician and rheumatologist dr stephanie barrett before and after its redesign

tors to navigate with ease and find the information they’re looking for with no issues.

 navigation problems

There are tried and tested methods for website navigation that do not need to be played with. your visitors will look for buttons, navigation bars, sidebars and similar familiar navigational elements. Simple, structured order is

essential. a ny attempt to make navigation clever are unnecessary. We recommend making sure your visitors can reach their intended page or destination in a maximum of three clicks; complex navigational panels and clever tricks won’t allow this.

no visuals

Visual content can be as important as the words. While

you want patients and visitors to read the information you are providing, you can use visuals to direct them to the right places.

In the case of the Chelsea medics website we created (www. chelseamedics.co.uk), you can see large icons that are used to further enhance the navigation of the site. you can quickly pinpoint relevant pages from their logo, such as Travel advice and Vaccinations (a globe) and Corporate and Film (a tower block).

If you avoid all these initial sins, then you need to think about what it takes to keep your website both engaging and informative over time.

 why you mUST keep your website updated

a n old and out ­ of ­ date website can be worse than not having one at all. Keeping your website updated is an absolute must for any medical professional who wants to maintain a strong online presence.

partnering with web design and content marketing professionals

ensures your website will always be kept up to date and maintained, even if you don’t have the time to do it yourself.

For your website to be found in search engines such as Google, it needs to be regularly updated too. Fresh content is a key determiner in where your website appears in search engines, so it is absolutely essential your website is up to date if you want it to be found online.

equally important to remember is that your patients may be visiting your website for the first time. an out­of­date phone number or details of clinics that no longer run can be misleading and even result in patients turning up for appointments that can’t be scheduled.

your website should be an additional and helpful source of information, not confusing or obsolete.



visual content matters too: time to update your photos

We’ve already discussed visual content being a helpful way of

boosting your site’s navigation, but it also makes good sense to use photography on your website too.

a s you provide a daily service direct to the public, on a face­toface basis, putting up photographs of yourself, your team and your practice can help create a sense of community and belonging on your website.

It gives your website a more personal and approachable feel, with patients able to recognise yourself and others, as well as the surroundings.

Bespoke photography for your website helps it stand out and further enhances the professional appearance of your design.

Face­to­face services are key to what you offer and giving patients the chance to see your practice and team in advance of attending an appointment or clinic can be very reassuring.

The Web Surgery offer photography services to private practition­

ers. We come to your practice and provide bespoke photo shoots to ensure you have some great­quality shots for your website and social media, adding a sense of the ‘real practice’ to your online presence.

website health check

There are a large number of private practitioners who have websites but unfortunately have not updated them in a long time. ask yourself questions such as:

 Is my website responsive to work on mobiles and tablets?

 When did I last add any new content?

 When was the design last looked at and modified?

 Have I updated the images on my website recently?

 Is my website being found on search engines for specific keywords?

many doctors’ websites unfortunately look like they haven’t been

updated for some time and it doesn’t take much more than a few tweaks in many cases to update them and bring them into the 21st century.

an mOT for your website can be exactly what is needed to give you a true picture of how your website is performing.

Our company routinely offers website health checks without cost to help site owners get a better understanding of what their site does well, and where it could improve.

There is no obligation involved and the whole process is all about providing site owners with the knowledge to move forward and make the changes themselves, should they feel able.

a website health check will ask many questions of a website, including:

 Is it fully search engine ­ optimised? Can search engines find this site and rank it appropriately?

 does it have quality, regularly updated content?

 Is graphic and video content optimised?

 Is it fully responsive on all devices of different screen sizes? These are just some of the questions that a health check will seek to answer and provide recommendations from. It can be a great base to work from and may show that you may be unknowingly committing some of those website sins that everyone should be trying to avoid.

almost every professional in the modern world can make use of a good website. In private practice, it can be a showcase of your work, a way of inviting in new patients and a great information source. This is what it can be, should you avoid those telling website sins and you ensure your website is fully up to date. 

Grant Brookes is chief executive at thewebsurgery.com

The times are a-changing

Bob d ylan wrote the immortal lines: ‘Come writers and critics, who prophesise with your pen, and keep your eyes wide, the chance won’t come again’.

In our digital world, prophecies remain precarious, accelerating as they do through increasing broadband speeds that impact on our everyday lives in ways unimaginable in Bob’s time.

One significant factor is unquestionably the impact of technology on all aspects of healthcare creating effective solutions whilst also placing additional pressures on private practices, Gps, consultants and administration staff.

The debate over delivering services in ­ house or outsourcing them has been in discussion now since before the millennium.

Terror stories of mislaid information and, worse, misdiagnosis is still recognised, but diligence in choice of outsourced provider is ensuring that the transition is now accepted as a necessary business decision by managers keen to

THe advanTages of an ouTseC TyPisT

reduce costs while maintaining efficiencies.

Opportunities abound by outsourcing invoicing and debt recovery as well as the ‘virtual office’.

But if you prefer to continue to promote the ‘human touch’ in this ever­increasing digital world, while also saving as much as 30% on your typing, outsourcing is a clear and obvious choice for those who record their dictations and cur ­

rently pass them to internal staff for processing.

OutSec Services ltd is delighted to announce that Ray Stanbridge, known to many readers of Independent Practitioner Today, has recently become our chairman.

a s m r Stanbridge says: ‘In our business advising clients, we are constantly looking at ways to improve efficiency.

‘For many, in this age of Comp­

etition and m arkets a uth ority rules, outsourcing of typing services may be highly efficient and will ensure that the best use is made of all staff resources who can then focus on patients.’

perhaps now is the time to consider your potential savings by choosing to go down this route.

Special offer: free trial

How it works: d ictate [digital recorder/smartphone] ➡ upload dictation to OutSec ➡ work returned within 24 hours.

The OutSec team of medical transcriptionists are hand­picked and all have at least seven years’ experience in their discipline conversant with all specialist terminology appropriate to the field.

Give OutSec a call to discuss and take advantage of 30 minutes’ free dictation for Independent Practitioner Today readers.

Email: stephanie.carmichael@ outsec.co.uk

Website: www.outsec.co.uk

Phone: 01366 348088

• Completely open scanner

• Weight-bearing scans for spine and joints enable a more precise diagnosis

• Patients who are large or cannot lie down can be accommodated

MyTh 1: An apology is an admission of liability

Patients often want an apology and this should be given as early as possible when you know something has gone wrong or the patient believes this is the case, regardless of whether or not the complaint is justified.

Regulatory bodies and the Medical Protection Society support this approach and do not see it as being an admission of liability. Empathising with a patient and acknowledging their perception of what has happened often resolves the matter.

You may wish to consider wording such as: ‘I am sorry this happened to you’ or ‘I realise this must have been a difficult time for you, and would like to apologise if I have added to your distress in any way’. But if you have identified

particular failings you may wish to specifically apologise for these.

MyTh 3: it is best not to admit to making a mistake

MyTh 2: it is not my job to respond to the complaint

While NHS trusts have established complaints procedures, and a team who will support the doctors involved in responding to a complaint, the situation is more variable in the private sector.

If your investigation into the complaint reveals that an error has been made, then this should be conveyed to the patient. Doctors owe a duty of candour to their patients, as set out in the GMC’s Good Medical Practice

It is worth approaching the organisation within which you practise for assistance, but this may not be forthcoming.

