September 2016

INDEPENDENT PRACTITIONER TODAY

The business journal for doctors in private practice

Wellington doesn’t get the boot

The competition watchdog says forcing HCA to sell hospitals is a ‘disproportionate’ remedy P25

When you’re under suspicion

A medical crime lawyer explains what doctors can expect to undergo if they are accused of a crime

P26

A 12-page pull-out supplement of leading practice management suppliers to the aesthetic medicine industry at next month’s CCR EXPO

Don’t let Brexit vote deter you Worried about stock markets? Our investment guru explains why it’s important to keep calm P36

£1m VAT victory

By Robin Stride

A consultant dermatologist has been saved from a crippling £1m-plus tax bill after his accountant – an Independent Practitioner Today columnist – settled a VAT case out of court.

HM Revenue and Customs (HMRC) contended that the specialist’s company should have registered for the tax, as the business was largely providing ‘cosmetic’ procedures as opposed to procedures for medical purposes.

But the doctor’s camp successfully argued that although he carried out non-medical procedures, the amount was miniscule compared to medical procedures and was certainly below the VAT registration limit of £83,000 on a rolling annual basis.

The case underlines the need for doctors to keep meticulous records – which this now much-relieved consultant did. He described the 18 months of the case as ‘a living hell’.

Any consultants with concerns about their VAT position are being advised to take advice about the whole issue.

Accountants fear some may have done non-medical treatments exceeding the registration threshold.

Accountant Susan Hutter said:

‘The confusion arises with HMRC, as their definition of “cosmetic” is different to the medical definition.

‘Although the patient may think they are going to the doctor for a cosmetic procedure – i.e. because after the procedure they look better than before – the actual definition as to whether or not the procedure is non-medical depends on whether or not there are any medical benefits.

‘If the treatment improves, repairs or enhances the skin, including repairing sun damage, then it is a medical procedure.’

She said it appeared that HMRC

originally thought any procedure that included the use of Botox, fillers or laser was almost certainly non-medical, making it purely cosmetic and therefore VAT- chargeable.

But she told Independent Practitioner Today: ‘We clearly proved that the procedures carried out by our client, apart from a miniscule amount, were for the protection, maintenance or restoration of skin-related diseases/disorders.

‘Therefore, the primary purpose of the services was for medical not cosmetic benefit. Had HMRC been successful, they could have gone back to the commencement

of trading and demanded the VAT from that time to date.

‘As this was more than ten years ago, the VAT itself could have been in the region of £1m plus.’

Mrs Hutter, of Shelley Stock Hutter, London, said the case’s success was helped by the consultant keeping excellent records of all treatments and appointments.

In virtually all cases, apart from the very few, these proved they were all medical procedures.

She described the outcome for the consultant as ‘life-changing’. n See more on this story in Accountant’s Clinic next month. Susan Hutter this month – page 10

Publication of fees delayed

Consultants are having to wait to see when the Private Healthcare Information Network (PHIN) will publish their fees.

The Federation of Independent Practitioner Organisations (FIPO) now plans to return to the Competition and Markets Auth ority (CMA) with new evidence gathered since the competition watchdog’s 2014 final report on its private healthcare inquiry.

FIPO lost an appeal court chal-

lenge this summer against findings of the Competition Appeal Tribunal (CAT). But FIPO then said more recent material changes to market circumstances had caused ‘an adverse effect on competition that restricts patient choice’ and the appeal court could not consider these issues.

PHIN boss Matt James said: ‘Publishing fees is a more complex process than you might first imagine so it needs careful design, but

it’s a great opportunity to move the sector forward.

‘We believe that transparency on both clinical quality and fees will mean that consultants who offer good value will do well, leaving plenty of scope for different approaches to value.’

He said the CMA needed to consult on a new timetable.

n Patients’ views matter, page 12 n On our website: ‘Private units have to supply data for patients’

In this issue

Be more attractive our new series ‘top tips for busy doctors’ starts with advice on getting patients P16

Stop burning your cash a billing expert demonstrates what can be done to shield you from losing money P19

electrify your marketing email can be a powerful marketing tool for doctors. We show how it can help P22

September is the right time to act this month is the time to implement ideas for growing a private patient unit P28

Sorry is the hardest word – but vital being open when things go wrong can cut risk of a complaint or litigation P30

Keep your data safe practice owners have some important data protection obligations to follow P34

PlUS oUr regUlar colUmnS Doctor on the Road: audi a4 P40 starting a private practice: Liquidating your firm P42 Profits Focus: cardiologists P44

editorial comment

The right advice

The relief felt by the consultant in our story on page one of this issue has, not surprisingly, been life-changing.

Imagine facing demands out of the blue for a massive tax bill going back years when you thought your tax affairs were handled correctly all along.

It must have been a stomachsinking, worry – not only for this consultant but for friends and colleagues who have been nervously watching the case.

Fortunately, his specialist medical accountant, Independent Practitioner Today columnist Susan Hutter, took strong action, brought in VAT expert

pays off

re-inforcement and fought for a just outcome.

Even so, it took a time-consuming battle involving, among other things, a massive redacting of patients’ identities on records the tax officials were eager to study.

Thankfully, private doctors can these days call on an army of excellent advisers to help them through an ever expanding range of sticky business issues.

Many will be at this year’s Practice Management Expo (see centre pages), so if you are going, then give them a visitand do drop in and say hello at our stand too.

tell US yoUr newS Editorial director Robin Stride at robin@ip-today.co.uk Phone: 07909 997340 @robinstride

to advertiSe Contact advertising manager Margaret Floate at margifloate@btinternet.com Phone: 01483 824094 to SUBScriBe lisa@marketingcentre.co.uk Phone 01752 312140

Publisher: Gillian Nineham at gill@ip-today.co.uk Phone: 07767 353897

Head of design: Jonathan Anstee chief sub-editor: Vincent Dawe Circulation figures verified by the Audit Bureau of Circulations

Get help now to cut tax on your pension

By leslie Berry

Senior doctors may need to take immediate steps to protect their pension’s value now that HM Revenue and Customs (HMRC) has finally opened its new online application scheme.

The lifetime allowance for pension savings – the total amount which can be saved into a pension free of tax – was reduced to £1m on 6 April 2016.

Many doctors do not realise this savings limit could easily be breached even for middle-earners, particularly if accumulating benefits from the NHS scheme for several decades.

The Government has introduced an updated pension protection scheme (Individual Protection 2016) which can restore the value of a saver’s pension limits up to a maximum of £1.25m, provided they held pension savings in excess of £1m as at 5 April this year.

Patrick Convey, technical director of specialist financial planners Cavendish Medical, explained: ‘The tax charge for saving more

into your pensions than the new limit can be an eye-watering 55%, so it is an important issue for you to consider.

‘Although £1m sounds like a large figure, a doctor in the 1995 NHS scheme with a predicted pension of just over £43K per year will easily hit the limit.

‘Hopefully, the launch of the long-awaited online applications will mean more doctors seek help with this issue. Excessive pension tax charges can be minimised with careful management.’

If your pension was valued in excess of £1.25m as at 5 April 2014, you may still be eligible to apply for the original protection scheme, Individual Protection 2014. This will restore your allowance up to a maximum of £1.5m as long as you apply by 5 April 2017.

Mr Convey added: ‘Remember that the lifetime allowance limit applies to the sum of your NHS pension value plus any private pensions you hold. However, the calculations to ascertain the value of your pensions are complex –HMRC uses different methods to value private and NHS schemes.’

CQC to publish its ‘tick list’

The long awaited Independent Doctors Handbook, outlining how future Care Quality Commission (CQC) compliance inspections will take place, is due to be published later this month.

It will be crucial reading for every CQC-registered doctor in preparation for future inspections.

And it will include the Key Lines of Enquiry and the methodology the inspection team will use following pilot visits earlier this year.

See our next issue where Martha Walker will highlight the inspection changes.

 Surgeons have welcomed a Department of Health proposal to expand the CQC’s public ratings system to providers of cosmetic surgery, saying it will complement the new system of certification of surgeons it is launching.

The Royal College of Surgeons’ vice-president Mr Stephen Cannon said: ‘The easier it is for patients considering cosmetic surgery to identify providers that meet the high standards required for safe surgery, the better.’

Consultation on the plan closes on 14 October.

Online register to speed bill queries

By a staff reporter

Official medical bill clearing company Healthcode has developed a central online register of independent practitioners to make it quicker and easier for private medical insurers (PMIs) to recognise consultants.

The Private Practice Register (PPR) aims to be an industry-wide solution to the current application process which frequently involves delays while insurers contact consultants to resolve outstanding queries and obtain documents.

Doctors will complete a single online form which covers the minimum information required by different insurers. This includes contact details, specialty and clinical interests, qualifications, biography, indemnity, the Disclosure and Barring Service certificate and licence to practise status.

Each practitioner then gets a

profile page which can be accessed by subscribing PMIs when the doctors applies for recognition.

Doctors will also have complimentary access to Healthcode electronic billing and secure encrypted messaging services to support their practice.

Managing director Peter Connor said: ‘The PPR shows how our

technology can streamline administrative processes and reduce costs across the private healthcare sector. We are currently working with insurers to refine the system and we expect to add more features in future.’

AXA PPP and Aviva have already subscribed and the company is talking with other insurers.

Aviva’s Jayne Evans said: ‘The service makes the process of recognising non-hospital providers fast and efficient for us and is far more cost-effective than developing the technology in-house.

‘It reduces the administrative burden for practitioners when applying for recognition and it is better for patients because it will be easier to carry out due diligence on specialists and keep up to date with changes in their practice.’

An easier application process is expected to encourage doctors to seek recognition.

New boss for Wellington

HCA Healthcare UK has appointed Sarah Fisher as the new chief executive of The Wellington Hospital with effect from 30 September.

She join’s London’s biggest private hospital from HCA Joint Ventures where she has been chief executive.

Ms Fisher oversaw a successful programme of partnerships with University College Hospital London, Queen’s Hospital, Romford, and The Christie NHS Foundation Trust.

HCA after 18 years for a new role.

HCA Healthcare chief executive Mike Neeb said: ‘Sarah’s dynamism, drive and commitment to delivering the highest-quality patient care make her ideally suited to take the Wellington forward.’

She also established the company as operator of the pioneering new Manchester Institute of Health and Performance.

Neil Buckley, current chief executive of The Wellington, is leaving

Ms Fisher said: ‘It’s an exciting time for the hospital and, as it continues to expand, my focus, as it always has been, will be on providing the highest quality care for our patients.’

Claire Johnson, previously interim director of HCA Joint Ventures South, has been promoted to chief executive of HCA Joint Ventures.

otHer Hca moveS

John reay, chief executive of Hca’s london Bridge Hospital, will take on the new role of president of operations from 1 october.

He will lead the team of chief executive officers to support the drive to deliver the best-quality care to patients across the Hca UK network. an announcement on his replacement is imminent.

Tell defence body if police come calling

Doctors are being advised to notify their defence body as soon as possible if they become aware they might be involved in a police investigation.

The advice follows some highprofile cases of doctors in the private and public sector being involved in manslaughter prosecutions.

Doctors were advised by the MDU that a quick alert about police interest meant they would get the best possible legal representation and support from the outset.

Medical manslaughter investigations involving healthcare professionals are more common than in previous years, and a recent BBC Radio 4 documentary highlighted the difficulties for doctors involved in them.

Ian Barker, a senior MDU solicitor who supports doctors involved in manslaughter investigations, was interviewed for episode three of the BBC Radio 4 documentary, A Matter of Life and Death. Talking on the likelihood of a doctor being involved in a manslaughter investigation, he said it could be emotionally devastating for doctors when something went wrong and there was a suggestion that something they played a part in might have resulted in a patient’s death.

‘That’s tough enough. What can then happen is that it’s suggested that not only did you get it wrong, but you’re a criminal to boot and the police want to speak to you. That can turn something which is pretty awful into a nightmare.’

 See ‘When you’re under suspicion’, page 26

Hca UK has also appointed teresa Finch (right) to the role of chief financial officer. She takes over from John Bugos. in her Hca career in the US, she was in a similar role for a number of flagship hospitals.

Share your experience of what has and has not worked in your private practice. even if it’s bad news, let us know and we can spread the word to prevent other independent practitioners falling into the same pitfalls. contact editorial director robin Stride at robin@ip-today.co.uk or phone him on 07909 997340

Healthcode boss Peter connor

Hca’s Sarah Fisher

Bid to update GMC register

A GMC consultation on changes to transform the online medical register – also known as the List of Registered Medical Practitioners –closes on 27 September.

As well as publishing mandatory information, such as a doctor’s name, qualifications, gender and licence status, the body is consulting on adding voluntary information that doctors could choose to add to the register to make it more useful for them and patients.

current register has changed little from the register of 1859 – but medical practice and patients’ expectations have changed radically and the register now needs to reflect that.

Suggestions which have been made to the GMC include:

 Higher qualifications;

 Scope of practice;

 Declaration of competing professional interests;

 Languages spoken;

 Practice location;

 Photographs to demonstrate identity.

GMC chief executive Niall Dickson said: ‘In some ways, the

‘It contains limited information about doctors, such as where and when they qualified and whether they are on the GP or Specialist Register. But it does not provide a complete picture about a doctor’s practice – for example, what other qualifications they may have, where they work or if they now practise in another specialty. In many cases, years of experience and training are not reflected.

‘We very much hope this will be an opportunity for doctors to take joint ownership of their entry on the register to provide a fuller picture of their practice.’

 More information at www. gmc-uk.org/LRMPconsultation

Pioneer opens clinic named in his honour

A new clinic for lupus and Hughes Syndrome patients has opened in honour of Prof Graham Hughes, head of The London Lupus Centre at HCA’s London Bridge Hospital.

The Madeira clinic – The Graham Hughes Centre for Autoimmune Diseases – was dedicated to him in honour of his lifelong commitment to research and treatment of lupus and his discovery of the related condition

Hughes Syndrome, now recognised as the most common treatable cause of recurrent miscarriage. Also present were the city’s mayor and dignitaries, doctors from all over Portugal, and lupus specialists from around the world. Prof Hughes said it was a great honour to be recognised, but most of all he was delighted that more patients would now get lifechanging treatment.

Pensions baffle doctors

By Robin Stride

Confusion among doctors trying to understand their pensions and the surrounding rules is so rife that their retirement plans could be hit.

New figures reveal widespread confusion:

 Three ­ quarters do not understand the pension’s key features;

 A fifth incorrectly think they can withdraw their full pension fund, tax free, at any time;

 Many are confused about how much to save;

 Sixty ­ nine per cent of doctors are unaware how much the Government contributes for every pound they invest in a pension. They also do not understand the

recent pension freedom reforms.

The great pension puzzle was revealed in a survey for specialist financial mutual Wesleyan.

Spokesperson Vicki Wentworth said: ‘It is very hard for a busy doctor, with all the pressures that come with the job, to free up the time to frequently review their plans for retirement.

‘As a result, there is clearly still some confusion around what pensions are there to do and how they can help you plan for the future. But proper planning is essential to help us enjoy the standard of living we dream of in retirement.’

Ninety per cent of the 200 doctors surveyed had researched into their pension in the previous 12 months, but most remained ‘unclear’.

WeSLeyAn SuRvey finDinGS

 full-time private practice remains an attractive option for nHS doctors

 nearly 14% of hospital specialists surveyed by Wesleyan have given up nHS work to go entirely private, while 43% have considered it. Similar figures were revealed for GPs

 The company found 78% of 200 doctors surveyed were worried future generations would be put off starting a medical career due to reduced financial incentives and increasing education costs

 Half said their biggest concerns for the profession over the next five years was nHS privatisation – up from a third last year

Ms Wentworth added: ‘How much doctors need in retirement depends on their own circumstances and needs.

‘But what is clear is that many

have an idea of what they would like to have after they finish work, but don’t understand enough about pensions to make effective plans to achieve it.’

Prof Graham Hughes at the opening of The Graham Hughes Centre for Auto-immune Diseases on the Portugese island of Madeira

GMC’s nial Dickson

Beauty ops’ false gripes

By Leslie Berry

Cosmetic surgeons are being warned they face a sharp rise in the volume of ‘unmeritorious’ negligence claims.

Lawyers blame spiralling ‘vicious’ review site content for sparking the increase.

Law firm Manleys claimed exaggerated complaints and claims, combined with the collapse of some cosmetic surgery insurers, could cause some surgeons to leave London.

Solicitor Mark Manley said: ‘We have seen a near doubling of reputation management claims in the past year.

‘But we question whether at least a quarter of them had any real validity, because the patient went through with treatment against advice – or they frankly expected miracles.

‘This is an increasingly competitive industry. We have been surprised to see some claims which have clearly been encouraged by some surgeons against others and who themselves profit from undertaking “corrective” work.

‘While there are cases where things do genuinely go wrong, there’s no doubt some claims are whipped up without any proper grounds and are wholly unmeritorious.’

Surgeon’s firm wins top grant

A consultant’s clinic awarded £150,000 from Government agency Innovate UK is thought to be the first medical facility to win the business growth grant.

Varicose veins treatment centre

The Whiteley Clinic is now in its second year of a three ­ year Knowledge Transfer Partnership (KTP) with the agency and The University of Surrey.

The Whiteley Clinic won backing to develop a new way of treating varicose veins, setting up a new research, development and teaching division headed by biomedical engineer Dr Jaya Nemchand PhD, who has extensive experience in developing new products and devices.

Knowledge Transfer Partnerships have been awarded to help UK businesses expand and compete here and overseas. The UK Government then gets the grant money back and hopefully more from the increased tax revenues generated.

