17 years of support
To celebrate our 168 issues, we’ve compiled advice, tips and insights independent practitioners need to be aware of to help achieve practice success. n See page 16
We wish all our readers a happy and prosperous 2025.
For many consultants and GPs in independent practice, the new year is set to bring some exciting professional opportunities in an increasingly busy private healthcare sector.
But to everything there is a season and for the current editorial team at Independent Practitioner Today it is now time to enjoy new work/life challenges.
‘IPT’ – as we fast became widely known – is now in its 18th calendar year but we came of age in journal terms more quickly than we dared expect.
With the prospect of redun -
dancy beckoning following the imminent closure of a big publisher’s medical titles, a group of four of us faced the big questions familiar to most private doctors: ‘Should we go independent?’ ‘Where will we work from?’, ‘What will we be called? and ‘How much should we charge?’
Half an hour after the redundancy announcement, we were blessed to have attracted enough promised support from would-be investors to enable our move. Much-valued sponsors also came on board and we soon had a company, directors and a diverse group of backers.
Business contacts provided an amazing amount of goodwill and advice to cut through the inevitable red tape and within four
months our unique journal, featuring the first monthly 24-page print edition, was delivered to thousands of doctors.
Things snowballed with readers’ and advertisers’ support and we were soon the fastest growing medical publication and regularly featuring over 60 pages.
With Covid-19 forcing big business decisions for independent practitioners, and us too, we moved to a totally digital format with the option of page-turn editions with the editorial mirrored separately on the website.
These have been supplemented by popular weekly news updates and our online Business Directory.
Our aim has always been to provide you with the easy-to-read news you need to know and expert
articles to assist you in developing a stronger and safer private practice business which ultimately benefits your patients.
We hope we have done that for you and can echo the words of the orthopaedic surgeon who recommended us as ‘a great resource for information and advice’ in his article ‘Ten tips from my first year in private practice’.
Now we leave you on a positive note with 168 expert tips, advice and observations drawn from every issue (starting on page 16) –including those from the consultant above.
Thank you for reading us and for all your support, which we hope will continue under the new team.
➱ continued on page 2
Over the past 15 years, the private healthcare landscape has undergone profound change. Throughout this transformation, Independent Practitioner Today has been a constant, providing in-depth coverage of the challenges and developments facing medical professionals in this dynamic sector.
After 168 issues and a remarkable legacy since June 2008, Independent Practitioner Today is preparing for its own transformation by evolving into Healthcare Today. Launching in January 2025, this new platform will broaden its focus to include both the private and public healthcare sectors, delivering essential news, features, expert
insights, and interviews for an audience of healthcare professionals driven by a desire to do better for the patient.
Building on the legacy of IPT, Healthcare Today will combine the accessibility of a responsive website with the depth of a monthly digital digest. True to its roots, Healthcare Today will remain an independent and trusted voice, addressing core topics such as:
n Patient safety;
n Litigation and inquests;
n Government and policy;
n Regulation and compliance;
n Technology and innovation;
n Biotech and pharma.
‘Healthcare Today is committed to
empowering those in the business of improving lives,’ says incoming editor-in-chief Glen Ferris. ‘It’s our mission to listen and learn from the UK’s most respected medical professionals.’
With insightful contributions from experts across all specialties, as well as interviews with MPs, policymakers and thought leaders, Healthcare Today aims to track significant sector advances, share actionable insights, and equip medical professionals to navigate a rapidly evolving healthcare landscape.
Boasting a subscriber base of 130,000 healthcare professionals at launch – including more than 80,000 doctors, resident doctors,
consultants and specialists, as well as 30,000 support staff and 4,000 business leaders – Healthcare Today is poised to become a vital resource for fostering meaningful discussions on improving patient care.
What to expect later in January
The inaugural issue will feature an exclusive interview with former Health Secretary Jeremy Hunt MP, sharing his views on the NHS’s upcoming patient safety reforms. It will also include contributions from leading clinical specialists, prominent consultants, and innovators in the MedTech and biotech sectors. n For more information, visit www.healthcaretoday.com.
TELL US YOUR NEWS.
Contact editorial director Robin Stride (right)
Email: robin@ip-today.co.uk
Independent Practitioner Today would like to pay tribute to the following:
☛ Former directors: the late Ray Stanbridge, the late Hamish Millar, Gillian Nineham and Colin Jones;
Phone: 07909 997340 @robinstride
ADVERTISE WITH US.
To advertise in the digital journal, on our website or in our business and lifestyle directories, contact Andrew Schofield at Spot On Media.
Phone: 0161 408 3912
Email: andrew@spotonmedia.co.uk
Chief sub-editor: Vincent Dawe
Head of design: Jonathan Anstee
www.independent-practitioner-today.co.uk
☛ Staff members: chief sub-editor Vincent Dawe, head of design Jonathan Anstee, Joy Clarke, Margaret Floate, Andrew Schofield, Andy Parrott, Round Ash Associates;
☛ Past and present sponsors: Bupa, HCA Healthcare UK, Cavendish Medical, Civica Medical Billing and Collection, the MDU, Healthcode and Medserv;
☛ Advertisers too numerous to mention – and all writers, who, without exception, willingly gave their services free of charge.
☛ Special thanks also to: Alex Acaster, Chris Adams, Mike Broad, Rob Finch, Steve Ripsher, Julia Anderson, Fiona Booth, Elizabeth Boultbee, Dawn Boyall, Jane
2024 – January 2025
Duty of candour problems revealed P5 London’s private health network extends P6
Business Dilemmas:
How to discuss sex in old age
Assume nothing and expect anything when it comes to sexual activity in older people, says Dr Ellie Mein P46
Start a private practice: Ten tips to avoid the tax inspector
Accountant Alec James gives his top ten tips to ensure you have the upper hand on tax inspectors P48
Doctor on the Road:
Comfy, but where is the charisma?
Audi’s Q6 electric car failed to excite our motoring correspondent Dr Tony Rimmer P52 www.independent-practitioner-today.co.uk
Braithwaite, Simon Bruce, Garry Chapman, Darren Clare, Megan Cleaver, Stephen Collier, Peter Connor, Anne Marie Cooklin, Maria Davies, Jessica Delplace, Rosalind Dewar, Glen Ferris, Susan Field, Richard Gregory, Jessica Hammonds, David Hare, Liz Heath, Philip Housden, Neil Huband, Rochelle Humphrey, Alec James, Dr Tony Lopez, Dr NatalieJane Macdonald, Oliver Maughan, Alistair Moses, Suresh Menon, Martin Murray, Richard Norbury, Sue O’Gorman, Julia Price, Dr Tony Rimmer, Tingy Simoes, Ian Tongue, Ted Townsend, Kate Tullett, Prof Mark Whiteley.
Also the Association of Independent Specialist Medical Accountants (AISMA), 108 Harley Street, Hempsons, Independent Doctors Federation, LaingBuisson, the Royal Society of Medicine, Sandison Easson, God and the teams at the Royal Surrey County Hospital and Frimley Park Hospital.
Stay ahead of the cybercriminals
Cybercriminals demanding ransoms are a threat to private doctors as much to hospitals. Dr Sally Old shows what you can do to protect your business P10
Help to look after disabled staff New resources from Bupa are equipping employers to ensure better support for disabled people in their teams. Bupa’s Dr Robin Clarke reports P12
recent fee and policy updates, private consultants have a prime opportunity to enhance revenue. Medserv’s Derek Kelly shows how P42
. . . but others are still awaiting delayed pension tax
By Edie Bourne
Doctors who had received incorrect pension tax figures as part of the ‘McCloud remedy’ are now starting to receive corrected calculations – but many others have still not received any figures from NHS Pensions.
Every doctor impacted by McCloud should have received ‘remedial service statements’ by 6 October to show the recalculations of their pension growth and therefore their annual allowance positions across the seven years known as the ‘remedy period’.
Some doctors received their statements shortly after the deadline but many did not. Of those that did, many found significant
errors in their figures. After complaining, some corrected statements are now being issued, while other doctors still await their initial statements.
At the same time, there has been no extension to the self-assessment deadline in January.
Samuel Kirton, financial planner with specialist financial advisers Cavendish Medical, said: ‘With the considerable delays in implementing the McCloud remedy, it was always going to be a substantial task to get the statements issued – and without errors.
‘However, the problems being witnessed now are particularly worrying. When contacting NHS Pensions, doctors are being told there is no time-scale for issuing
the statements or providing corrections on statements that have already been issued.
‘Although the January tax deadline has not been extended, the official rules for submitting revised figures to HM Revenue and Customs is three months after
receiving the pension statement. This in itself will be difficult to enforce, as there is such a variation on when people are receiving the information they need.’
To recap, the ‘McCloud remedy’ aims to recompense NHS Pension Scheme members deemed to have suffered age discrimination when the 2015 pension scheme was introduced.
Consultant numbers active in private healthcare rose by 281 (2.7%) to 10,900 – the highest since the pandemic – in the latest quarterly analysis.
The largest increase among the top ten procedure groups was in clinical oncology, the second largest rise in volume – an extra 26 consultants – and the largest percentage rise (14.5%).
Private Healthcare Information Network (PHIN) figures for Q2 2023 compared to Q2 2024 found medical oncology was the only specialty in the top ten with fewer active consultants, having four less (-1%).
Reported private hospital admissions (232,000) in April to June 2024 hit a record level for that period in a year, and the second highest level ever.
Private medical insurance funded most – up 9% on the same quarter in 2023 – while reported
self-pay admissions fell slightly but remain well above pre-pandemic levels.
The biggest percentage increase came in the 10- to 19-year-old age group, which was up 12% from 4,500 to 5,000. The nought to nine-year-old age group also rose from 4,700 to 5,000 (9%).
There were 46,900 admissions for 50- to 59-year-olds (up 5%), the highest private patient age group.
The number of admissions for two popular forms of weight loss surgery fell – bypass operations (-20%) and gastrectomy (-23%).
PHIN director Richard Wells said:
‘Overall, the number of reported private hospital admissions is up on the equivalent quarter in 2023, especially across the most popular procedures, such as cataracts, chemotherapy and diagnostic upper-GI endoscopy. However, there are procedures which seem to be bucking this trend.
‘The reduction in weight loss surgery admissions could be due to people choosing alternative types of weight loss treatments, the growing availability and popularity of weight loss drugs or people opting to go abroad for treatment.
There were fewer operations for breast lifts (-18%). Breast enlargements (-7%) and breast reductions (-9%) were also down, as were face lifts (-16%).
Mr Wells said: ‘The fall in the number of people having this sort of procedure may reflect people’s changing priorities or inability to afford to have procedures that are not for purely clinical purposes.
‘Alternatively, like weight loss surgery, people may be choosing to go abroad for cosmetic surgery.’
PHIN is encouraging people considering private treatment, at home or abroad, to visit its free impartial website first to find out more about their options. Robot-assisted hip replacements were up 53% (590) and knee replacements were up 58% (790).
By Douglas Shepherd
Doctors and hundreds of people they work with came together to celebrate the best in private health and social care at the 19th LaingBuisson Awards.
Nearly 1,000 guests attended the spectacular ballroom at the Park Plaza Westminster Bridge where the finalists were chosen from 370 entries by an independent panel of judges.
The Hospital Of The Year award went to Royal Marsden Private Care. The judges’ citation noted: ‘The market leading genomic work sets a new standard for the future of cancer care.
‘The introduction of innovative technologies in this specialised hospital is impressive and likely enhances capacity, which patients greatly appreciate.’
Hospital Group Of The Year was won by Circle Health Group.
Judges said: ‘This organisation showcases an excellent growth story driven by aggressive innova
tion, achieving market leading outcomes through effective data utilisation to enhance care.’
Circle was also praised for providing ‘a muchneeded and innovative solution that significantly improves patient access and affordability.’
The best in primary care and diagnostics award went to One Bromley Adult Hospital At Home.
Judges commented: ‘This service embodies the future of medicine by prioritising care before hospitalisation, utilising a brilliant
multidisciplinary team approach.
The awards offered providers and advisers a valuable opportunity to acknowledge and celebrate the most inspiring and innovative contributions to the sector, according to LaingBuisson founder and executive chairman William Laing.
He said: ‘This year’s nominations showcased an array of impressive projects, organisations, and professionals, all passionately dedicated to significant health and social care causes.’
INNOVATORS AND LEADERS
Public Private Partnership: InHealth Group
Innovation in Care: Guy’s and St Thomas’ Specialist Care
Excellence in Training: Right at Home UK
Leadership Team of the Year: Cleveland Clinic London
Health Tech Product of the Year: Nobi NV
Technology Support Provider of the Year: Birdie
Rising Star: Sarah Adomah – The Royal Marsden
Health Cover Provider of the Year: Bupa UK Insurance
CLINICAL SERVICES
Hospital group of the year: Circle Health Group
Best in healthcare outcomes: OCL Vision
Hospital of the year: The Royal Marsden Private Care
Best in primary care and diagnostics: One Bromley Adult Hospital at Home
Nursing Team of the Year: The London Clinic
LaingBuisson’s Outstanding Contribution: Justin Ash, chief executive, Spire Healthcare
A new comprehensive oncology and haematology centre is being opened in Leeds by cancer care provider GenesisCare.
The facility will be the 15th and largest centre in its UK network, housing two of the world’s most advanced and sophisticated radiotherapy platforms, revolutionising treatment for patients with cancer.
It will have the ability to personalise radiotherapy in real time, using both MRI and CT imaging, offering patients treatment precisely tailored to their specific cancer.
Chief medical officer Dr Eliot Sims said: ‘Adaptive radiotherapy
represents a transformative advancement in cancer treatment.
By using the technology’s ability to provide live images of both the tumour and normal tissue, we can create a new treatment plan every day based on the patient’s anatomy.
‘This gives our clinicians the confidence to deliver high dose radiotherapy with exquisite precision, while minimising sideeffects, thereby improving patient outcomes. This is truly personalised radiotherapy.’
By Robin Stride
Private consultants’ and GPs’ difficult experiences with the duty of candour have been revealed in a survey for Independent Practitioner Today by the Medical Defence Union (MDU).
It demonstrates much more needs to be done to back doctors when things go wrong and shows how many admit they struggle with their duty to be transparent.
Among those at the centre of a duty of candour engagement, 30 doctors (27%) said they did not feel they received adequate support from colleagues and/or the organisations they worked in.
Asked if there had been times when they felt unable to be open and honest with a patient following an incident, 40 doctors (21.9%) said ‘sometimes’ while four (2.2%) replied ‘yes, often’.
They listed their primary concerns about being straightforward were about being blamed 29.5% (13), litigation 20.5% (9), patient’s reaction 27.3% (12), while ten doctors gave a wide variety of other reasons.
Dr Michael Devlin, MDU head of professional standards and liaison, said: ‘A significant minority of MDU members still have concerns about admitting errors because they fear being blamed, being caught up in litigation or how patients might respond.
‘It’s important to realise that apologising for errors is not an admission of legal liability for what has happened but an acknowledgement that something could have gone better.
WHAT HAS BEEN THE IMPACT ON YOUR PRACTICE OF THE STATUTORY DUTY OF CANDOUR
survey, 54% said the impact of the statutory duty of candour meant they were more likely to apologise and explain when something goes wrong, while 45% replied: ‘There has been no impact, I haven’t changed the way I practise.’
Dr Devlin said the study showed that being open and honest with patients when things go wrong continued to be second nature among medical professionals.
‘This is welcome news, even though there is still work to do in improving transparency. Apologising meaningfully and explaining fully and promptly what has happened is vital for maintaining trust and respect, which is at the heart of the doctor patient relationship.’
Just over half of respondents had been involved in a duty of candour incident, involving complications
of treatment or surgery (44) medication error (27), delayed diagnosis (22) patient death (17), and psychological harm (eight).
Sixty per cent (110) had used their work’s patient safety reporting system, but only 71 of them received feedback on the outcome of any investigation or action arising from their report.
Responses to feedback involved apologising (31), providing an explanation (43), explaining how things would be put right, if possible (41) and arranging followup care/appointment (30).
Asked about outcomes of the incident, 61 doctors said the response was accepted and 63 said no further action was taken or nothing further was heard. A legal claim for compensation happened in seven cases and 11 complaints were made.
HAVE THERE BEEN TIMES WHEN YOU’VE FELT UNABLE TO BE HONEST WITH A PATIENT AFTER AN INCIDENT
‘I think it’s not a good idea and provokes unnecessary anxiety when no harm came to the patient.’
‘Duty of candour is just normal good medicine.’
‘I think that being open about a problem can be less stressful and maintain a bond between the patient and their relatives. I can also appreciate this can be difficult in more serious situations. The support network at work is essential to prevent feeling like an outcast.’
‘I think it right patients are told there has been an event, it is being investigated and they will get a response within a clear time-frame, but the problem is, in some instances until the investigation is done, it is not known whether something has been done wrong or not. This process then increases stress for patients and staff.’
‘It does make a difference to the patient and avoids unnecessary stress and anxiety.’
‘A positive concept, though process is too slow to review and feed back.’
‘Patients are usually grateful to hear about honest mistakes than false cover-ups.’
‘Good to start by being open with patients anyway. They are reasonable folk, in my experience, and don’t like pomposity. A little humility goes quite a long way.’