Your medical defence organisation will be able to advise you on handling and resolving a complaint. Private practitioners can also benefit from involving the Independent Healthcare Sector Complaints Adjudication Service (ISCAS) .

BesT pracTice

A desire to ensure the same mistake does not happen again is often a factor driving complaints. Once you have identified an issue and accepted that things could have been done differently, however minor, you should try to put in place measures to prevent them from happening again and revisit any changes you have made on a regular basis.

Having a robust system in place for dealing with complaints can help to minimise stress, improve efficiency and improve the chances of the matter being resolved without escalation.

Your private clinic or hospital should have a system to record complaints, investigate them and provide a report with your findings and conclusions which reassures patients that you have taken the matter seriously.

Demonstrating reflection and learning can help to reassure the patient and prevent them from taking the matter further. 

it would be reasonable to use the NHs complaints procedures as a basis for your system. any documentation relating to complaints should be kept in a separate complaints file rather than in the medical records, and draft documents should be destroyed.

Once a complaint has been received, you should send a letter of acknowledgement to the patient indicating a time frame in which a response will be provided.

➲ a list of concerns raised

You should ensure you allow yourself and your medical defence organisation adequate time to deal with the matter properly – bearing in mind that you will need to obtain the necessary consent from the patient if they are not the complainant.

The key elements to include in your letter of response are as follows:

➲ an apology along with an acknowledgement of distress – and condolences, where appropriate

➲ a chronology of events, setting out details of the relevant consultations, can be useful

➲ an outline of the steps taken to investigate the complaint. such steps could include reviewing the medical records, discussing the case with colleagues, reviewing relevant guidance and discussing the complaint at a formal meeting

➲ all concerns should then be addressed in a way that the patient can understand. avoid abbreviations, and explain medical terms

➲ reflection, along with a discussion of any action or learning points arising

➲ Details of iscas, if appropriate

➲ an offer to meet with the patient to discuss any outstanding concerns

Dr Lucy Hanington is a medico-legal adviser and Terri Bonnici is medical complaints adviser at Medical Protection

Bupa’s bid to make cover affordable

Independent Practitioner Today’s last issue reported on the appointment of Bupa’s new medical director for UK Insurance, Dr Luke James (below). Here he sets out his focus for the future

PeoPle BuyIng health insurance are looking for convenient access to high-quality, safe, affordable healthcare and expect a great customer experience when claiming and being treated.

WorkIng together to Improve quaLIty

o ur relationships with consultants and healthcare professionals are very important to us. We want to work together to provide highquality care to Bupa patients and demonstrate the value of private healthcare.

We’re always keen to work with consultants to improve quality, outcomes and cost-efficiency for patients. However, we have only ever worked with them individually until now.

In early July, as reported by this journal in the last issue, we launched accreditation for clinician groups in the specialties our patients are referred to.

The number of consultants working together in groups is steadily rising. We believe these groups offer real benefits for patients in terms of clinical service and experience, especially with increasing subspecialisation in clinical practice.

Introducing accreditation will be the first step of a phased approach to test new ways of working with consultant groups.

I firmly believe that driving the quality and safety agenda in private healthcare is our responsibility as an insurer, working alongside other insurers, hospitals and clinics, and healthcare professionals.

Sharing outcomes and other

from our news pages in our Julyaugust issue

healthcare information is becoming increasingly important. Recent events, such as the case of Birmingham breast surgeon Ian Paterson have highlighted the need for greater co-ordination between the nHS, private hospital groups, other healthcare providers, clinicians and insurers to identify and take faster action on outlying clinical behaviour.

Hospital networks

As a commissioner of care for our customers, we aim to promote the adoption of best practice. We are about to renew the network of hospitals and clinics offering endoscopy services to our customers and, as part of the quality criteria, we are asking them to confirm that they have registered with the Royal College of Physicians to work towards Joint Advisory group on gastrointestinal endoscopy (JAg) accreditation if they do not have it already.

This assures our customers of the quality of the care that they will

receive and helps them feel better equipped to make an informed decision about where and from whom they receive their care.

The Getting It Right First Time programme is helping to improve the quality of nHS care by reducing unwarranted variations, bringing efficiencies and improving patient outcomes, and this is something we would like to see extended to private hospitals. We have a role to play in helping our customers avoid unnecessary surgery where we see a variation in care; for example, by ensuring that we only fund care in line with best practice guidelines. our knee arthroscopy funding criteria were drawn up using the evidence-based framework developed by e uropean Society for Sports Traumatology, Knee Surgery and Arthroscopy, and we have seen a 14% drop in intervention rates for knee arthroscopy between January to February 2018 compared to the same period in 2017.

We have recently signed a memorandum of understanding agreement with the Care Quality Commission which is a public commitment to share information about the quality and safety of the care our customers receive and we believe it will help make sure they continue to receive the best possible care.

We have consistently been very supportive of the Private Healthcare Information n etwork’s (PHIn’s) role in publishing standardised measures on the quality and effectiveness of private healthcare.

This will help us achieve our objective to fairly reward healthcare professionals who deliver the

very best care to our customers, as well as offering reassurance about the standard of care that they can expect.

We would encourage consultants to go further when submitting information to the relevant registries and hospitals by collecting information to allow comparability with the nHS.

We are encouraged by the recent announcement of a new n HS Digital initiative, jointly with PHI n , to ensure private healthcare data is recorded in the same way as nHS data in england. It is only through transparency that the sector can demonstrate the value we offer and return the private healthcare market to growth again.

ImprovIng afforDabILIty

Affordability is one of the primary reasons for the decline in the consumer segment. The introduction of treatments such as immunotherapy and ever more personalised medicine all lead to significant increases in the cost of care for people with health insurance.

It is important that we work together to ensure that private healthcare offers clear value for money. For example, we can make sure that care is delivered in line with best practice and that patients do not opt for unnecessary surgery which can mean both better outcomes for the patient and reduce costs.

o ptimising care pathways so that patients see the right clinician first time also has a part to play. our Direct Access Service –where there is no need for a g P referral – means patients for cancer, mental health, physiotherapy and cataracts can get faster advice and treatment.

Where we have offered patients the option of seeing an MSK physician as an alternative to going straight to a surgeon, they are 40% less likely to have surgery, with all its associated risks, in the following year.

They also give us positive feedback about the service – a n et Promoter Score* in the high +70s – and they commend the thoroughness of the review and diagnosis, as well as their appreciation

for having non-invasive treatment options explained to them.

Having demonstrated the effectiveness of these approaches, we need to work with healthcare professionals, hospitals and clinics to commission pathways of care rather than individual episodes so that all patients can experience the same benefits.

the benefIts of neW technoLogy

It is an exciting time for healthcare and for Bupa with technology driving significant change and benefits. Future technological advances will gather momentum at increasing speed, as patients are now often the ones setting the pace of change.

We are already seeing a change in the public’s approach to cancer care, especially in where they are embracing P4 medicine (predictive, preventive, personalised and participatory). They want their healthcare delivered in a personalised and participatory way, eventually moving to the predictive and preventative space.

o ther technological advances in cancer treatments mean we are seeing increased use of genetic profiling in diagnostics, monitoring and personalised medicine.

The role of artificial intelligence will become ever more important both in diagnostics and triage, while the use of robotics in surgical procedures is becoming more common.

Although healthcare and health insurance are highly regulated sectors, which mean they can sometimes be slower to change, we as clinicians and insurers need to embrace new technology to make sure we are not left behind.