Chosen companies must identify the area or product they can develop into a business expansion

and then provide around a third of the total funding.

The backing has allowed The Whiteley Clinic researchers to explore the commercial aspects of developing products from their work, and to offer research opportunities to firms producing vein treatment products.

Prof Mark Whiteley said many companies wanted to develop and improve their products but did not have the laboratory resource or access to clinical cases to do so easily.

His clinic could now do this work for medical device and product companies, either confidentially for product development and competitor analysis or to be presented and published.

He added: ‘We are thrilled to win this KTP, which has allowed us to develop our strong reputation for research, development and teaching into a separate entity within the company.

‘Under Dr Nemchand’s guidance, we are already seeing this whole area of our business leap forwards.’

He said the rise in popularity of review sites was a big contributing issue.

Patients who received ‘successful’ surgery could get doubts placed in their minds by people who might have made unwise decisions about the choice of treatment, or simply had wholly unrealistic expectations.

His firm was busier than ever getting inaccurate, defamatory or plain wrong reviews removed from the internet.

‘It’s a minefield and a timebomb, because you have a subjective matter for which there is no proper scientific measurement –that of whether the surgery has

“worked” or not – but which can also take quite some time to reach a point at which the surgery can be judged because of the inevitable requirement to wait for swelling and suchlike to subside.’

Manleys, based in Chester and London, has held a series of crisis meetings with a number of cosmetic surgeons.

Mr Manley added: ‘We’re in a review­vulnerable society and cosmetic surgeons need to ensure they are both protected by insurance and legal understanding, and be prepared to sacrifice those “little extra work” requests if their patients or clients resist advice to draw a line.’

Major expansion for Spire Bushey Hospital

Hertfordshire­based Spire Bushey Hospital is developing a new £22.7m medical centre as part of a two­phase redevelopment.

The Spire Bushey Medical Centre, near Watford, is due to open in autumn 2017 and will offer a musculoskeletal diagnostic and outpatient centre, located on Centennial Park.

Alongside this, an additional operating theatre, an enlarged theatre sterile services department and ten more bedrooms will open at the main hospital site.

Hospital director Lisa Trybus said: ‘This is a considerable investment for Spire Bushey Hospital and reinforces our commitment to deliver outstanding patient care.’

The development will see part of the current outpatient area moved to the new purpose ­ built site at Centennial Park, close to the now established Elstree Cancer Centre and Spire Pathology Services. This facility will provide 14 purpose­designed consulting rooms and associated treatment rooms, outpatient diagnostics and a second MRI scanner.

There will be more bedrooms at the hospital’s main site and an extension which will be added onto the theatre block – bringing the number of theatres to six –and an enlarged theatre sterile service unit to be created. This part of the redevelopment is due in summer 2018.

Bupa’s ‘webchat’ service expands

By a staff reporter

Bupa is launching its webchat instant messaging service to hospitals nationwide this month, following praise from private consultants who used the service first.

The insurer’s team of speciallytrained advisers is available to help with specialists’ and hospital staff’s queries on topics such as invoicing, pre-authorisation queries and extending patients’ length of stay.

Hospitals are having a series of demonstrations of the service following successful trials.

Bupa said its team had already chatted to over 33,000 private consultants, medical secretaries and therapists in the first eight months of 2016 – some 4,000 chats a month – exceeding last year’s total of 26,000.

Specialists say they are particularly pleased with the ability to print and save transcripts from chats for later reference.

Ninety per cent of those who have used the service rate it ‘good’ or ‘excellent’.

One said: ‘I cannot think of anything to improve it. Every time I have used this service I have been very impressed with

the speed and the helpful way the team respond.’

Bupa has increased the original team of six advisers who launched it in March 2015 to 26 to keep up with demand from private consultants and in readiness for the hospital roll-out.

Private consultants can access the service at www.bupa.co.uk/ providers-online from 8am-6pm Monday to Friday, and from 8am1pm on Saturdays.

By using Bupa’s Providers Online website and logging in before starting a chat, they can begin without needing to answer security questions.

BMI begins consultant-led admissions round the clock

Consultant general physicians are giving round-the-clock care and treatment for a broad range of conditions and illnesses under a ‘general medical’ admissions service at 14 BMI Healthcare hospitals.

National clinical services director Liz Sharp said this was a response to many patients’ requests. Some felt they needed rehabilitation, others wanted more care after NHS discharge or had asked for diagnostic investigations to find out what was wrong with them.

She added: ‘There’s a clear need for a private medical service that provides patients with inpatient medical care for a broad range of conditions such as a fall, respiratory, infections, common elderly medical complaints and chronic conditions, providing them and their families with the peace of mind that comes from consultant-led care.’

BMI research recently assessed 1,237 respondents aged 40 to 80:  35% felt they or a relative had been discharged too early from

A&E, without appropriate diagnosis or treatment;

 84% said they would prefer to avoid A&E if there was an alternative route into a medical service;  61% would consider a private hospital admission; but, of these, 40% would let their GP advise on the best place to go.

The service is available in Cheadle, Blackheath, Canterbury, Harrow, Longfield, Hendon, Rochdale, Guildford, Windsor, Glasgow, Chertsey, Croydon, Beckenham and Sheffield.

Bank offers loans to tide over tax bills

A new digital service aims to make it easier for professional practices to apply for finance to spread the cost of their tax bills.

Wesleyan Bank’s Tax Portal enables doctors to obtain an instant quote online for spreading the cost over six or 12 monthly instal-

ments. Loans can be paid directly to doctors or to HM Revenue and Customs (HMRC).

The bank’s boss Steve Deutsch said: ‘Many doctors put off planning around tax and then struggle to find the cash to meet their tax liabilities on time. The poten-

GMC speeds up inquiries into errors

Two GMC pilot schemes aim to speed up fitness-to-practise cases.

One involves cases where doctors are alleged to have made a one-off mistake involving poor clinical care. Instead of opening a full investigation, the council will first gather a few pieces of key information about the case, such as medical records and incident reports.

Only after reviewing this evidence will it decide whether to open a full investigation, refer the case to the doctor’s Responsible Officer or close it with no action.

If the evidence shows this was indeed a one-off mistake without an ongoing risk to patient safety, that the doctor accepts his or her error,and takes steps to make sure it will not be repeated, the case is likely be closed.

The GMC said this built on a successful similar approach, started last year, for other types of cases. Its initiative is expected to avoid the need for a full investigation in around 230 cases a year, as well as significantly increasing the speed with which these cases are handled. Cases dealt with in this way on average conclude within around three months – half the time for most investigations.

A second scheme requires designated bodies, such as independent healthcare providers and NHS organisations, to disclose whether the doctor being complained about has previously raised any patient safety issues.

The person referring the concerns will also have to declare the complaint is being made in good faith and is fair and accurate.

New NHS clinics

tial impact to their bottom line is now further compounded by HMRC taking a strict stance on late payments.’

In a recent survey, as many as 5% of respondents fell into this late category. Quotes are available from www.taxfunder.co.uk

Over 50 consultants are offering clinics at Royal Brompton and Harefield Hospital (RB&HH) Specialist Care’s newly opened private outpatient and diagnostic facility at 77 Wimpole Street, London. It is the first NHS specialist trust to open a private facility in the Harley Street area.

Call to revise remit of NHS

By Charles King

The Government is being urged to review its priorities for the NHS and be honest with the public about what the health service’s budget can deliver.

According to The King’s Fund, key waiting time targets may need reviewing and the commitment to deliver seven-day services revisited if the priority is to restore financial balance in the NHS.

The think tank’s analysis found NHS providers and commissioners recorded an aggregate deficit of £1.85bn in 2015-16, which is three times more than the previous year and the biggest deficit in history.

It argues that the extent of overspending shows that the deficit is not down to mismanagement in individual organisations but is a systemic problem, with the NHS unable to meet rising demand and maintain standards of care within its budget.

Staffing cuts and reductions in the quality of patient care are inevitable if restoring financial balance is the Government’s top priority, it says.

Helen McKenna, an author of the report, said: ‘We are drawing attention to these issues now while there is still time to have an informed and honest debate about the best way of sustaining and transforming care.’

Aspen strikes novel deal with police force

Consultants at Aspen’s Claremont Private Hospital are seeing more police officers following a deal for South Yorkshire Police Healthcare Scheme members.

Under the contract, Sheffieldbased bobbies also use the premises when they need toilet or restaurant facilities.

Hospital director Andy Davey said: ‘We can’t offer emergency care, but we can offer first-class private healthcare for everyday health concerns, tests, scans and surgery.’

Other hospitals in the group may now approach their local police federations to offer similar deals.

Reward for bariatric unit

The South East Weight Loss Surgical Centre at BMI Chelsfield Park Hospital has been re-accredited as a Bariatric Surgery Centre of Excellence by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

The Orpington hospital’s gong is an official European recognition for hospitals that

have achieved excellent results, including significant weight loss and low complication rates, in the field of bariatric surgery.

The accreditation recognises the hard work of the hospital’s consultant bariatric surgeon Mr Shamsi El-Hasani (pictured) and dedicated bariatric team in delivering sustained, longterm results for its patients.

London Diabetes Centre is launched

Diabetes specialist Dr Ralph Abraham said the clinic had gained a global reputation for advanced, exceptional expertise and unrival-

led service over the last 25 years. Its new name would help flag up its widely acknowledged role as a centre of excellence as well as its complete care approach, which the team pioneered.

General manager David Briggs said: ‘Many medical conditions

NEWS IN BRIEF

A regular wage

The salaried private consultant post option is being investigated by a number of specialists who have contacted Independent Practitioner Today following the story in our July-August issue. We have put them in touch with Schoen Clinic London, which plans to employ ‘a substantial amount of consultants directly’ after its opening in Wigmore Street, London, next year.

New at Nuada

Consultant obstetrician and gynaecologist Ms Anne Henderson has joined Nuada Medical, Harley Street, and will run its Menopause and HRT Clinic with gynaecologist Ms Amanda Tozer.

A plus for Proton

Proton Partners International has received £450,000 investment from a regional growth fund programme for its Northumberland cancer centre opening in early 2017.

are interconnected and few more so than diabetes, where complications implicate every system in the human body. The fact that The London Diabetes Centre is able to draw from the consciously designed interconnectivity of services at London Medical sets it

Defence in depth

Defence body the MDU says that as claims against doctors have risen over recent years, so has its success rate in defending cases.

Last year, it only paid compensation in 20% of medical claims, successfully defending the remaining 80%.

But it said unmeritorious claims still took their toll on doctors and there were considerable costs in investigating and responding to many of them.

apart from other diabetes clinics.’

The facility provides on-site access to consultants – including cardiologists, endocrinologists and ophthalmologists, diabetes nurse specialists, clinical nutritionists, dietitians, podiatrists, orthotic specialists and clinical psychologists.

Six at Edward VII

Six new consultants have been selected for practising privileges at King Edward VII’s Hospital, Marylebone, London.

They are breast cancer and surgery specialists Mr Giles Davies, Mr Debashis Ghosh, Mr Ragheed Al-Mufti and Prof Jayant Vaidya; dermatologist Dr Nilesh Morar and orthopaedic surgeon Mr Nick Strouthidis, director of the glaucoma service at Moorfields Eye Hospital.

The diabetes team at private outpatient clinic London Medical will now operate under The London Diabetes Centre brand.

pREvEnTivE mEdicinE

AIHO leads drive to boost well-being

Private hospitals are backing efforts

to

bring a shift towards positive public health messages, preventive healthcare and more workplace health initiatives. Fiona Booth (right) reports

tax advice and planning For doctors

• tax consultancy

• self-employed and company accounts

• property investment structuring

• payroll and vat services

Contact: nick Brecker. tel: 020 7253 0030

Email: nbrecker@caldwellandbraham.co.uk

Web: www.caldwellandbraham.co.uk

Ensuring p E rsonal health and well-being is crucial to creating an environment where individuals, families and workplaces feel empowered, healthier and happier.

it is important that this includes both a positive approach to physical and mental health, as well as having quick access to treatment when needed to prevent absence from work or deterioration of conditions.

i n order to boost this and reduce the reliance on health services when things go wrong, we must instigate a cultural shift toward greater personal responsibility over our healthcare.

The association of independent Healthcare organisations (aiHo), working with other industry partners, has been at the forefront of the debate for some time.

We recognise a range of pressures are creating unsustainable levels of demand for healthcare treatment.

With additional g overnment funding for the n H s unlikely beyond the current 2015 spend-

ing review settlement, we must consider how to reduce demand and improve our nation’s health within current budgetary constraints.

ai H o believes this can be achieved through increased corporate and personal responsibility for healthcare. Effectively using capacity that exists outside of the n H s will also ensure patients receive treatment more quickly when required.

positive messages

This must, however, be underpinned by a shift towards positive public health messages, preventative healthcare and workplace health initiatives.

There is a lot more that can be achieved by identifying and incentivising the link between health and the workplace.

The number of hours people work in the uK is increasing year on year, with the average person in full-time employment now working 37.6 hours a week. u nemployment rates are also falling.

What the private sector is doing

We are actively exploring ways to make the independent sector a more accessible route for treatment, both for nhs and private patients. there is considerable additional capacity within independent hospitals, which can help reduce waiting times and improve patient choice for nhs patients.

independent sector providers treat patients, on average, ten days faster than the nhs, yet recent surveys have shown that the number of patients being offered choice by their gp over where they are treated has reduced since 2010.

the nhs should educate patients, gps and support staff on the individual’s right to choose. this applies to choice over provider, consultant and location.

Medical insurance should also be easier to access for corporates and individuals. this would give more patients swift access to elective procedures as well as to treatments and therapies to meet overall health and well-being needs.

a reformed and incentivised insurance market that provides an alternative route to care could support demand moderation for the nhs and boost innovation, efficiency and productivity in the UK economy.

We are working directly with hospitals and insurance providers, as well as communicating with government to improve the patient and corporate experience of accessing healthcare privately.

We hope to normalise its use and increase its acceptability over time as an essential complement to the nhs and vital to the nation’s health.

a s a population, this is, of course, hugely positive; not only are we better able to provide for ourselves, but there are proven psychological benefits from being in work.

However, with employers reliant on the availability of their workforce, they should have a growing stake in the health of their staff. n ot just in the short term to avoid absences, but also over the long term to ensure overall well-being and high levels of productivity.

Workplace incentives

The nHs is leading the way in this regard. Workplace health featured strongly in n H s England’s Five Year Forward View as a means to reduce demand for nHs services and long-term costs.

o ver the next five years, they are looking to ‘help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment’.

The ‘Healthy Workforce’ programme is already well underway with pilots in place both within the n H s itself and with private sector employers.

a dozen nHs providers are currently acting as test beds, with Commissioning for Quality and

i nnovation (CQ uin s) payments available to successful organisations.

Financial incentives are targeted towards areas vital to meeting staff health and well-being needs, including musculoskeletal physiotherapy, mental health care as well as supporting a healthy diet.

n H s England is also working with selected major uK employers to explore the longer-term workforce and economic benefits from corporations taking a more active role.

Whereas in previous years, workplace well-being has focused on health and safety requirements, it is increasingly being seen as critical to business success. reduced sickness absence, staff retention and increased productivity can boost company performance. But progress is slow.

a survey in 2013 by King’s College london found only 26% of organisations were focused on improving health and well-being as a key challenge. We must now consider how to take forward this agenda at scale and pace and ensure workplace health is an attractive proposition to employers. 

Fiona Booth is chief executive of the Association of Independent Healthcare Organisations (AIHO)

AccoUnTAnT’s clinic

It returns again!

Oh no, it’s that time of year again. Just don’t be tempted to leave your tax affairs too late, urges Susan Hutter. You really should get moving – now!

Although the 2015-16 tax return is not due for submission until 31 January 2017, it is not really that far away, and tax departments in most firms of accountants are now becoming extremely busy due to the fact that most clients leave everything until the last minute.

So for those consultants and private gPs who sent their information in before their holidays, well done. For the rest – which is probably the majority – it’s time to get moving.

tax planning opportunities should have been dealt with before the end of the 2015-16 tax year. h owever, putting your tax return information together now may prompt you to start planning for 2016-17 before it is too late.

For 2015-16, doctors do still have time to ensure their expenses claim against private practice income is as full as it can be. So do not forget such things as:

 t ravel/motor expenses to courses and conferences;

 travel/motor expenses between hospitals;

 Professional subscriptions, including journals;

 Software for business purposes;

 hardware for business purposes;

 Internet connection if used for business;

 office equipment and furniture;

 Professional indemnity insurance.

Another important reason for dealing with the tax return sooner rather than later is that you will be aware of the exact tax you have to pay on 31 January 2017 in good time to put aside a cash provision, if you have not already done so.

Also, some doctors may be in a position whereby they have overpaid tax by payments on account in January and July 2016, and as soon as they submit their 2015-16 tax return, the overpayment can be refunded to them.

Many firms of accountants send out an ‘aide memoire’ which acts as a check list for the information required in order to complete the tax return.

If not, the previous tax return is as good a place to start as any. If this has been mislaid, then con-

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sultants and private g Ps should contact their accountants as soon as possible to get a list of what they require.

Private practice income means tax returns cannot be completed until the private practice accounts have been prepared.

t his should be a priority and you should work on the accounts first, submit the information to your accountants and then follow up with the other information,

such as investment income such as bank and building society interest and income from property.

Many consultants trade as a limited company. here they will need to ensure the practice accountant has full information regarding dividends and salary drawn from the company in the tax year 2015-16.

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this may not be the same as the company’s year-end date. It is crucial that the company’s books and records are kept up to date on a regular basis so that this information is obtainable.