‘The majority of people understand errors occur through no fault but imperfections in human nature, both patients and the experts treating. We are not perfect machines, any of us!’
The Leeds centre is due to open in
Genesis said patients would have access to a wide range of services including 3T MRI, PET CT and CT, the systemic therapy suite that will deliver chemotherapy, targeted therapies and immunotherapy for every type of cancer all under one roof.
early 2026 and expects to treat people from the north of England and Scotland who previously had to travel to GenesisCare in Oxford or London for advanced treatments.
‘We need to ensure no obstacles get in the way of the move towards a more open and learning culture. In addition, regulators and employers need to ensure there is a proportionate response to how they deal with clinicians when mistakes are made.’
Of 183 doctors taking part in the
‘I recognise the need for doctors and other health care workers to be open and honest with patients, but think the statutory mechanism can serve to make things worse. It is necessarily proscriptive and heavy-handed and sometimes makes things worse for patients and relatives, although that’s not the intention, and it can certainly increase levels of stress among staff.’
By Agnes Rose
Healthcare London, the collaborative network of leading private healthcare providers and NHS teaching hospitals, has struck new partnerships with three more renowned clinics and hospital groups.
They are Proton International London, The London Psychiatry Clinic and Priory.
The partnerships are seen as a significant step in strengthening the group’s ability to serve international patients seeking advanced medical treatment – with a focus on expanding services to those from Saudi Arabia, the wider Middle East and North Africa (MENA) region.
Project director Michael Barker said: ‘We’re thrilled to welcome these esteemed partners to Healthcare London.
‘Our partners are recognised for their expertise and innovation, and together we are creating a dif-
ferentiated healthcare destination for patients seeking the best in medical care.
‘London brings together top medical talent, expertise and resources to deliver unparalleled treatments and services for patients from Saudi Arabia, the MENA region and beyond who are seeking to advance their complex care needs.’
Proton International London brings cutting-edge cancer treatment to Healthcare London’s network. Partnered with University College London Hospitals NHS Foundation Trust (UCLH), it is one of only two proton beam therapy centres in the UK and the only private PBT facility in the country. With expertise in treating a wide range of cancers – including paedi-
atric, brain and prostate cancers –it enables cancer patients to access one of the world’s most advanced precision therapies.
The London Psychiatry Clinic provides comprehensive mental health services with a strong emphasis on wellness, offering bespoke care from a team of more than 50 specialists.
The clinic’s multidisciplinary approach provides mental health support across all ages and conditions, including child and adult psychiatry, autism and ADHD, supported by specialist clinics such as Cancer Psychiatry, Women’s Mental Health and the innovative Ketomind programme.
Priory, with an extensive network of private hospitals and wellbeing centres in Greater London, offers fast access to expert treatment for conditions such as addictions, depression, anxiety and OCD, as well as autism assessments.
Multidisciplinary services extend to children and adolescents, supported by a private inpatient ward within the Priory Hospital grounds in Roehampton.
Its Harley Street Wellbeing Centre offers access to repetitive transcranial magnetic stimulation treatment for depression and OCD, and Life Works in Woking, Surrey, offers The Cottage, which treats just one client at a time.
Fast-expanding Re:Cognition Health (RCH) has signed a 20-year lease for a new centre in the Harley Street Health District.
Consultant-founded, the company’s pioneering UK and US brain and mind clinics specialise in diagnosis, treatment and care of people with neurodevelopmental, traumatic, neurodegenerative conditions, mental illness and mental health concerns.
The latest move brings its three sites across Marylebone under one roof at 62-64 New Cavendish Street. RCH’s team work collaboratively to provide an early and accurate diagnosis and world-class care with access to the best and novel treatments and management strategies.
Chief executive and medical director, consultant neuroradiologist
Dr Emer MacSweeney, said: ‘Having operated out of the Harley Street Health District for more than a decade already, it was only right that we found a new, long-term home in this highly respected esteemed and well-connected destination.
‘Working closely with the team at Howard de Walden, we have completed an extensive really exciting refurbishment to allow where our patients will be able to navigate their treatments through purpose-built zones, ensuring a streamlined and personalised healthcare experience.’
By Olive Carterton
Independent healthcare providers and private medical insurers have joined forces to help support the sector to better demonstrate progress towards achieving net zero carbon emissions.
The Independent Healthcare Providers Network (IHPN) and the Association of British Insurers (ABI) have launched a new data dashboard for healthcare providers to showcase their work to achieve net zero.
It will enable them to fulfil their reporting requirements to all private medical insurers as well as
NHS England, making it easier for providers to report progress and avoiding the need for multiple different reporting templates.
Independent healthcare providers, who employ over 160,000 people, expressed commitment four years’ ago to playing their part in tackling climate change.
Eight-in-ten independent providers have so far signed up to IHPN’s industry-wide pledge to achieve net zero emissions by 2035 and net zero supply chain by 2045.
In 2021, the ABI also committed to a ‘Climate Change Roadmap’ which included a set of 2025 mile-
Compiled by Philip Housden
Top 12 out-of-London trusts earn £100m+ for first time
Analysis of final accounts for 2023-24 reveals the Top 12 out-ofLondon’ NHS trusts achieved an aggregated income from private patient services of £111m in 202324, up 18.2% and £17.1m on the previous year.
All the top performing regional Trusts grew except University Hospitals Sussex, where private patient income fell £1.4m and 14.7% to £8m. The trust dropped from third place to sixth.
Highest growth was recorded by Somerset NHSFT increasing by 232% and £5.4m to £7.8m due to the merger of Yeovil District and Taunton and Somerset Trusts.
Southampton plans to enter PPU market
University Hospital Southampton (UHS) is embarking on a bold vision to invest in the trust’s infrastructure and redefine the integration of NHS and private healthcare.
Central to this ambition is the development of a first onsite private patient unit in around five years’ time.
A new facility will enable it to grow private services while directly benefiting the NHS by creating additional capacity, modernising facilities, and generating new revenue streams to reinvest to support NHS patients.
stones towards meeting the Paris climate change goals.
IHPN chief executive David Hare said: ‘With climate change representing the biggest global threat of our times, we are committed to supporting our members in whatever way we can to help the sector reduce their carbon emissions.
‘We are therefore pleased to be collaborating with the ABI on this most important of issues. In working to streamline reporting requirements, this will help ensure providers are able to get on with the important job of directly reducing their carbon footprint.’
Danielle Henry, the network’s
IHPN
net zero lead, added: ‘We can only successfully respond to the global climate change threat if everyone plays their part and we hope this dashboard will make a real difference and help the sector in progressing on its net zero journey.’
The ABI’s Ben Howarth said the agreement would ensure the data provided was consistent and comparable. ‘It will allow us to understand where we have the most potential to reduce emissions and, by making the reporting process easier, allow us to put our energy into taking action together.’
Members of the Independent Healthcare Providers Network (IHPN) are celebrating after winning the prestigious UK Association of the Year category at the annual Association Excellence Awards in central London.
Her new clinic offers a comprehensive suite of services for patients of all ages, from children to clinical trial participants. Features include clinical trial services, specialised care in ADHD, autism, Alzheimer’s treatments (including Leqembi), neurology, neuropsychology, brain injury, mental health and medico-legal services.
The facility also boasts purpose-
built zones to enhance comfort, including child-friendly areas and a serene low-sensory suite for patients undergoing transformative treatments.
Royal United Hospitals Bath held onto the top spot due to the success of Sulis Hospital, the former Circle Hospital purchased by its trust.
Wrightington, Wigan and Leigh join this list for the first time after growth of 32.5% and £1.7m to £6.8m.
UHS is looking to learn from the model developed by University Hospitals Birmingham in partnership with HCS, which recently opened the Harborne Hospital.
Trust commercial director Peter Baker said: ‘This project represents a transformative step forward, bringing innovation and opportunity to healthcare in our region.’
Philip Housden is director of Housden Group healthcare consultancy
Seeing off competition from trade associations and membership groups, private providers were recognised for supporting members to deliver the best possible care for rising numbers of NHS and private patients.
This included an important role for independent providers within
the NHS through working with both the previous and current Governments to increase private hospital use for NHS patients and develop a political consensus. IHPN was also honoured for supporting members to improve quality and safety of care and working with the Care Quality Commission (CQC) to deliver training and events for members to understand the impact of its new regulatory approach.
Success was reflected with over 90% of IHPN members rated ‘Good’ or ‘Outstanding’ by the CQC.
Independent charitable hospital
The London Clinic and US-based academic healthcare organisation Northwestern Medicine have announced a collaboration to boost their commitment to improving healthcare and enhancing lives worldwide.
The deal focuses on four key areas:
1. International collaboration: Consultants’ and physicians’ leaders will collaborate in patient care, research and innovation to deliver advances in the care of rare and complex conditions.
2. Maximising performance: Sharing best practice to optimise operational efficiency, which will allow more resources to be directed towards patient care and charitable initiatives.
3. Enhancing patient care: Combining clinical expertise to deliver better care through increased access to innovative treatments.
4. Amplifying charitable impact: A shared commitment to philanthropy to enable both organisations to expand their community outreach and increase access to care.
The London Clinic chief executive Al Russell called the link ‘an incredibly defining moment in our history’.
Consultants and hospital teams are being invited to access a new ‘Learning Academy’ launched by the Private Healthcare Information Network (PHIN).
The training covers:
Requirements and compliance under the Private Healthcare Market Investigation Order;
The role of the Competition and Markets Authority (CMA) in enforcing the Order;
How PHIN can help.
PHIN said: ‘The Learning Academy contains a series of training modules which can help users learn more about the processes involved in submitting fees and uploading and approving data in the portal.
By a staff reporter
Surgeons are finding science fiction has become science fact as they get set to use holograms to transform surgical procedures.
on 3D- printed models to test the feasibility of using AR and MR (mixed reality) during lower jaw surgery.
He said: ‘Not only have we found a partner that shares the same notfor-profit values, but one with the scale that will give our charity access to the resources we need.
‘We are determined to do as much as we can to support the health challenges our country faces. This collaboration with Northwestern Medicine will take this support to a new level, allowing us to further fulfil our charitable purpose.’
The clinic will draw on Northwestern Medicine’s experience in healthcare innovation, technology and research, alongside opera-
tional efficiency. The US company has 11 hospitals and more than 200 diagnostic and ambulatory sites and aims to expand its own international reach, build partnerships with other healthcare systems and develop patient-centred pathways with ‘world-renowned’ consultants.
Dr Howard Chrisman, its president and chief executive, said the collaboration would assist the development of innovative healthcare solutions and drive ‘breakthrough research for the betterment of all patients’.
‘The Learning Academy is more than just a help guide and, through its interactive content, users can gain a thorough understanding of how PHIN can help them above and beyond complying with the Order.’
Learners earn badges for successfully completing modules and a certificate at the end of a course.
The certificate can be used in appraisals and potentially for those looking for new roles in the private healthcare sector.
To access the Learning Academy, visit the PHIN portal at www.phin. org.uk and click on the enroll button.
Consultants and their team at Nuffield Health Woking, Surrey, have celebrated a new milestone in performing 100 robot-assisted surgeries using the Mako robot. The 100th surgery was a total knee replacement. Forty-five per cent of these operations at the hospital have been funded by the NHS.
Manufactured by Styker, the robot uses an arm to remove damaged bone and cartilage and supports the precise positioning of a new hip or knee implant.
News of the development brought a ripple of excitement at the winter meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) as researchers presented a study entitled ‘Does augmented and mixed reality have a future role in reconstructive surgery’.
Exploring a potential application in mandibular reconstruction, the study showed how ‘in the near future’ augmented reality (AR) headsets could be worn by surgeons to project holographic images onto patients’ bodies during surgery, improving surgical precision and patient outcomes, while reducing preoperative time. The study, originally carried out at Princess Alexandra Hospital in Brisbane, Queensland, Australia, focused on using the technology
Cancer care provider GenesisCare, has placed an order for RaySearch Laboratories AB’s RayStation® treatment planning system to replace its current Pinnacle system.
Alex Morris, head of medical
Researchers discovered that in using holograms instead of traditional physical cutting guides, they are able to display additional data, such as key anatomy information and surgical plans.
In doing so, they say this may in future allow for more precision during surgery and save money by reducing pre-operative planning time, decreasing turnaround time, and eliminating the need to print 3D cutting guides.
Resident medical officer Tyler Ferdinands said: ‘Our early findings show that augmented and mixed reality has the potential to transform how surgeons plan and execute complex reconstructions.
‘This preclinical pilot study demonstrates how AR/MR technology may improve efficiency while making complex anatomical details more accessible to the surgical team in real-time.’
physics at the operator, which has 14 specialist outpatient cancer centres, said: ‘Our vision is to redefine the standard of cancer care with passion, innovation and a unique national network of the best.
‘Within this vision is our roadmap to continually strive for higher standards in treatment quality and extend GenesisCare’s adaptive radiotherapy services across multiple treatment platforms.’
RaySearch also markets the oncology information system RayCare®.
A technician uses a virtual reality headset to view holograms, including surgical plans, projected onto the patient’s body
The process is similar to traditional surgeries, with the primary difference being the use of holograms instead of physical cutting guides. The surgeon scrubs for surgery while wearing the headset, then scans the patient’s QR code to register the device.
Software loads the holograms specific to that patient and projects them onto their body. For the study, participants used the Microsoft HoloLens 2 headset, which features tracking technology similar to that of gaming headsets like the Oculus Quest. The holographic image of the patient anatomy includes details such as bone anatomy, blood vessels, an outline of the skin and surgical cutting planes. The final reconstruction is also displayed in the surgeon’s field of vision, allowing them to refer to it throughout the procedure.
Consultant plastic surgeon and BAPRAS president Mr Mani Ragbir, said: ‘This innovation aligns perfectly with our vision to advance surgical technology.
‘By integrating AR/MR tools, we can equip surgeons with real-time, enhanced views that lead to safer, more efficient outcomes, particularly in complex cases like mandibular reconstruction. It is exciting to imagine AR as a significant part of the future of all surgery.’
AR involves superimposing computer-generated images or data onto a real-world view. In the study, this meant projecting information onto a 3D-printed model, but it could be used on live patients in the future. These holograms allow surgeons to see essential details without looking away from the surgical site.
Spire Portsmouth Hospital marked its 40th year with the completion of a £6.4m refurbishment project to expand theatre capacity, refurbish patient areas and deliver a wider range of inpatient and daycare treatment options.
It said its investment into new facilities would alleviate pressure on NHS waiting lists and cut diagnosis waiting times in the area.
The project also aims to ensure the hospital can expand the services to support waiting times and
changing patient demands towards shorter stays in hospital.
A new day-care facility increases the hospital’s capacity to deliver more scan and investigative treatments, while the refurbished walkin unit will provide people with fast access to orthopaedic, ophthalmology, gynaecology and urology treatments. The development has increased the hospital’s overall capacity and is intended to help treat more than 1,700 additional patients a year.
If your independent practice neglects IT security, then you are effectively leaving the door open and disabling the alarm
A MAJOR RANSOMWARE attack on Synnovis , which provides pathology services to the NHS, caused huge disruption and alarm last summer.
This included the cancellation of hundreds of operations and blood test appointments and the publication of stolen patient data on the dark web.
Cyberattacks of this kind are on the increase globally and are an ever-present threat in the UK, prompting the new Government to announce a Cyber Security and Resilience Bill in the King’s Speech
The NHS is a tempting target due to the large amounts of sensitive personal data, the frequent need to share care data and also its sometimes creaking IT systems.
But it is important to think of cybercriminals as opportunists who are forever testing boundaries. If your independent practice neglects IT security, then you are effectively leaving the door open and disabling the alarm.
The Information Commissioners Office (ICO) has repeatedly warned that complacency poses the biggest risk to companies and has powers to impose fines of up to £17.5m or 4% of your annual worldwide turnover for serious breaches of data protection principles.
Cybercriminals do not just target large healthcare organisations with the resources to pay ransoms. They are a real threat to independent practitioners too. Dr Sally Old (right) explains what you can do to protect your patients and avoid cost and reputational damage to your business
Figures from the Information Commissioners Office regularly show that health organisations report more data security incidents than other sectors –20% of the 3,064 data security incidents reported in Q2 2024
Policies should include:
The use and review of security software – including updates and data back-up
Procedures for safe handling of patient information, including the use of encryption
The need for signed written contracts with all third-party suppliers, including IT contractors, setting out your confidentiality requirements
Rules on the use of home computers or mobile devices
Access controls and audits of electronic systems
icy at regular intervals to take account of new regulations and guidance or when there has been an IT security incident/near miss.
Ask yourself whether the policy needs updating to reflect the ways your practice currently processes data – migration to cloud data storage, for example.
Check out what the policies should include (see box on the right).
Check how you measure up
It is worth looking into the Government-backed Cyber Essentials programme which enables you to assess your practice’s cybersecurity controls and obtain certification to show you meet the scheme standard.
In February 2024, for example, it fined the Ministry of Defence £350,000 for sending ‘emails inadvertently using the “To” field rather than the “BCC” field’.
Unfortunately, figures from the ICO regularly show that health organisations report more data security incidents than other sectors – 20% of the 3,064 data security incidents reported in Q2 2024.
So, what more can you do to improve your practice’s IT security and resilience?