Bupa is always looking to use

new technology to do this. We are already working with digital healthcare provider Babylon to give our business health insurance customers and their employees round-the-clock access to advice. It is an exciting time to be in the healthcare sector and there is so much potential to harness digital innovations to make a positive difference to the patient experience. I look forward to working with

Introducing accreditation will be the first step of a phased approach to test new ways of working with consultant groups

clinicians, hospitals and clinics to deliver the highest quality, affordable and most effective care to all our shared patients. 

* Net Promoter Score is an index ranging from -100 to 100 that measures people’s willingness to recommend a product or service to others. It is determined by subtracting the percentage of those who are detractors from the percentage who are promoters of the product or service.

We reported in our last issue on bupa’s aim for more data transparency

Do they know your terms?

With the requirement for greater fees transparency and recent General Data Protection Regulation, many private doctors would do well to review their terms, warns Findlay Fyfe (left)

It Is a good time to consider your fees right now – and here is why.

As we know, the Private Healthcare Information Network (PHIN) is due to publish data on its consumer ­ based website from early 2019.

this will enable patients to have more information to decide who treats them and where the treatment takes place.

And this all ties in with the requirement on consultants to make patients aware of their fees in advance of treatment.

With this now on the horizon, we at Medical Billing and Collec­

tion (MBC) are recommending getting ahead of the curve and thinking about this now while there is time to deal with it in an unhurried way.

Patient registration form

For pricing in a commercial environment, a set of business terms and conditions will describe how the company will conduct its business and the document will normally form part of a commercial contract.

In private healthcare, particularly for consultants, this will be your patient registration form.

On this form, it is good practice to describe how transactions will take place between the patient and the practice. If you were to use a third­party company such as MBC, a simple line should be added to state that MBC will carry out all billing and collection requirements for the practice.

If you want to communicate –for marketing – with the patient after treatment, you will need to have an opt in/out question asking clearly if the patient would like to be included in these emails and communications. this will comply with your General Data Protection Regulation requirements.

doctor’s biography

A practice may also consider having a consultant’s biography for the patient, including any performance statistics and papers written. But if you do this, please ensure you diarise time to keep this up to date.

the most important thing is the patient is clearly aware of all information before treatment starts.

In our experience, when a patient has private health insurance, many automatically assume that all the costs will be covered under this policy, whereas in reality there can be shortfalls or limi­

tations of cover, resulting in a secondary invoice for the patient. typically, few patients read the small print of their policy where any limitation will be highlighted. Your patient registration form should also inform the patient of any additional charges such as charges for non ­ attendance or last­minute cancellations.

And it should also detail any areas where the practice charges for items traditionally not covered by private medical insurers. these could include phone consultations and prescription services.

All the above information should be included into a patient registration form, as well as any other commercial considerations specific to your practice, such as domiciliary visits.

If your practice has a website, I would suggest that the wording exactly matches that on your registration form and is consistent across all media.

I appreciate there are too many variables to cover all of them in this article, but I have provided an example of how you can use a template (opposite) and adapt it to your practice. 

Findlay

Fyfe is the managing director of Medical Billing and Collection

PATIENT REGISTRATION FORM

PATIENTS COVERED BY MEDICAL INSURANCE

This is a private appointment and the patient’s insurance provider will be contacted for payment. Should the insurer not cover part or the whole payment, then the patient will be responsible for settling any outstanding amount.

SELF-PAY PATIENTS

This is a private appointment and the patient is responsible for all charges. Payment may be requested in advance, if full costs are known, or immediately after any treatment.

FEE SHEDULE

The consultant’s fee schedule is typically met by the insurer. However, this may vary by insurer. You will be provided with fees where possible in advance of treatment. It is the patient’s responsibility to establish if their policy will cover the costs of the treatment.

FURTHER CONTACT

Following your treatment are you happy to be contacted by the practice to keep you abreast of information we feel may be relevant to you? YES NO

ADDITIONAL

The practice reserves the right to charge £xx for non-attendance or last-minute cancellations.

Cancellations 48 hours in advance of treatment will not be levied a charge.

The consultant’s fees are separate to any invoices raised by the hospital where you receive treatment. All invoices will be raised by xxxxxx, our billing partner, who will also collect any monies owed. The consultant’s fees for the following procedures are typically not covered by insurance policies:

l Home visits £#

l Phone consultations £#

l Prescription charges £#

PRivATE PATiENT UNiTs

Large income gaps means room to unite

This month’s financial tour of private patient units (PPUs) by Philip Housden (right) analyses private patient revenue growth for ten NHS acute trusts across the East Midlands counties of Northamptonshire, Leicestershire, Nottinghamshire, Derbyshire and Lincolnshire

Figures From the most recently published annual accounts for this group of trusts show that total private patient revenues were flat in 2016-17 after a period of growth.

Total revenues were £11.9m in 2016-17, up from £10m in 201415, a growth of 18.6% (see Figure 1 opposite).

This now represents 0.31% of these trusts total revenues, essentially a flat figure for the last few years. This is below the combined national average outside of London of 0.5%.

These ten acute trusts can be divided into three groups based on analysis of private patient revenues, growth and size (Figure 2):

 Growing contribution: Two trusts have each grown by over 25% in the past four years and also contribute in excess of 0.25% of total trust revenues and offer a multi-site ‘chain’ approach to PPu services. These are: Derby (now

with Burton) and North Lincolnshire and goole.

 Teaching units: Two trusts provide non-inpatient services while achieving revenues over £2m a year: Nottingham and university Hospitals of Leicester.

 Lowest contribution: The final group of five trusts are those that have very low present earnings; four below 0.15% of trust turnover.

These are united Lincolnshire, Chesterfield and sherwood, all of which are also declining, and Kettering, which has grown in comparison to 2013-14 base year, but has declined since.

Growing contribution

The rising star of the region is Derby, where the NH s PP u is branded Derby Private Health, which has delivered growth of 140% in the last four years, reaching £3.18m in 2016-17.

To support further growth, the

looking to share expertise or link up in some other form.

Northern Lincolnshire and g oole also have found success with their own ‘chain’, branded Lindsey Private Patients, with a presence in goole, grimsby and scunthorpe.

over the past four years, the service has grown revenues by 29% to £1.03m to now be up from 0.28% to 0.34% of total turnover and rising. At goole and District Hospital, the Lindsey s uite provides single-room accommodation, and services offered include those not routinely offered on the NHs, such as cosmetics and some ophthalmic procedures plus the expected range of fast access to imaging and self-pay admissions.

Teaching trusts

trust is investing £2m to build and equip a new dedicated operating theatre for private patients at the r oyal Derby Hospital using surpluses which locally have been declared as in excess of £1m in 2016-17.

The PP u houses 11 en-suite inpatient rooms, five consultation rooms, a private chemotherapy suite and minor procedures room. in addition to the investment of a dedicated theatre, Derby Private Health is launching a fully equipped ophthalmology outpatient clinic this year.

The recent trust merger to form university Hospitals of Derby and Burton enables the inhouse PPu team to expand further, incorporating into Derby Health the private patient activity in Burton, including the Burton Clinic PPu, worth approximately £1m a year.