In all cases, it is worth discussing the procedure with your accountant as s/he can advise on the most streamlined way of presenting the information to them.

As soul-destroying as the task is, organisation is the key to success and the sooner doctors deal with matters for 2015-16 the better.

Susan Hutter (right) is a partner with accountants Shelley Stock Hutter

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Patients’ views

From next April, all private healthcare organisations will be required by a Competition and Markets Authority order to collect and publish outcome data. But Dr Andrew Vallance-Owen, chairman of the Private Healthcare Information Network, is urging all private consultants to encourage the hospitals they work with to go beyond simple compliance with the order.

He believes private consultants need to be leading the way in developing how patientreported outcome measures (PROMs) data can be used to drive quality improvement and enhance patient experience in their practice.

Here Dr Vallance-Owen (left), former chairman of the National Stakeholder Reference Group on PROMs, explains how PROMs can benefit consultants, hospitals and patients

matter

As consultA nts , we are all aware of the nHs national PRoMs programme. But did you know that PRoMs were first developed in the private sector?

I was chief medical officer at Bupa until four years ago and, for many years, I was responsible for assuring the quality of a lot of care being provided at a lot of hospitals.

A particularly serious adverse incident in 1995 led us to really think about how much we knew about the quality of care we were providing.

We were relying on the reporting of adverse events, and no one was asking the patients themselves if they were happy with the outcomes of their treatment. this led to a system which only really measured failure and did not even do that in a very reliable way.

Bupa started engaging with patients about outcomes, collecting ‘before and after’ information from them about their care. this sort of approach had been taken before on a smaller scale to inform research, but it had never been done in routine clinical practice. Rather than just measuring

when things went wrong, we were suddenly able to build a picture of quality across all of our 37 hospitals, enabling consultants to compare their patient outcomes with others.

It helped to identify problem areas, but it also highlighted areas of excellence, which worked as an improvement tool.

PRoMs were introduced in the nHs in 2009 on the back of our work at Bupa. We had shown that the approach could be used operationally and a study by Prof nick Black at the l ondon s chool of Hygiene and tropical Medicine, commissioned by the Department of Health, also showed that the approach carried academic weight.

t he n H s PR o Ms programme piloted measuring patientreported outcomes in four surgical procedures: hip and knee replacements, varicose vein and groin hernia.

The time is right for change seven years later and the national PRoMs programme is now under review. Meanwhile, the c ompetition and Markets Auth ority (cMA) order will come to fruition next year, requiring the private sector to publish a much wider range of performance and outcomes data in the public domain.

t his is a big ask and is an uncomfortable change for some. But it is also an opportunity for private healthcare providers to work as a sector to really enhance the way they collect and use data about outcomes for their own benefit.

➱ p14

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CMA requireMent fOr priVAte seCtOr

the CMA’s Order requires private healthcare providers to share much more open and consistent information about their quality and performance. pHin’s role is to collate and publish that data, making it as accessible as possible to the public, the aim being to help patients make more informed choices when considering private healthcare.

patient-reported outcomes will be part of this. Of course, many private healthcare providers already collect outcomes data, much of it informed by patients. But the private sector is not currently doing this in a consistent way, making it hard to compare data.

pHin has been working with private hospitals, consultants and medical insurers to look at how best to introduce a national approach to prOMs in the private sector. A large consultation group reached a consensus in 2014, deciding on 11 areas we will measure, and what tools we will use to do it.

this goes way beyond the scope of the nHs prOMs programme. We will include three of their original measures: knee and hip replacement and groin hernia surgery, but also: shoulder surgery, carpal tunnel, turp (transurethral resection of the prostate), cataract, septoplasty and three cosmetic surgery procedures.

the potential for prOMs measures to add value to clinical interactions means that a process of compliance with the CMA’s requirements can be turned into something with a wider benefit. We have focused on developing a programme that will deliver value and benefits for the sector as a whole and, most importantly, for our patients.

t he national PR o Ms programme in the n H s has always been seen by the consultant body as really just about comparing hospitals.

It was never promoted to clinicians or fully used by them in the way that we wanted it to be: as a tool that would also help consultants develop their clinical practice and understand more about what their patients wanted.

By influencing how the hospitals they work with respond to the c MA order, private consultants can push for PR o Ms to now be used to their full potential. this will create a better measure of quality which can add real value to patient care.

measuring the positive instead of the negative I have always lobbied hard for use of patient outcomes as a measure of quality. I feel very strongly that the main things we obsess over

currently – adverse events, infection rates, re-admissions or repeat operations – while important, are not actually outcomes. Instead, they are things that go wrong on the pathway to an outcome.

Measuring mortality rates has been the big nHs focus for years. But only just over 3% of the patients who come into the nHs die.

this is obviously still too many, but my question is what happens to the 97% of people who live? How good are their outcomes? How could we make them better? this focus could do just as much to improve survival rates in our hospitals.

It could also do so much to change our culture from one of blame when things go wrong to a focus on improvement and continually seeking to provide better care.

If we engage with PR o Ms and make sure we implement them in

a way that really benefits consultants and patients in every sector, we can reframe how we talk about measurement altogether. let’s talk more about the many benefits we bring to patients and how we can build on that. l et’s measure success instead of measuring failure.

Using PRoms to enhance care and drive improvement

I want to talk a bit more about that value. As well as the obvious benefits of enabling patients to compare providers and make informed decisions about their care, my argument has always been that PRoMs are a tool to put patients at the centre of care. In the uK, patients opt for private healthcare for many reasons. they want to be treated quickly and by the best in their field. But they also want to establish a relationship of trust with a doctor who has the time to dis -

cuss what treatment will be best for them.

the PRoMs tools can help build on that. A formal process for asking people about their needs and expectations before treatment starts will give their doctor a really clear idea of what the patient themselves is feeling about their condition, prompting further conversation. It helps us to ask patients the right question; not ‘What’s the matter with you?’, but ‘What matters to you?’

If we encourage the hospitals we work in to embrace PR o Ms and use electronic systems to manage the process – giving practitioners real-time access to information at patient and consultant level – PRoMs can become a valuable tool to help consultants engage with and understand more about their patients’ needs. t his will help with diagnosis, with deciding what kind of procedure might be appropriate for

each patient and to manage expectation about what treatment can achieve.

If consultants can then also view patient responses following treatment, PRoMs can become a different kind of learning tool, one that drives clinical improvement.

Being able to review patient outcomes and compare them to those achieved by colleagues gives doctors vital information about their own work. You can see how this could be used very powerfully at case, consultant and hospital level.

Another side-benefit from the national collection of PR o Ms across the private sector is that it will collect together all the outcomes data consultants are now required to provide for appraisal and for revalidation by the GMc, including data derived from professional activity in the nHs

When you need it at the end of

the year, the data will all be there, published online, already signed off by you.

making it work for us

I see the requirement by the cMA as a chance to start again with PRoMs and do it right.

this is an opportunity for private practitioners to get ahead and show leadership, as we did when PR o Ms were first created, putting the patient at the centre of everything we do. Individually and at hospital level, it’s also a chance to show how good we are. together we can make PRoMs more than just a comparison tool. And certainly more than a performance tool.

Instead, PRoMs are a means to drive quality improvement, to enrich the patient-consultant relationship and to enhance patient experience.

And what doctor doesn’t want to do that? 

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NEw sERiEs

Be more attractive

Independent Practitioner Today’s new series by Jane Braithwaite (below) kicks off with tips for all those readers who ask us: ‘How do I get more patients?’

and tested methods of promoting your practice.

quency of their practice sessions. Marketing is essential to the success of any business, including private medicine. While unfamiliar to many doctors, it does not have to be complex or time-consuming. So here are some effective strategies to help promote your busines.

➫ Referrals

The most effective way to expand your practice is through word of mouth and via existing patients, friends and family.

Are your patients familiar with the full range of services you offer? Are they aware you are actively aiming to expand your practice?

Contented patients will automatically act as ambassadors and refer you to their friends and colleagues. It is also a good strategy to maximise communication with your colleagues – including GPs and specialist consultants.

1 Traditional marketing methods

With current focus firmly on the innovative world of digital marketing, it is easy to overlook tried

A brochure or simple flyer is a cost-effective marketing tool, which can be handed directly to patients and potential referees or simply displayed in your waiting room. Articles in relevant publications will enhance your reputation. Paper newsletters are another potent tool for marketing your practice; there are many available options once you start thinking creatively.

: Check your online profile Google your name and see what you find. Prospective patients will do this before they book their first appointment. It is vital to take control of your online presence. Ideally, your website should be prioritised within any list of results. It is not necessary to pay for listings – there are numerous free directories featuring private doctors in London. You should ensure your details are listed accurately and updated on each one of them.

You may get mentioned on websites such as Mumsnet. While you cannot control this, you can engage with the process positively.

: website

A website is an integral aspect of digital marketing and a powerful communication tool – allowing you to monitor, amend and update content as your practice develops.

It is often the first port of call for potential patients and a vital

attractive

component in promoting your unique expertise and services.

Fundamental technical components include 24-hour email contact and a well-designed, userfriendly interface, fully compatible with mobile device access. Make it easy for potential patients. Your phone number and email need to be highly visible. Facilitate this with a one-click appointment process.

4 Publish

Blogs are a vital tool in promoting your business and communicating positively with patients.

Frequent blogging is a highly effective way of reassuring prospective and existing patients and letting them know what to expect when they book an appointment. By citing existing patients’ positive experiences, using real examples, you can ensure readers will have highly positive expectations.

J social media

Use social media to your advantage as part of your digital marketing strategy. It is a highly-effective way of driving patients to your website prior to booking an appointment. By posting content related to your personality and practice, you can strategically attract more patients.

Twitter, Facebook and LinkedIn are all relevant in this field. LinkedIn is primarily used to network with colleagues and patients; Facebook to interact with patients and to perfect and control your public profile.

 speaking at conferences

Good speakers are continually in demand both nationally and globally. This could be an excellent opportunity to impart your expertise and expand your network.

Speaking commitments require careful planning, both leading up and afterwards. Focused research to establish the right event, location and correspondence procedures would be logical first steps. Allow plenty of time for this process.

O Events

With careful planning, a successful event can yield productive results and, ultimately, bring you more patients.

It does not have to be ambitious in scale; a well-planned social gathering can be very relevant – if you get the initial focus right.

Think about your guest list, whether a small-scale occasion or a focused educational event with the aim of referring doctors. Allow plenty of time to choose the right venue and location, appropriate catering and, crucially, allow sufficient notice for your guests to plan their attendance.

To summarise: authenticity is always a good strategy – use the marketing tools you feel most comfortable with – but do not be afraid to branch out. Good luck.

 Next month: To tweet or not to tweet?

 see ‘Electrify your marketing’, page 22

Jane Braithwaite is managing director at Designated PA

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Stop burning your cash

So what can be done to protect you from losing money? In the follow-up to his report last month, Garry Chapman looks at the tax impact on consultants who may have accrued over £250k’s worth of unpaid bills

Consultants are typically taxed on work invoiced through the practice, so if any bill goes uncollected, they are literally pouring money down the drain. this is further compounded if aged debtors are not managed efficiently. s ome practices have no structured, objective process

for tracking bad debts, including when to write them off. t his means that tax has been paid on the billing that has never been claimed back. and practices with sole practitioners don’t have the exclusive rights to losing money. In fact,

inc. VAT.

the bigger and more successful the practice, the worse the billing and collection outcome can be –resulting in even bigger problems.

In most cases we see, the situation only becomes apparent when it is brought to the practice’s attention through a major event. t his could be anything from when the secretary falls ill or leaves, to a HM r evenue and Customs’ demand which cannot be met.

n eglecting the finance issues can result in the practice losing anything from tens of thousands of pounds to hundreds of thousands of pounds. Money that can never be recovered.

t hat sort of financial loss is unsustainable and yet there is no need for the practice to suffer the financial losses when alternatives exist.

outsourcing collection

What’s the answer? outsourcing your medical billing and collection to a specialist organisation where the sole focus is to obtain reimbursement on behalf of doctors.

this is a full-time job and if the practice wants to maximise its

time with patients, to be paid all it is entitled to, to have steady cash flow and minimal bad debts, it should let professionals perform their re-imbursement tasks.

using a specialist organisation not only means the practice receives the maximum amount it is entitled to for the patients’ treatment, but also prevents it from having to invest time in administration learning and keeping abreast of the art and science of getting paid by insurance companies. It allows them to maximise time for patients and generate more income.

benefits of outsourcing

Medical practices may be nervous about outsourcing their finances, but they need to balance that feeling against the benefits, which are:

 t he relationship between the consultant and the patient is kept purely at the medical level, ensuring that the relationship is not tainted in any way regarding the commercial aspects.

 Collectors have expertise in both medical codes and the nuances of each insurer about how the codes should be used, ensuring that the billing revenue is optimised.

FinanCial HealtH CHeCk

it is hard for most practices to admit, but the chances are that they have been losing money for years. are you one of them?

to find out, you can carry out your own billing audit, establish:

 How much you are owed

 How old your debt is

 How much of the debt is collectable or needs to be written off

 Which patients owe you the most money and decide if they are a risk

 Whether your treatments are being coded correctly

 Whether your codes are being accurately billed per insurer

 Whether you are billing at the market rate

 How far behind with the billing you are – what date was the last clinic that you billed

 once all of the above is known, then you need to decide what action you need to take in order to gain control of your finances and to stop losing money or

to register for a free billing audit, visit www.medbc.co.uk or contact Gary nials on 01494 763999. email: sales@medbc.co.uk

 expertise in ensuring all the relevant information is present and correct when raising the invoice means there are no delays in the insurer or the self payer accepting the invoice.

 t he resources are in place to ensure that there are no delays in raising the invoice. this, in turn, means the invoices can be chased in a timely manner, ensuring that the best chance is given to minimising bad debts.

 t he resources combined with an efficient process are in place for chasing unpaid invoices, following up on shortfalls and dealing promptly with any problems with claims.

this results in vastly improved cash flow combined with bad

Case studies

debts being reduced to a negligible level.

 a variety of management and tax reports can be tailored to the requirements of each practice.

 a nother advantage of using a dedicated billing service is that any disruption in a consultant’s practice, such as secretarial absence for sickness or holiday, does not affect the all-important billing and payment collection. t herefore, continuity in that vital area is assured. 

Garry Chapman (right) is executive chairman at Medical Billing and Collection

the following two case studies are examples of what we see on a regular basis and are based on consultants who joined us in the last 18 months:

Case study one

a private practice had debts of over £150k on joining us and had not changed its pricing since starting up ten years earlier.

its fee structure bore no resemblance to current market conditions nor the insurance companies’ fee schedules.

the secretary was chasing the patients for money, which was both an unpleasant experience for both parties, but also a time-consuming one, as a large part of the practice was based on self-pay patients. this was also having an adverse effect on the practice, with much friction between patients and the practice staff.

since then, we have reduced the bad debts to our average across all clients of less than half of one percent. the practice has increased the fee structure to a level commensurate with the market, which has led to an increase in revenue of up to 25%.

the above changes resulted in the practice earning more than £100,000 a year extra without doing any additional work when compared to the previous years.

Case study tWo

one of the group practices who joined us in 2014 were a group of consultants who were so busy clinically the secretaries could not keep pace with the growth.

this led to an outstanding debt in excess of £250,000, as it was not being actively chased. the doctors were also behind with their billing by two to three months. result? Major cash flow issues.

We also identified that because they were so busy, the clinical procedures were not being billed correctly and, in many cases, were resulting in a loss of revenue.

so we set about reducing this backlog going back years and ended up with a successful collection rate of over 98%. We also billed the outstanding work very quickly and then ensured the billing was done correctly and in a timely manner by keeping pace with the group’s growth.

this led to an increase in net income of 20% as well as a much improved cash flow for the entire practice.

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Electrify your marketing

Email can be a powerful marketing tool for private practices. Dev Lall outlines how it can help grow yours

Peo P le buy from people they know, like and trust, and you need to foster that in your marketing. And one excellent way to do that is through email.

What is email marketing? It is using email as a method of generating new patients for your practice. That is something many have not heard of, but it is extremely powerful. It is powerful because it allows you to do three things:

➊ It differentiates you from your colleagues. Remember, it is highly unlikely you will be the only consultant in your particular specialty that potential patients will be aware of, and you need to

encourage them to choose you over the other options they have;

➋ It allows you to demonstrate your expertise – to again make yourself the patients’ preferred choice of consultant.

➌ It allows you to build a relationship with potential patients – to become the person they know, like and trust.

Email marketing in practice

Imagine someone with a given condition has arrived at your website. They might have got there through organic search (natural search engine listings), paid search (AdWords, Facebook,

marketing

forum marketing and so on) or through having seen an advert in a magazine or PR piece about you in the press – it doesn’t matter.

Now, most consultants offer visitors only one option: to phone and make an appointment.

The trouble is, that’s quite a big ‘ask’. It makes many patients feel daunted, even a little intimidated. Don’t forget, some will not want to face their health problem in the first place.

Which means that even with the very best designed and most

well-written websites, only a very small proportion of visitors ever go on to become patients. An ugly and uncomfortable truth a web designer may not tell you.

If you have analytics software on your website, you might already know this to be true. So what’s the solution?

Instead of asking visitors to your website to pick up the phone and book an appointment, choose a less threatening call to action.

Ask them to give you their email address instead.

Even with the very best designed and most wellwritten websites, only a very small proportion of visitors ever go on to become patients

step one: Offer visitors something of value

Here’s how it works. Potential patients arrive at your website and those that are ready to do so go on to call your secretary to book an appointment.

For those that are not yet ready to do this – the vast majority – you offer them some useful information about their condition which they can get from you for free.