Your practice should already have an information security policy and a designated person to ensure personal data is protected from unauthorised or unlawful processing, accidental loss, destruction or damage.
But this should not be the end of the matter and the policy document left to gather dust.
It is important to revisit the pol-
The website includes resources such as a Readiness Toolkit, which provides a personalised list of actions to improve cybersecurity.
Seek expert advice
Seek professional advice from a reputable specialist about IT security measures such as firewalls, virus protection and encryption.
This extends to disposing of data securely when it is no longer
The use of strong passwords and individual log-in profiles, which should be changed regularly
Staff data protection training
Social media use and patient confidentiality
needed. You can also find detailed guidance on security measures for organisations on the ICO website, and the National Cyber Security Centre (NCSC).
Whether it is clicking on an insecure link or sharing passwords, human error is a common factor in many cyberbreaches, so it is essential to provide appropriate staff inductions and training on IT security policies and procedures.
That includes identifying when your data protection defences have been compromised so you can respond promptly and appropriately to limit the damage.
The ICO defines a personal data breach as ‘a security incident that has affected the confidentiality, integrity or availability of personal data’.
It may belong to one or more of
these categories. For example, an unauthorised or accidental disclosure of or access to personal data, an accidental or loss of access to or destruction of personal data or unauthorised or accidental alteration of personal data.
If the worst happens, you must report data breaches which are likely to result in a ‘risk to the rights and freedoms of individuals’ within 72 hours of becoming aware of the breach, using the ICO’s breach reporting service
When you notify a breach, you will be required to provide information, including:
The categories and approximate number of individuals concerned;
Categories and approximate number of personal data records concerned;
Name and contact details of the Data Protection Officer or other contact point;
Description of likely consequences of a personal data breach;
Description of measures taken or proposed to be taken to deal with a personal data breach, including measures to mitigate possible adverse effects.
The ICO advises organisations to consider reporting major cyber incidents to the NCSC, while incidents that might heighten the risk of fraud against individuals should be reported to Action Fraud or Police Scotland, where applicable.
Dr Sally Old is a medico-legal adviser at the Medical Defence Union (MDU)
New resources from Bupa are enabling employers and their staff to be more equipped to ensure better support for disabled people in their teams. Dr Robin Clark (right) reports
THERE ARE 16m disabled people in the UK, 1 and around 4.9m are employed. 2 Mental health and mobility impairments are most common in disabled working-age adults.3
According to the Equality Act 2010, disability is any long-term physical or mental condition. It has a major impact on a person’s ability to do daily activities. 4 Conditions such as cancer are also covered by the Act once they have been diagnosed.
Bupa recently carried out research with disability equality charity Scope 5 which showed
almost seven-in-ten (68%) disabled people who were not well supported at work experienced poor mental health as a result.
Many disabled employees felt their managers were not given knowledge to support them effectively, with accessibility barriers hampering career growth (44%) or impacting work performance (55%).
Disability and the law
If somebody in your team has an impairment or condition, or develops one, they do not have to tell you.
It is important that businesses equip their people managers with the tools and resources to support all colleagues and build confidence, so that everyone has the opportunity to thrive in their careers
But if they do tell you, you must help them to access any support they might need.
In the UK, people are legally protected from discrimination by the Equality Act 2018. This includes disabled people in the workplace.9
For example, you cannot:10
Withdraw a job offer when you learn someone has an impairment or condition;
Terminate employment for reasons related to their impairment or condition;
Refuse to consider or provide reasonable workplace adjust -
continued on page 14
ments. Adjustments help a disabled person to do their job.
Inclusivity in the workplace
Our research with Scope also found that only one-in-three (33%) line managers have been provided with comprehensive resources to manage disabled employees and 25% have never received training to support disabled colleagues.
This has left many feeling unequipped to have necessary conversations, with 26% of managers admitting they have never initiated a conversation with a disabled employee about their needs.
Furthermore, two-in-five (42%) managers feel they lack enough understanding of the issues faced by disabled colleagues or worry about not having all the answers (25%).
It is important that businesses equip their people managers with the tools and resources to support all colleagues and build confidence, so that everyone has the opportunity to thrive in their careers.
It is also better for businesses, as by recognising the value that every person brings, organisations can benefit from workforce attraction, retention, productivity and growth.
The majority of managers surveyed (73%) want to learn more about supporting disabled team members.
So, to help businesses do this, we
have created a toolkit in partnership with Scope to provide practical advice to help managers support their disabled employees.
Key learnings
1 Communications and training: All employees need to understand the importance of inclusion and how to support co-workers, so employers should provide regular training on disability awareness and inclusion practices.
Scope offers resources that can help with this. It highlights the support that’s available – for example, by signposting to internal policies and guidance, your employee assistance programme and relevant external organisations and charities.
2 Regular reviews and feedback: Employers must make reasonable adjustments to ensure all employees receive equal treatment.
This could include providing assistive technologies or flexible working arrangements. Carry out regular reviews to assess the effectiveness of the adjustments and support you provide.
Gather feedback from disabled employees to understand their experiences and find improvement areas; this will help you to make necessary changes and enhance your inclusion efforts.
3 Lead by example: As a line manager, set the tone by demonstrating inclusive behaviour. Show empathy, understand-
An inclusive culture boosts employee satisfaction and productivity. At the same time, it improves business performance by incorporating diverse perspectives
form for all staff to work collaboratively and deliver positive change.
4Be aware of ableism: Ableism can happen everywhere, including the workplace. Ableism is:
Discrimination towards disabled people, including direct and indirect discrimination;
Prejudice against disabled people in favour of non-disabled people.6
Ableism can be both intentional and unintentional. It also exists culturally. Cultural ableism is the harmful way that society views or treats disabled people. This includes:7
A lack of accessibility in public places and employment;
Negative depictions of disabled people in the media.
All employees should be given the same resources, support and opportunities for them to thrive in their roles.
An inclusive culture boosts employee satisfaction and productivity. At the same time, it improves business performance by incorporating diverse perspectives.
Find more information about all the learning above in the toolkit here: https://bit.ly/3XLtAxq and
by visiting our Workplace Academy here: www.bupa.co.uk/ business/workplace-wellbeinghub/inclusive-workplaces/manager-guides.
References
1. Employment of disabled people 2023. Department for Work and Pensions. www.gov.uk, published October 2023.
2. Family Resources Survey: financial year 2020 to 2021. Department for Work and Pensions. www.gov.uk, last updated May 2023.
3. Employing disabled people and people with health conditions. Department for Work and Pensions. www.gov.uk, last updated September 2022.
4. Definition of disability under the Equality Act 2010. UK Government. www.gov.uk, accessed February 2024.
5. Conducted by disability charity Scope on behalf of Bupa, with 465 participants with both management and non-management experience. Of
those, 194 were currently in paid work, 43 were seeking work after previous employment and 228 were not looking for work but had prior work experience. The survey took place in May 2024 using Scope’s Lived Experience Research Panel, with a sample of disabled people with a range of multiple access needs and experiences.
6. Everyday ableism. University and College Union. www.ucu.org.uk, accessed February 2024.
7. Discrimination: your rights. www. gov.uk, accessed February 2024.
8. Employing disabled people and people with health conditions. Department for Work and Pensions. www.gov.uk, last updated September 2022
9. Let’s Talk. Scope. www.scope.org.uk, accessed February 2024.
10. Talking to your employer about disability. Scope. www.scope.org.uk, reviewed May 2023.
Dr Robin Clark is medical director for Bupa Global and UK Insurance
ing and respect towards all employees.
Encourage your team to do the same. A disability employee network is an excellent way to support your teams. It gives employees the opportunity to ask questions, discuss topics and learn about disabilities. And it provides a plat -
Sandison Easson is a firm of truly specialist medical accountants who provide personal and tailored advice to clients.
We act for medical professionals throughout all stages of their career with clients in almost every town in England, Scotland and Wales.
We cut through the complicated jargon and deliver practical, easy to understand advice. Call us today to organise your FREE no obligation consultation.
WE PROVIDE THE USUAL SERVICES YOU WOULD
practice and consequently more motivated to help you improve it. Remember that your secretary, practice manager or practice management team are the face of your practice. Empower them, equip them and motivate them to get on with the jobs that you have not spent years studying to do.
Tina Barrett, PHF Services Ltd
7
Protect famous patients from the media
There are plenty of things a good hospital can help you with. If your patient is very well known, discuss privacy and security at the outset.
Chose a ‘new’ name for the admission – not an obvious one either! – and arrange that the hospital has a specific list of visitors and callers with a code name each caller must use to be identified as genuine.
And another tip: tell them not to accept flowers at reception. When trying to find out where a famous singer was having her baby, as a reporter for the Sunday tabloids, I used to send flowers to several hospitals and the one that accepted them was ... well... more than likely to be the one.
Neil Huband, Priority Counsel Ltd
8 Use a DIY PR tip toolbox
Generate goodwill among your chosen audience;
Define what makes your practice special or unique;
Prepare biographies and photos;
Use factsheets about any new equipment/technology;
Do a patient poll to make news;
Be available for local community talks;
Research the right outlet and journalists.
Tingy Simoes, managing director, Wavelength Communications
9 Make your hospital work for you
Build and maintain a strong working relationship with your private hospital.
Make it a point to get to know and understand its marketing department and actively engage it in discussions in order to explore new opportunities.
The success of your practice is in the hospital’s best interests, so
work with its managers to see how they can raise your profile, whether it be through giving talks and seminars or simply being added to their existing marketing literature and websites.
Darren Clare, managing director, Create Marketing Ltd
10
Keep on the right side of your NHS trust
Juggling two jobs? Things which put you in trust managers’ bad books include:
Disputes with clinical staff, particularly trainees and nurses, where complaints of rudeness, aggression or bullying are made;
A reputation for absence during direct clinical care sessions, or repeated lateness, especially if associated with times when you are known to have private commitments;
Lack of co-operation with management and administrative staff over rotas and booking of leave;
Poor attendance at NHS meetings, particularly multi-disciplinary team meetings, directorate meetings and clinical governance meetings. These can be a trigger for management action;
Not adhering to trust policies, especially around leave of absence and mandatory training.
Dr Mike Roddis, director, Healthcare Performance Ltd
11
Form a group
The way in which we practise private medicine is changing rapidly. Healthcare insurers are becoming more cost-conscious, overt medical marketing and competition is steadily evolving and governance in private practice is becoming more demanding.
Slowly and steadily, more groups are being formed in all areas of private medicine
12
Get on with partners
Choose partners that share your values, hold regular, minuted meetings and divide up business responsibilities between each other.
Identify your target markets and define your value proposition: who are you and what do you do that is of value to your market?
Ask each prospective partner to make a financial commitment up front to cover initial costs: this will shake out those who are not committed.
Appoint a legal adviser with experience of setting up partnerships and a financial adviser to advise on incorporation and tax issues: don’t skimp on their fees.
Take advice from a business development professional who will help identify the quickest route to revenue generation and reduce unnecessary expenditure. Avoid ongoing financial commitments until you have secured regular revenues. Don’t be distracted by operational detail before you start trading: focus on what is essential and urgent. Alun Davies, business development consultant
13
Use a coach
It will become increasingly difficult to work as a single-handed practitioner in the forthcoming years in the way that GPs have experienced in the past. Slowly and steadily, more groups are being formed in all areas of private medicine and I believe that those willing to spend the time, effort and money to organise themselves now will see their efforts rewarded in the future.
Mr Brian Cohen, medical director and consultant orthopaedic surgeon, London Orthopaedic Clinic
Mr Brian Cohen’s LOC Partners group chose the ‘jumping man’ to be their logo, conveying health, vigour and athleticism
Private doctors are looked up to by so many that they often find it hard to see an opportunity to talk about their own needs and share their concerns openly.
Friends are fine, but they often give just nice words to placate their friends without supporting them through the big changes they face.
So who will tell you the hard truths when you are working excessively and lose sight of what else is important in your life or when you have lost perspective?
Nowadays, doctors in private practice need not only to be technically brilliant, they are expected to have commercial expertise, creative thinking and excellent customer focus.
But, as with any leadership role, seniority can be accompanied by an increasing sense of isolation. When people are deferring to you, who is really going to challenge you without fear of reprisal?
This is where I think coaching
➱ continued on page 20
The most difficult period of my career began on a sunny Saturday morning. I’d just sat down with a coffee to catch up with the never-ending emails. One of them was from my employer. They were instigating formal disciplinary action against me. Having found gaps in my notes, they were alleging that my operating techniques were deficient. I was restricted to non-clinical duties pending investigation.
I just felt numb. I called Medical Protection and was assigned a very supportive medicolegal consultant. That support was a lifelineespecially when, not long afterwards, I was completely suspended.
Medical Protection instructed an independent expert surgeon, whose main criticism was around record-keeping. I did a lot of reflection on this and took an online course as part of my membership. Eventually, the investigation found no grounds for ongoing suspension, and I returned to clinical practice. Medical Protection got me through those two long years of regulatory and legal process, and constantly kept the pressure on the hospital to move forward. More than that, their insight and understanding helped to make me a better doctor.
Always there for you
comes to the fore. Having a coach as an independent-thinking partner to challenge, support and hold you accountable can be a really powerful force for good.
Vanessa Anstee, life coach
14
Develop a communications plan
☛ Keep it simple – your communications plan does not need to be pages long, just clearly presented and easy to understand.
☛ Make it focused – do not try to do everything; be realistic about what is achievable.
☛ Know who – consider all your audiences, not just patients. Include staff, investors, media and so on.
☛ Hold a brainstorming session – talk with colleagues to trawl for fresh ideas and approaches.
☛ Think outside the box – external factors may have a bearing or influence on your plan.
☛ Be prepared to be flexible –update your plan as you go along, making the most of experience and opportunities as they arise.
☛ Keep your eyes open – look for opportunities for working with external organisations or partners who may be targeting the same groups as you.
☛ Feedback – ask colleagues for feedback on your plan, as they may have useful suggestions, Carys Thomas Ampofo and Kelly Blaney, Ash Healthcare
15 Break through the £300k profit barrier
The secrets of success to be a top earner: find the right location, choose the right specialty, add value, avoid trouble with insurers, ‘market market market!’, go for self-pay, specialise in a particular procedure, avoid a divorce and
hone the administration. Oh, and be prepared to work hard.
Ray Stanbridge, partner, accountancy, finance and tax advisory medical specialists
Stanbridge Associates
16 Hold an open evening
Check the level of presenting skills of the doctor/person presenting. A confident consultant does not always equate to a confident presenter.
In plenty of time, ask for colleagues to volunteer to help greet guests and to show them around the facilities. Time in lieu is offered back to our staff.
If you are running a series of open evenings, it will be more economical for you to block book media, rather than buying advertising space month by month.
Ask your guests to tell you how they found out about the open evening; it will help your media spend.
Depending on the time of your open evening, lots of food is not always a necessity, but good wine and soft drinks are.
Lorna Slater, Optegra
17 Observe the golden rule
‘Do not mess with a colleague’s private patient.’
Miss Gubby Ayida, consultant obstetrician and gynaecologist, founder of The Women’s Wellness Centre, Chelsea
18 Market yourself to GPs
The most effective investment any new consultant can make is that of time; time writing to and meeting and talking to GPs in your catchment area.
Holding breakfast seminars at your independent hospital is
extremely valuable, as are trips to larger GP practices in the evening. They’ll always remember the consultant who made the effort to visit their surgery.
The cornerstone is the messages you will give GPs: how GPs can reach you quickly for an urgent referral, what sets your work apart from others and why your outcomes are among the best. And how patients will be looked after when you are on leave or ill.
James Barr, chief executive, The Lister Hospital, London
➤ Protect your idea or design and always use a non-disclosure agreement (NDA).
➤ Research your marketplace to prove an unequivocal need for your idea.
➤ Identify your competitors and make sure your offer is better.
➤ Identify your route to market and customer base – sales are king.
➤ Keep your overheads low and profile high.
➤ If you part with shares to raise funding, make sure it is to people who can add value.
Dr Vincent Forte, GP, inventor, Forte Medical
➲ It is crucial that the individuals concerned need to accept that when they effectively sell their business they relinquish control.
If you aren’t prepared to do this, think twice about even considering an approach.
➲ You need one or two key, committed people to drive the process otherwise things just won’t happen. These key people need to organise the meetings, overview and manage the various processes and ensure everyone is on board,
Keith Davey, Oliver Backhouse and John Bradbury, Yorkshire Eye Hospital ophthlamologists
throughout what is an extremely lengthy process. Commitment to the cause is crucial.
➲ It is vital to appoint a competent legal team and ensure other advisers like accountants are fully on board with the activity.
➲ Parties such as banks need to be fully appraised of the situation and have a full awareness and understanding of proceedings.
➲ Agree realistic time-scales –don’t be too optimistic, as an acquisition is a very labour-intensive process and simply cannot be rushed.
➲ Always leave a contingency in terms of time to complete the deal.
➲ Financial and legal due diligence is the most time-consuming aspect of all– it is important not to underestimate the time this takes and to accept that it is an unavoidably lengthy process.
Yorkshire Eye Hospital ophthalmologists Keith Davey, Oliver Backhouse and John Bradbury – acquired by Optegra
21 Write a press release
1. Develop a catchy headline.
2. Capture the essence of the story in the first two paragraphs – don’t expect a journalist to wade through reams of words to get to the core of the story, because they won’t.