This is one of the emerging PPu ‘chains’ that may develop expertise that can support other trusts

Nottingham university Hospitals has also experienced growth, but without investing in a PPu. The local market is competitive with a long-standing treatment unit run by Circle now joined by a new £60m flagship hospital opened by spire in 2017 and recently rated outstanding by the Care Quality Commission. The trust does not have a separate PPu, but houses private patients on NH s wards. Despite this, the trust had income of £2m in 2016-17, up 30% in four years.

university Hospitals of Leicester is a second regional teaching trust without dedicated inpatient private patient accommodation. services are located between three main sites across the city, which also has both a spire and Nuffield Hospital, each of which supports higher than average complexity case mix.

The trust achieved £2.86m revenues in 2016-17, a slight downturn in cash terms from £3m in previous years, but private patient earnings as a percentage of total turnover is on a declining trend, down from 0.45% in 2013-14 to 0.37% in 2016-17.

Both Leicester and Nottingham have advantages in the local market with regards to most complex care and a dedicated PPu looks to be worth considering, particularly in Leicester where service and site reconfiguration has recently been announced and private patients may be able to be incorporated within a future capital investment.

Lowest contribution

We now turn to the group of five trusts with the lowest contribution from private patient revenues. Northampton g eneral Hospital is the highest earner of these, earning £910k in 2016-17.

Northampton does not have a dedicated PPu. By contrast, Pilgrim Hospital, Boston, does have a dedicated private patient unit – the Bostonian Wing – with 18 beds.

The united Lincolnshire Hospitals trust, including Boston, Lincoln and grantham sites, delivered £551k revenues in 2016-17; essentially flat over the past three years, but well down on the £1.1m in 2011-12 when this was 0.3% of total trust income (now 0.14%).

Perhaps there is potential to link up with Lindsey in the north of the county to help with branding, back office and leadership?

Kettering general and Chesterfield royal Hospital trusts have a negligible level of private patient earnings (less than 0.1%) at £175 and £80k respectively in last published annual accounts. Neither are known to have plans for investment.

However, at s herwood Forest Hospitals, plans are being drafted to extend the present limited private patients service at the King’s mill Hospital near mansfield. The trust reported revenues of only £119k in 2016-17.

NHs trusts in the east midlands have a mixed approach to private patient activity, as is shown through this analysis. There remain several trusts where the present absence of any private patient capability is likely to mean that complex treatments on local insured patients are defaulting to the NHs as a cost.

By contrast, other trusts are embracing the opportunity and are developing multi-site locations through which to develop branded services. The gap in contribution is clear from chart showing annual revenue for all ten regional trusts (Figure 3). Perhaps this is the region where those with current and growing expertise could link up with those not yet able to enter the market in a meaningful way.



Next month: West Midlands

Philip Housden is a director of Housden Group

Perhaps this is the region where those with current and growing expertise could link up with those not yet able to enter the market in a meaningful way

Figure 1

Figure 2

Figure 3

What to beware of when saying goodbye to staff

Recent

employment law changes and developments

are particularly

relevant to employers managing negotiations and the financial entitlements of departing employees. Fiona McLellan (right) reports

TAxATion oF TERminATion

pAymEnTs

Important changes to the way termination payments are taxed came into force on 6 April 2018, which are likely to have – unhelpful – implications for employers negotiating exits with employees.

The new taxation rules relate specifically to payments in lieu of notice (PILONs) in respect of employment which ends after 6 April 2018 and where the sums are paid on or after that date.

In summary, the new rules mean that all notice pay should be treated as earnings and subject to tax and National Insurance contributions.

This is regardless of whether there is or is not a PILON in the employment contract.

Previously, where there was no contractual PILON, the payment

could be made tax free up to £30,000.

A specific formula is set out in the legislation to calculate what element of a termination payment must be treated as notice pay –referred to as Post Employment Notice Pay or PENP.

The PENP is the basic pay an employee would have received if they had worked out their notice – whichever is the longer of the statutory or contractual notice period – from which any PILON already paid would be deducted.

The well-known £30,000 tax exemption provisions for termination payments, set out in the tax legislation, can still be utilised in respect of any additional sums payable to the departing employee, where these genuinely represent compensation for loss of

employment – for example, statutory redundancy payments.

Note that injury to feelings payments, where connected to the termination of employment, now fall outside the tax exemption provisions unless the injury amounts to a psychiatric injury or another recognised medical condition.

While these changes to the taxation of termination payments were heralded as simplifying this complex area, it is safe to say that the position is far from straightforward and is also likely to impact detrimentally on employers conducting exit negotiations, given that the carrot of a tax-free notice payment is no longer available.

Finally, and for completeness, it should be noted that, from April 2019, termination payments above £30,000 will be subject to class 1A (employer’s) National Insurance contributions.

Case Law deveLopMent

Newcastle upon Tyne Hospitals NHS Foundation Trust v Haywood

the supreme Court’s judgment in this case confirms that where a contract is silent on when notice is deemed to be given, notice takes effect when it is received by the employee and they have read it, or had a reasonable opportunity to do so.

the claim was brought (initially in the High Court) by Mrs Haywood, a long-serving nHs employee. In april 2011, her post was identified by the trust as being at risk of redundancy. Both parties knew that if she was made redundant on or after 20 July 2011 – Mrs Haywood’s 50th birthday – she would be entitled to a higher-value nHs pension.

she told the trust that she would be on holiday from 18 april to 3 May 2011 and in egypt between 19 and 27 april. on 20 april 2011, the trust issued written notice – by three different methods, namely: ordinary post, recorded delivery post and by email to her husband’s email address – of the termination of employment on the grounds of redundancy. the notice stated that Mrs Haywood’s notice period was 12 weeks and that her employment would end on 15 July 2011 – five days before her 50th birthday.

there were no provisions in the employment contract detailing when notice would be deemed to have been received. Mrs Haywood read the letter on her return from her holiday on 27 april and therefore claimed that her 12 weeks’ notice did not begin until she received and read the letter, meaning the notice period expired on 20 July 2011 and she was entitled to the higher nHs pension.

the High Court ruled in favour of Mrs Haywood, as did the Court of appeal and those decisions were upheld by the supreme Court.

the supreme Court held there was no reason to depart from case law dating back to 1980, which had held repeatedly that written notice does not take effect until the employee has, or has had a reasonable opportunity to, read that notice.

Further, the court found it was open to employers to make express reference to when notice is deemed to be received.

this case emphasises the importance and benefit of express contractual provisions, to avoid uncertainty when, in a case such as this, a situation is timecritical.

It also serves as a useful reminder that employers need to understand the importance of acting in accordance with contract terms – which should be regularly updated – or to seek advice when there is doubt about the position.

For example, in this case, the issue for the trust could perhaps have been addressed by giving Mrs Haywood notice in person before her holiday rather than by post.

nEw compEnsATion limiTs

From 6 April 2018, compensation limits and minimum awards payable under employment legislation increased.

The key increases to be aware of are:

 A week’s pay – for the purposes of calculating statutory redundancy payments and the basic award for unfair dismissal, among other things – £508;

 Maximum basic award/statutory redundancy pay – £15,240;

 Unfair dismissal compensatory award limit – £83,682 – or a year’s salary if lower.

The new rates apply when the appropriate date for the cause of action – that is to say, the effective date of termination in an unfair dismissal claim – is on or after 6 April 2018.

If the appropriate date falls before 6 April 2018, the old rates will apply.

The level of payment for injury

to feeling awards – a sum that can be claimed in an Employment Tribunal claim for discrimination in contravention of the Equality Act 2010 – also increased as of 6 April 2018.