This offer is typically an ebook or free report, but could be almost anything: access to a series of online videos or even a physical report or book posted out to them.

So an endocrinologist could offer an ebook all about diabetes, an orthopaedic surgeon a free report or series of videos talking about ACl repair, and so on.

once the visitor clicks the button requesting their information, they are asked to enter their name

and email address into an online form before being sent to the download page for the information they requested.

you now have something very valuable indeed: a list of names and email addresses of potential patients who have ‘put their hands in the air’ and declared themselves as interested in the service you provide.

step two: stay in contact through regular emails

Now you need to build and nurture a relationship with your list of potential patients. This is done by sending them regular emails sharing information about their medical condition, recent advances in treatment and how you have helped patients with similar problems in the past.

For example, an ophthalmologist might send regular emails all about cataracts: what a cataract actually is, what causes cataracts,

how they are diagnosed and how they are treated.

each email does not need to be long – say, several tens or perhaps a hundred words long at most. If you ‘salami slice’ any condition you care to mention, you will see how easy it is to come up with 15-20 emails on even the most mundane of conditions.

And at the end of each email you send, you invite recipients to book a consultation to see you.

they should be sent out and the software will handle the rest for you automatically.

These programs vary from the cheap and simple AWeber (starting at $19/month) to the hugely powerful and complicated Infusionsoft (starting at $199/ month + Kickstarter training fee) and everything in between.

The magic of automation

While it is possible to do this manually, there is no doubt it would rapidly spiral into a huge chore. b ut, luckily, there are numerous types of cloud-based software called ‘autoresponders’ that will automate the entire process for you.

All you have to do is write your emails, decide how frequently

Technical aspects of setting up such a campaign is way beyond the scope of this article and you will almost certainly require the help of a professional web developer to create the campaign and to integrate it with your website.

No doubt, you’re thinking this all sounds like a lot of work; and you’re right – to set it all up is indeed a lot of work. b ut the beauty is that once it has been set up, the input required from you to maintain it is minimal. It just quietly works.

The pay-off

Automation is a wonderful thing, but even better is how the numbers stack up.

I’ve already said that only a small percentage of people who arrive at your website will go on to pick up the phone to make an appointment. The amazing thing is that with a system such as this, many more people will give you their contact details – and not just a few more; often an order of magnitude more.

And not only will more people ‘raise their hands’ than will pick up the phone to make an appointment, a greater proportion of those people will go on to become patients further down the line.

It’s a bit like dating. The analogy I always like to use is from the world of dating. If a man went to a bar and asked 100 women to go back to his room one after another then possibly one might do so –and he would, unsurprisingly, collect numerous slaps in the face.

In effect, that’s what you’re doing when you expect visitors to your website to make an appointment to see you at the very first encounter – as I said, it’s a very big ask. but if the same chap were to go to a bar and invite 100 girls out on a date, to go for a meal or a drink – well, perhaps five, ten or more

might agree. Why? b ecause it is much less in your face, less threatening and intimidating. This corresponds with you offering visitors to your website something of value to them in return for their email address. over time, as you send out your emails – start ‘dating’, if you will – the recipient gradually gets to know, like and trust you and will be much more inclined to take up your offer of an appointment further down the line.

Email marketing in action

The process can be difficult to appreciate in the abstract, so to see how it works in practice, go to: www.privatepracticesuccess.co.uk. on the home page is a sign-up box and button as described above. o n a medical website, this box would be smaller and there would be other content on the page too, of course, but this is for clarity. To encourage visitors to leave their details, I offer a series of 31 emails detailing easy ways to grow your private practice. This is analogous to information about cataracts that an ophthalmologist, for example, might offer potential patients. o nce the visitor enters their details, these emails are delivered through an entirely automated process – and if you enter your details, you will see exactly how the process works for yourself. e mail marketing is both a hugely effective and efficient way to grow your private practice. effective because so many more people go on to become patients than will pick up the phone ‘cold’. It is efficient because it is both scalable and amenable to automation. And while there’s no doubt it takes considerable effort to set up and master the technology, the rewards far outweigh the effort required. Anyone in any specialty could do this.

Sadly, far too many people think marketing is beneath them (why?), that it’s unprofessional (done wrongly, yes, it can be) or simply doesn’t work (it does). Don’t you be one of them.

Mr Dev Lall (right) is a an upper-GI surgeon who runs a specialist private practice consultancy PrivatePractice Expert.co.uk

INDePeNDeNT PRACTITIoNeR

ToDAy The business journal for doctors in private practice

www.independent-practitioner-today.co.uk

CCR EXPO

CLINICAL + COSMETIC + RECONSTRUCTIVE

6-7 OCTOBER 2016 – LONDON OLYMPIA EXHIBITORS’ LIST

By Edie Bourne

The uK’s largest medical aesthetic exhibition is getting even bigger to give independent practitioners and their managers access to companies who can provide them with the business back-up and expertise they need.

CCR expo – the annual Clinical + Cosmetic + Reconstructive event – is launching a new Practice Management expo (PM expo) alongside it on 6-7 o ctober 2016 at l ondon olympia. And it is free.

The event is the meeting place for more than 5,000 practitioners and 200 suppliers committed to excellence across both the surgical and non-surgical sectors.

organisers are confident that whether doctors are starting out in aesthetics and want to learn about best practice, or already own a clinic but want to inject more profit into their business, then PM expo is the event to go to.

They expect over 5,000 visitors to the combined event which will feature more than 200 exhibitors, five conferences, surgical and nonsurgical workshops and live demonstrations.

PM expo will host a dedicated exhibition and conference run in association with Allergan. Stephen Schofield, the company’s medical aesthetics manager, said: ‘We are delighted to be official sponsor of this year’s PM expo.

‘Supporting our network of practitioners is a primary focus for Allergan and we look forward to sharing insight from our team of business consultants at the PM expo conference who will be exploring business at the forefront of the patient journey.’

practice management conference

The dedicated practice management conference will feature popular ‘Getting Started in Aesthetics’ sessions.

And it will also tackle controversial issues focusing on the significance of training, ethical advertising and how to stand out from the crowd while adhering to guidelines for best practice.

other presentation will focus on the importance of consultation, with step-by-step advice from leading clinicians, plus a look at insurance claims unique to cosmetic surgery and non-surgical treatments.

Internationally-renowned speakers will present on topics such as:

❑ Attracting new patients through digital marketing and managing suppliers;

❑ Maximising the opportunities within the patient consultation;

❑ Creating an outstanding patient journey to maximise patient satisfaction;

❑ Measuring the business effectively to ensure continued efficiency;

❑ The power of maximising patient retention on business growth;

❑ Setting up an aesthetic clinic from concept to reality;

❑ Making the most of design and consultancy advice;

❑ exploiting customer relationship management systems and enhancing front of house;

❑ Taking care of after-sales and developing additional revenue streams;

❑ New furniture and designs to kit out your clinic;

❑ understanding insurance – what policy is right for you?

❑ Recruiting qualified staff to join your team;

❑ Taking the training journey – what is adequate training in the uK?

❑ Adhering to regulations and standards.

The dedicated exhibition will feature manufacturers and service providers relating to:

l Training;

l Infection prevention;

l beds/couches;

l lighting;

l Digital marketing and PR;

l Stock management;

l Financial services;

l Recruitment.

 Visitor passes are available free of charge

– find out more at www.ccr-expo.com/ practice-management

AESTHETIC RESPONSE

Have you considered benefiting from a specialised aesthetic and cosmetic inquiry and consultation management business, whose focus for your practice is to make every call a winning call?

Our team are highly trained and dedicated to the aesthetic and cosmetic industries, with the ability to relay extensive knowledge about the treatments you provide, your clinic and about you as a practitioner, while maintaining a friendly and understanding approach. Seamlessly, your practice calls can be looked after promptly and professionally at all times.

Our experience in the sector allows us to help our clients to build their businesses, consolidated by our new inquiry-to-appointment booked conversion rates, which frequently reach 75% and above. We have seen clients expand into larger or multiple premises and see our clients’ patient bases increase dramatically.

Whether you wish to grow your practice, free up valuable time, or both, Aesthetic Response can support you in achieving your business goals.

To find out more, visit us on stand B144

Phone: 0191 495 8400

Web: www.aestheticresponse.co.uk

Email: enquiries@aestheticresponse.co.uk

AMEDICA

Amedica UK as a company was launched in June 2106 and the Happy Lift range of lifting threads are our front-line product.

The ageing process reverses the ‘triangle of beauty’. Along with the sagging of the tissues, appearance of deep furrows and wrinkles indicate an inner change in the supporting structure of the skin.

Happy Lift threads are the key to a small step in time, a minimally invasive, short-recovery technique that can shave years off a person’s age without major surgery or visible scars.

As an example, BOCA is the newborn of the Happy Lift range and is a longer-lasting alternative to commonly used lip fillers. It is a well known fact that lip fillers last an average of 6-9 months and in some patients, particularly if they have an active social life, much less.

BOCA is also an option for patients who have had success with lip fillers but are looking for a longer-lasting effect. The result lasts for three years.

We also have the Platinum range of vitamin injections which are targeted anti-ageing injections with potent mixtures of vitamins, peptides and anti-oxidants. These treatments are for both the face and body, without any downtime.

We have a range of products including targeted treatments that help to destroy fat, lighten eyes and even give a liquid face-lift.

We hold regular training sessions on all our products and for further information, please contact:

Kevin Eley, UK and Ireland sales director. Email: kevin@amedica.co.uk Mobile: +447 557 020236

ARTERIOCYTE MEDICAL SYSTEMS

Arteriocyte Medical Systems, Inc. is dedicated to helping patients heal faster. The company’s lead product, the TruPRP™ Magellan® Autologous Platelet Separator, is a fully automated system that uses advanced technology to provide therapeutic concentrations of a patient’s own platelets for the purpose of promoting tissue healing, rejuvenation and regeneration.

The Magellan® is also approved to process bone marrow aspirate utilising the TruMAR0™ kit, which provides a final product rich in stem cells, platelets and monocytes. Bone marrow contains both the Mesenchymal stem cell responsible for tissue regeneration as well as the hematopoietic stem cell which aids in angiogenesis or the formation of a new blood supply. Consistent and reliable outcomes have been seen across all applications including aesthetics, hair restoration, sexual wellness, urinary incontinence and pain management.

Other product offerings include J-Plasma®, an advanced energy device that combines the unique properties of cold helium plasma with RF energy. Helium plasma focuses RF energy for greater control of tissue effect, enabling a high level of precision and virtually eliminating unintended tissue trauma.

Plastic surgery applications include: breast reconstruction, wound debridement and scar revision. Several physicians have also seen great results using cold plasma for their dermal resurfacing cases. TruPRP™, combined with any of the above-mentioned J-Plasma® procedures, helps to provide accelerated healing and reduced down-time.

Customer Service – phone 001 866 660 2674 Web: www.DiscoverTruPRP.com

BLM LAW

It’s been over three years since the Regulation of Cosmetic Interventions Committee chaired by Sir Bruce Keogh published its final report containing 40 recommendations for change within the industry. This year, the GMC published its guidance for doctors who offer cosmetic interventions, which came into effect on 1 June 2016.

BLM will be presenting on ‘Trends and emerging risks in cosmetic treatment’ at the CCR Expo. We will look at existing areas where cosmetic treatments are still giving rise to litigation, along with emerging risks. We will also consider how to reduce the risk of being the subject of a claim or a fitness-to-practise investigation by the healthcare regulator.

BLM is the leading insurance and risk law specialist in the UK and Ireland. Our dedicated healthcare team acts for practitioners in aesthetic medicine and plastic surgery and their insurers. We provide a full legal service from advice on risk and scope of indemnity cover through to management of claims and defence at court, including dispute resolution, professional discipline, regulatory issues, product liability, public law and healthcare advisory work, as well as providing advice on issues such as information law, crime, defamation, privacy, contracts, employment and commercial disputes.

Our team are highly skilled, professional, empathetic people who understand that when a claim is brought against you or your business, it is your livelihood and reputation that needs to be protected.

Come and meet our BLM team on stand F122

Contact Juliette Mellman-Jones, partner. Phone: 0207 865 8051 Email: juliette.mellman-jones@blmlaw.com Web: www.blmlaw.com

COSMETIC COURSES

Cosmetic Courses, established in 2001 by renowned consultant plastic surgeon Mr Adrian Richards, is the longest-running provider of medical aesthetic training in the UK.

Mr Richards explains: ‘My goal with Cosmetic Courses was to offer the highest-quality training in Botox and dermal fillers to medical professionals in the UK. Over the years, we’ve gone from strength to strength, adding more courses and training more professionals from around the world so they can offer the most up-to-date non-surgical techniques to their patients.’

Mr Richards and his handpicked team of expert trainers have now successfully trained and mentored over 4,000 doctors, dentists and nurses – many of whom have gone on to build their own profitable aesthetic clinics. Our award-winning training programmes include:

 Botox and dermal fillers from basic to advanced level

 Non-surgical facelift

 Platelet-rich plasma therapy

 Skin peels

 Dermaroller

 Microsclerotherapy.

All our training courses will provide you with ample practical hands-on training under close supervision so that you feel confident to go straight out and practise. We also offer plenty of marketing advice along the way, making sure that you leave every course feeling fully prepared to tackle the next stage of your medical aesthetic journey.

One aspect we pride ourselves on is we don’t believe in a ‘one size fits all’ approach. From our experience, we have learnt that each individual requires a specific training plan, tailored to their needs. With Cosmetic Courses, you control your training.

For more information on our training courses, please visit our website: www.cosmeticcourses.co.uk or phone: 01844 390110

DGL PRACTICE MANAGER

DGL Practice Manager is a practice software solution designed specifically for private consultants and medical secretaries, carefully curated to follow their daily workflows and tasks. With over 25 years on the market, we have a wealth of experience working with our 6,000+ customers in all fields of the private sector, such as private practices, clinics and hospitals.

We understand the needs and challenges of working in each and have tailored our DGL practice manager software offering to meet the requirements of our users. DGL Practice Manager also strives to deliver the best standards of service to our user base. In 2016, we invested heavily in enhancing our technology platform, to ensure greater levels of reliability, improved performance and accessibility.

We understand that the key to successful growth of a software solution is to evolve with our customers and DGL Practice Manager is committed to doing just that. Our product roadmap and development is based entirely around the needs and requests of our users, to deliver the optimal package for private consultants.

We value any chance to engage with those working in the sector and to gain a greater insight into the field of private healthcare, from both customers and non-customers alike and so we see the CCR expo as a great opportunity to speak and listen face-to-face with private consultants.

For more information, visit us at stand B143 or to talk with a member of our team in advance of the expo, please get in touch by visiting www.dglpm.co.uk

COSMETRONIC AESTHETIC EQUIPMENT

Cosmetronic Aesthetic Equipment is supported by 25 years of industry experience in multiple fields.

Our high-quality furniture is available at very competitive prices with free kerbside delivery as standard, with optional room of choice delivery available. Specialist patient chairs with fully electric control as standard, with handset and foot controller choices. Don’t forget to look at our renowned Nious+ model patient chair.

Phone: 01322 290101

Web: www.cosmetronic.com

DOCTORS APPRAISAL CONSULTANCY LTD

Doctors Appraisal Consultancy Ltd (DAC) is an organisation which was set up in 2012, when appraisals become a regulatory requirement for doctors to hold a GMC licence to practise in the UK. It provides support to doctors regarding all aspects of appraisal and revalidation, and in particular helps doctors find an appropriate designated body. DAC also provides hundreds of appraisals to licensed UK doctors each year, for doctors all over the world.

DAC uses a dedicated appraisal software which is considered the most ‘user friendly’ one available. Appraisals arranged through DAC follow a straightforward process and can be arranged either face to face or as Skype videoconferencing.

DAC can offer considerable flexibility in appraisal dates and times, now even offering weekends for added convenience.

Feedback both from various designated bodies that have been using DAC over the last four years and from doctors having had appraisals has been uniformly extremely good.

The medical director of DAC, Dr Paul Myers, is a full-time appraiser for doctors in the independent sector. He worked as an NHS GP for 25 years and subsequently as a private GP with an interest in aesthetic medicine and medical lasers.

Advice, revalidation support and the provision of appraisals can be arranged through the DAC website: www.dacuk.net or by calling 07956 393916

Email: doctormyers@me.com

HAMILTON FRASER COSMETIC INSURANCE

Hamilton Fraser Cosmetic Insurance has 20 years of experience providing insurance within the cosmetic industry. From injectable treatment and breast augmentation to general beauty treatments, we will find the right policy to suit you.

Hamilton Fraser provides specialist insurance services throughout the UK and abroad. Not only do we offer competitive premiums, but we also believe in providing expert customer service to provide you and your business with the right protection.

Phone: 0800 63 43 881 Email: cosmetic@hamiltonfraser.co.uk Web: www.cosmetic-insurance.com

COSMETIC REDRESS SCHEME

The Cosmetic Redress Scheme is the new consumer redress scheme for the cosmetic industry. The Cosmetic Redress Scheme is designed to assist cosmetic, beauty and other health care professionals to comply with their legal requirement to signpost complaints to an authorised consumer redress scheme.

The Cosmetic Redress Scheme (CRS) is authorised by the Chartered Trading Standards Institute to provide consumer redress to the industry.

Although membership of a redress scheme is not compulsory, the CRS is launching to allow all practitioners in the cosmetic industry to easily comply with this new legal requirement while also providing added benefits to its members.

Membership is on an annual basis and starts from £30 plus VAT for individuals and from £60 plus VAT for clinics.