3. Remember the crucial five ‘W’s – WHO, WHAT, WHERE, WHEN, WHY.
Make sure you address all of these elements in the first couple of paragraphs and then pad out the release with other facts, figures and background information.
4. Include a quote from a spokesperson. This adds a personal touch to the story and can be an effective way of getting a name-check for your organisation in the final editorial.
5. Round off with a summary about you and your organisation – including details about your website or a number for patients to call for more information.
6. Always conclude with your contact details – journalists will often want to speak to you to clarify some of the details or they may need additional information. Include your email address and phone numbers.
Jo Gulliver, Trinity PR
22
Attract investors
However knowledgeable you may be about a particular aspect of medicine, investors will want to know that the team they would be backing have the business skills, experience and openmindedness to adjust the strategy to fit the world as it is, not as it could or should be.
Too often, investors see entrepreneurs who are scornfully dismissive of their competitors. Often, they are told that there are no competitors for a particular new product or services.
Or, if competitors exist, they are assumed to be foolish or ignorant and unable to adapt to whatever innovation the entrepreneur is planning to bring to the market.
Investors know this is very rarely true and that businesses actually succeed by staying one step ahead of their competitors.
Mr Krishna Vemulapalli
or is on the way, so hearing that competition is not an issue is a real warning sign. Steve Adkin, partner, Apposite Capital
23
Subscribe to Independent Practitioner Today Ten tips from my first year in private practice
Regard your private practice as a serious business investment, don’t cut corners;
Invest in a practice management system with online access;
Get a notebook PC and go paperless;
Get a secretary who will be a true ambassador for you;
Invest time networking with consultant colleagues and GPs
Practitioner Today – it’s a great resource for information and advice ;
Get a professionally-designed website;
Send out all bills promptly;
Remember, it’s all about Availability, Ability and Affability. Mr Krishna Vemulapalli, orthopaedic surgeon at Spire’s Hartswood and Roding hospitals, Essex
24
Retain and attract international patients
Get to know the team at your local private hospital. Greet everyone by name and they will respond positively;
Expand slowly. Work on the demand and then fulfil it, not the other way around ➱ continued on page 22
This can only be done by understanding what competition exists
Subscribe to Independent
As the international patient market becomes more competitive, UK hospitals and specialists must up their game in all aspects of the ‘international patient experience’. Too many specialists pay little attention to the customer service aspects of international patient care, believing that their skill, expertise and reputation will
Diagnostic Audiology Including Paediatrics • Tinnitus Rehabilitation • Vestibular Testing • PTA & Tympanometry • Speech Audiometry • Speech In Noise Testing• Specialist Tests Including OAE, VEMP & ASSR • Ear Wax Removal • Independent Hearing Aid Provider
ensure a steady flow of international patients.
But it is often these customer service aspects that build a reputation and create a competitive edge for a particular specialist.
Keith Pollard, managing director, Intuition Communication
Business plans should be regularly updated and provide logical, clear rationale for funding requests.
Provide details of the business’s historical financial performance, highlighting key figures and trends and providing explanations of anything unusual.
Details should be provided of the current financial year and forecasts for the next few years. Banks will expect to see up to three-year forecasts and a clear business strategy.
Those seeking to set up a business for the first time should provide a forecast of income and expenditure. Assumptions, which should always be realistic, will need to be explained.
And for consultants seeking to group together, a bank will require a breakdown of each consultant’s past and current earnings – evidenced by individual audited accounts, if available, or tax return. This should be combined with a projection for the future, taking into account any synergies to be derived.
Tony Burgess, HSBC senior commercial manager
Social media activity should form an integral part of your overall marketing strategy; if it is not, then you are missing out on a beautifully organic and free opportunity to spread the word about your services.
But be warned. Diving headfirst into social media without doing your homework can be as damaging as not dipping your toe in the water at all.
Social media marketing is a very different discipline to traditional marketing and to maximise its value, it is essential to recognise this and put a considered strategy for using social media in place.
Sara Robinson, Working Word communications agency
In the case of the independent doctor, the patient’s heart and mind has to be won or they will simply go elsewhere. Communication skills are not just a nice but fluffy addition to your practice –they can make or break it.
The first rule of good communication is to take responsibility for the delivery of the message.
Do not ignore the signs that a patient has fully understood, and ask the right questions to ensure that they have.
The right question is not ‘Do you understand?’ because most often, nervous patients will say they have even though they have not.
The right questions are:
‘Is there anything about that you would like more detail on?’
‘Have I managed to explain this well or would you like me to explain this differently?’
‘Would a diagram help my explanation for you?’
‘I am happy to answer any more questions’;
‘Tell me if these are things you already know’.
Dr Ali Shakir, founder, Harley Therapy Institute
It is almost inevitable that at some stage in a partnership’s history there will be some grievance about remuneration.
You therefore need to make sure that you have in place in your agreements a comprehensive and transparent remuneration structure which will go a long way towards stopping arguments and retaining the most talented partners – and the goodwill that goes with them.
The remuneration system needs to be aligned to the objectives of the practice.
The temptation is obviously to link remuneration to profits generated by each partner, but this does not always encourage partners to focus beyond their own individual practices.
Consider the other activities required to operate a successful business, such as practice development, marketing and development of skills.
We have seen cases where all
these non-chargeable activities fall on the shoulders of one or two of the partners but without any specific remuneration and this can cause resentment and ultimately the break-up of the partnership.
You should therefore consider how each partner’s contribution should be remunerated.
A ‘one size fits all’ approach rarely works.
Chris Inson, Capital Law LLP
29 Expand – slowly
Work on the demand and then fulfil it, not the other way around.
Expanding your practice should be a slow, low-risk and phased process that is a response to demand.
Bringing in more doctors or nurses and then attempting to fill their time through marketing is a high-risk strategy.
The marketing should come first and only when you find yourself turning away patients, consider bringing in medical colleagues in a phased approach – perhaps initially for a day, and then two and so on.
Make sure you do the maths –you might be increasing your turnover by bringing in another doctor, but are you more profitable?
Remember that more doctors means more medical supplies, more rent, set-up costs and administrative support as well as the doctors’ fees.
If the maths work, then go for it. Bringing in colleagues means that you continue to earn when you are not working; it frees you up to see
higher-paying patients and can increase your appeal to corporate clients.
Dr Enam Abood, founder, Harley Street Health Centre
30 Consider Saturday teachins
We did not want to get a group of GPs in and lecture them. Not only is this a boring prospect on both sides, but also it does not allow for us to meet and interact with them and it is far less likely they will feel comfortable in asking questions.
We felt a format in the style of an objective structured clinical examination (OSCE) would be different, allowing us to communicate in short sound bites using visuals –on laptop computers – with ample opportunity for questions.
We brought patients along to give that human element to the message, and we felt that it would be better for them to only be speaking to a small number of GPs each time to make it less intimidating for them too.
We had six ‘stations’ for the workshop– a group member on each to cover a few topics under their specialty. There was capacity for 40 people, with 35 attending and nearly all of those who said they would come did so.
Mr Mark Chapman, consultant bowel surgeon, North Birmingham Colon Care
31 Let in the cameras
A documentary team followed consultant bariatric surgeon Mr Shaw Somers for 18 months to create just a one-hour ➱ continued on page 24
television programme on his work with a patient claimed to be The World’s Fattest Man.
His verdict: ‘From a business perspective, taking part in the documentary gave us a real platform to make more people aware of Streamline Surgical and the services we offer.
‘I feel the debate it generated around obesity was worthwhile and it was fantastic to see the team I work with receive recognition for the incredible work they do.
‘Following the documentary, the phone did ring more than usual –and that, of course, is a real benefit.’
32 Stick to agreements
A consultant group was at an advanced stage of negotiation with a hospital for a joint venture.
Solicitors had been involved and instructed. Heads of Agreement had been signed and legal issues were being finalised.
One member of the group suggested instigating a very fundamental rewrite of the whole deal. Result – the hospital became fed up at the lack of seriousness of the group and withdrew from the negotiation.
Independent Practitioner
Today guide to Negotiation, by Ray Stanbridge
33 Beware image copyright on your website
‘I think the digital age has blurred the boundaries of image copyright in many people’s minds and some business owners mistakenly think that because an image is freely available on the internet, it can be re-used without permission.
A lot of people are spending thousands of pounds and not realising what they are buying. They would not do it in any other area of life…
‘Additionally, many smaller businesses entrust web design companies with the whole process of registering and creating their website, and presume that their web design company will only use images they are entitled to use.
‘However, this isn’t always the case, so I would urge business owners to check they are legally entitled to use each and every image on their websites.’
Phil Orford, The Forum of Private Business
34 Have an overseas patient strategy
As more countries become interested in medical tourism and governments work with both hospital providers and tour operators to develop a ‘medical tourism cluster’, the levels of non-clinical services in many countries is getting hard for UK doctors to beat.
For example, many overseas hospitals have opened international outpatient centres to provide multilingual services and travel arrangements including visa application, airport transfers and assistance for patients’ families.
In Korea, a dedicated reception area for inbound medical tourists has been established at the international airport.
It is against this background that consultants need to consider the implications for their practice and develop strategies with the UK hospitals to maintain their current patients and attract new patients. International work requires a long-term commitment and strategy.
Elizabeth Boultbee,managing director of Boultbee & Co
International work requires a longterm commitment and strategy
35 Brand your procedure
For branding my own procedures, I always try to use attractive terminology that anyone in the street can relate to.
For example, I could easily have named my latest lip plumping and shaping treatment something wordy, but instead went with a simple and straightforward ‘Heart Lips’. It resonates with people as a positive, voluptuous image. It is a concept that will grab the attention of the consumer and, from a purely marketing standpoint, members of the press.
Similarly, the ‘Dr BK Lift’ – a combination I have developed of Botox and fillers to soften an angular jaw – identifies me instantly as the founder and creator of the procedure and makes it a marketable and promotable proposition.
Dr Bob Khanna, cosmetic and dental surgeon
36 Know who owes you
Always know the patients who owe you money so you can bring it up in any follow up consultations.
Colin Miller, general manager, financial report, Nuffield
37 Understand your defence body small print
A lot of people are spending thousands of pounds and not realising what they are buying. They would not do it in any other area of life…
The survey we undertook revealed up to 70% ignorance rate on crucial points.
Considerations such as what ‘claims made’ and ‘losses occurring’ mean, what is a ‘limit of indemnity’ or what is meant by, and the significance of, ‘run-off cover’.
Failure to understand these points could result in significant financial loss.
Kevin McCluskie, author, On The Market For Medical Malpractice Indemnity, for the Federation of Independent Practitioner Organisations (FIPO)
38 Audit for finance fitness
You should establish:
Which patients owe you the most money and decide if they are a risk;
How far behind you are with the billing – what date was the last clinic/that you billed;
What procedures are in place to chase the outstanding invoices;
If the procedures you have are being followed;
What percentage of your practice is with self-pay;
Establish what percentage of your practice is with Bupa and monitor that situation.
Then decide what action to take to gain control of your finances and to stop losing money.
Garry Chapman, Medical Billing and Collection
39 Beware the dangers of 1
The problem with one of anything is dependency and vulnerability.
One source of referrals;
One source of income;
One critical assistant;
One merchant account;
One consulting room;
A relationship with one private insurer;
One key business customer or employee;
One form of marketing;
One business diary;
One ‘you’.
So do all you can to avoid them.
Mr Dev Lall, laparoscopic upperGI surgeon and director of www. privatepracticeexpert.com
40 Use GP liaison teams
GP liaison teams in private hospitals can assist with securing opportunities for consultants to engage with GPs, by way of facilitating continuing professional development or by attendance at practice meetings, although this is also the responsibility of the individual consultant. Best results are achieved when the two work in tandem.
These teams can be quite large, so it is important for consultants to make the effort to meet with them on a regular basis. Getting together just once a year and expecting them to know who you are, what you do and when you are available is not enough.
But bear in mind that it really does boil back down to the amount of time and effort you are prepared to put into your own practice too.
Also, encourage your secretary to meet up with the GP liaison teams or speak to them on a regular basis. It is good practice and helps to raise your profile.
Sue O’Gorman, independent development consultant, Medici Marketing
Define how many hours and days per week to work in your practice and how flexible you are prepared to be.
Be very specific about the patients you wish to see so that you get suitable referrals. When you offer something unique, people know when to refer.
Deal with emails once or twice a day only. See your patients at their appointment time and have satisfied patients at the end of the consultation, so start on time, be aware of the length of the consultation and develop effective techniques for ending.
Identify your personal timewasters to eliminate or reduce them.
Do paperwork and other admin during working hours; don’t take it home.
Dr Susan E Kersley, The Doctors’ Coach
While refunds and goodwill payments are a feature of complaints in independent practice, there is no guarantee that this kind of goodwill gesture redress will settle a complaint or avoid a future negligence claim.
In addition, it may be a mistake to assume that a complainant is only interested in getting a refund.
also demonstrate that you are taking their complaint seriously.
Members who wish to make a goodwill gesture payment should seek advice on wording the letter.
Dr Catherine Wills, MDU deputy head of advisory services
43 Network Networking is essential.
I would strongly advise anyone setting up their own practice now to become involved in a couple of well-chosen medical societies such as The Indees (part of the Independent Doctors Federation) or the Chelsea Clinical Society. You really need to keep going to events to meet people.
I had always done so because I enjoyed the social aspect and also because I wanted to meet the people I was referring my patients to.
Dr Samina Showghi, Harley Street GP
44 Update partnership agreements
Rising numbers of consultant group bust-ups are costing specialists vast sums of money because they have never bothered with a proper practice agreement.
Many partnerships formed during the surge in group growth have set up their structures on a basis of trust.
Lawyer Chris Inson advises: ‘Problems can be avoided, or at least mitigated, by ensuring that partnership agreements are comprehensive and up to date.’ Independent Practitioner Today news story
45 Don’t kill them with bullet points
Bullet points – like a bullet to the head, they can kill a presentation stone dead!
The problem with bullet points are as soon as you put up the slide,
WE UNDERSTAND YOUR PAIN
As a health consultant you’re probably facing these concerns:
• Higher tax bills as a result of the reform of the tax basis period.
• Delays in getting accounts and tax returns prepared. Sound familiar...?
How much you are owed, how old your debt is and how much is collectable or needs to be written off; ➱ continued on page 26
With the team having quite literally hundreds of consultants to support, you need to keep your name out there.
Patients who make a complaint generally want an explanation of what happened, an assurance that steps have been taken to try to prevent it happening again to them or anybody else, and an apology and remedial treatment by the doctor. For this reason, it is important that any complaint response addresses each issue or concern the patient has raised.
Offering a refund may even appear insensitive, unless you can
If your accountant hasn’t already spoken to you about these concerns, then our dedicated healthcare accounting team are ready and waiting to help you right now. Contact us for a complimentary review of your accounting requirements.
Scan this QR code to watch a recording of our webinar: ‘Tax Basis Period Reform: Is Your Healthcare Practice Prepared?’
Email: healthcare@robson-laidler.co.uk
Tel: 0191 281 8191
www.robson-laidler.co.uk/healthcare
Some private practitioners work in quite a solitary way and may not have the regular meetings with peers that their NHS colleagues may have
your audience will start reading it, from left to right, top to bottom.
Which means they won’t be listening to you, the presenter, as you make the first point. Since reading is faster than talking, your audience will have finished reading the slide before you’re anywhere near talking about it.
This means they wont be listening to your commentary, as they already know what’s coming up. Philip Adcock, commercial psychologist
46
The first step to achieving a realistic savings pot is to think about how much you will need to fund your lifestyle when work has ceased.
Most doctors have no realistic idea of how much this is and it can come as a surprise, particularly if you have left it to others to manage the household and book the holidays.
A good rule of thumb in the majority of cases is to aim for around two-thirds of your normal NHS annual income.
Simon Bruce, managing director, Cavendish Medical, a feebased independent financial practice helping doctors in private practice and the NHS
47 Beware of professional isolation
Some private practitioners work in quite a solitary way and may not have the regular meetings with peers that their NHS colleagues may have.
As well as not having as many opportunities to meet up and discuss clinical issues and promote learning in this way, the biggest impact when working in isolation is not having a colleague on
hand with whom to share the experiences and frustrations of the day.
Talk to other colleagues and try to arrange a peer support or learning group to prevent isolation and encourage team learning.
Dr Rachel Birch, medicolegal consultant, Medical Protection Society
48 Choose between adverts or PR Advertising attributes
☛ You pay for the mention;
☛ Full control over copy;
☛ Less credibility;
☛ Date it appears is established by you;
☛ Only expert/clinic included is yours;
☛ You can include photos, logos;
☛ Final ‘proof’ is provided before print;
☛ Is not affected by external events.
v Editorial (PR) attributes
☛ The coverage is free;
☛ You don’t control what’s written;
☛ More trust from the public;
☛ You may not necessarily know when it comes out;
☛ Other experts may be quoted;
☛ Will rarely, if ever, include logos;
☛ You won’t know how it looks or its context;
☛ Space depends on other news.
Tingy Simoes, managing director, Wavelength Communications
49 Research financial support
Very often, grateful patients want to give something back when they have received great care and we are hoping that we can help direct those philanthropists to invest in our research. We have already had some success in this area.