The new compensation bands are:

 Lower Band: £900-£8,600 for less serious cases;

 Middle Band: £8,600-£25,700 for cases that do not merit an upper band award;

 Upper Band: £25,700-£42,900 for the most serious/severe cases.

The increase in compensation levels, especially following the removal last year of the requirement to pay a fee to lodge a claim in the Employment Tribunal and then a further substantial hearing fee, is likely to mean that exemployees may feel that they have little to lose and much to gain by raising a claim in respect of the termination of their employment.

ex-employees may now feel that they have little to lose and much to gain by raising a claim in respect of the termination of their employment

conclusion

Terminating a contract of employment is rarely a straightforward or risk-free matter for employers, especially smaller employers such as GP practices with limited specialist human resources staff to assist.

It should therefore always be conducted cautiously after appropriate consideration has been given to the potential employment law issues that could arise in each particular case.

The potential financial and reputational risks for employers should not be overlooked, but with some careful planning such issues can be mitigated against and managed.

If in doubt, and especially in complex or acrimonious exit situations, it is prudent to take specialist legal advice. 

Fiona McLellan is a partner at Hempsons

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

Free legal advice for independent practitioner Today readers IPT

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

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

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

Advice is available on:

 Business structures (including partnerships)

 commercial contracts

 Disputes and litigation

 HR/employment

 premises

 Regulatory requirements and investigations

michael Rourke Tania Francis m.rourke@hempsons.co.uk

whEn To winD Down woRk

Retiring requires planning

So what is your ideal retirement age? Dr Benjamin Holdsworth on planning the right time to leave

The laT es T version of the N hs Pension scheme could keep those of us with health service appointments toiling until age 68.

We often hear that 60 is the new 50 and 70 is the new 60, but how many doctors are prepared to stay on? a nd is the N hs creating an environment where older consultants can thrive?

a ccording to GMC data, there are currently 19,749 doctors aged 60 and above, who are registered and licensed to practise in the UK.

statistics from the Nhs Working l onger Review (W l R) in 2013 –when most retirees were part of the 1995 pension scheme –revealed that the average age of retirement for medical practitioners was 62 for men and 61 for women. Many had stayed on beyond the required 60 but were not prepared to make it to 65.

It is easy to understand why doctors choose to wave goodbye early – decades of dedication to

front-line medical practice will take its toll in many ways.

Figures suggest that some 80% of senior hospital doctors now consider early retirement. a recent physician survey cited the most common reasons include red tape, pressure of work, length of working hours and dissatisfaction with the Nhs

Different abilities

Of course, each doctor’s ability to work into the third age is very different. Most will not experience significant health issues until well after pension age, but practice can be taxing in terms of dexterity, hand-eye co-ordination and rapid response, particularly when combined with long hours and middle-of-the-night activity.

Two-thirds of doctors of current working age told the BM a that they would not be confident of being able to practise to at least the same level of competence if they worked post retirement age.

however, given the high cost to the health service when talented individuals take their experience and skills set with them, not to mention the increased stress on work colleagues left behind, is the N hs doing enough to facilitate doctors who need/wish to work for longer?

Many consultants state that there are not adequate workbased opportunities for older employees.

When questioned, BMa members believed there should be greater flexibility in terms of how their working time is arranged. This would take into account changes in the ability to cope with unusual timetables and fatigue by offering reduced hours and adapted roles.

The survey asked whether doctors intended to continue working after drawing their N hs pension. s ome 34% said yes –although the vast majority of

these respondents (82%) stated it would be in a part-time capacity.

The average age for doctors who intend to continue working if their normal pension age is 60 is 65 years. a lmost one quarter intend to work beyond 65, showing the real need for the Nhs to accommodate older workers.

The Working l onger Review asked doctors what their approach to work would be if required to work to the new pension age of 68.

Unpaid work

Only 15% said their working life would remain unchanged as opposed to 70% who suggested they would be less likely to work outside their contracted hours. 60% said they would be less likely to do work not specified in their contract.

Given that the same study found that most consultants give an extra eight or nine hours a week in unpaid work, the N hs

would lose a substantial level of input from older employees. among our clients at Cavendish we have many examples of those who wish to retire on a set day and never work again and others who wish to retire gradually, distancing themselves from the more troublesome aspects of the job while still enjoying private practice, mentoring, academic work and legal projects. s ome 67% of our clients express a desire to retire before 65.

having the choice to keep working – whether for financial assurance or the rewarding nature of the job – presents different challenges than being forced to do so in order to draw your N hs pension. Those seeking a work-life balance will need to weigh up the cost to their wallet and their health carefully.

The important part of retirement planning is to take the first steps as early as possible. Reflect

on your own ideas of what your later life should resemble and then consider how to achieve these goals by mapping a realistic yet flexible financial plan for the future.

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

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

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

EXPERT ADVICE YOU CAN TRUST

EXPERT ADVICE YOU CAN TRUST

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

• Setting up in Private Practice

• Setting up in Private Practice

• Developing your Private Practice

• Developing your Private Practice

• Developing your Private Practice

• Tapering of the Annual Allowance

• Tapering of the Annual Allowance

• Tapering of the Annual Allowance

• Lifetime Allowance planning

• Lifetime Allowance planning

• Lifetime Allowance planning

• Personal Allowance planning

• Personal Allowance planning

• Personal Allowance planning

• Reviewing your PAYE Coding Notices SPECIALIST

• Expenses that you can claim and those you cannot

• Expenses that you can claim and those you cannot

• Reviewing your PAYE Coding Notices SPECIALIST

• Expenses that you can claim and those you cannot

• Minimising your tax bills

• Minimising your tax bills

• Minimising your tax bills

• Reviewing your PAYE Coding Notices

01625 527 351

Preserve privacy when publishing

Dr Ellie Mein (right) explains the importance of anonymising cases in medical publications

Dilemma 1 How can I retain confidentiality?

QI have recently read stories in the press of a couple who withdrew consent for their medical photographs to be used in a medical publication after their story was picked up by national newspapers, both in the UK and overseas.

It is my understanding that, although written consent was initially given, this was later withdrawn and the article was removed.

What steps can I take to ensure that I am not inadvertently breaching the patient’s confidentiality?

ACase studies and personal reflections can be a valuable educational tool, whether for individual doctor’s practices or to enhance understanding more widely.

However, there is a risk of what the Information Commissioner’s Office (ICO) calls ‘re-identification’. This is where an individual or group already knows about the subject of a case study, perhaps because they are a family member

or colleague, and are therefore able to identify them, even though an ‘ordinary’ member of the public or an organisation could not.

In its confidentiality guidance, the GMC also makes clear doctors ‘must anonymise information in training records and case studies as far as it is possible to do so’.

The council stresses that ‘simply removing the patient’s name, age, address or other personal identifiers is unlikely to be enough to anonymise information’ to the standards required by the ICO in its Anonymisation Code of Practice.

The ICO considers data to be anonymised if it ‘does not identify any individual and that is unlikely to allow any individual to be identified through its combination with other data’.

Neutral pronouns

In practice, this means using neutral pronouns, such as they/their, rather than referring to the patient’s gender, giving a broad indication of age – for example, a patient in their 60s – and avoiding initials; instead, a single letter unconnected with their name (such as ‘Patient X’) should be used.

Particular care should also be given when writing about rare conditions or unusual presentations, which might easily identify the patient.