Email: info@cosmeticredress.co.uk Web: www.cosmeticredress.co.uk

E-CLINIC

e-clinic is the leading clinic management software package in the UK and is used by everyone from individual aesthetic practitioners to some of the biggest cosmetic surgery groups. Hundreds of clients including aesthetic clinics, cosmetic surgeons and private hospitals across Britain and further afield rely on the software for the smooth running of their businesses.

e-clinic helps increase revenue, improve competitiveness, streamline admin, target marketing spend and analyse success. e-clinic puts every clinic in a position to perform at their best.

e-clinic is powerful, flexible and fast, with a straightforward and intuitive interface that users enjoy working with. The streamlined solution is securely hosted in the ‘cloud’ and accessed on a desktop computer, laptop, smartphone or iPad.

If you want to boost revenue, cut admin and improve the experience of your patients, we’d love to show you how e-clinic can make a difference in your clinic.

Phone: 01274 530505

Web: www.e-clinic.co.uk Email: sales@e-clinic.co.uk Facebook: www.facebook.com/eclinicsoftware Twitter: www.twitter.com/eclinicuk

HARLEY ACADEMY

As the UK’s first provider of a fully Ofqual-regulated Level 7 qualification in botulinum toxins and dermal fillers (L7Cert), Harley Academy ensures that new and experienced cosmetic practitioners can meet the latest government guidelines.

Trust is becoming increasingly important in the aesthetics industry as standards are diluted by a lack of regulation and the scarcity of standardised training. As such, it is increasingly essential for practitioners to be able to formally demonstrate that they have rigorous training.

Harley Academy is dedicated to raising standards in aesthetics training up to a standardised, higher education level. The Harley Academy Level 7 course in aesthetic medicine (L7Cert) is targeted as medical professionals who want to pursue a long-term, high-level career in aesthetics.

The L7Cert meets the needs of those who are new to aesthetics, or who have completed one of the very short (1-2 day) courses currently available, and want to develop their skills. Achieving the Level 7 qualification in injectables entails over 40 hours of clinical practice with an experienced mentor, six university-level distance learning modules, and a series of written and practical assessments.

The qualification is an end-to-end training programme. In other words, it provides all of the practical and theoretical training required to become a fully competent practitioner who complies with the latest Health Education England (HEE) Qualification Requirements for the Delivery of Non-surgical Cosmetic Procedures (2015; 2016) and GMC guidelines (2016).

Harley Academy are committed to academic independence and use only peer-reviewed (rather than industry-sponsored) research.

Phone: 0203 859 7598

Web: www.harleyacademy.com

INITIAL MEDICAL

Initial Medical delivers a range of industry-leading products, services and support to help ensure your practice manages all clinical waste safely and effectively. We offer a complete collection, disposal and recycling service for hazardous and offensive waste produced by healthcare providers, utilising our extensive expertise and experience of the relevant legislation to optimise your compliance.

Our comprehensive service involves a pre-acceptance audit to determine your various waste streams, with a wide selection of waste bags, rigid bins and sharps containers available to suit your specific needs. We will help you identify and segregate your waste by the appropriate colour code, as recommended by the Department of Health, offering practical tips to help you implement the most effective and efficient protocols in your practice.

Other popular products include our Signature COLOUR range of washroom hygiene units, available in nine colours and three finishes to complement any décor.

Adding further value for our customers, Initial Medical offers the innovative online resource myMedical. Here, customers can manage their accounts with a single login, including invoice and billing information, their contract details, download support documentation and gain valuable CPD via myLearning. With all this in one place and easily accessible at any time, it has never been easier to manage your waste disposal and collection.

For more information on Initial Medical and how we can help you, please visit www.initial.co.uk/medical or call 0870 850 4045

For details on the waste management colour coding system, use #Followthecolourcode on twitter

LONDSDALE INSURANCE BROKERS

Lonsdale Insurance Brokers have been insuring cosmetic practitioners and clinics for a number of years, providing tailor-made policies ensuring that high-quality and efficient service is not compromised. We can provide insurance for doctors, dentists and nurses performing aesthetics; we can also cover cosmetic and plastic surgery.

We have a dedicated medical malpractice team with a wealth of knowledge, experience and understanding of the growing industry. We understand our customers’ needs and provide the assurance that, if anything was to go wrong, we will be able to provide them with quick and professional support.

Our business has been built on the specialist knowledge and understanding of our team with a good proportion of our business being placed under various binding authorities and facilities.

We are a recommended insurance broker and work in partnership with leading insurers. Lonsdale Insurance Brokers is a UK and International Lloyd’s Broker focused on niche markets. In order to obtain a no-obligation medical malpractice insurance quotation, please contact us today.

Phone: 0207 469 4984

Email: Nicola.Swann@lonsdaleib.com

Web: www.lonsdalecosmetics.co.uk

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MGB INSURANCE

MGB Insurance Brokers Limited – experts in medical malpractice insurance.

MGB are a Lloyd’s insurance broker who specialise in arranging medical malpractice insurance. As a Lloyd’s broker, we are authorised to place business directly into the Lloyd’s market as well as the surrounding insurance companies. We have forged strong relations with these insurers over many years, negotiating quotations on behalf of our clients to ensure that they have the widest cover available at the most competitive premiums.

We pride ourselves in working very closely with our clients to understand their risk and make them fully aware of the cover they require and how it protects them. We will work with you to prepare a full, clear and concise presentation, which we will use when negotiating with prospective insurers to present your submission in the best light.

Our dedicated team is committed to providing you with the very best professional service tailored to your individual circumstances.

We can provide indemnity solutions to a wide range of healthcare practitioners, offering cover for both private practices and entity-based insurance, giving a seamless transition whether you are moving from the MDU, MPS, MDDUS or from another commercial insurer.

For further assistance, please contact either: Pat Boreham (pat.boreham@mgbib.com) on 020 3757 0138 or Sandi Gill (sandi.gill@mgbib.com) on 020 3757 0145 Web: www.mgbib.com

MONEYPENNY

Moneypenny – the UK’s leading telephone answering and outsourced switchboard service.

Moneypenny provides a professional, 24-hour service that’s dedicated to handling calls for the healthcare sector. We give you one person who gets to know you, your patients and how you run your hospital or clinic. As a member of our experienced healthcare team, your Moneypenny receptionist will allow you to get on with what you do best: working without distractions and ensuring you never miss another opportunity

 Never miss a new patient enquiry  Work more effectively

 Improve customer service levels  Maintain a professional edge at all times.

 Get on with what you do best

Your Moneypenny receptionist is a real person, employed for her polite and professional ‘can do’ attitude. Working closely with you and your team, she will quickly become an invaluable asset to your hospital or clinic.

Try Moneypenny for free

You may not know at this point what your call volume will be. This is what the free trial is for. Having experienced first-hand the benefits Moneypenny will offer your business, you’ll be able to make an informed decision, safe in the knowledge of what your ongoing costs will be.

Phone: 0333 202 1005

Email: hello@moneypenny.co.uk

Web: www.moneypenny.co.uk

OXFORD ANAESTHESIA

OES Medical – Oxford Anaesthesia – is a well-established 21-year-old British company (started in 1995), specialising in the design and manufacture of high-quality, world-class British-made anaesthesia machines.

With a 18,000 ft2 bespoke factory in Oxfordshire, all design and manufacture is undertaken in Britain for our high-quality anaesthesia machines, ventilators, absorbers, vaporisers, pipeline probes, hose assemblies and advanced patient monitors. Sales are via exclusive distributors to over 20 countries globally.

UK installation, training and maintenance is available direct from OES Medical – either at our training facility within our factory or direct to the end user at the hospital/clinic.

All products are CE marked to 93/42/EEC Medical Device Directory and meet IEC 60601-1 3rd Edition. The company is ISO 9001 and ISO 13485 certified and all parts are tested at every stage of the manufacturing and assembly process in the factory.

We offer affordable, quality, British-made anaesthesia machines which are easy to use and low cost to maintain. Starting at just £9,950 for an entry-level model with all accessories ready for immediate use and a four-year service pack kit for just £750. Replacement service parts average cost are £187 a year for the first four years of ownership (excluding labour) – less than £4 a week.

Training can be given to the end-user facility’s engineers to allow maintenance to be undertaken in-house if required. We offer a free technical helpline for advice and reassurance.

Phone: 01865 301711

Email: sales@oes-medical.co.uk

Web: www.oes-medical.co.uk

OXFORD ANAESTHESIA

THE UK’S LARGEST MEDICAL AESTHETIC EXHIBITION

5000+ Visitors

200+ Exhibitors

Non-Surgical Conference Practice Management Conference

Aesthetic Nursing Conference

Co-located with:

BCDG Expert Session

BAAPS Annual Scientific Conference

Uniting both the Surgical and Non-Surgical Communities

BAAPS Trainee Programme

Surgical & Non-Surgical Workshops

Live Demonstrations

Whether you’re a surgeon currently working within the NHS, a GP thinking about additional revenue streams you can offer in practice, or a dentist interested in facial aesthetics and fillers; the pioneering Practice Management programme will give you practical guidance on the ‘How and Why.’ NEW FOR 2016

“We are delighted to be official sponsor of this year’s Practice Management Expo (PM Expo) 2016. Supporting our network of practitioners is a primary focus for Allergan and we look forward to sharing insight from our team of Business Consultants at the PM Expo Conference who will be exploring business at the forefront of the patient journey.”

Stephen Schofield Medical Aesthetics Manager, Allergan Inc.

PATIENT JOURNEY APP

Our award-winning platform brings paper care plans into the 21st century. Patient Journey App allows healthcare professionals to update their patients with the right information at the right time. Through interactive push notifications, you can educate, activate and empower them about the next steps in their patient journey.

The app is delivered custom-branded, making it your app with your content. Even when downloading the app in the App Store or Google Play, your organisation’s logo and name is visible. This makes it easy for your patients to find you.

In-house content management

The content can be easily managed in-house, allowing you to process changes real-time into the app. Enrich your app with photos and videos by adding your own multimedia content or using our stock photographs.

Already 35,000 patients use our app, rating it as ‘a very useful addition to the treatment’, valuing it a 9 out of 10. Interested? Find our more and request a tailor-made demo app on patientjourneyapp.com.

Email: info@patientjourneyapp.com

Web: https://patientjourneyapp.com

PRIVATE PRACTICE SOFTWARE

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Many practitioners come to us with a desire to transform their business into a completely paperless environment; our combination of practice management solutions make PPS the obvious choice.

The first step to going paperless is considering and adhering to data protection laws. With electronic records, you reduce the potential of data loss. The ability to create back-up files, sign off clinical notes and retrace your steps with a time- and date-stamped audit trail are just some of the tools PPS employs to ensure data integrity.

During this transition period, you will also be considering what to do with your existing data. Whether you’re looking to upgrade your software or if you’re completely paper-based, PPS can accommodate you. We’re well versed with converting your data or scanning paper documents into your new digital database so that you don’t have to compromise when it comes to your patient records.

Once you’ve taken those first steps, the rest is easy. With a comprehensive appointments diary, clinical notes, billing and key performance indicator reports, PPS gives you the tools to manage your practice, your way. Over the last two decades, we have worked closely with thousands of practitioners to ensure that we continue to offer relevant and valuable solutions which allow you to work seamlessly and securely across all of your devices, giving you the freedom to practise anywhere, anytime.

Phone: 0845 0680 777

Email: sales@rushcliffe.com

Web: www.rushcliff.com

REDWOOD COLLECTIONS

Redwood Collections is a fully accredited debt-collection agency working for businesses throughout the UK, from small/medium firms to global corporations. We offer a ‘no collection-no commission’ debt-collection service at a typical commission rate of 15%. Because we only charge commission upon success, our clients truly enjoy a competitive solution in maximising collections of overdue accounts economically and swiftly.

With no onerous contracts, our clients have the freedom to use our services as and when they are needed. We do not charge joining fees or monthly subscriptions.

Our professional and detailed approach to each case often unearths the real reasons behind non-payment. Every debt is treated individually and our dedicated account managers will liaise with clients to ensure a business-sensitive approach is adopted where required. In many circumstances, we can mediate a resolution and negotiate a mutually agreeable settlement for all parties. If a resolution is not forthcoming, we can quickly escalate to a statutory demand as precursor to full insolvency proceedings or County Court action for smaller or disputed debts.

Redwood Collections Ltd is authorised and regulated by the Financial Conduct Authority for accounts formed under the Consumer Credit Act 1974 (amended 2006). We are also members of the Credit Services Association (CSA) and have achieved company accreditation status in the CSA’s Collector Accreditation Initiative, a respected industry accolade. We have also achieved ISO9001 accreditation and are audited annually to ensure the standard is kept. We are also registered with the Information Commissioners Office and are fully insured.

We would be delighted to meet you at stand number C122. We also regularly attend meetings with clients and prospective clients across the UK.

Phone: 020 8288 3566

Email: gmurray@redwoodcollections.com

Web: www.redwoodcollections.com

RYNA MEDICAL

RYNA MEDICAL UK LIMITED is a key supplier to the UK medical market, installing high-quality equipment such as LED operating theatre lights, examination lights, mobile and transfer operating tables and systems, gynaecology and urology examination chairs, examination couches, patient trolleys, medical supply pendants, clean air systems, procedure packs, hospital furniture, surgical drapes, sharps bins, light handle covers, sterile and non-sterile single-use items, equipment trolleys and related items and much more from world-renowned manufacturers.

All products include the latest technology, highest specification, modularity, safety, user-friendliness, yet at competitive pricing. Many products are on the NHS National Framework Agreement. We offer a full sales, installations, after-sales and maintenance service for all the products that we sell and have the complete back-up from our specialist international manufacturers.

Since its formation in 2009, Ryna Medical has seen year-on-year growth due to its success in meeting and fulfilling customer requirements. For example, with the advances in operational procedures undertaken, customers suffering from poor-quality light output, high running costs and excessive heat output have benefited greatly by installing our latest-generation MACH LED operating lights which have improved the operating environment for both the surgical team and patients and help reduce overall running costs.

Ryna Medical has a good UK installed base both in the NHS and private sectors and we look forward to working with both our existing and new customers to fulfil their project requirements.

Phone number: 01454 801560 / 07817 753098

Email: info@rynamedical.co.uk Website: www.rynamedical.co.uk

STEP INTO PRACTICE

Step Into Practice Ltd is a unique business in terms of assisting any business owner who wishes to set up in private practice. Initially designed for the medical and dental field and designed by Mr Paul Baguley and Mr William Howlett.

Step Into Practice Ltd offers a unique 12-step system and a revolutionary network of high-level partners from both the insurance and business world to assist doctors and dentists like never before setting into private practice. Years of trying to develop your own business and private practice can be condensed into weeks or months ensuring that everything is done right the first time.

All the legal back-up that you will need, all the financial advice and services that you need in an unprecedented network of providers. With discounts available from each of the providers services, allowing for better cash flow and savings for the business.

Step Into Practice Ltd offers a never seen before method of starting up and maintaining a business and ultimately realising value in what you have developed. Step Into Practice Ltd allows the business owner to concentrate on a balance between work and lifestyle while providing all the support needed to grow a private practice or business.

Phone: 01642 794154 Web: www.stepintopractice.com

SERCHEM

Brexit – Don’t run for the exit! Will leaving the EU increase the cost of your department’s chemistries?

Fact: A wide range of the decontamination detergents used in UK healthcare enter the country from abroad. European chemistry providers from Germany, France, Switzerland and other countries are popular brands. To add to the mix, there are also providers from America – where the pound is valued against the US dollar.

‘While the effects of Brexit on end users in healthcare cannot yet be quantified, I think it would be reasonable to accept that the prices of imported products will increase,’ says Paul Arnold, sales director of decontamination chemistry supplier Serchem. ‘The pound in your “department’s pocket” will be worth less outside our shores, resulting in a further squeeze of hard-pressed budgets for managers who purchase these imported goods.

‘But enough of the doom and gloom,’ adds Paul. ‘As a UK, family-owned chemistry producer, we have a proven and cost-effective option for your department’s decontamination needs. Serchem uses UK-supplied raw materials in its formulae, to produce a very successful range of specialist decontamination detergents.

‘We are not planning to increase our prices anytime soon. In fact, we haven’t increased a single price across our product range for over eight years. The pound in your department’s budget before the Brexit vote is still worth a pound today to a UK company, even after the decision was made to leave the EU.’

Paul adds: ‘Before the Brexit vote, Serchem competed on product, service and price to become one of the largest, independent providers of specialist chemistry. This will not change post-result and you may find that Serchem will become even better value than before.

‘If you haven’t previously considered Serchem as a viable option for your department’s chemistry, perhaps post-Brexit you will consider our solutions in the future. Our many NHS and private hospital clients know that we pride ourselves on family values and customer service, offering excellent products and prices.’

If you would like to investigate your chemistry options in more depth or arrange for a representative to visit your department, call Serchem on 01952 223130, email support@serchem.co.uk or visit www.serchem.co.uk

Forced sales dropped

By robin Stride

Fo LL o W ing A four-and-a-half year review of the private healthcare market, the Competition and Markets Authority (CMA) has finally confirmed it will not require HCA to sell off any of its hospitals in London.

Independent Practitioner Today reported in April that the hospital group might not be required to divest after all, following new evidence about the likelihood of more private units opening in the capital.

Earlier this month, the longawaited verdict was announced –the CMA had decided that extra remedies planned for the London private healthcare market ‘would not be proportionate’.

Under threat of a forced sell-off were the UK’s largest private hospital, The Wellington, along with the newly opened £33m Platinum Medical Centre.