Dr Paul Glynne, cofounder, The Physician’s Clinic, Devonshire Street, London
50 How to end up before the GMC: 1
Neglect your own health, commit a crime – and forget to tell the GMC about it, decide to take up a new area of practice in which you have no experience, be rude to patients and colleagues and don’t listen to their concerns.
Dr Claire Macaulay, medicolegal adviser, MDU
51 How to end up before the GMC: 2
Turn to drink or drugs, tell a few white lies, keep poor notes, date a patient, keep your mouth shut. As above
52 Don’t ruin your appraisal
Why appraisals go wrong:
1. Poor preparation;
2. Use of unsuitable venue;
3. Not leaving time for appraisal;
4. Attempting to have a mate do it;
5. Having meeting in middle of busy schedule;
6. Not taking appraisal seriously;
How to end up before the GMC? Turn to drink or drugs tell a few white lies, keep poor notes, date a patient, keep your mouth shut
7. Technical problems;
8. Mistaking the end of the interview as the end of the process;
9. Not keeping your appraisal portfolio up to date;
10. Not keeping focused on the appraisal structure.
Dr Paul Myers, director, Doctors Appraisal Consultancy
53 First impressions are vital
The front office is first point of contact for a client, whether by phone or in person. This first interaction makes the first impression and is critical.
The phone must always be answered, preferably by a realtime nice human being.
When the client enters the clinic, they must always be welcomed and the staff should be aware if they have previously attended or not. They should not have to ask the client.
Your investment in staffing must permit this. If the staff take a call when you are busy and say that you are going to call them back, then call them back as soon as possible.
The client needs to know that you care.
Mr Donald Gibb, consultant obstetrician and gynaecologist, The Birth Company, 137 Harley Street, London
54 Ten steps to consider when responding to subject access requests
1. Identify whether a request should be considered as a subject access request;
2. Make sure you have enough information to be sure of the requester’s identity;
3. If you need more information from the requester to find out
what they want, then ask at an early stage;
4. If you’re charging a fee, ask for it promptly;
5. Check whether you have the information the requester wants;
6. Don’t be tempted to make changes to the records, even if they’re inaccurate or embarrassing…
7. …But do consider whether the records contain information about other people;
8. Consider whether any of the exemptions apply;
9. If the information includes complex terms or codes, then make sure you explain them;
10. Provide the response in a permanent form, where appropriate.
Source: Information Commissioner’s Office
55 Selling and buying a practice
The selling consultant needs to consider:
The reputation of the purchasing doctor;
His or her personality;
Their ability to work together;
Their commitment;
The time frame for the transfer and ultimate sale of the practice.
The purchasing consultant needs to consider:
The available practice performance;
Reputation;
Turnover;
Medical insurance recognition;
Practice profile;
Location;
Security of tenure;
Operating facility arrangements;
The time frame of transfer;
The purchaser needs to make a commitment to the new practice that will give enough time to exploit its potential.
Maitland Cook, director, Maitland Cook Medical Management Company Ltd and The Cadogan Clinic, London
Doctors who are asked to do medical reports they expect to get paid for are being warned to agree terms or risk going unpaid.
The advice came after a disgruntled consultant neurologist told Independent Practitioner Today that an insurer failed to pay his fee for writing a lengthy response to its request for more information.
He explained he was asked to
provide ‘a somewhat in-depth report on a patient with a new chronic condition’.
But when he invoiced the company ‘as I would anyone requesting a specific undertaking’, it ‘refused to pay, stating it was not “policy” to do so and not something they would do with any consultant’.
The doctor argued that by specifically writing to him – to see if the patient’s condition was within or outside the cover – the company had created a direct contract and was responsible for associated costs.
He claimed he had been treated unreasonably and unfairly.
Specialist medical accountant Ray Stanbridge said: ‘This is all to do with offer and acceptance. If there is a contractual relationship between the consultant and this particular insurer, then it must pay.
‘But if it was a casual request for a report and there was no formal agreement, then the insurer is right. The moral for doctors is not to do casual reports for insurers, if requested, unless the terms are agreed.’ News story
57 Entrepreneur inventors, get a patent!
Crucially, the invention must remain secret until the filing of a patent application if you are to obtain a valid patent.
So, it is important to seek professional advice early in the development of an invention prior to any public disclosure, including any testing of the device or publication in a trade journal.
Kate Lees, European patent attorney, Harrison Clark Rickerbys
58
Use a log to record all business miles
Following a long-awaited tax case ruling, we now know that:
➲ Travel by consultants to undertake itinerant work – for example, home visits to patients – is taxdeductible;
➲ Travel expenses for journeys between places of business for purely business purposes – such as two private hospitals – is taxdeductible;
➲ Travel expenses for journeys between a location which is not a place of business – for example, an NHS hospital – and a location which is a place of business (such as home or private hospital) is not tax-deductible;
➲ Travel expenses for journeys between home (even where home is used as a place of business) and places of business – for example, private hospitals – are generally treated as not tax-deductible.
Ray Stanbridge, partner, accountancy, finance and tax advisory medical specialists Stanbridge Associates
59 Update your website
Your website is all about promoting your story. When you have something to say, say it.
If you have performed a groundbreaking procedure or you have been mentioned in an article, then put this on your site. Website content is not meant to be static; it is meant to evolve and should be updated regularly.
Sarah Bakker and Holly Broadway, Merchant Healthcare Marketing
60
Work with your PA
In many cases, relationship problems start during the recruitment phase because the usual job specification has been trotted out without a great deal of forethought. Essentially, the candidate is doomed to failure. Take time to consider what their role will involve. Ask yourself: Why did the last person leave? What was wrong? Find it, then fix it and write the right job spec.
More often than not, you will find that your employee wants to do more than you originally expected, but if you don’t ask or they don’t tell, you may be missing out.
Having the right tool for the job is as right for the medical professional as it is for their PA. Every team member needs to understand the goals ahead to achieve success.
Don’t wait until the chips are down to make sure your PA knows what you need.
Michael Bolt, managing director, Need More Time Ltd
61
Plan your succession
Succession documents should reflect the existing partnership agreement in place, but also deal with important provisions relating to partnership property, liabilities – both past and future – and distribution of assets and profits.
A lack of succession documents or improperly drafted succession documents could prove disastrous for the partnership, the remaining partners and potential investors and other stakeholders.
A change of partner composition is often a good opportunity to refresh the partnership agreement of your practice, ensuring your agreement is up to date with the latest laws, regulations and general good practice expected in the private medical sector.
Ensure that notice is given to all relevant organisations and individuals, including the London Gazette , relevant suppliers and customers.
Robert Capper, a partner, Health and Social Care Team at Harrison Clark Rickerbys
62
Use integrated practice management software
Let me be blunt: any consultant running a private practice with annual revenues of more than £50,000 should be using some form of practice management software.
Of course, I would say that, wouldn’t I, but most of the consultants I know would be the first to admit that they are not business people; they’re too busy being doctors.
There’s nothing wrong with that, of course – I’m sure that’s exactly how their patients would want them to be – but it still surprises me how many consultants have never even heard of integrated practice management software, let alone considered using it. The benefits are numerous, obvious and immediate – and yet I still meet consultants who rely on ancient physical filing systems and ledgers. Practice management software will save you money, paying for itself in months. It will improve the quality of care you give your patients. It will make your practice administration much more effi -
Practice management software will save you money, paying for itself in months. It will improve the quality of care you give your patients
cient. It will reduce stress and aggravation. And it will free up your time and your practice manager or secretary’s time to focus on what really matters: looking after your patients and generating more business.
Tom Hunt, managing director, PPM Software Ltd
63
Get a web presence
In our experience, most doctors seem to write their websites for other doctors and not for patients.
Have you stood back and really examined it and felt happy with how it looks? A good website should be a good reflection of how you are in practice.
Website designs should ensure that these key factors are a priority: easily accessible and simply explained.
Catherine Harriss, founder, MultiWorksMarketing.co.uk
64 Boost profile on video
☛ Dress smartly in clothes suitable for meeting a patient in a clinical setting.
☛ Bring along any ‘props’ you think may be appropriate to your specialty; for example, vertebrae of the back or model of the heart. They need to be recognisable to the patient viewing the video, but avoid anything too graphic.
☛ Practise your personal script prior to the recording.
☛ Keep your language simple and avoid jargon.
☛ Arrive at the scheduled time for your video recording. You need to look as good as you can on camera, so avoid running late and arriving hot, sweaty and harassed.
☛ Remember to smile. You may find you concentrate so hard on your lines that you forget the most important thing – smiling.
☛ Put your video on your own website, on YouTube and on the websites of the private hospitals where you practise. Tell patients. Leslie Berry, writer, Independent Practitioner Today
65 Embassy work
Some quick tips: LOG: It is vital that a letter of guarantee (LOG) is obtained prior to any treatment; this document will vary slightly depending upon the embassy that is issuing the document.
Most doctors seem to write their websites for other doctors and not for patients
There is normally a set of terms and conditions covering the LOG and you must always submit this document in conjunction with your invoice to the embassy in a timely manner to ensure the best possible chance of receiving payment.
Some embassies also require a medical report along with the invoice and LOG. If this process is not followed, then you run a much greater risk of working without getting paid.
FEES: How much do you want to charge for your treatment needs careful consideration. Your fees could be for consultations such as initials and follow ups, inpatient care, inpatient consultations and intensive care.
Whatever you decide needs to be clearly articulated to the embassies before you start to see their patients to avoid any misunderstanding after the treatment has been carried out – and to avoid dealing with disputed invoices.
PAYMENT: Be prepared for extended payment cycles and allow for this within your practice, particularly where you are likely to be paying tax to the HMRC, even if you have not collected payment.
This could have a devastating effect on your cash flow if you have not planned accordingly.
CHASING: Even when all the above is done, you will still need a robust system in place to chase for payment on a continual basis to ensure that your money is collected.
Garry Chapman, Medical Billing and Collection
Listen to their opinion and act accordingly.
Chris Miller, head of development at The Good Care Group, London
68
Check out leasing deals
For many, an upfront capital outlay may not be a viable option. Leasing, rather than buying and paying up front, will often prove the most affordable option, spreading equipment costs over a three- or five-year period through regular monthly payments.
What’s more, a cash flow analysis will highlight potential returns on investment – and these can prove substantial.
Making employer pension contributions on behalf of a spouse may be one of the most tax-efficient strategies of all, not only saving tax now but also in retirement. James Gransby, partner, MJA MacIntyre Hudson
We are all invariably so busy in our own lives that we tend to put off making a decision on care until we are faced with an emergency.
Look for the warning signs; for example:
An increase in the level of forgetfulness where the individual wanders out of the house and can’t find their way home;
An increase in falls around the house;
Not eating or drinking properly, leading to weight loss or loneliness and depression.
As a first action, I would strongly recommend carrying out research into possible care even if you don’t need it for months or even years. Consider the options of hourly care, live-in care or a care home. Explore the costs involved and how to fund care over several years.
Review the need for a Lasting Power of Attorney. Discuss these matters among the family and in particular with the person who may need care to ensure that, wherever possible, they are comfortable with and participate in choosing care for themselves.
A lender with good knowledge of the market will be acutely aware of any potential return on investment that new equipment may generate and will therefore be more likely to provide approval. In certain cases, the equipment will be in place before the borrower has even been required to make a payment, allowing them to immediately reap the rewards from greater revenue streams.
Mike Nolan, managing director, Academy Leasing
69
Our experience is that consultants typically do not charge correctly. This is because they have either not done enough research when setting the pricing in the first place or they have not reviewed the pricing on a regular basis.
Garry Chapman, Medical Billing and Collection
As an independent practitioner, it’s unlikely you will have to deal with workplace conflict very often, but given how destructive such disputes can be, you owe it to yourself to be prepared. While mediation may not be the answer in every case, it is considerably cheaper than instructing a lawyer. Most importantly, it is a great way to initiate a conversation when communication has broken down.
Mike Hill, director, Human Connection
➱ continued
Make sure you stand out by offering a special something which defines you and your business and sets you apart from the crowd: What is your unique offering (USP)? Is there something that sets you apart, something that will attract prospective patients?
Find it and capitalise on it. If not, you may wish to reconsider your move into aesthetics, as there are many providers who don’t offer anything unique and are simply peddling commodities.
Ask yourself: ‘Why should patients choose me instead of X?’
One of the greatest pitfalls of any business – and especially in aesthetics – is trying to be everything to everybody.
When you offer too many choices, you ultimately just confuse the patient while reducing your potential profitability.
Creating a service menu offering competitive – but not too cheap –prices is essential. But your ultimate goal is to create a solid concept of who you are and what your aesthetics business is, something that maintains your integrity while being marketable.
If you want to be really successful, take a step back, look at the marketplace and ask how you can positively disrupt it. You can disrupt by price, by innovating and charging more (like Apple), by using technology, by sheer quality of service or by becoming a master of marketing.
Pam Underdown, chief executive, Aesthetic Business Transformations
72 Have a social media policy
Clinic and practice staff should bear in mind that any content they post on social media should not:
Interfere with their work commitments;
Contain libellous, defamatory, bullying or harassing content;
Contain breaches of copyright and data protection;
Contain material of an illegal, sexual or offensive nature;
Include confidential information about practice patients, expatients, staff (clinical and non-clinical) and other practices and healthcare organisations;
Bring the practice or profession into disrepute or compromise the practice’s reputation.
Julie Price, Medical Protection Society
73 Avoid the taxman
This can be done by:
1. Submitting ALL tax returns online and in time;
2. Keeping records for FOUR years;
3. Keeping a diary;
4. Keeping a LOGICAL invoicing system;
5. Identifying debtors at year-end;
6. Having a formal policy for bad debts recovery;
7. Keeping records/invoices for expenses;
8. Keeping a mileage log;
9. Maintaining a business bank account – compulsory for a company;
10. Operating a full PAYE system and maintaining proper records.
Ray Stanbridge, partner, Stanbridge Associates
74 Take professional fee protection insurance (PFP)
While mediation may not be the answer in every case, it is considerably cheaper than instructing a lawyer
I always recommend my clients take out PFP insurance, which means that, in the event of a tax inquiry, professional fees, usually up to a limit of £50,000, are covered by the insurance policy.
The fees for dealing with a tax inquiry are generally between £1,500 and £5,000 plus VAT, depending on the complexity.
Bearing in mind the premiums are relatively inexpensive – between £200 and £300 a year – it is money well spent.
Most accountants will use a registered scheme that they recommend to their clients.
Susan Hutter, partner, Shelley Stock Hutter
Care Quality Commission regulations specify independent hospitals have an independent review stage for complaints. 98% of independent hospitals in England choose the Independent Sector Complaints Adjudication Service (ISCAS) to provide this independent review.
It is vital to share information in a timely fashion with the registered manager about any complaints made against you and to involve them if you are finding the complaint difficult to resolve.
Co-operate with any requests to meet with the patient. ISCAS encourages registered managers to offer to meet with patients to discuss their complaint and the vast majority of complaints are resolved through this means.
It is also important that you make your consultant notes available to ISCAS if requested, with the appropriate consents, without delay.
Ensure you have a copy of the hospital’s complaints policy and are familiar with its contents, particularly around time-scales within which to respond to complaints and how to signpost complainants on if you are not able to resolve their complaint.
Disa Young, senior adviser, ISCAS
76
Watch out for website turnoffs
Lack of information to explain treatments;
General look being outdated;
Not able to view the website on a mobile phone or tablet;
Lack of guidance about cost/ price of plans;
Old-fashioned images;
Talking in the third person/corporate language;
Adverts;
Lack of verifiable/scientific, peer-reviewed, citations;
Selling the practice rather than giving a balanced view on procedures;
Slogans.
Joel Calliste, cofounder, Smart Medical Web
77 Beware of competition law
If you work as part of a group, it’s vital to check that you’re not discussing or sharing information that could land you in trouble. This will largely depend on how you work together and whether you are part of the same economic entity.
If you and your fellow group members work as part of a limited liability partnership (LLP) or limited company and only apply your services via this intermediary, then you are part of one economic unit and any discussions you have internally about fees would not be a competition issue.
The situation becomes more complicated if you also work as a sole trader outside the group, as well as being a member of a group, as decisions made internally within the group could then be used to influence your commercial conduct as a sole trader –such as the fees that you may charge for specific procedures.
Furthermore, if you do work within a group such as an LLP, you must be mindful of the fact that other LLPs and groups active within the same medical specialism are still your competitors. Any choice about fees or whether you intend to accept an insurer’s or facility’s package price should be made independently and not as a result of discussion with other consultant groups.
Ann Pope, senior director for antitrust enforcement at the Competition and Markets Authority
78 Minimise inheritance tax
Whether you choose to pass on some of your wealth now or in the future, ensure you have the full picture of what this could mean in terms of the tax that might be applicable for you and the people you would like to protect.
Hugh Davies, financial planner, Cavendish Medical
79 Have an uptodate will
For the busy independent practitioner who is juggling a heavily congested schedule, making a will can often be overlooked and forgotten about. However, wills remain an essential piece of planning which require careful thought and consideration.
Edward Jacobs, solicitor, Gross and Co
80 Protect your practice’s goodwill
There are two alternative circumstances in which a restrictive covenant would be considered necessary.