If it is difficult to anonymise material and retain enough detail for it to be useful or if it is necessary to include identifiers to allow a record to be audited, the GMC says you should seek the patient’s consent.

If this is not practicable, the GMC draws a distinction between training records that ‘will be kept securely’ and managed in line with data protection requirements and information ‘that is likely to be more widely accessi-

Particular care should also be given when writing about rare conditions or unusual presentations, which might easily identify the patient

Are doctors allowed to treat animals?

A private GP is asked to treat an animal. Dr Kathryn Leask (right) gives her advice

ble’ such as case studies in journals.

For the former, it should be possible to include the information, provided you have removed as many identifiers as you can. Otherwise, you should usually only use the information with the patient’s explicit and informed consent.

When seeking consent from the patient – or someone with legal authority to act for them – you must describe the information you plan to disclose, indicate who will have access to it and how it will be used.

Remove identifiers

You still need to remove as many identifiers as you can and only use the information for this purpose. A patient’s refusal should be respected.

Also, beware of discussing cases on social media, even in doctorsonly online forums, and it is safest to avoid doing so. It is easy to drop your guard if you think you are communicating with colleagues, but the information may be seen by others or shared more widely.

Your duty of confidentiality continues after the patient’s death. Respect any instructions left by the deceased patient, but if there are none, the GMC says you should take into account:

 Whether the disclosure is likely to cause distress to their family;

 Whether the material would identify a third party;

 Whether the information is already public knowledge or can be anonymised or de-identified;

 The purpose of the disclosure.

Finally, remember to contact your medical defence organisation if you are unsure about your duty of confidentiality.

Dr Ellie Mein is an MDU medico-legal adviser

Dilemma

2

Is it fine to treat my friend’s dog?

QI am a private GP and have been asked by a friend to treat her dog, which has an eye infection as well as a patch of eczema on its back.

She has taken it to a vet who has said it needs chloramphenicol eye drops and some Betnovate cream as well as a follow­up appointment next week.

Due to these costs, my friend has asked me to prescribe the medications privately, which she is happy to pay for, and for me to check that there is an improvement with the treatment, rather than returning to see the vet. Is it OK for me to do this?

AAlthough, oddly, there is no restriction on veterinary surgeons treating humans, it would be contrary to section 19(1) of the Veterinary Surgeons Act 1966, as amended, for a doctor to treat an animal.

The only person who can legally treat an animal, according to the Act, is someone included in the register of veterinary surgeons or the supplementary veterinary register. Anyone who acts in contravention to this could be liable to a fine of up to £100 and could face a criminal conviction.

Section 19 does allow animals to be treated by registered medical practitioners at the request of a registered vet. However, this is generally related to circumstances where the vet may require the specialist skills of the doctor. Another exception is where doctors operate on animals to harvest their organs where these are intended for human treatment.

If you were to treat your friend’s pet and consequently received a criminal conviction, this would be notified to the GMC.

And, on top of this, you would have your own obligation to inform them of the conviction in accordance with Good Medical Practice , which could put your registration at risk.

Dr Kathryn Leask is an MDU medico-legal adviser

Chartered Accountants, Tax & Business Advisers specialising in the Healthcare Sector

• Tax structures for Hospital Consultants

• Surgeon groups and consortia

• GP practices, including mergers and federations

• Solvent liquidations

The biggesT shake-up in the tax system since self-assessment is on its way: Making Tax Digital – or MTD – as the taxman calls it.

h M Revenue and Customs (hMRC) estimates that it loses as much as £9bn in each year due to the inaccurate submission of tax returns.

s o its new requirements force taxpayers who are paid outside of the PAYe system to electronically disclose their earnings/ income more regularly than the current annual tax return or ‘self-assessment’ system. it also affects other taxes such as VAT.

The measures are sold to us as improving accuracy of the information disclosed by pushing taxpayers onto digital recordkeeping.

eventually, this will allow the taxpayer to see all of their tax information in one place in a similar manner to online banking.

The cynic in me would argue that these measures do little to improve accuracy of data supplied by the vast majority of small businesses and the agenda is to eventually accelerate tax payments for those paying income tax under self-assessment.

Time will tell whether this happens, but hMRC is committed to digital reporting and obtaining more accurate information of a taxpayer’s affairs and on a more timely basis.

This article outlines the new measures and how you can prepare for the changes that will affect you over the coming years.

What’s it all about?

historically, information regarding a taxpayer’s affairs could be submitted manually, whether this be for a self-assessment tax return or other taxes such as VAT.

Most consultants will have moved to some form of digital record-keeping, as it is generally a more efficient way of running the business, but there are those who still keep manual records or just send the source documents for the accountant to sort out.

The new measures effectively prevent you from having anything other than a digital accounting system. importantly, this software needs to have a direct link to submit the information to hMRC.

The changes were penned for April 2018, but with brexit and other pressing matters, the timetable was pushed back – although you could adopt early from 1 April 2018 on an invite-only pilot scheme. Quite sensibly, h MRC also decided to phase in the changes for different taxes.

Much is still outstanding and changes will no doubt be made both in the run-up to implementation and after. Therefore, the information highlighted within this article is as things stand at the time of writing.

Timetable for implementation

The first batch of businesses affected are those that are VATregistered. For doctors, this usually means those who are engaging in medico-legal work or other non-medical work in excess of the mandatory VAT registration threshold of £85,000 on a 12-month rolling basis. it does, however, affect any VAT-registered business and implementation is set for 1 April 2019.

No doubt, the finalised timetable for other taxes will be made following the introduction of MTD for VAT, but as things stand, hMRC wants to go live for income and corporation taxes from 1 April 2020.

This is the date that most consultants carrying out private work will need to be ready. With the continued uncertainty over brexit and the inevitable teething problems that will arise, it remains to be seen whether this proposed date is realistic.

What will it involve?

eventually, hMRC sees each taxpayer and business having a digital portal with all of their tax information visible and largely up to date.

The PAY e system switched to

Eventually, HMRC sees each taxpayer and business having a digital portal with all of their tax information visible and largely up to date ➱ p48

monthly reporting some time ago. But if that system is anything to go by, we are in for a bumpy road, as the supposed up-to-date information is often not available for a long time.

The VAT-registered businesses affected from 1 April 2019 will not be able to manually enter their figures onto the current online reporting platform.

There must be a link from your software direct and if it is not compatible by that date, you will be expected to replace it with a system that is. Otherwise you cannot fulfil these new obligations and will eventually face penalties.

The frequency of submission will vary based on your current submission pattern and any VAT schemes that may be in place. Your accountant will be able to advise you based on your individual circumstances.

The second phase

For the second phase of implementation affecting income and corporation taxes, it is anticipated that you will report your figures to HMRC on a quarterly basis with an opportunity to submit a yearend reconciliation in a similar manner to the annual self-assessment tax return.

It is anticipated that the reporting will be on a cash in-out basis for most businesses, due to the burden and cost of preparing accounts on the usual invoice basis.

The exact detail will be rolled out in due course and no doubt covered within Independent Practitioner Today , so keep an eye out for updates in 2019.

Making Tax Digital is going to be a painful transition, as rarely do such radical changes run smoothly.

With VAT-registered doctors being in the minority, it does at least limit the initial numbers affected, but is inevitable that HMRC will move to this system over the coming years.

There will be benefits for the taxpayer to understand their tax affairs in more detail, but I suspect that, in the longer term, it will result in paying tax more frequently than the current tax system.