Alternatively, there were two other candidates for disposal –The London Bridge Hospital and the Princess grace Hospital. originally just the latter two hospitals had been proposed for an enforced sell-off by HCA, while hospital group BMi faced having to sell seven of its hospitals in greater London, the Home Counties and the north-west of England.

But as the months ticked by –and with the cost of the private healthcare investigation mushrooming into many millions of pounds – HCA was left on its own as the only hospital group facing a sell-off threat.

The screw tightened in the Spring of 2014 when a ‘final report’ from the CMA gave HCA bosses a shock ‘Sophie’s Choice’ ultimatum by adding The Wellington and the Platinum Medical Centre to the list as alternatives to the original two.

HCA vowed to fight the decision all the way, saying the main allegation against it appeared to be that it was ‘too successful, too efficient, too innovative’.

The report had concluded that certain features of the markets for privately-funded healthcare services were leading to ‘adverse effects on competition’ or AECs.

Remedies introduced in the report, including the provision of greater information about private units’ performance for patients and a crackdown on incentives offered to referring clinicians, were subsequently implemented.

After an appeal to the Competition Appeal Tribunal, the CMA then admitted errors in a statistical analysis and asked the tribunal to remit the parts of the findings affected by the errors back to the CMA for it to reconsider and reach a new decision.

Finally, the CMA reported this month: ‘Having corrected the errors and considered the new evidence

and submissions received during the remittal, the inquiry group of five independent panel members has unanimously confirmed that there is an AEC in the market for private healthcare services in central London and that HCA’s prices are higher than would be expected in a well-functioning market.

‘The CMA considered a number of possible remedies to address the identified AEC, including its original remedy of the divestiture of hospitals by HCA, but concluded that there were no further remedies, beyond those already put in place, which would be both effective and proportionate.

‘Regarding the divestiture remedy, the CMA concluded that this would be disproportionate. Two of the members dissented from this conclusion.’

The reacTion

a hca healthcare spokesman said: ‘HCA Healthcare UK welcomes the conclusion of the CMA’s market review, and its decision that no further market remedies are required.

‘We will continue to invest in delivering high quality care across our network of facilities.’

a Bupa UK spokesperson said: ‘It is extraordinary that, after five years of investigation, the CMA has confirmed that there isn’t enough competition between private hospitals in central London, but has failed to find a solution.

‘This means health insurance customers will continue to pay more than they need to, even though the CMA agrees that HCA faces weak competitive constraints in the private hospital market and is charging prices that are too high.

‘We fully support the CMA’s aim to ensure markets work well for consumers, businesses and the economy, but this final report makes us question whether it is delivering on that. We will be considering our next steps and will continue to campaign to make private healthcare more affordable for our customers.’

The CMA’s Roger Witcomb said its reconsideration of the central London market considered new evidence and confirmed a finding that privately-funded healthcare customers in central London paid too much ‘largely because of HCA’s strong market position’.

Although it still believed the market required more competition, ‘the level of uncertainty that now surrounds the likely impact of a divestiture, and the real prospect of new entry into the market adding greater competition over time, mean that we believe divestiture is no longer a proportionate remedy.’

He believed that remedies already ordered after the original investigation would bring significant benefits to private patients in central London. 

hca’s Wellington hospital and the long-running battle over its future

When you’re under

We look behind the scenes of a medical crime lawyer. MDU solicitor Sara Mason (right) explains why doctors need expert representation if they are accused of a crime and describes what her work entails

What are the most common criminal allegations made against doctors?

Ü It’s unusual for a doctor to be accused of a criminal offence, but the MDU is supporting more doctors with cases compared to five years ago.

Sexual assault allegations make up around two-thirds of cases we see and there was a spike in numbers following the Jimmy Savile case.

There is now a much greater likelihood that the Crown Pro -

secution Service decides to charge a doctor with sexual assault, even when it is simply the patient’s word against theirs.

In the past, we used to attend many police interviews under caution with a doctor, fully expecting that the case wouldn’t go anywhere, but now I advise members that the case is likely to proceed to a trial unless there is independent evidence contradicting the patient’s account.

Another part of our work involves manslaughter allegations in a clinical setting. They are less common, but there has been a significant increase in the number of police investigations in recent years, even though it is rare for there to be enough evidence to justify prosecution.

The majority of cases are referred to the police by a coroner, but investigations can also be triggered by a complaint from a family member or the Care Quality Commission.

Even more unusual – but not unheard of – are criminal allegations concerning abortion, assisted suicide or murder.

Why do doctors need specialist legal representation?

Ü These are complex cases, not least because the doctor’s acts or omissions can be open to different interpretations. If you are facing a criminal allegation, you need a solicitor with relevant knowledge and experience of both the law in this area and medical practice.

At the MDU, we have a team of three in-house criminal solicitors who have amassed over 50 years’ combined experience and we have a very good track-record of successfully assisting members before charge and also of defending cases which go to trial.

The majority of police investigations against members we represent do not result in a prosecution, and conviction in sexual cases in particular is very infrequent.

Another important factor is that the doctor has the benefit of our wider expertise. Anything which occurs or is said during a police investigation might have repercussions for the doctor during any

suspicion

other related investigation, such as those by the GMC, the doctor’s employer, NHS authorities or if a civil claim is brought.

How did you find yourself focusing on medical crime?

Ü After qualifying as a barrister, I practised for two years before obtaining a masters degree in medical law and ethics and then joining healthcare law specialist solicitors Hempsons.

My colleague Ian Barker and I regularly received instructions from the MDU. In 2000, Ian become the MDU’s first criminal law specialist and the following year I jumped at the opportunity to work for the organisation too. The other member of the criminal law team is Nick Tennant who joined in 2008.

What does your work at the MDU involve?

Ü There is no ‘typical’ day because I might be called at any time to represent a member who has been arrested anywhere in the UK.

Fortunately, it’s usually possible to arrange for a doctor to attend the police station voluntarily and one of the most important aspects of my job is to prepare them before they step anywhere near the interview room.

Police officers are often very experienced, have access to expert advice and will have worked out their interview strategy in advance. If you don’t know what you are doing, you can badly damage your defence at the interview stage.

In the run-up to a trial, the pressures on doctors can be overwhelming and half the battle is ensuring they can cope with the process.

Doctors in this position might not be able to work because of conditions imposed on their prac-

tice when given police bail or by the Medical Practitioners Tribunal Services’ Interim Orders Panel.

If the doctor has a young family and is accused of sexual assault of a minor, they will be subject to an assessment by social services and could be separated from their children or not allowed to be alone with them at any time between charge and trial. There is often press attention too, particularly with accusations of sexual assault.

Ultimately, it’s my job to ensure the doctor gets the best possible representation. That means appointing an experienced barrister at an early stage so there is a legal team working on the case; obtaining expert opinion; and liaising with the doctor’s MDU medico-legal adviser and other departments such as the press office to ensure they get appropriate advice.

What are the best and worst aspects of the job?

Ü It’s incredibly satisfying when a doctor is able to return to practice after the ordeal of a criminal investigation. On the other hand, it’s terrifying to think about the amount at stake for the doctor who, if convicted, is facing not only deprivation of their liberty but the end of their career and their livelihood.

It is terrible to see the toll a criminal investigation and trial can take on their health and family life.

What advice would you give a doctor who was accused of a criminal offence?

Ü Contact your medical defence organisation straight away. Criminal cases are often extremely complex, but with our specialist knowledge and tenacious approach, we often achieve a successful outcome for the doctor. 

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September is the right time to act

I always thInk september is the real start to the year. In this case, not back to school but back to work.

we are programmed from an early age that the year really starts now – not with fireworks and hogmanay, and certainly not with the artificial construct of 1 april. s eptember is ‘check your pencil case time’, buy your new uniform, leave summer behind … as it is for school, so it is in the real world of work. From years of close observation, I have noticed how the optimism of the new financial year’s plans before senior management leave for summer holidays is soon punctured by the realisation that, as the leaves fall, nearly half the financial year has already gone – and the surprise that those plans are not on track.

My trust’s experience has led me to expect not an Indian summer in september, but rather to expect reviews of performance and a revising of plans.

is it the same with your local private patient unit (PPU)?

PPUs do have the important benefit of working with real money –they can influence income as well as manage expenditure.

But working within a nhs trust structure, this does not inure PPU managers from needing to take part in any autumn round of recovery planning.

But PPU managers, working with the consultants that support them, should have the ability to play a strong hand in the trust in any such review process: ‘Back us now and through the winter by protecting beds and theatre space and we will deliver profitable growth’.

least anecdotally, been the busiest season for private providers, certainly for self-pay.

therefore, this is a good time to implement new ideas for growth and to take stock of your unit’s competitive position.

two examples of local market opportunities that have been shared with me by PPU colleagues are worth sharing.

t hese concern paediatrics and competitor refurbishments, and each offer different insights to how to strengthen a trust PPU in the eyes of key customers – the consultants.

Increasing regulation has squeezed the ability of independent hospitals to provide private care for children under the age of 16. t he need to ensure trained paediatric staff, the centralisation of skills and capacity, and the media spotlight have all played a part in driving up standards – but also increasing costs.

Most provincial private hospitals have now essentially stopped providing children’s services, as they cannot meet the standards. and if they do, it is, at best, financial break-even and, I hear, often at a loss.

hospital directors cannot afford such a drag on overall margin and so services have ceased, sometimes at no notice.

Filling the gaps

nhs PPUs essentially provide private patient services in most markets that fill in the gaps rather than competing head-on for prime market share against strong local competitors.

This month is the time to implement new ideas for growth and to take stock of your unit’s competitive position, advises Philip Housden in his continuing journey following a year in the life of a NHS private patient unit (PPU)

I urge you to engage now with your trust executive management so you can ‘get your story in first’. Do it before the wet/cold weather leads to increased pressure on a&E and nhs admissions.

For these reasons, september is a burst of activity – not just for the management annual business cycle, but importantly for private healthcare demand too.

as the schools go back, so surgeons are available and hungry for private work. a nd patients, too, seem keen to take action with their health, perhaps planning for all to be well before Christmas.

so autumn has traditionally, at

By that, I mean it is my experience that they actually stimulate and grow the size of the private patient market – they do not cannibalise it.

t he service gaps I refer to are because PPUs support the most complex insured cases – those procedures that need specialist equipment and those patients best supported by 24/7 infrastructure, and private patients needing acute non-elective care too.

In other words, these are the patients that the local private hospital cannot support. so, without a PPU, they either do not get treated and/or most likely defaulted to the nhs cost line. But with a PPU it is different.

I belIeve In PPUs

Following my 2014 Independent Practitioner Today series on PPUs, I have continued to work with many nHS trusts to help develop and grow profitable private patient services.

This has enabled a real insight into the day-to-day challenges of delivering a private service within a public sector environment.

I am passionate about how PPUs can be part of the answer to the strategic and financial challenges that the nHS faces and so, in these articles, I plan to share learned, practical insights and also comment on how PPUs can best respond to changing policy issues and healthcare current affairs.

so what about private paediatrics? Children requiring surgery who are covered by health insurance – most typically E nt and urology – have generally found a home in nhs trusts and such services perfectly fit the ‘can’t/won’t be done in the local private hospital’ bill.

But the challenge, now that private hospitals have pretty much retreated from all paediatrics, including outpatients, is a trickier one for PPUs.

If the service made no return for your competitor, should the PPU take it on? In most cases, I expect not. the only winners here might be the insurers who will, short-term at least, see reductions in spend. what has happened where you are?

t he other recent example shared with me relates to a PPU’s local competitor taking advantage of a ugust consultant leave to complete long overdue theatre refurbishment.

w hat an opportunity for any PPU. In this case study, the learnings are:

 Engage senior trust management to the ‘once in a generation’ opportunity;

 seek early first call on unused trust theatre sessions;

 Make regular communication between the PPU and surgeons and their medical secretaries;

 Put in the effort to ensure capacity is ‘sold’.

PPUs must not miss these shortterm boosts. But, more importantly, they need to take advantage of working with consultants that have perhaps not used the PPU before, to demonstrate the significant advantages they offer.

these include on-site convenience, round-the-clock support, patient safety excellence and –with trust executives on board –the goodwill to be earned from making a positive contribution

towards the trust’s financial challenges.

Of course, you may have returned in s eptember to find your PPU missed acting on such an august refurbishment.

Consultants and PPU managers need to keep an eye on local market capacity and competitors’ forward plans.

I hope in your area the next closure of capacity by your competitor is actually being planned for Christmas/ n ew year, or next august.

 Next month, I will share some thoughts on the importance of best practice governance for a PPU and that will mean I touch on two important acronyms we all need to understand: MAC and CMA.

Philip Housden (left) is a director of Housden Group, a management consultancy specialising in commercial support in the healthcare sector

DEAling wiTh A complAinT

Sorry is hardest word – but vital

Being open and saying sorry are the best policies when things go wrong. And it can cut the risk of a complaint or litigation, says Dr Gordon McDavid (right)

D O ct O rs m AY hesitate before speaking up when things go wrong. t his is despite their defence body having advocated a culture of openness in healthcare and advised them to be honest and apologise when an adverse incident occurs.

there are many possible reasons for this, but it does seem that concern around the potential consequences may act as a barrier to openness following an error.

A medical Protection survey of over 500 UK members revealed that 68% of respondents believe there is a ‘blame and shame’ culture in healthcare and that it will be difficult to overcome this.

t his echoes the findings of a similar survey we carried out five years ago, which suggests a disappointing lack of positive change.

As doctors, we are highly trained on clinical matters and communication. m odern medicine also requires us to be prepared for managing errors and knowing what to do when an adverse incident occurs.

Under the statutory duty of candour, doctors in England have a legal obligation to be open, honest and to offer an expression of sorrow and regret – often an apology – following an error.

For doctors working in private practice, there is a need to be familiar with local procedures for incident reporting, investigation and complaints handling. t his

will provide you with the appropriate tools when talking to patients and their relatives about what the next steps are likely to be following an adverse event.

speaking to a patient following an adverse incident can be one of the most challenging discussions a doctor faces. An apology can help set an appropriate tone for that interaction and is a powerful communication tool – demonstrating empathy and support to the patient.

Below we look at how best to approach an apology and why it is

such an effective tool in managing an adverse incident.

when should you say sorry?

It is important that patients – and sometimes their family – receive a meaningful and timely apology when an adverse incident occurs. An apology should be offered as soon as it becomes apparent that something has gone wrong or as soon as the patient expresses they are unhappy with their care.

While it may be some time before all the facts are understood, this should not hinder a prompt

and meaningful expression of regret and the full explanation of the circumstances can follow, when determined.

It is important to ensure the apology is phrased correctly to avoid unintended admissions of liability. For example, saying ‘I’m sorry this has happened to you’ is different to stating ‘I am sorry I made this mistake’.

Your approach to an apology After an adverse incident, the first step has to be to ensure the patient’s safety. As soon as it is

Speaking to a patient following an adverse incident can be one of the most challenging discussions a doctor faces

appropriate to, you should then listen carefully to your patient to understand exactly why they are upset. If they are unhappy, it is likely they will want to have their story heard and their distress acknowledged.

An open and truthful discussion should follow, in which it is important to demonstrate an appropriate expression of regret or sorrow.

Once you have all the facts, a full explanation of what happened and any anticipated consequences should also be conveyed so the patient is prepared for what to expect next.

If required, propose a management plan for ongoing care. If you cannot provide this, explain how the patient can obtain further help and assist with these arrangements by providing contacts and resources.

Depending on the circumstances, this process may require

several meetings with the patient and/or their family – with the patient’s consent to do so.

A full and objective review of the event should always be carried out, with the patient being informed as to any lessons that can be learnt for the future.

A commitment should be made to understand and learn from what has happened to address lessons learned in order to reduce the likelihood of it recurring and happening to someone else.

You should also ensure that detailed notes are made to ensure it is clear what has happened. If the situation is complex, or you would like advice, it would be pertinent to discuss your particular circumstances with your medical defence organisation.

The benefits of saying sorry

A failure to apologise was cited as the reason that more than a third of patients escalated a complaint

to the Parliamentary and Health service Ombudsman in 2014-15. It therefore seems that an appropriate apology is not being offered frequently enough.

c ontrary to popular belief, when something goes wrong, an open and honest explanation of what happened, including an apology, is likely to reduce the risk of complaints or litigation.

much like a diagnostic conundrum or consideration of treatment options, doctors should be able to openly communicate and work in partnership with their patient to decide how to proceed.

An apology does not mean you admit responsibility or that you have done something wrong. It is important to ensure this is phrased correctly to avoid unintended admissions of liability.

Effective management of an adverse incident has many benefits. most importantly, the patient will understand what happened

and receive a much sought-after apology and recognition of the distress they feel. Learning can then ensue in a blame-free manner, minimising the risk of the same error happening again.

Unfortunately, things sometimes go wrong in healthcare. Even when things seem to go right, patients may still feel disappointed or upset with the care they have received.

We support open communication and encourage members to apologise when a patient expresses dissatisfaction and to follow up with an appropriate investigation. this applies equally to doctors in all specialties and in private or NHs practice.

If the situation is complex, or you would like advice, discuss your circumstances with your medical defence organisation.

Dr Gordon McDavid is a medico-legal adviser at Medical Protection

Get it together!

Independent Practitioner Today’s ongoing series for clinical negligence expert witnesses continues with advice on the combined report. Michael R. Young reports

The cOMbIneD report is exactly what it says on the tin: it is a combination of a liability and causation report, and a current condition and prognosis report.