Firstly, those purchasing a practice will want to protect the goodwill they have bought by seeking to prevent the seller from setting up in competition immediately after the sale.
Secondly, those with established practices will want to prevent those engaged in the practice from seeking to take patients away with them if they depart and set up a rival business.
In either case, a carefully drafted restrictive covenant, contained within either the business transfer agreement (BTA) in the former case or within the consultant’s agreement in the latter case, can ameliorate the risk.
Without having a restrictive covenant in writing, the practice owner runs the risk of their goodwill being diluted if the incumbent – be they the original owner or a consultant, the leaver – leaves the practice and seeks to take advantage of the relationships they have built up direct with the patients while at the practice, with the intent of poaching them.
Lynne Abbess and Puja Solanki, Hempsons solicitors
Take advantage of valuable protection schemes to help safeguard your pension from harsh tax charges.
Every senior doctor is likely to breach the new allowance due to the very nature of making pension contributions into the NHS scheme over a number of decades.
Unfortunately, the pension protections available are nearly as complicated as the pension schemes themselves, so it is a very difficult area for the busy professional to get right.
If you are unsure how to proceed, you should seek help without delay – the tax charge if you breach the lifetime allowance can be a staggering 55%.
Patrick Convey, technical director, Cavendish Medical
82
Adopt a good marketing plan
This includes:
Analysis of your current situation – PEST / SWOT;
Objectives and goals of your practice;
Who are your customers and whom are you targeting? These may differ – for instance, patients/ doctors/general awareness;
Your brand;
Marketing your service;
Defining the product or service you are selling;
Pricing;
Geography – where are you promoting yourself;
Promotional tactics;
Budget;
Implementation – who does what, when and how? Is training needed?
Evaluation. Do you have any metrics in place?
Malcolm McCoskery, marketing consultant
83
Combat fraud against your business
➤ Never divulge online banking passwords or online banking secure codes to anyone on the phone, even if you think you are talking to the bank.
➤ Do not rely on your phone’s caller display to identify a caller. Fraudsters can make your phone’s incoming display show a genuine number.
➤ Be aware that a bank will never call you and tell you to transfer your money to a ‘safe’ account.
➤ If you see unusual screens or pop-up boxes when using your online banking or unusual requests to enter bank passwords, log out immediately and call your bank.
➤ If possible, set up your online banking so that two separate people are required to make any payments.
Ian Crompton, UK Head of Healthcare Banking Services, Lloyds Bank
84 Use liquidation As a retirement strategy, liquidation 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 pension schemes where the expected retirement age is 65-plus.
Hence, this has been a popular strategy for many consultants who can afford to leave money in the company.
Ian Tongue, partner, Sandison Easson chartered accountants
85 Get PHIN fit The Private Healthcare Information Network (PHIN) is coming. My advice is to embrace the process and all the opportunities it offers.
Like it or not, it’s regulation now anyway. We’d have to collect this information one way or another. Why not let PHIN do it for us?
Ultimately, once all these glitches with the system have been ironed out, collecting information in this way will help improve clinical quality, and it will improve patient information.
It’s going to be so powerful in the future to be able to say to my patients: ‘Look, here’s a link to
PHIN’s website giving all the data about my practice. I see X many people a year, no complications, I have a 90% patient satisfaction rate...’
This kind of transparency is going to give confidence to GPs when they are making referrals, and to patients and families when they are making choices. I would say embrace the change and make it work for you.
Dr Voi Shim Wong, consultant gastroenterologist, Highgate Hospital, London
86
Don’t miss calls
In a recent analysis of phone calls to the private healthcare sector, we identified that healthcare practitioners are missing the most calls at the beginning of the week, with their lines busiest at 10am on a Monday – followed by Tuesday and Wednesday at 3pm.
This suggests clinics are the most under-resourced at these times.
This strongly indicates that, as the high volume of calls are occurring at times when we would expect patients to get in touch –first thing in the morning – many practices are underestimating the number of calls they receive from patients trying to get through to them.
It’s all too easy for a practice to think they have the staff resources to cover busy call times, but many won’t be aware of the number of calls they are missing.
Stephanie VaughanJones, telephone answering specialist, Moneypenny
Ask your accountant for more regular reports in the form of a set of management accounts – for example, monthly or quarterly.
Ensure you have a copy of the hospital’s complaints policy and are familiar with its contents
You will be able to make informed decisions which will affect your business within the current financial year.
There are several benefits in taking this more involved approach, including:
Better control and understanding of costs;
Ability to compare year-to-date performance with previous years;
Forecasting future earnings;
Boosting cash flow;
Tax and dividend planning –and much more.
Ebert Hyman, chartered global management accountant and general manager at London Urology Group and 101 Diagnostics
88 Stay abreast of GMC confidentiality guidance
The GMC has updated its website guidance with a 76-page document Confidentiality: good practice in handling patient information. We suggest all independent practitioners ensure they and colleagues familiarise themselves with it and changes affecting them. We can’t detail them all here. Just listing the new bits takes the GMC another six pages. There is explanatory guidance too – and more to come.
But we will pass on the body’s accompanying stark warning:
‘Serious or persistent failure to follow this guidance will put your registration at risk’. Editorial Comment
89
Know new law on consent to treatment
‘Surprising numbers’ of independent practitioners are putting themselves at risk because they have not caught up with new duties for obtaining consent to treatment.
Solicitor Paul Sankey said doctors across the specialties seemed to have missed a law change two years ago.
The landmark Montgomery v Lanarkshire Health Board case redefined the legal doctor-patient relationship and placed a higher obligation on specialists to warn of treatment risks.
If you work as part of a group, it’s vital to check that you’re not discussing or sharing information that could land you in trouble with competition law
But Foot Anstey LLP partner Mr Sankey said: ‘Many seem to know little or nothing of the change. The continued use of standardised consent forms suggests practice has not sufficiently changed. Standard forms are unlikely to record the sort of patient-centred advice and discussion the law expects.’
News story
90 Dictate accurately and clearly
An outsourced secretarial service relies more readily on the information as dictated by the clinician.
A remote typist, albeit who may work within a case management system, will not have access to clinic data, patient notes, test results or hand-written summaries, so will rely solely on the information dictated by the clinician with regards to which patient the letter is on and who the letter is to.
With the cost-savings of outsourcing secretarial typing, which can be substantial, it is imperative to dictate clear, detailed and concise information on each and every sound file.
Stephanie CarmichaelDrage, www.outsec.co.uk
91 Get money from lawyers
Your terms of business should always make it clear to solicitors when you expect to be paid for medico-legal work.
The majority of firms are very
good at paying their experts on time, but some do need a gentle reminder by way of a phone call. ‘I am expecting a cheque but it hasn’t arrived yet. I was wondering if it might have got lost in the post’.
It’s amazing how many of these cheques arrive the following day. Some firms need a written reminder, but very few, if any, never pay.
Don’t expect to be paid in advance for a report. But it is not unreasonable to expect to be paid promptly once you have submitted your invoice/fee notice.
Michael R. Young, expert witness
Your practice’s information security policy must include clear guidelines for secure communication and the appropriate use of email. (Healthcode still receives emails which include screenshots of invoices with unredacted patient information).
For example, there should be a requirement to ensure personal information is transmitted securely; restrictions on the use of personal devices and unsecure personal email accounts; checks to ensure new recipients’ arrangements are secure before messages are sent; and disabling email functions such as auto-complete addresses which can lead to personal information being sent to the wrong person.
Peter Connor, managing director, Healthcode
Until the Competition and Markets Authority (CMA) 2015 final order arising from its private healthcare investigation, many doctors never realised they could put money into equity participation schemes.
But Dr Tony Lopez, chief executive and medical director of Incorporated Health, said although the CMA put a prohibition on unfair business relationships between consultants and private facilities, it also made clear they must not hold more than 5% in these projects.
This meant they could indeed invest and there were now plenty of well-funded new companies who wanted to work with consultants.
Collect feedback from patients
He said schemes could be ‘very profitable’ and a typical investment might be £25,000 to £70,000.
‘If they had the opportunity, I think there would be about 2,000 doctors willing to get involved. They just don’t know how to do it. But there are companies, as well as mine, who can help them.’ News story
94
Sort these financial tasks now
Do you have a retirement plan?
Are you on the right pay scale for any NHS work?
Will you exceed the annual allowance for pension savings? Will you exceed the lifetime allowance?
Have you protected the value of your pension?
Are you confident your practice structure is tax- and pension-efficient?
Are you taking advantage of your available allowances every year?
How are your investments performing?
Dr Benjamin Holdsworth, practising medic and business development director of Cavendish Medical, specialist financial planners
95 Seek help for professional stress
Stress is often the elephant in the room when it comes to the highperforming health professionals whom I’ve worked with.
I see many medical consultants, some at the very top of their game, struggling with stress, often for far too long.
Many of these doctors have been delaying seeking help, suffering in silence for fear of being found out
as not coping or not being good enough at their job.
In their attempt to eradicate stress and avoid any of the nasty feelings that may come with others knowing that they aren’t coping too well, they have engaged in a number of very unhelpful, yet understandable coping strategies that have made their problems much worse, in the longer term anyway.
Dr Michael Sinclair, consultant counselling psychologist
96 Be aware of a salaried option
Doctors’ expressions of interest in working on a salaried basis in a new flagship private hospital has gone through the four-figure mark, its chief operating officer has revealed.
Mr Keith Hague said London’s Cleveland Clinic, due to open in two and a half years’ time with an initial 200 beds (29 ITU), had sparked interest from ‘thousands.’
His remarks came in response to a challenge from a representative of the Independent Doctors Federation (IDF), whose members have voiced opposition in recent months to a private salaried service model.
News story
97 Collect feedback from patients
Certain aspects of a practice can be hard to measure in hard data – such as how well staff communicate with patients and how patients feel about the service they receive.
So consider collecting feedback from patients – this will give you the chance to understand things on a more personal level.
Jane Braithwaite, managing director, Designated Medical, secretarial support services
A mistake we found was a consultant’s secretary had charged all insurers at one insurer’s rates, not realising different insurers will accept different fees for similar work and procedures. In some cases, there was up to a 100% differential, costing the practice tens of thousands of pounds over several years.
Another common mistake we find is the incorrect billing of multiple procedure codes because each insurer has their own specific rules about how the invoice total is derived.
If these are misunderstood, you could be missing out or billing incorrectly – and that can cause you problems with the insurers.
Findlay Fyfe, managing director, Medical Billing and Collection
Jane Braithwaite, managing director of Designated Medical
Are you aware? Under Article 22.2 of the Compet ition and Markets Authority Order arising from its long-running inquiry into private healthcare, consultants must send patients written fee information before outpatient consultation (operative by 31 December 2017) and prior to further tests or treatment – by the end of February 2018. News story
Recognise why private healthcare is popular in this age group and do what you can to tailor your service to their needs. If it is long consultations that are popular, look at amending appointment times. If it is same-day appointments that prove popular, think about how and if this could work for your business.
Liaise with your target audience and market your practice based on your findings. If you have existing patients in this age group, reach out to them to request feedback and ascertain what is important in terms of what they expect from the patient experience. Be authentic. Use testimonials and engaging stories of people’s healthcare journeys to help people to engage with your practice brand and better understand your values.
Use content that is high quality and shareable on social media –this will be more effective in terms of reaching out to this group than more traditional advertising methods.
Jane Braithwaite, managing director, Designated Medical
As with any building works, you would be well advised to ensure there is a contract in place for the architectural appointment. At the very least, the contract should state the extent of the architectural services you require, the scope of the work, a statement that professional indemnity insurance is held, key responsibilities of all parties to the contract, architectural fees and whether there are any special terms for dispute reso-
lution and what to do in the event of a dispute or complaint.
The RIBA Standard Agreement 2010 (2012 Revision) sets out the terms of the architect’s appointment in detail so that you can clearly understand the service you will be receiving.
It is also a good aide memoire for clients to ensure nothing is missed out from the appointment.
Understanding, agreeing and setting out in writing the terms of the architect’s appointment is key to a good working relationship with your architect.
Philip McQuillen, founder and managing director of Earlsmarch (www.earlsmarch.co.uk), architecture and interior design studio and residential property development company
In ten years’ time, there will be fewer beds and overnight stays. All hospitals will be embracing day case treatment referrals.
Insurers will cease to register consultants as individuals and will deal with properly established and regulated groups.
Those who do not want to join with groups will work through locum agencies or become employed by hospitals.
In ten years’ time there will be fewer beds and overnight stays. All hospitals will be embracing day case treatment referrals
Positive and consistent clinical outcomes will be reflected by additional pay.
Those who are not up to standard will have their fees further reduced.
New hospitals and clinic groups will emerge around the country and some existing ones will be under extreme pressure or be put out of business. These new hospitals will tend to be located where people live.
The NHS will continue but will offer more and more of its noncore business to the private sector. The biggest dilemma will be how to insure cancer patients where, for many, their conditions will be of a chronic nature rather than a critical condition. Trouble to come here!
Consultants in private practice will do well – the market is still growing, particularly for self-pay. The prospect for those wanting to engage seriously in private practice is steady but employment is the easier attraction and offer for many!
The days of the great and the good massive practices will probably be gone in ten years’ time.
Ray Stanbridge, Independent Practitioner Today chairman and founder of Stanbridge Associates accountancy, finance and tax advisory medical specialists (writing in June 2018)
You should be provided with not only the hourly charge-out rate of the individuals concerned, but also with an estimate of the overall time/cost that may be spent on your case. If you are unclear about anything don’t be afraid to ask! If a ‘fixed fee’ is proposed, clarify whether this is ‘fixed’ as an absolute figure – even if the case does not proceed all the way – or whether it is ‘capped’. And if it is fixed, and the case is indeed concluded, check whether there is any prospect of an additional charge being levied if it has taken longer than expected.
While it is natural for a consumer to want to secure a ‘good deal’, if you try to screw your fees down to a bare minimum, it is bound to impact upon the level of advice provided.
In fact, you should be wary of a ‘fixed’ fee which is absolute, as it is human nature that once the ‘budgeted’ figure has been reached, there may be a natural tendency for those involved to want to ‘wrap it up’ as quickly as possible thereafter, even though it might not be in your best interests to do so.
Lynne Abbess, consultant solicitor, Hempsons
There are a large number of private practitioners who have websites but unfortunately have not updated them in a long time. Ask yourself a few questions like: Is my website responsive to work on mobiles and tablets?
When did I last add any new content?
The Private Healthcare Information Network (PHIN) is coming. My advice is to embrace the process and all the opportunities it offers
When was the design last looked at and modified?
Have I updated the images on my website recently?
Is my website being found on search engines for specific keywords?
Many doctors’ websites unfortunately look like they haven’t been updated for some time and it doesn’t take much more than a few tweaks in many cases to update them and bring them into the 21st century.
An MOT for your website can be exactly what’s needed to give you a true picture of how your website is performing.
Grant Brookes, chief executive at thewebsurgery.com
At the start of your career, you probably found your finances fairly manageable and easy to track.
The difficulties begin as the professional pace picks up, clinics overrun, income streams become more complex and you acquire more assets, liabilities and possibly family members.
This is usually allied with increasing complexity of tax reporting and payments in advance through HMRC’s ‘payments on account’ in January and July as well as navigating NHS and private pension rules.
You know you need to do something but you just don’t have the time to put yourself first.
Deadlines then get missed, decisions are delayed and before you know it, much time has passed and you are entirely frustrated as you don’t feel well organised and you aren’t making the progress that you would like in your life. Where do you turn for help?
A good financial planner takes the time to really listen to you, help give an objective and empathetic appraisal of your unique situation and challenge you where this is merited. This can take the emotion out of money choices, make the complex simple to understand and create a structure that encourages action.
This means taking a long-term view, making some well-consid -
ered decisions and creating a plan to reflect this.
In doing so, your adviser may discover financial needs you have not even considered, or indeed potential problems that have not yet come to light.
Simon Bruce, chief executive, Cavendish Medical
Good complaints management is an integral part of good governance and quality management. If patients have concerns, we must listen to them and find a way to satisfy them if that is possible.
In doing this, we get to see ourselves as patients see us, and that is sometimes very enlightening. And it is not easy to do that if it is your own work or your hospital or clinic that is being criticised.
A level head and cool approach is needed if a patient’s concerns are to be addressed empathetically and we are to gain valuable lessons to apply to the future care we give.
The tried and tested Independent Healthcare Sector Complaints Adjudication Service (ISCAS) Complaints Code of Practice is the helpful tool of choice used by 95% of independent healthcare providers to evaluate complaints and to draw out the learning points they may contain.
The Code is not to be used just by doctors, because almost invariably the substance of the complaints adjudicated through the agency of ISCAS touch upon multiple aspects of the patient’s pathway through the clinic or hospital.
Sally Taber, director, ISCAS
When payments arrive, every practice needs a system in place to record exactly what invoices are being paid and identify shortfalls which then need to be queried with the private medical insurer or charged to the patient. This can be time-consuming with a manual system and, in some cases, practices have been obliged to write off outstanding debts because payments have not been reconciled against the correct invoice.
Before investing in practice management or invoicing software, check how easy it is to manage payments and shortfalls, as this feature could make all the difference to your credit control process.