 Next month: Top tips for the newly appointed consultant

MEdICal sofTwaRE

Most private practices of any significant size will use one of the practice management software packages and great efficiencies can be experienced from their use.

at the time of writing, I understand that most, if not all, of the bespoke medical software packages do not have a direct link to report under MTd

This is perhaps due to the timetable being pushed back or perhaps the assumption that some form of work-around solution may be available, such as exporting data to another package.

as things stand, HMRC expects the software used to export the data directly from the software, as it considers an interim step as an opportunity to introduce error. It remains to be seen whether it changes its stance, but its logic seems sound.

If your private practice is VaT-registered and you are using medical billing software, you should speak to the software supplier as soon as possible to discuss what steps it is making for MTd to ensure your obligations are met.

Hopefully, these packages will update in time for the en masse migration of income and corporation taxes scheduled for 2020. Having to run a separate accountancy package would be inefficient and no doubt expensive.

KEy quEsTIons To ConsIdER

 are you VaT registered? – If yes, contact your accountant as soon as possible if you have not already had a discussion on MTd

 are you using manual records? – Time to get with the times and go digital

 are you using medical software? – don’t assume they are or will be compliant with MTd

 are you worried about this?

– speak to your accountant at your next meeting unless, of course, you are VaT-registered, as now is the time to be having that conversation

Ian Tongue (right) is a partner with Sandison Easson chartered accountants

Healthcare 2019, the ideal event for you.

Future Healthcare 2019 is the UK’s leading healthcare Exhibition and Conference taking place at Olympia London from 18 to 19 March 2019. The event will provide a unique gathering of global healthcare buyers and leaders across government, associations and industry.

Future Healthcare 2019 will connect you with global VIP Buyers, Senior Procurement Officers, Governments, and Distributors across the public and private sector. It will present you with a vital opportunity to demonstrate your products, services and capabilities to the senior decision-making audience who will attend.

Can your business afford to miss this unique opportunity?

Dawn Barclay-Ross, Event Director +44 (0) 203 740 4666 dawn@futurehealthcareuk.com

Welcome to augmented

The new A-Class is much more than an update. There is a brand new and roomier body and the interior has been brought bang up to date

This Merc’s latest and innovative offering is set to be a winner with independent practitioners, predicts Dr Tony Rimmer (below)

Any wELL-ESTABLISHED private practice with a good reputation and a history of performing well is likely to attract a steady flow of clients.

In the motoring world, too, it is all about brand image. If there is one car maker synonymous with long-established service and premium products it is MercedesBenz, a favourite of many independent practitioners.

The maker’s biggest-selling car in the UK is the Golf-sized A-Class and it has recently launched a new updated model. Let’s take a look at what versions are available and how it drives on UK roads.

The new A-Class is the fourth generation of a Mercedes class first launched in 1997. The third generation, launched in 2012, has been a massive success for the German brand. In 2017, the UK was the largest market for the A-Class globally.

But the new car is much more than an update. There is a brandnew and roomier body and the interior has been brought bang up to date. Indeed, it is the new tech

available and the driver’s access to the cockpit displays and controls that leapfrogs the new A-Class ahead of most competitors.

Leaning heavily on systems developed for the bigger and much more expensive S-Class models, the stand-out feature is the full-length single sheet of glass that houses two infotainment screens side by side and creates a widescreen cockpit display.

A pair of seven-inch screens are standard, but one or two impressive 10.25” screens are optional.

Engine options

There are three engine options available at launch. The A 180d uses a 1.5litre four-cylinder turbodiesel producing 116bhp. The A 200 uses a new 1.3litre four-cylinder turbo-petrol engine producing a healthy 163bhp.

The A 250 is the sporty one. Using a 2.0litre four-cylinder turbo-petrol generating 224bhp, it can sprint from 0-62mph in 6.2 seconds.

There are three levels of trim: SE, Sport and AMG-line. All mod-

els get a multimedia system with voice activation, alloy wheels, DAB radio, active lane keeping assist, active brake assist, Keyless-Go starting, air-conditioning and Mercedes sat-nav

An augmented reality navigation display is also available as an option. This overlays a real-time camera picture of the road ahead with navigation data and instructions – more on this later.

The new car looks sharper and more stylish. Slimmer light clusters at the front and the rear help the more modern look. The slightly larger dimensions allow greater head and leg room for rear-seat passengers and the boot is roughly Golf-sized with a wider opening for access.

The interior is a revelation; the futuristic wide-screen dashboard looks great and works intuitively, controlled by solid, high-quality steering wheel-based touch-control buttons and haptic (tactile) feedback touchpad on the centre console.

It loses some of the dramatic appeal, though, if you stick with

augmented reality

The dashboard is controlled by tactile touchpad on the steering wheel

the standard seven-inch screens. They look lost in the long black glass-covered widescreen. Go for the full dual 10.25” set-up and you feel that you could be driving an S-Class – praise indeed. The voiceactivated multimedia and sat-nav works well and pretty accurately.

Sophisticated tech

The only feature that I am not so convinced by is the augmented reality navigation display. The camera picture appears automatically before junctions and roundabouts and shrinks the usual pictorial map.

In my view, it actually distracts rather than aids progress. Despite this caveat, the A-Class now has the clearest and most sophisticated tech in its group and has leapt ahead of all premium rivals. The fit and finish and quality of materials seems to have improved from the last model and you certainly feel that you are driving an executive hatchback worthy of wearing the three-pointed star. I drove two versions of the new car: an A 200 with AMG Line trim

and an A180d with SE trim. The A 200 was a great surprise. Despite the small-capacity engine, it really felt lively and sporty.

Power never felt inadequate and it never suffered from a lack of torque. Being a petrol unit, it was smooth and quiet too; particularly when cruising on a motorway. It felt like a fun warm hatch that would entertain the interested driver.

The A180d was rather underwhelming in comparison. The initially noisy diesel unit felt a bit sluggish and the car drove very ordinarily.

Welcome improvement

Handling is predictable with good traction and little body roll. The steering of the AMG Line car is sharper than the SE. The general ride quality of both cars is firm but smooth and the wind and road noise suppression is above average if not exceptional.

All launch A-Class cars get a seven-speed automatic gearbox as standard and it works seamlessly with smooth gear changes.

MeRCeDes-benz A 200

You certainly feel that you are driving an executive hatchback worthy of wearing the Mercedes three-pointed star

body: Five-seat hatchback. Front-wheel drive engine: 1.3 litre four-cylinder petrol

Power: 163bhp

Torque: 250nm

Top speed: 139mph

Acceleration: 0-62mph in 8.0 secs

Claimed economy: Combined 51.4mpg

CO2 emissions: 123g/km

On-the-road price: £27,500

The latest version of the A-Class is a welcome improvement in many areas. The biggest advance and what makes it stand out among rivals is the innovative driver-friendly tech.

If specified in the right way, it can challenge premium luxury saloons from the classes above. The availability of a small peppy petrol engine is a further bonus. It could be the new favourite of many of us medics. 

Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey

Larger dimensions allow greater head and leg room for rear-seat passengers

All you need to know about accountancy for private practitioners

Earnings all pumped up

Patients are raiding their ISAs to pay for operations after finding heavily-taxed insurance premiums too pricey. Ray Stanbridge reports on our latest earnings benchmarking survey

In the September 2017 issue of Independent Practitioner Today, we commented that, despite many changes going on in the market place, ‘we anticipate continuing growth in the average private cardiology practice over the next few years’.

how right we were. In fact, cardiologists have had rather a good year.

the average cardiologist’s gross income from private practice in the UK rose by 7% between 2015

and 2016 from £142,000 to £152,000.