LEAding oRgAnisATions bEyond REgULAToRy CompLiAnCE

London Event – 19th october 2016

the care Quality commission (cQc) is mandated to inspect every independent hospital by december 2016, with the second half of the year seeing a significant increase in independent hospital inspections. their ‘well-led’ key question focuses on how the leadership, management and governance of an organisation assures high-quality person-centred care delivery, supports learning and innovation and promotes an open and fair culture. delivered by an experienced cQc chairman and facilitators who are experts in their fields, this three-hour programme focuses on developing a clearer understanding of the Well-Led domain as interpreted by the cQc, and provides invaluable facilitated group work.

main objectives:

 Understanding the Well-Led domain: What does this mean?

 Leading beyond compliance – good governance is good business’ –drivers and barriers

 What are we currently doing? What should we be doing? How do we achieve this? (Linked to vision; governance; leadership and culture; engagement; continuous improvement)

 Good examples of ‘well-led organisations’: What we will look for?

 case-studies – Learning from others.

the session will be held from 2-5pm with a networking lunch starting at 1pm for all attendees, at a cost of £195.00 + Vat per delegate.

For more information or to book a place, please contact us on 01189 036 363 or email info@tle-miad.com

The solicitor will usually ask for a combined report in low-value cases when they want to keep costs down.

I would treat the combined report as being two separate reports: the first one dealing with issues that happened in the past; the second dealing with things as they are in the present and in the future.

Therefore, I would address liability and causation first and then go on to record what you found in the clinical examination, before finishing off by dealing with the prognosis. This seems a logical way of writing a combined report.

To avoid any doubt in the lawyer’s mind, make it absolutely clear that the first part of your report is about liability, the second is about causation, the third is about the current condition, and the fourth is about the prognosis.

You should refer to the subsections ‘The liability and causation report’ and ‘The current condition and prognosis report’ for full details of how to set these reports out and what you should and should not include.

The first page of the combined report is the introduction, which should include the following data:

 Why the report has been written – its purpose;

 Your name and qualification as the report’s author;

 The name of the firm of instructing solicitors, not the individual solicitor’s name;

 The name of the solicitor’s client;

 Whether the client is the claimant or the defendant;

 A summary of your instructions, including the date of the letter of instructions. This is the terms of reference.

It is best not trying to paraphrase the instructions, because, in doing so, you may unknowingly alter their meaning. Therefore, it is advisable to copy the instructions word for word from the solicitor’s letter;

 The sources of the evidence. This should be comprehensive and must include where the evidence has come from, the dates the evidence relates to and, perhaps equally as important, what is missing;

 A list of the contents and page numbers. This helps the reader to find information quickly.

The report must contain a statement that you understand your duty to the court and that you have complied with that duty. The declaration can be set out on the second page – see box to the right.

Liability and causation

The report’s next page is a summary of your conclusions about liability and causation. These could, of course, be copied and pasted from the conclusions section, but it is a summary that is needed.

Think in terms of the following questions:

 Was there a breach of duty of care? If so, in what context did it occur?

 Two further questions then follow – was anything done that should not have been done, and was anything not done that should have been done?

 Did the breach of duty result in substandard care and treatment?

deCLARATION

I, declare THAT:

1

I understand that my duty in providing written reports and giving evidence is to help the court, and that this duty overrides any obligation to the party by whom I am engaged or the person who has paid or is liable to pay me. I confirm that I have complied and will continue to comply with my duty.

2

I confirm that I have not entered into any arrangement where the amount or payment of my fees is in any way dependent on the outcome of the case.

3

4

I know of no conflict of interest of any kind, other than any which I have disclosed in my report.

I do not consider that any interest which I have disclosed affects my suitability as an expert witness on any issues on which I have given evidence.

5

I will advise the party by whom I am instructed if, between the date of my report and the trial, there is any change in circumstances which affect my answers to points 3 and 4 above.

6

7

8

I have shown the sources of all information I have used.

I have exercised reasonable care and skill in order to be accurate and complete in preparing this report.

I have endeavoured to include in my report those matters of which I have knowledge or of which I have been made aware that might adversely affect the validity of my opinion. I have clearly stated any qualification to my opinion.

9

I have not, without forming an independent view, included or excluded anything which has been suggested to me by others, including my instructing lawyers.

10

I will notify those instructing me immediately and confirm in writing if, for any reason, my existing report requires any correction or qualification.

11

I understand that:

11.1 My report will form the evidence to be given under oath or affirmation;

11.2 Questions may be put to me in writing for the purposes of clarifying my report and that my answers shall be treated as part of my report and covered by my statement of truth;

11.3 The court may at any stage direct a discussion to take place between experts for the purpose of identifying and discussing the expert issues in the proceedings; where possible, reaching an agreed opinion on those issues and identifying what action, if any, may be taken to resolve any of the outstanding issues between the parties;

11.4 The court may direct that, following a discussion between the experts, a statement should be prepared showing those issues which are agreed and those issues which are not agreed, together with a summary of the reasons for disagreeing;

11.5 I may be required to attend court to be cross-examined on my report by a cross-examiner assisted by an expert;

11.6 I am likely to be the subject of public adverse criticism by the judge if the court concludes that I have not taken reasonable care in trying to meet the standards set out above.

12

I have read Part 35 of the Civil Procedure Rules and the accompanying practice direction and I have complied with their requirements.

13

I have read the ‘Protocol for Instruction of experts to give evidence in Civil Claims’ and confirm that my report has been prepared in accordance with its requirements. I have acted in accordance with the Code of Practice for experts.

 Did any substandard care and/ or treatment cause physical injury and financial loss and expense?

Section 1 is a synopsis of the evidence, Section 2 is the interpretation and analysis of the evidence, Section 3 is the argument or discussion and setting out the range of opinions, if appropriate, and Section 4 is the conclusions.

Current condition and prognosis

The report’s next page summarises your conclusions about the current condition and prognosis.

Section 1 is the current condition and should be restricted to the findings of the clinical examination and special tests and the interpretation of any X-rays.

Section 2 is the prognosis and Section 3 is the recommendations.

The latter is as much to help the client by pointing him or her in the direction of other specialists. It may also help the solicitor

decide if additional reports are needed.

The combined report’s final paragraph is the statement of truth, saying:

‘I confirm that I have made clear which facts and matters referred to in this report are within my own knowledge and which are not. Those that are within my own knowledge I confirm to be true.

‘The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer.’

The report must be signed and dated. When writing a combined report, get it clear in your mind exactly what each part is about or it will end up being very confused and confusing.

 Adapted from The Effective and Efficient Clinical Negligence Expert Witness , by Michael R. Young, price £60 from Otmoor Publishing

lEgAl bRiEFing: dATA pRoTEcTion

Keep your data safe

Practice owners have some important data protection obligations to follow or their business could be at risk. Chris Alderson (right) and Puja Solanki (far right) explain

If you handle and process personal information about individuals, you have a legal obligation under the Data Protection Act 1998 to protect that information.

The Act requires that those who record, use and process personal information must be open about how that information is used and must also follow the eight principles of ‘good information handling’, which govern how data can be used. These apply to all private practices.

The definition of ‘processing’ is very wide and will essentially catch almost everything that is done with personal information which exists, whether in paper or electronic format. It can mean obtaining, recording or holding the data.

The ‘information’ regarded as personal data is that relating to any living individual who can be identified from that information.

This will be significant for a private practice or consultant or private GP, as they will hold personal

information on both their patients and employees. The individuals concerned are known as ‘data subjects’.

A private practice owner or consultant will be the ‘data controller’ within the meaning of the Act and will be responsible for implementing the requirements arising under it.

Your responsibilities

These include the requirements to process data fairly and lawfully, informing data subjects how their information will be used and ensuring that their information is not used in any manner not compatible with this.

The data controller is also responsible for allowing data subjects access to the information held about them.

In addition, the Act imposes other responsibilities to ensure that the data collected is adequate, accurate and up to date and is kept securely.

When selling a private practice,

concern can arise in trying to weigh up the competing demands of compliance with the Act and compliance with other regulations.

A common query among practice owners who employ staff is how they can comply with their obligations under the Transfer of undertakings [Protection of Employees] Regulations 2006 (TuPE) while also complying with the provisions of the Act – and, in particular, keeping information secure and confidential.

However, the Act allows employers to disclose the information as required by law – and the TuPE regulations make it clear that disclosure is required.

Requirement to register

However, when handling such personal information, both the buyer and seller must take care to comply with the Act. f or example, steps should be taken to ensure the information supplied is accurate, up to date and secure. And a buyer may use the information only for the purposes of TuPE.

The Act also requires data controllers to register with the Information Commissioner’s o ffice (IC o ), which is the authority responsible for regulating data protection.

failure to register is a criminal offence – unless you are exempt from doing so. When conducting their due diligence of the practice, a buyer should obtain confirmation from its seller of their registration with the ICo.

A breach of a data controller’s responsibilities under the Act can lead to the imposition of a financial penalty of up to £500,000.

A significant breach of confidence will also be a breach of the

obligation to keep personal data secure, and may lead to a penalty substantially higher than civil damages that might be payable to the victim.

The need to keep personal data secure is of prime importance –almost all of the financial penalties imposed to date relate to failures in the arena of data security.

So practices should ensure not only the physical security of paper records but also see they have adequate electronic protection, especially in relation to items that would make tempting targets for criminals, such as laptops and other mobile devices.

Compliance with the Act is a priority for every practice owner – so be aware of your obligations because a breach of them, together with the ICo’s enforcement action for breach, will severely impact the practice’s ability to carry out its day ­ to ­ day business.

The law relating to the protection of personal data will change in May 2018, when the European General Data Protection Directive comes into effect.

This will increase the obligation placed on data controllers, including mandatory reporting of some information security breaches and greatly increased penalties for breaches of the data protection principles.

With so much at stake if you get it wrong, it is essential to keep abreast of the various changes afoot and of the way in which they could impact upon your business. If in doubt, take advice. 

Chris Alderson is a partner and Puja Solanki a senior solicitor at Hempsons solicitors

invEsTmEnT sTRATEgiEs

Don’t let Brexit vote deter you

Worried about stock markets after Brexit?

Simon Bruce (right) explains why it is important to keep calm and remember the foundations of good investing

I N v ESTING IS the process of delaying consumption from today to some time in the future and employing that money in the meantime in the markets to grow at a rate at least in line with inflation, but preferably more.

Not scaring oneself to death along the way is also a key goal. As the old saying goes, investing is simple but not easy.

Recently, we have seen many market commentators react to news that the UK has voted to leave the EU.

The media likes to report that we are heading for recession and, as individuals, it can be very difficult to remain disciplined in your investing while ignoring the noise that you should be doing something.

If your portfolio is well-struc -

tured and well-diversified, and you remember that investing is a long-term game, you should not need to act.

However, at times when the economy is facing challenges, it can serve to highlight areas of an investor’s portfolio which are unevenly weighted or that contain higher-than-appropriate risk or illiquid assets.

For example, as I write, a large number of popular UK commercial property funds have suspended withdrawals. In basic terms, this means investors cannot access their money for an indefinite period of time.

Amid uncertain market conditions for property, investors have attempted to withdraw substantial sums from these funds which are ordinarily worth around £25bn in the UK.

But property is not liquid – it is not quick to buy or sell and the ‘keys-to-cash’ period can take months – as most of us soon realise when selling our own houses. So the funds must pay out to investors from their back-up ‘liquid’ pot first.

When the number of potential withdrawals becomes too many, the fund can cease trading in order to be able to process these requests. In 2007, many such funds were forced to sell buildings cheaply to pay out to investors. It is believed this created a fall in property markets and contributed to the credit crunch at the time.

Unfortunately, the story of property funds are too enticing for some where bank accounts

yield little interest – after all, we all understand a tangible asset like buildings – and investors piled back in despite the warnings. This proves a timely reminder that although the commercial property market is considered fairly low volatility, it is not low risk.

Investing may never be easy, but it can be far easier once you employ a systematic approach. We believe that there is a sensible and highly effective way to invest your money if you follow these foundation stones.

1

Have faith in capitalism and confidence in the markets

Capitalism is an adaptive, robust economic system that has delivered incredible developments to the benefit of mankind. It may not be fair, but it creates wealth. The equity markets are an efficient mechanism for price discovery, rewarding those who provide capital to those engaged in the pursuit of wealth creation.

2

Accept that risk and return go hand in hand

One of the inescapable truths of investing is that to achieve higher returns, you have to take on more risk. That seems logical enough, but you would be surprised just how many investors seem to think that it is possible to get high returns with low risk. The one thing we know for sure about risk is that if an investment looks too good to be true, it probably is.

3

Let the markets do the heavy lifting

In investing, there are two main sources of potential returns. The first is the return that comes from the market and the second is the return generated through an investor’s ‘skill’.

There are two main ways in which a professional active equity investor tries to deliver a better return than the market: one is to time when to be in or out (market timing); the other is to pick great individual stocks (stock picking). Empirical evidence reveals that ‘skill’ is almost impossible to differentiate from luck and beating the market return consistently over time – and after costs – is the rare exception in relation to the

Unfortunately, evolution has hard-wired the human brain to be particularly poor at making investment decisions

number of managers. As one cannot control the return of the market, and returns from skill/luck are rare, your decision-making framework and the consequent structure of your portfolio becomes key.

4

Be patient – think longterm

There is no easy, quick or worryfree route to investment success. In the short-term, market returns can be disappointing. The longer you can hold for, the more likely the returns you will receive will be, at worst, survivable and hopefully far more palatable. It is time that allows small returns to compound into large differences in outcome. If you want to be a good investor, you have to be patient. Impatient investors tend to lose faith in their investments too quickly, with often painful consequences.

5 Be disciplined

Patience and discipline are close bedfellows. Once you realise that generating good long-term returns takes time, patience and belief in the markets, it is essential to put in place the discipline to stop yourself succumbing to impatience and ill-discipline. Discipline comes in many forms:

 Constructing well-researched and tested portfolios that should weather all investment seasons;

 Not chasing investments that have gone up dramatically, but sticking with the logical reasons for not owning them in the first place;

 The discipline to not become despondent about short-term, unimportant market noise, and to focus on your long-term strategy.

6

Build a well-structured portfolio

Once you accept that returns come from markets and are rarely enhanced by the judgemental

approaches of professional managers of market timing and stock picking, it is evident that structuring a well-thought-out mix of different investments – referred to as asset classes – should sit at the heart of your investment programme.

Your long-term portfolio structure will dominate the investment returns obtained during your investment lifetime.

Successful investing is all about taking on well-understood risks that deliver a positive return expectation – these are carefully selected market risks associated with ownership and lending.

It avoids taking on risks that add little to – or worse, detract from – the portfolio, such as illiquidity, investment fads, poor judgemental portfolio manager performance and opaque and complex product structures.

7 Use diversification to manage an uncertain future

Not putting all of your eggs in one basket is an intuitive and valuable concept. No one knows what the future holds and owning a highly diversified portfolio is the key tool that we have to make sure that we are prepared for whatever the markets throw at us over time. It brings its own challenges. Inevitably, there will always be one or two parts of the portfolio that are doing well, but one or two that are not. The patient and disciplined investor knows that there is little point in knee-jerk responses and that this is simply the way that markets are. The impatient and ill-disciplined will seek to change their strategy.

8 Avoid cost leakage from your portfolio

Costs eat away at the market returns that you should be gathering for yourself. Small differences in costs will compound into large differences over extended periods of time.

9 Control your emotions by adopting a systematic approach

Unfortunately, evolution has hard-wired the human brain to be particularly poor at making investment decisions.

Evidence of wealth destroying, emotion-driven decision-making

is plentiful, as impatient and illdisciplined investors have a propensity to chase fund managers and markets that have previously performed well, and sell poorly performing investments.

Buy-high, sell-low is not a good investment strategy. Research reveals that this bad behaviour may cost investors around 2.5% a year, on average. Given that equities have only returned around 5% above inflation, on average, that is a material erosion of potential wealth.

10 manage risks carefully across time

Our approach to investing positions us as risk managers, rather than performance managers as advisers have traditionally been. Keeping the risk in your portfolio at an appropriate level is achieved through ‘rebalancing’ periodically back to your long-term portfolio strategy.

Rebalancing involves selling out of better performing assets and buying less well performing assets i.e. selling, rather than buying ‘hot’ performing asset classes. Fund selection and due diligence and the ongoing governance of the investment process are all important risk management functions.

Employing a systematic investment approach – like the one Cavendish has developed – provides the discipline and objectivity that is required to avoid the pitfalls that all investors inevitably face.

These foundation stones certainly make investing far simpler and easier, but never easy. 

Simon Bruce is managing director of Cavendish Medical, specialist financial planners helping senior 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.

When your interests cross over

Avoiding conflicts of interest are in the minds of readers’ questions answered by Dr Beverley

Ward

Dilemma

1 Conflict of interest in joining CCG

QI have been a dermatology consultant for several years and share ownership of a clinic.

The other day, an old colleague sounded me out about joining the board of a clinical commis sioning group (CCG) where a vacancy had arisen.

It sounds an interesting opportunity, but there would be an obvious conflict of interest if my clinic decided to bid to provide dermatology services.

What would you advise?

AIf you decide you want to join the CCG, you will need to formally put on record your financial interest in the dermatology clinic, ensure you are alert to potential conflicts and be proactive when they arise.

The potential for commissioning arrangements to create conflicts of interest has already led NHS England to produce updated statutory guidance for CCGs1 which requires them to provide clear rules for their members and employers.

When appointing members to its committees and governing

body, CCGs are expected to consider whether conflicts of interest should exclude individuals from being appointed, bearing in mind the extent of the interest and the nature of the role.

The guidance also states that anyone with an interest in an organisation which provides, or is likely to provide, substantial services to a CCG should not be a member of the governing body or committees ‘if the nature and extent of their interest and the nature of their proposed role is such that they are likely to need to exclude themselves from decision-making on so regular a basis that it significantly limits their ability to effectively perform that role’.