Kingsley Hollis, head of business development (ePractice), Healthcode
Think about the ways in which you already do this and what you could do to make your customer journey even better. Take a look at your competitors and compare how you measure up as well. What services do they offer? Can you book an appointment online, for instance? Is there anyone to pick up phone calls or inquiries once the doors close at 5.30pm? No? Herein lies your opportunity to exceed the ‘norm’ and the rewards of this are there to be reaped. Word quickly spreads about extraordinary service, and those recommendations are priceless. Practices who raise the bar are inevitably the ones that rise to the
top. Not only do they surpass their own expectations of what constitutes good service, but also the industry’s standard. This can be enormously powerful.
Stephanie VaughanJones, commercial manager at communications specialist Moneypenny
Repeating back stops mistakes happening Communication failure represents the single most frequently occurring element in adverse events that harm patients. This is well established:
‘Since 1995 the Joint Commission on Accreditation of Healthcare Organizations has reviewed 2,455 sentinel events. Communication problems are consistently implicated as a leading factor in patient deaths and serious injuries.’ [Brown 2004].
And yet there seems to be very limited awareness of this issue among doctors and nurses.
Pizza home delivery services mandate the use of read-back and summarising plans to ensure customers don’t get the wrong pizza toppings.
One of our junior doctors, while attending a human factors training day, told us that the one and only time she had ever received formal training in the importance of read-back and summarising plans was during a holiday job – in Pizza Hut!
John Reynard, consultant urological surgeon; Tim Kane, consultant trauma and orthopaedic surgeon; Peter Stevenson, airbus pilot – cofounders of Practical Patient Safety Solutions.
Many consultants and GPs think they can treat their PA and other employees as ‘self-employed’. This could lead to problems for your business as HMRC, in most cases, will regard that person as an employee who should be dealt with under Pay As You Earn (PAYE) within a formal payroll structure. If you do not do this and pay your staff gross, assuming that they will prepare their own tax returns under self-assessment, you are making a grave error. If there is an inspection by HMRC – and they do make inspections from time to time – they will pick this up immediately.
The consequences are that if the person whom the consultant/GP has regarded as self-employed is actually an employee, their pay going back six years will be grossed up for tax and employer’s National Insurance which can almost double the bill.
Susan Hutter, partner, Blick Rothenberg
Keep up your voice volume. 99% of the microphones in court are for the benefit of recording, not for the room. Only answer the question you are asked. Try and speak reasonably slowly. Watch the judge’s pen. If you gabble, then he wont be able to keep up. Speak in paragraphs.
Take nothing at face value. Don’t look for traps though when being questioned or you will be constantly digging a hole for yourself. Don’t try and defend the indefensible. If you are referred to a document, don’t try and answer a question without going to it and reading it.
Augustus Ullstein QC
112
Revalidation difficulties? Don’t despair
There is a plethora of help available on the GMC website and other organisations such as the royal colleges and independent provid-
ers who are available to give support, guidance and advice. It does not have to be a seemingly impossible mountain to climb.
The key to successful appraisal and revalidation is clear understanding of what exactly is required of you and how you can manage the process as part of your daily routine so that it does not become burdensome and stressful for you.
Kate Lewis and Darren Wiggins, ACI Training and Consultancy Ltd
Branding is often misunderstood as being just a name or logotype, but it is so much more.
Good branding will help communicate everything your organisation believes in. Trust, devotion, reassurance and recognition are all driven by clear and consistent branding.
Good brand communication is often a subconscious understanding. When a series of well-branded communications, environments and signage come together, then people perceive a professionalism that is reassuring and trustworthy. These are important values when someone is placing their health in your hands.
Nick Butcher, creative director of Beyond London; Dr Nick Hayward, NHS resident doctor in anaesthesia
The risk of fraud and cybercrime is growing at an alarming rate with no real signs of any slowdown. Fraudsters are targeting individuals and businesses across the world and across all sectors.
Healthcare is certainly no exception, so it is essential that you know what to look out for when it comes to these risks and, more importantly, what steps you can take to protect yourselves and your practice against fraud.
Medical practices and GP surgeries can be a favourite target for fraudsters, as the responsibility for managing the finances and organising day-to-day administration often falls on one or two individuals. They have to perform many
functions, whereas larger organisations can call upon more resources and greater funding to protect against fraud attacks.
This also means less opportunity to segregate duties within a practice and if there’s little or no oversight from senior colleagues, preventing insider fraud can be more difficult.
The main objective of fraudsters isn’t always the practice’s money; in some cases, it is to gain access to confidential sensitive data such as patient records.
Vin Pandha, commercial fraud manager, Lloyds Banking Group
Having a plan when it comes to property investment is vital. It’s like setting up a business or becoming a doctor – you’re unlikely to succeed if you set out without a plan or identifying the steps you need to take to achieve your goals.
You need to know as much as possible about the different ways you can invest in property, choose a strategy and focus on it.
Dr Lafina Diamandis, cofounder, Eurekadoc and author of Property Investing for Doctors
Doctors need to be aware of the potential problems and risks when posting their thoughts online.
Our advice is that prior to posting, even in a closed group, consider what the purpose of the post is and who may read it.
practice management packages out there now.
Commit 100% to private GP practice; don’t try to balance this with working as a GP in the NHS. You need to be available to offer daily appointments as most of our patients book within 48 hrs of their consultation.
Dr Sibel Peck, private GP
119
Setting up a company –decide these issues
Could it potentially identify an individual and what could be the repercussions if the post was reproduced elsewhere? If you are unsure, it may be best to alter your post or not to post the comment at all.
Dr Sally Old, medicolegal adviser, Medical Defence Union
A feature of the market is the increasing trend for surgeons to offer non-surgical interventions themselves or partner with specialist aestheticians who do.
This has the benefit of extending the reach of individual practice but, for the consumer, provides reassurance about treatments being offered in a more balanced, ethical way by properly trained practitioners.
Non-surgical treatments can act as a gateway to future surgical intervention, so this approach can make business sense, but also retains the patient within a clinical setting where they can have confidence in the skills of the practitioner.
Liz Heath, author of LaingBuisson’s first major study into the UK cosmetic surgery market
118 Starting a private general practice
I would say have a GP colleague to start in practice with because it can be isolating to work alone and a team works far better.
Have a robust system for patient records and invoicing; we used EMIS, as we were already proficient in it from our NHS days. There are now many more patient/
If you are to all own shares in a company formed for the purpose of the business, consider these questions:
Are all the shares to have the same powers and rights to dividends?
Can the shares be sold to other people?
If a shareholder retires/leaves working in the company, will they retain their shares?
If a shareholder is to have their shares bought back from them –who by, what will the payment terms be, who will decide the value?
Who will the directors of the company be – they will manage the day-to-day running of the company?
What decisions will be reserved for the shareholders to make?
What happens if you decide to sell the company and the other shareholders refuse to sell their shares? Can they be forced to sell their shares?
Michael Rourke, partner, Hempsons solicitors
120 Rising costs of hospitals’ engagement with doctors
Whether this is through salaries and guaranteed bonuses, or through other means such as splitting out portions of a hospital’s business and allowing consultants to co-invest, the different business models available from different, competing, hospitals suggest that the overall price of consultants will continue to go up, affecting hospital margins still further.
Ted Townsend, author of LaingBuisson’s Private Acute Healthcare Central London Market Report 6th edition ➱ continued on page 38
The doctors and their staff have spent hours preparing for inspection, going through the KLOEs (Key Lines of Enquiry) and ticking off the criteria considered outstanding, having two or three inspectors and advisers spending eight or nine hours in the practice and in many cases being given the impression they would get an ‘Outstanding’ designation. Then the report arrives rated overall ‘Good’ but with no indication as to how they could have attained ‘Outstanding’ or what needed improving.
It is easy to see why some doctors adopt the attitude ‘Good will do’.
Martha Walker, writing in the Independent Doctors Federation’s IDF News
Coroners reports
Do…
Write your report honestly;
Don’t be influenced by others;
Write it as soon as possible, while the incident is still fresh in your mind;
Only include details of events that you personally were involved in, unless attributed to others – for example, ‘Mr X was seen by Dr Y on…, the medical notes indicate…’;
Only include relevant facts; your opinion is only necessary if specifically asked for. Do not..
Comment on behalf of others –but you can say ‘Dr X said…’;
Exceed your level of competence;
Deliberately conceal anything –this will cast doubts on your integrity and will make subsequent comments less credible.
Dr Gabrielle Pendlebury, medicolegal consultant at Medical Protection
123 Avoid oversharing your screen
During online meetings and calls, be extra cautious when sharing your screen with others. If possible, do not leave any windows open that you do not want to share, as these may have details that are sensitive to you or another
person whose data you have access to.
Accidents do happen, and sometimes you might share something that you did not mean to.
Murray Hart, senior IT director at transcription company OutSec Services Ltd
124 Medical witness work
An obvious reason to take on this work is the remuneration. Medical experts are very well paid for their time and expertise, and rightly so. In return, though, they work hard. Considerable investment of time is needed to read through medical records and witness statements in order to become familiar with a case. The report writing process requires a methodical approach, and some time must be spent refining the report to ensure the terminology has been explained and the opinion is clear and well-reasoned.
It has often been said that acting as a medico-legal expert witness brings a fresh perspective to one’s own clinical practice. Many experts comment that they have developed and improved their clinical practice as a result of something they have seen in, or learnt from, a case they have worked on.
Caren Scott, managing director at inspiremedilaw.co.uk
125 Listen to your patients
If you are not listening to your patients or you do not ask them what they think of the service you are providing them with, how do you know that they’re happy? The answer is you don’t. Building a simple post-consultation patient survey in a tool like
ing a meeting where rivals agree prices is illegal.
59% don’t know that agreeing to split up markets and share customers with competitors is illegal.
This lack of understanding of competition rules is worrying. Not knowing that a business practice is illegal is no excuse for wrongdoing and the consequences of getting caught are serious:
Survey Monkey is a simple way to ensure you are capturing patient feedback, learning what is good about your service and also where you need to improve.
Simon Marett, Ellerton Marketing Ltd
Avoid anything that might have a novelty factor, like a treatment that you have pioneered or that only your clinic offers. The last thing news outlets want is news. If you are sadly cursed with having something medically interesting to promote, make absolutely sure that you present it to mainstream media as if you were writing for a peer-reviewed journal. Use incomprehensible jargon wherever possible, no diagrams, ideally graphic photos and anonymous case histories (more on that later). Do not link it to anything remotely topical that regular people reading their Sunday newspapers or a woman’s magazine could possibly relate to.
Tingy Simoes, founder and managing director of Wavelength Marketing Communications
If you are caught instigating, participating in or facilitating anti-competitive practices you could face fines of up to 10% of your annual global turnover.
Company directors could be banned from acting as a director for up to 15 years. In the most serious criminal cases, individuals could even face prison.
Louise Banér, Competition and Markets Authority director
The first requirement of any IT provider you choose to work with is the ability to talk your language, because clear, effective communication is key to finding a solution that meets your particular business concerns and avoiding misunderstandings.
Here are some other important questions to consider:
1. How did they respond to your initial query – excellent customer service from the start?
2. Do they have expertise and a proven track record in the independent health sector?
3. Are they financially stable? Ask for business references, check with Companies House or buy a report from a reputable ratings agency.
I do not believe we can prevent burnout; rather, we have to manage it, recognise it, minimise it and deal with it when it occurs. Anyone working so close to human suffering will, at some point in their career, develop some aspects of it. What is important is recognising when:
We can go on no longer;
Negative attitudes turn to loss of compassion;
Our sense of futility becomes a feeling of hopelessness and helplessness;
Our work loses its sparkle day in, day out;
We need to remove ourselves from the stressor.
The best place to start is in the workplace and in particular reduce the pressured environment in which staff work.
Environments where excessive
workload, long work hours, fatigue, intense emotional interactions, restricted autonomy and where constant structural and organisational changes become the norm lead to increased risk of burnout.
Dr Clare Gerada, medical director of the Practitioner Health Programme, London, and a former RCGP chairman. Adapted from Beneath The White Coat: Doctors, their minds and mental health
130
The madness of markets
As an investor, it is generally a good idea to ignore what is going on in your portfolio most of the time. At the very least, it can be distracting and at worst it can be a source of unnecessary anxiety.
Dr Benjamin Holdsworth, director, Cavendish Medical specialist financial planners
131
Collaborative ‘consultant power’
The shift to collaborative and group working presents many opportunities for consultants and providers, not least the ability to engage proactively with providers to design and deliver self-pay pathways.
Many consultants are establishing a strong online and digital presence, which can have a role in influencing patient choice. The ability to leverage ‘consultant power’ collaboratively and productively offers many mutual benefits.
Liz Heath, selfpay market consultant (pictured right)
132
Communicating research transparently
The scientific community’s response to Covid-19 has resulted in a large volume of research moving through the publication pipeline at extraordinary speed through the means of preprints, press releases and social media amplification.
Although the nature of this emergency warrants accelerated publishing, measures are required to safeguard the accuracy of scientific evidence. As we look ahead, we must be prepared for future pandemics by establishing an efficient research response.
We need to develop a transparent and trusted system that clearly communicates what data is being collected and why to effectively harness information to support ➱ continued on page 40
Independent Practitioner Today has joined forces with leading healthcare lawyers Hempsons to offer readers a free legal advice service.
We aim to help you navigate the ever more complex legal and regulatory issues involved in running and developing your private practice – and your lives.
Hempsons’ specialist lawyers have a long track-record of advising doctors – and an unrivalled understanding of the healthcare system as a whole.
law
A key message is that competition law and the rules that govern businesses apply equally to you, as private practitioners, as they do to large corporations.
Yet we know from research with a broad range of businesses across the country, that awareness and understanding of competition law remains low.
Only 57% of those we polled know that it is illegal to fix prices and 41% don’t know that attend-
4. Do they have the resources to respond quickly to problems and a development team to ensure the system keeps pace with new technology?
5. Can you speak to other users about their experience of system functionality, reliability and customer service?
6. Can you trial the system for a limited period to ensure it meets your needs?
7. What training and technical support can they provide?
8. How will they help you safeguard patient data?
Kingsley Hollis, head of business development (ePractice) at Healthcode
Call Hempsons on 020 7839 0278 between 9am and 5pm Monday to Friday for your ten minutes of free legal advice.
the delivery of knowledge-driven care.
Global collaboration is an essential element that will allow clinician-researchers to effectively balance delivery of patient care while also channeling efforts to establish the required research trials to progress future evidencebased treatments.
It is vital that, going forward, we create a culture that promotes high-quality research by guaranteeing transparency and ethics.
Oli Cram, MACRO general manager, Elsevier Clinical Solutions
133 Support staff mental health
Make sure your team members know what’s available to them, both inside and outside of work.
If someone in your team is struggling with their mental health, you may need to make some adjustments for them. Perhaps you need to make some changes to their environment or working hours, ensure they take time off or ease their return to work to help them recover.
More information and resources on mental health and well-being for managers are available at: www.bupa.co.uk/health-information/workplace-mental-health.
Dr Pablo Vandenabeele, clinical director for mental health, Bupa UK Insurance
134 Being a competent expert witness
The court expects:
Independence and impartiality. While this might seem obvious, it was concerning that, in a 2019 survey, 25% of expert witnesses had felt pressurised to change their report in a way that damaged their impartiality. 41% indicated that they had come across other expert witnesses they considered to be a ‘hired gun’.
Expert evidence must be ‘expert’.
Take the task of ‘being an expert’, being aware and competent in their duties to the court.
Continual critical examination of their own work or opinion.
Ownership or, as expressed by
137
Promote yourself on PHIN’s website
The PHIN website not only plays a unique role in providing independent information to patients about hospitals and consultants, but it also offers consultants an opportunity to promote their practice to patients.
Patients continue to tell us that they are more likely to look at a profile that provides information about a consultant’s training, their specialty and subspecialty interests, the procedures that they perform, and where the profile includes a photograph of the consultant.
Lord Justice McFarlane in a 2018 speech in one word, ‘Clarity’. Lord Hodge, deputy president of the Supreme Court, speaking at an Expert Witness Institute (EWI) online conference
135
What is a practice worth?
The answer to this is whatever someone is prepared to pay for it.
It is not just based on previous performance but more on future potential. The accounts for the years before need to be scrutinised and therefore need to be complete, tidy and understandable. A good accounting software package and a diligent accountant are important.
Net profit is more important than turnover. A calculation of EDITDA (Earnings before Interest, Taxes, Depreciation and Amortisation) should be made.
The advisers of the seller and the buyer will both consider this in determining the worth of the business by using a multiple, which is usually x 4-6 in small medical businesses. It should also be remembered that the value is greater with more potential buyers.
Selling a smaller personal practice is more of a challenge. The benefit for the buyer may be room rental security and a digressive profit share of 30%, 20% and 10% over a few years. This may be a personal arrangement between a senior consultant retiring and a junior consultant stepping up to private practice.
There is only a limited legal framework for such a sale. This may be fraught with difficulties and damaging to personal relationships unless done correctly.
Patients cannot be sold as an asset because, if they do not like a successor, they will go elsewhere.
Dr Donald Gibb, The Birth Company
Private GPs’ phlebotomy cases
Requests for help with phlebotomy complaints from NHS GPs are rare, but there were more than we expected among private practitioners, including several patients who experienced bruising or soreness after their blood was taken.