Costs appear to have been stable at about £57,000. As a result, taxable profits have risen by 11.7%, going up from £85,000 to £95,000.

Significant changes there have been some significant market changes over the years which make it difficult to compare like with like. these include:  t he growth of Choose and Book work;

aveRage INCOMe aND eXPeNDITURe OF a CONSULTaNT CaRDIOLOgIST WITH aN eSTaBLISHeD PRIvaTe PRaCTICe

Expenditure

 t he squeeze on consultant newcomer fees from the insurers;

 the growth of groups;

 the anomalies and comparison difficulties that may arise when consultants incorporate their businesses.

As we have made clear on many occasions, our figures can only be treated as a guide as to what is happening in the market place.

So why have cardiologists fees risen so healthily between 2015 and 2016? Clearly, there was a squeeze on fees charged for new consultants.

But it seems that most of the growth has come from self-pay. Many patients have forgone the medical insurance premiums as a result of the heavy insurance premium taxes and paid for operations through their ISAs.

cost analysis

While overall costs seem to have been constantly about £57,000, there appear to have been a number of changes.

Staff costs have continued to rise – this is obviously an artificial figure consisting of costs charged by hospitals, or private structures, or family members – or a mixture.

Consulting room hire costs

RaNge OF

It looks as if cardiologists in private practice will continue to enjoy a reasonably good living. This is despite fee squeezes from insurers

have not changed and are constant. Following the Competition and Markets Authority (CMA) rules implementation, we might have expected to see a small rise. Use of home showed a small rise but office costs showed a small fall. t here seems to be no clear explanation here, save that we may have missed some allocated costs on previous years.

Accounting/legal costs have shown a modest increase.

Finally, other costs – primarily marketing – seem to have shown a small fall. Most cardiologists have by now constructed or paid for their own websites.

It looks as if cardiologists in private practice will continue to

Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)

Source: Stanbridge Associates Ltd.

enjoy a reasonably good living. this is despite fee squeezes from insurers.

In recent months, there has been a significant increase in

In time, it may be that cardioloCaRDIOLOgISTS BOOSTeD INCOMe WHILe keePINg eXPeNSeS STaBLe

groups or consultants who are thinking of joining or moving into groups, encouraged by private hospitals.

gists take the lead in promoting group culture.

t he headline figures here are subject to the usual caveats and are not, of course, statistically significant.

Our survey criteria remains as it always has, despite many changes in market conditions.

Our sample includes those who:

 have had at least five years’ private practice experience;

 have held or hold either a maximum part-time or a ‘new’ consultant contract in the nhS, so are not completely private;

 Are seriously interested in promoting private practice as a business;

 earn at least £5,000 in the private sector, including Choose and Book work, 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 specialist, Stanbridge Associates

How ARE YoU doiNg?

Use

benchmarks to compare your

performance with others

what’s coming in oUr october issUe

Make sure you don’t miss our next issue, published on 25 October. you may not receive every issue if you have not yet subscribed to the journal. Don’t risk missing out on vital topics we tackle next time:

 Raise your fee income by up to 20% by avoiding the medical billing banana skins!

 Should you buy advice? Cavendish Medical’s Simon Bruce on why investing in a professional adviser could be crucial to your financial success

 Business development in your practice – Jane Braithwaite shares a host of useful suggestions

 Hempsons solicitors take a look at the possible legal and regulatory developments following the Dr Bawa-garba case, the junior doctor who successfully appealed a decision to strike her off the Medical Register following an earlier conviction for gross negligence manslaughter

 Top tips for newly appointed consultants who want to start a private practice

 So should your resident medical officers be directly employed by private hospitals rather than outside agencies?

eDITORIaL INqUIRIeS

The business journal for doctors in private practice

Published by The Independent Practitioner Ltd. Independent Practitioner Today is editorially independent and thanks Bupa for its assistance with distribution. Printed by Pepper Communications Ltd Material is governed by copyright. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form without permission, unless for the purposes of reference and comment. Editorial layout is the copyright of the publishers. If you wish to use it for promotional purposes on websites or for reprints, we would be happy to discuss licensing the copyright to you.

© The Independent Practitioner Ltd 2018

Registered office: 7 Lindum Terrace, Lincoln LN2 5RP

Write to Independent Practitioner Today PO Box 198, Cranleigh GU6 9BB

Robin Stride, editorial director Email: robin@ip-today.co.uk Phone: 07909 997340

 gifts to private doctors are not always as straightforward as flowers and wine. They also come disguised as a discount on a new car or the offer of a stay in a cottage. a medico-legal expert explores the ethical arguments surrounding this area and looks at how a doctor can handle things without causing embarrassment or prompting a loss of trust

 Mirroring data across NHS and private practice by the Private Healthcare Information Network is hugely significant for consultants. Consultant urological surgeon Mr ken anson argues this is the future, so specialists must engage with it

 a patient refuses to have a chaperone present for an examination –so what do you do? Dr Sally Old investigates

 Dr kathryn Leask responds to a paediatrician’s concerns about an unmarried father’s parental responsibility

 a look back at how private practice was rudely interrupted, through the eyes of a new book: The NHS at 70: a Living History

 Profits Focus looks at the latest earning trends for eNT surgeons

 Our series on private patient units focuses on the West Midlands

 Small with a big car feel. Our motoring correspondent Dr Tony Rimmer finds Nissan Micra’s new lease of life makes it one of the most improved cars around

aDveRTISeRS: The deadline for booking adverts in our October issue is 28 September

aDveRTISINg INqUIRIeS

Margaret Floate, advertising manager Email: margifloate@btinternet.com Phone: 01483 824094

SUBSCRIPTION RaTeS

£90 independent practitioners. £90 GPs and practice managers (private & NHS). £210 organisations. Save £15 paying by direct debit: individuals £75 (organisations £180).

TO SUBSCRIBe – USe SUBSCRIPTION FORM ON Page 22 or eMaIL: lisa@marketingcentre.co.uk or phone 01752 312140 or go to the ‘Subscribe’ page of our website www. independent-practitioner-today.co.uk

Publisher Gillian Nineham Phone: 07767 353897. Email: gill@ip-today.co.uk

Save £15 WITH DIReCT DeBIT!

guarantee delivery of your next copy of Independent Practitioner Today. Take out a subscription and you will get full access to our news, features and previous issues on our website. See details on the left.

BaCk ISSUeS: £12.50 including post & packaging CHaNgINg aDDReSS OR SUBSCRIPTION DeTaILS?

Phone 01752 312140 or email lisa@marketingcentre.co.uk

Circulation figures verified by the Audit Bureau of Circulations

 Electronic Billing

Remove printing, posting and admin costs

 Payment Tracking

Ensure you have been paid for the bills you submit

 Financial Reporting

Keep track of your practices’ performance

 Complimentary App

Free Apple and Android app available

 Appointments and Diary

Manage your schedule and send appointment letters

 Membership Enquiry

Real-time online checks for patient membership number

 Pre-populated Invoices

Which contain the information you require to submit bills

 Shortfall Reminders and Letters

Automated prompts to keep you on top of any shortfalls