From your perspective, if you are appointed to the CCG, you should abide by the CCG’s established arrangements in the event of a possible conflict.

For example, the chairman may ask you to leave for the relevant part of a meeting or permit you to join in the discussion but not have a vote. CCGs are obliged to record how any conflict of interest issue has been managed in the minutes of the meeting and in its registers.

You should also follow the GMC’s ethical guidance2 by being open about conflicts of interest

and taking steps to manage the conflict, such as excluding yourself from the decision-making process and any subsequent monitoring arrangements.

While the GMC recognises that conflicts of interest are sometimes unavoidable, it expects doctors to take responsibility when they arise.

Dilemma 2

Patient thinks I am on the take

QA man in his 40s presented to my private orthopaedic clinic with persistent knee pain from a running injury.

We discussed the need for an MRI scan to determine the level of soft tissue damage and I suggested it might be convenient for him if I referred him for a scan to be done within the same private hospital.

The patient seemed happy with this at the time, but is now grumbling that I probably made money from the referral.

How should I deal with this situation?

APerception of a conflict of interest can risk attracting criticism and reduce the confidence of patients in those looking after them, even if no actual conflict exists.

What is more, such conflicts are not always financial but can be perceived when the practitioner has a long-standing relationship with or loyalty to a particular organisation, even when they may not directly benefit.

It therefore makes sense to talk to the patient about his concerns in order to restore the trust necessary for a good doctor-patient relationship.

One approach might be to explain your position as a doctor

with practising privileges at the hospital and reassure him that competition law prevents you from accepting any direct incentive or any obligation from a private hospital to prefer their facilities.3

However, it will probably help if you take the opportunity to discuss the patient’s wishes for their treatment and explain your fees, giving them the chance to ask any questions.

As ever, it is worth reflecting on this incident to see if there is anything you might do differently.

For instance, when seeking consent for referrals, the GMC expects4 you to give the information it wants or needs, their options, the purpose of your referral, any fees they will have to pay, and ‘any conflicts of interest that you, or your organisation, may have’.

If there is more than one option for referral for further investigation

or treatment, you should explain this to your patients and document the discussion in the notes. Finally, if you have a website, it is a good idea to include factual information about the hospitals where you practise and the process for arranging referrals. 

References

1. Managing Conflicts of interest: revised statutory guidance of CCGs, NHS England; first published March 2013, updated April 2016 as a draft for discussion.

2. Financial and commercial arrangements and conflicts of interest, GMC; 2013.

3. Article 15.2, Private Healthcare Market Investigation Order 2014, Competition and Markets Authority; October 2014.

4. Paragraph 9, Consent guidance: patients and doctors making decisions together, GMC; 2008.

Dr Beverley Ward (right) is a medicolegal adviser at the MDU

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Roomy, fast and frugal

The new Audi A4 fits perfectly with the needs and expectations of the modern independent practitioner, says our tester dr tony Rimmer

There is no doubt that recent events in the UK have raised levels of uncertainty with regard to future borrowing and spending.

Many independent practitioners are thinking hard with regard to their own business and personal situations. But one thing is for sure, though – a business with solid foundations and high-quality services on offer is more likely to do well when the dust has settled.

An excellent reputation and loyal client base will place any private practice in a position of strength in challenging times. And, in the world of motoring, there is one brand which epitomises this confident business stance and that is Audi.

Currently, an independent practitioner’s choice of new car may tend to be more pragmatic than self-indulgent. For many who are not attracted to sUVs, a

mid-range estate car would fit the bill perfectly.

ideal for both practice and family commitments, an up-to-date product from a reputable maker would appeal. step up the new A4 from Audi.

New platform

Based on a completely new platform and launched in 2015 in saloon mode, the A4 is now available in the stylish Avant estate form.

Like Volkswagen does with the Golf (see July-August issue), Audi tends to keep external changes of new models to a minimum and the new A4 is more evolution rather than revolution. however, its understated looks belie the changes that have gone on under the skin.

New cleaner, more efficient engines and class-leading interior design and tech suggest an inter-

Audi A4 AvAnt

3.0 tdi quattro s line tiptronic

Body: Five-seat, five-door estate

Engine: 3.0 litre v6 turbo-diesel Power: 272bhp torque: 600nm top speed: 152mph

Acceleration: 0-60mph in 5.2 secs

Overall economy: 53mpg

On-the-road price: £40,065

esting and appealing new package.

The choice of three petrol and two diesel engines, frontwheel drive or Quattro fourwheel drive and manual or automatic gearboxes means there is a model to suit all preferences. Prices range from £27,880 to £40,880.

The interior meets all Audi expectations. The choice of top-notch materials, modern design and fantastic build quality in my opinion keep this German brand ahead of all competitors, including BMW and Mercedes.

The controls feel properly engineered and the facia now incorporates the wonderfully futuristic ‘virtual cockpit’ display. From behind the wheel, the A4 now feels like its superstylish coupé sibling, the TT. Passengers are better off in

the new car too. More head- and legroom in the back make the bigger A6 model almost redundant. The Avant estate has loads of space in the boot and, to my eye, looks better externally as well. sitting on its new chassis, this latest A4 rides better than previous models. still a bit on the firm side, especially with the optional bigger alloy wheels, it absorbs road imperfections without drama.

Improved handling h andling is also improved, but the keen driver will still have more enjoyment at the helm of a BMW 3 series or a Jaguar Xe. The Audi is best suited for soaking up motorway miles while passengers enjoy a quiet and comfortable environment.

Choice of engine will be determined by the type of driving you do. The diesels are better for bigger mileages and better fuel economy and Audi’s seven-speed

dual-clutch automatic gearbox is the best option for all models.

The optimal engine is probably the four-cylinder 2.0 diesel in 187bhp guise rather than the lesser 148bhp guise.

For those of us medics who like even more power from the right pedal, i can recommend the 3.0 litre V6 diesel engine as fitted to my test car. Producing 272bhp, it can get the A4 from 0-60mph in 5.2 seconds and still do over 50mpg.

This is the same engine used in the Porsche Macan s diesel and it is a gem. i t is amazing to think that back in 1971, as a teenager, i was astonished that the then new

the controls feel properly engineered and the facia now incorporates the wonderfully futuristic ‘virtual cockpit’ display

the elegant lines and understated image are complemented by a luxury interior that is class-leading in design, tech and build quality

Ferrari Daytona supercar posted a 0-60mph time of 5.4 seconds. how times have changed. The even faster petrol s 4 and rs 4 models will arrive in the next 12 months, but they will be significantly dearer to buy and run.

The new A4 Avant has a lot to recommend it. The elegant lines and understated image are complemented by a luxury interior that is class-leading in design, tech and build quality.

i t is roomy, fast and frugal. i t fits perfectly with the needs and expectations of the modern independent practitioner.

As long as you keep an eye on the options – as some of them can be pricey – it represents decent value for money too. in a world of uncertainty, it is nice to know you can trust the Audi brand to deliver just what is promised. 

Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey

STARTINg A pRIvATE pRAcTIcE

How to liquidate your company

It is worth knowing about liquidating your company from the outset of your private practice. Ian Tongue explains

For Those trading as a company, there is usually a finite life to their business, with liquidation being an option to dissolve the company when you cease your private practice.

‘Liquidation’ is often heard about in the news, usually in the negative context of a big business failing, but there are different types of liquidation and this article explores the most common for consultants: a members’ voluntary liquidation or MVL.

What is a liquidation?

In simple terms, a liquidation is converting the non-cash assets of the company into cash – that is to say, collecting debts due and selling equipment, paying off your debts you owe and being left with a pot of cash.

This process can take some time, particularly for those with debts due from medico-legal work, but typically the whole process can be done in a few months.

The members’ voluntary liquidation is basically saying that you have chosen to liquidate rather than this being forced upon you and, for private practitioners, this is almost always a ‘solvent’ liquidation, meaning that there is value in the company.

Why would I do this?

It is often the case that a consultant would not need to extract all of their private practice profit, particularly as they get nearer retirement. If the retained profits have not been extracted in full via dividend, there will be a build-up of profit or reserves in the firm.

This build-up of reserves may be included within the accounts as cash or the company may have purchased assets or investments of its own.

As a retirement strategy, it gives you an additional lump sum at the cessation of your private practice and this may be particularly attractive for those in the 2008 or new 2015 Nhs pension schemes where the expected retirement age is 65+. hence, this has been a popular strategy for many consultants who can afford to leave money in the company.

What is the tax advantage?

In simple terms, dividends and/or paying yourself a salary are subject to income tax, but a liquidation is regarded as a capital distribution and therefore subject to capital gains tax.

For those selling or liquidating their company, a favourable rate of capital gains tax has been available for many years because of a special relief, known as e ntrepreneurs’ r elief, which cuts the capital gains tax rate down to 10% where certain conditions are met.

This is in addition to an annual capital gains tax allowance, currently £11,100, which further reduces the gain. Therefore, a significant tax saving can be experienced through this method.

Important new regulations

As a result of the above tax advantage, the use of members’ voluntary liquidations was abused by some.

This lead to people using the favourable rates to liquidate their

As a result of the tax advantages, the use of voluntary liquidations was abused by some

business and start up a new company, which allowed them to accelerate the timetable. While not illegal in most cases, it was an area of interest for hM revenue and Customs ( h M r C) for some time and they had limited success in policing this area.

From 6 April 2016, h M r C issued new rules to prevent you liquidating your company and restarting soon after.

These new regulations focus on whether the trade of the company has effectively continued after liquidation.

As yet, this is largely untested, but it is fair to assume that anyone who liquidates their company and then trades as a sole trader or partnership will be caught by these rules. It will also apply to someone setting up a new company and carrying on the trade.

If the regulations are breached, the funds are subject to income tax rather than capital gains tax when distributed upon liquidation and it is therefore usually significantly more expensive.

opportunity is the separation of clinical from medico-legal work, as these are likely to be argued as autonomous trades. In these circumstances, the use of a members’ voluntary liquidation may allow different timing to the above, but careful planning would be required and again this is as yet untested.

Next steps

For those wanting to explore the option of liquidation, it is vital that they discuss matters with their accountant at the earliest opportunity. A liquidator is often a third party, and most accountants will work with a couple of liquidators whom they know do a good job.

Complications can arise with slow-paying debt, directors’ loans and other matters, but a good liquidator is able to suggest the best method of extraction of funds during the process.

The costs can vary considerably depending on the composition of assets and speed at which the liquidation needs to take place.

If you budget for around £2,000-£5,000, you would not be too far off. As always, advanced planning is the key to any strategy being successful, so discuss your intentions with your accountant.

While now subject to new rules and regulations, a members’ voluntary liquidation can still provide the longer-term strategy and tax benefits that many had planned for.

In order to be successful, it will require planning and involve your accountant as much as possible to ensure a favourable outcome.

 Next month: a guide to tax-deductible expenses

Ian Tongue is a partner with Sandison Easson Chartered Accountants

Liquidations post 6 April 2016

For anyone looking to liquidate their company after 6 April 2016, you must therefore be aware of the above changes. The rule around not continuing your trade has a two-year window and so, in practical terms, most would have to cease their private practice for at least two years.

While possible, it is likely to be impractical due to being out of the game for two years and having to establish yourself again later on when you are two years older.

Therefore, as a retirement strategy for those looking to cease private practice, the members’ voluntary liquidation is still often the most tax-efficient way of ending your business.

o ne would expect this, as the new rules are aimed at abuse of the old rules rather than someone who has built up value in a company and wants to realise this at the end of the business’s economic life.

o ne area that may present an

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Take heart for the future

A perfect storm has brought some bad news on the earnings front for cardiologists. But Ray Stanbridge believes the future will be brighter

There was a big surprise when we analysed consultants’ private earnings in 2014 for the latest in our benchmarking series.

On average, cardiologists’ gross incomes have fallen by nearly 5%, going down from £142,000 to £135,000.

To make things worse, costs have risen by 3.9%, increasing from £51,000 on average to £53,000.

a s a result, taxable incomes have fallen by a surprising 12% from £91,000 to £80,000.

The results are surprising, particularly as this column in Independent Practitioner Today reported last year that: ‘we are glad to say

prospects look reasonable for cardiologists in private practice’.

so what are the reasons for the decline in gross income?

some consultants attribute it to pressure by insurers on their fees.

To an extent this is true, as by 2014 consultants were subject to the full impact of the Bupa ‘open referral’ scheme and cost-saving programmes introduced by old insurers.

however, that does not account for all of the fall.

Others attribute it to a loss of Choose and Book work, which seems to have affected some – but by no means all – consultants.

aveRage INCOMe aND eXPeNDITURe OF a CONSULTaNT CaRDIOLOgIST WITH aN eSTaBLISHeD PRIvaTe PRaCTICe

Some consultants attribute the decline to pressure by insurers on their fees

Yet other specialists report that the private practice market was generally quiet in 2013-14, with patients opting to use the Nhs for their treatment.

e arnings also took another knock because expenses went up. Most consultants did not reduce their costs.

cost rises

There were small cost rises in consulting room hire and some consultants preferred to purchase secretarial and communications services through their private hospital or private wing of the Nhs

Office costs showed a modest, although not significant, cost increase. Bad debtors showed a modest reduction.

Other costs rose slightly. For many, this represented marketing and promotion expenditure.

h owever, we did note a trend among some cardiologists towards undertaking more exotic continuing professional development and other training courses than in previous years.

w hat then of the future? It could be getting better. a preliminary review of available 2015 figures suggests that 2014 figures may have been something of a blip.

For 2015, the figures look to

We did note a trend among some cardiologists towards undertaking more exotic CPD and other training courses than in previous years

Year ending 5 April. Figures rounded to nearest £1,000 (percentage is also rounded up)

Source: Stanbridge Associates Ltd.

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have improved. This is reassuring because, on a long-term basis, we have identified private practice cardiology as being a growth arm. we are seeing a growth of interest right now by some cardiologists in forming groups and this seems to be one of the keys of success, providing that group members can work together, of course.

Our overall conclusion is 2014 was something of a blip and not indicative of a long-term trend. we expect prospects for cardiologists generally to be bright – after

all, many more of us are getting heart disease as we get older. as regular readers will be aware, we have been having increasing data comparability problems in trying to determine what has been happening to cardiologists’ private practice incomes.

changes in trading

Consultants are changing the way they are trading. For example, there are fewer sole practitioners and more groups and other consultants have incorporated.

The significant market changes, including growth of Choose and Book, other Nhs expenditure in the private sector and the heavy insurance company pressures on fees – which has accentuated from about 2012 – have all had an impact on results.

as a result, we will be changing the format of Profits Focus after completing the 2014 data cycle.

It has always been known that our survey is not statistically significant. we have tried to present a fair representation of what is happening to a typical consultant working in private practice.

Our definition of consultants to be included in this survey remains the same as in previous years. The survey is restricted to consultant cardiologists who are not in fulltime private practice. They will:

 have had at least five years private practice experience;

 h ave held either a maximum part-time or a ‘new’ consultant contract in the Nhs;

 Be seriously interested in pursuing private practice as a business;

 Be earning at least £5,000 in the private sector, including Choose and Book work not paid through PaYe;

 May or may not have incorporated or be a member of a group. Ray

How ARE YoU doing?

what’s coming in oUr october issUe

Make sure you don’t miss our next issue, published on 20 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, including:

 COMING IN are you a NIP (New Independent Practitioner)? Then don’t miss two expert articles to help you. Dr Steve Iley, medical director for health insurance at Bupa UK sets out ten things you need to know when starting a practice, while accountant Ian Tongue presents a guide to tax-deductible expenses – something established private doctors will find useful too.

 GOING OUT… Retirement? Learn from the top mistakes being made by other senior independent practitioners

 Top tips for busy doctors – to tweet or not to tweet?

 a consultant involved in the Private Healthcare Information Network (PHIN) portal pilot – coming your way for real next year – claims a new age of transparency is going to give confidence to gPs when they are making referrals, and to patients and families when they are making choices

 Medico-legal risks to be aware of when dealing with overseas visitors and patients

 eU legislation and case law has had a huge impact upon UK employment law, so it is very likely BReXIT will have an impact on employee protection and employee rights. How much of a change are doctor employers likely to see?

INDePeNDeNT PraCTITIONer

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 2016

Registered office: 7 Lindum Terrace, Lincoln LN2 5RP

Write to Independent Practitioner Today PO Box 198, Cranleigh GU6 9BB

 Ouch! University and school fees: what you need to know about saving for your children’s future, what the new fee rises could mean and how you can make the most of compound interest to help you save

 a ten-point check list of things to do to make sure the practice’s billing and collection is well organised

 a leading defence doctor spells out what he believes should be the medico-legal priorities now for the new government

 accountant vanessa Sanders gives a reminder of the tax treatment of seasonal gifts and benefits to staff and helpful business contacts.

 Medicine’s Strangest Cases

 Breaking into medico-legal work – advice on editing and redrafting

 Doctor On The Road Dr Tony Rimmer finds the new Renault Megane gT is a competitor to the doctors’ favourite – the golf gTI

 Plus all the latest news and views you need to know

aDveRTISeRS: The deadline for booking advertising for our October issue falls on 23 September

IPT

eDITORIaL INqUIRIeS

Robin Stride, editorial director

Email: robin@ip-today.co.uk

Tel: 07909 997340

aDveRTISINg INqUIRIeS

Margaret Floate, advertising manager

Email: margifloate@btinternet.com Tel: 01483 824094

Publisher Gillian Nineham Tel: 07767 353897.

Email: gill@ip-today.co.uk

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