This may reflect that private GPs carry out fewer blood tests than NHS services, where this task is more commonly done by a dedicated phlebotomist in the practice or local hospital.
In the MDU’s experience, levels of expectation are likely to be higher in patients who are paying for medical services.
While bruising is a common side-effect of having blood taken, it is possible that the patients who complained did not expect this to happen. It highlights the importance of warning patients about risks when obtaining their consent, so they have realistic expectations.
Dr Sarah Jarvis, a medicolegal advisor at the Medical Defence Union (MDU)
140
Point of sale (POS) finance
POS finance products have been used extensively in the cosmetic and dental markets for a long time.
Both have traditionally had a significantly larger proportion of business-to-consumer work than the acute healthcare sector, whose business has historically and predominantly been based on relationships with private medical insurers and local NHS trusts and clinical commissioning groups.
Anne Coyne, consultant relationship manager, Private Healthcare Information Network (PHIN)
138 Interviewing for a PA post
Using a competency-based interview technique, you should ask relevant questions about past experiences and how the individual handled them, such as:
Describe a situation in which you dealt with an unhappy patient.
Give an example of a time when you made a mistake and how you would do things differently now.
How do you maintain good working relationships with your colleagues?
What has been your greatest achievement?
Describe an example in your previous role where you improved the efficiency of the practice.
Jane Braithwaite, managing director, Designated Medical
139 PPU potential is under valued
Outside of central London, few private hospitals have critical care capability and this leads to many trusts admitting insured patients as NHS cases for complex highvalue procedures and tests.
The true value of this missing potential income stream is not known, but estimates certainly put the opportunity at perhaps £1bn a year.
Philip Housden, managing director, Housden Group
The adoption of POS finance products in the acute sector has therefore been much slower to develop and was used mainly as a last resort for those patients who were struggling to afford upfront, private treatment.
There was little advertising, hardly any promotion and little mention of them early in the patient journey. But this has all now started to change as the selfpay market has grown, mainly due to the deteriorating state of NHS waiting lists. They have become a larger contributor to hospital revenues and profits.
Richard Gregory – runs an independent healthcare consultancy, specialising in selfpay
Independent healthcare providers have seen a greater improvement in the ‘speaking up’ culture in their organisation over the last year compared with other parts of the healthcare sector, according to the National Guardian’s Office (NGO). Surveying over 300 Freedom to Speak Up Guardians, the report found that almost four-fifths (78%) of respondents from independent healthcare providers said their organisation’s ‘speaking up’ culture had improved over the last twelve months.
This compared to 74% for respondents from NHS trusts, and 65% of those from the hospice sector.
The Independent Healthcare Providers Network is calling for all independent providers to appoint a Guardian if they have not already done so.
Independent Practitioner Today report
Your company year-end does not need to follow the usual 5 April personal tax year-end. In fact, it is often advantageous to have a company with a year-end which does not follow the usual tax year, as this can be useful for tax planning. The year-end can be changed and you may wish to consider this if, for example, your company is working in a group through another business such as a limited liability partnership– or LLP as it is known – so that your company year-end is in line with that of the LLP to aid accounting.
Alec James, partner, Sandison Easson & Co, specialist medical accountants
The Independent Sector Complaints Adjudication Service requires consultants to:
Provide patients with written information about the amount being charged, the associated method of payment prior to outpatient consultations and the commencement of the services;
Be transparent about the costs of any proposed care or treatment;
Explain to patients the reason for any proposed tests or investigations and provide details of any associated costs prior to them being carried out;
Advise patients to check the terms of any insurance policies, where relevant, to enable them to
145 Digital healthcare
While digital healthcare is not clinically appropriate for all circumstances, it is particularly suited to things such as follow-up appointments and the treatment of some ongoing chronic conditions where a physical assessment isn’t necessary.
However, in adopting a digital approach, we need to create a way forward that is accessible to all and takes account of patient needs and preferences.
determine their level of cover regarding any proposed tests, investigations or procedures;
Where alternative treatments are available, but the appropriate treatment can only be decided during surgery, to provide a written estimate of costs setting out relevant options and associated fees.
Managing the volume of activity generated by the group is the single biggest issue that they deal with and the more successful the group, the bigger this issue becomes.
The administration required for consultants working together is often underestimated. This covers all aspects, from the raising of the invoices to the volume of phone calls and emails that require answering on top of dealing with private medical insurers, clinics and hospitals.
In our experience, often the first job to be set aside is the reconciliation and chasing. Delays in reconciliation mean that debt and cash flow suffers, because if you do not know what is outstanding, then it is impossible to raise shortfall invoices in a timely fashion and chase any money owed.
This situation can easily escalate, as the busier the group practice becomes, the less time is spent on this function and money owed to the group accumulates.
Simon Brignall, director of business development, Medical Billing & Collection
We need to bear in mind the challenges faced by groups who tend to be digitally excluded and develop services that help them overcome the barriers to access; for example, by offering options in multiple languages and alternative formats.
Dr Leah Jones, head of Behavioural Insights, Bupa
146
Good first impressions
Doctors’ receptionists generally get bad press for a very difficult and stressful job. But your private practice is something different and your secretary is possibly your patients’ first contact. Are they kind? Helpful? Convey the information correctly? Portray you positively? Do their job? Respond to emails quickly? Some harsh questions, but all very important. This is a business and your secretary is the ‘face’ of your business being the first point of contact.
The surgeons I have worked for have easily gained patients that had planned treatment with others and then gave up as they did not get answers to their questions, a date for surgery or even a callback. I heard this so many times. An easy win for my clients but only because the others were missing a vital part of their business.
Catherine Harriss, founder of MultiWorks Marketing ➱ continued on page 42
147 Challenging times for private consultants
Why do most doctors go into private healthcare? The opportunity to increase income is an obvious factor, but this is only a small part of it.
I believe that the ability to give individualised high-quality healthcare where the doctorpatient relationship is paramount is the over-riding reason.
A consultant-led service, the ability to introduce innovation –within governance guidelines – and a degree of control over working practice are also key drivers.
But the wind of change is, as we all recognise, blowing hard in the independent sector. Traditional ‘practice privilege’ models, where doctors treat their patients in private hospitals, are transitioning to new models of delivery of medical care.
Salaried consultants, chambers models and fixed contracts are now becoming more common. It remains to be seen whether these new models of working will replace traditional working practices.
The future of private healthcare is unclear. There is clear evidence that recently appointed consultants are less attracted to private medicine.
This may be because of start-up costs, lower remuneration rates from insurance companies – compared to more established colleagues – increasing administrative overheads and the ability to boost
incomes without significant expenses by doing additional paid NHS work.
With colleagues retiring, this will in the near future lead to a significant shortage of doctors in the independent sector with severe consequences for patient care and indeed the healthcare system in this country as a whole.
Mr Ellis Downes, chair, London Consultants’ Association (LCA)
(CMA’s) Private Healthcare Order
The CMA is serious about ensuring hospitals and consultants comply with the obligations set out in the Order. We are in regular contact with them on the topic.
We will always work with consultants and the hospitals to avoid escalation and the CMA commencing enforcement action where we can. However, if consultants fail to participate, they should be under no illusion, the CMA will press ahead with enforcement measures as it does in many other sectors.
Dr Ian Gargan, chief executive, Private Healthcare Information Network (PHIN)
149 Expert witnesses certification benefits
Over the last year we have continued to see the credibility of expert witnesses called into question where experts have acted in the
role without fully understanding their duties to the court.
Certification provides a clear indication to those who instruct you that you can deliver. It provides validation of your practice as an expert witness by a professional body and demonstration of your commitment to professional development.
Certified expert witnesses appear at the top of all search results on the Expert Witness Institutes’ (EWI’s) ‘Find an Expert Witness’ Directory. They can make use of the postnominals MEWI (Cert) or FEWI (Cert) – if they have been previously accepted as a fellow of the Institute.
Simon BerneyEdwards, chief executive, Expert Witness Institute (EWI)
key opinion leaders for comments on topical issues and charities.
SpecialistInfo chief executive and consultant ENT surgeon Ms Olivia Whiteside
to look for in a PA
Excellent communication skills, strong organisational skills, flexibility and adaptability, resourcefulness, attention to detail, initiative, reliability, discretion and loyalty, resilience – and saving the best to last – a good sense of humour.
Dawn Shrives, director, Business Admin Services https:// dsbas.co.uk
GMC confidential helpline
Thousands of patients use the private sector every year in the UK and, as with all of healthcare, safety is a top priority. Our confidential helpline is a source of support open to health professionals across all sectors – if you have a safety concern you want to discuss, get in touch.
Charlie Massey, chief executive, GMC
Find out more on the GMC website www.gmc uk.org/ concerns#doctorcolleague.
151 Promoting yourself
We have information on over 100,000 UK consultants and GPs and our directory has become an invaluable resource for those working in and allied to the healthcare industry.
Though it was originally intended as a service for GPs to aid their referral process to consultants, the NHS has evolved and the database has developed much wider uses.
Although it is still used for this process, it also helps:
Doctors who undertake medicolegal work to promote themselves to law firms;
Doctors interested in clinical trials and research to communicate their interest, expertise and experience to pharmaceutical, medical device and research organisations ;
The media to find experts and
It is natural for providers to get overwhelmed during periods of high Care Quality Commission (CQC) interest and/or involvement in their service(s). Onsite inspections are often targeted and fail to accurately review a service as a whole.
This is indicative of the CQC’s ‘risk-based approach’, meaning that a provider is likely to only be inspected where the watchdog believes there are issues to be found.
Also, the accuracy of information obtained at an inspection is only reflected to the extent of an inspector’s understanding of the services offered by a provider.
This is evidenced through the limited and/or inaccurate information provided in a draft inspection report and/or warning notice.
A provider is the only reliable expert on the nature of its service. If the CQC fails to accurately cap-
ture a provider’s service, then we strongly encourage a provider to exercise its right of reply through factual accuracy comments and/ or warning notice representations. Samantha Guest, ‘registered foreign lawyer – New Zealand’, working for Ridouts Professional Services Ltd, London
Some consultants are not aware of how patients fund their consultations or treatments. While most treatments will be funded by an insurer, they do have to be pre-authorised by the insurer and it is important to know that this can be required at each stage of the process if the treatment/ investigation pathway changes. There may even be cases where a self-funded patient has underestimated the cost of the treatment they have agreed to.
Consultants have a duty of care to protect patients in this process to ensure they avoid falling victim to hidden charges imposed on them either by their insurer or by underestimating the self-funded costs.
By working with amii (the Association of Medical Insurers and Intermediaries), consultants can increase their awareness of funding options for patients, enabling them to better advise those who come to them seeking treatment.
David Middleton, executive chairman, amii
For our doctors, being salaried has a number of benefits. We are fully committed to supporting their further professional development in the shape of paid study leave, budget for training and courses, and providing the resources they need.
We also support with appraisals and revalidation and, of course, offer benefits such as sick leave, annual leave, pension, a far greater work-life balance than in the NHS and faster pay progression. But more than that, we run consultant-delivered services providing outstanding care and excellent patient outcomes. We are innovators and our doctors can quickly and easily implement ideas to affect change in their service without layers of red tape and bureaucracy.
Dr Marcelle Michail, medical director, Practice Plus Group
and how you see yourself attracting patients to your clinic. Discuss your opportunities for cross-referrals to other specialists in the hospital. The hospitals are there to help support your practice but they will expect a collaborative approach.
Sue O’Gorman, Medici Healthcare Consultancy
157
Stand out from your rivals
Finding ways to stand out over your competitors has never been more important than it is now.
Longer NHS waiting times mean more patients are looking for a private doctor. One-in-eight Britons used private healthcare in the last 12 months, with a further quarter considering it.
Regardless of the method potential patients use to reach out to your business, a swift response can dramatically improve outcomes.
According to a recent YouGov investigation, the main advantage of private healthcare for patients is speed, with over half saying the top reason they went private was to be seen quicker (53%).
The same logic applies when patients are getting in contact with private practices. If you don’t reply quickly, patients will look for someone who does.
Neil Davies, managing director of communications specialist Cymphony
158
‘Good Medical Practice’ 2024
privileges
Do not be tempted to gather practising privileges at multiple locations. You will spend more time travelling from A to B to C for which you are not earning, are likely to run late for clinic and frustrate the hospital staff who may have to pacify agitated patients on your behalf.
Ultimately, you will be treated as a ‘splitter’ rather than someone who is loyal to their facility.
You may be asked to meet with the facility chief executive ahead of your application, so be prepared to discuss your plans for growth
There are some revisions of Good Medical Practice you need to make yourself aware of. The GMC states that the standards have been updated in five key areas to:
Create respectful, fair and compassionate workplaces for colleagues and patients;
Promote patient-centred care;
Tackle discrimination;
Champion fair and inclusive leadership;
Support continuity of care and safe delegation.
To achieve this, the GMC has renamed and restructured the domains contained within the guidance and substantiated a number of areas with written ➱ continued on page 44
examples that can be applied to a contextual scenario, particularly where sexual misconduct and workplace bullying is concerned,
These are two areas the council has clearly placed emphasis upon when preparing the new Good Medical Practice. The first (included in Domain 1) instructs doctors that they must not ‘abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others’.
This applies to all interactions, including online. In addition, doctors should take action, or support others to take action, if they ‘witness or are made aware of bullying, harassment or unfair discrimination’.
In Domain 4, a specific reference to sexual harassment says: ‘You must not demonstrate uninvited or unwelcome behaviour that can be reasonably interpreted as sexual and that offends, embarrasses, humiliates, intimidates or otherwise harms an individual or group.’
Jordan Laybourn, trainee solicitor, and Tania Francis, a partner at Hempsons
159 Cooperative private practice
Co-operative private practice works for us individually and as a co-operative membership. It has undoubtably driven change for the better regarding patient care, surgical support and reassurance for the hospitals.
Together, GAS (Gloucestershire Anaesthetic Services) has been able to work to improve our business from a financial and quality perspective, but this has also helped our hospital partners build their business in partnership with us.
However, finally and maybe most importantly it has maintained a happy and cohesive group of individuals with our NHS department. I, for one, find the reassurance of colleagues who will work with me for the better of all stakeholders truly does prove that ‘working together is success’.
Dr Simon Webster, consultant in anaesthesia and intensive care and clinical lead for critical care at Gloucestershire Hospitals NHS Foundation Trust
Do you know how to protect your data?
160 Aesthetic doctors report business optimism
Reasons include:
Entrepreneurial opportunities;
Giving people back their confidence;
Helping people feel better about themselves;
New treatments coming onto the market;
Patient satisfaction;
Greater flexibility;
Growing market demand;
Diverse employment opportunities;
Continuous learning and development;
Less stressful than NHS job. Hamilton Fraser survey
161
PMI boom
New figures signal a boom in work for thousands of doctors in private practice from patients with private medical insurance (PMI).
Market analysts have revealed demand for private health coverincluding insurance, health cash plans and dental cover – has hit its highest levels since the launch of Independent Practitioner Today in 2008.
They report ‘considerably faster’ market growth than historic norms, with an annual rise of 6.1% between 2020 and 2022 compared to average annual growth of 1.7% between 2008 and 2019.
LaingBuisson said there was ‘surging demand for private health cover as access to NHS services continues to deteriorate’.
Its Health Cover UK Market Report 19th edition puts the overall value
of the health cover market in the UK at £6.7bn at year-end 2022 – up £385m on the previous year.
Report author Tim Read observed that growth was being led by company-backed schemes, which might suggest an increased awareness of the impact of employee ill-health on a business – and possibly frustration at the impact an inaccessible NHS was having on productivity.
News report
An organisation must report misuse of personal data to the Information Commissioner’s Office (ICO) if there is a risk to people’s rights and freedoms, which is often the case with sensitive medical information.
This must be reported within 72 hours of becoming aware of the breach. If your organisation suffers a data breach because of a cyber-attack, you should report this to the ICO within 72 hours of becoming aware of it. The sooner you contact us with detailed information, the better.
Accessing someone’s medical records without cause or consent can be a criminal offence. Working in private healthcare, your role may grant you access to other people’s personal information, but this does not mean you have the legal right to look at it for your own purposes.
If we find evidence that medical records were accessed illegally by a member of staff, we can take action which includes prosecuting the person responsible in court.
Rachel Clarke, senior policy officer at the Information Commissioner’s Office (ICO)
163 Private practice busier than ever
Predictions of a record year for private healthcare sector inpatient admissions have been confirmed by the latest official figures – and now, under a new Government, the sector says it stands ready to help the NHS deal with its everrising waiting list.
Independent hospitals still have spare capacity and have told the Private Healthcare Information Network (PHIN) they can still help
more to ease the pressure on patients and stop people suffering unnecessarily.
Figures from the data body released in June 2024 show new records, with more private inpatient admissions in 2023 than any year since recording began, beating the previous high in 2022. There are more insured and ‘selfpay’ admissions than ever.
PHIN said there were nearly 900,000 admissions to private hospitals in the UK in 2023.
News report
understanding
In the world of medicine, accuracy and efficiency in recording information are fundamental pillars for quality of care, correct billing and regulatory compliance.
Virtual secretaries, as key allies in practice management, play a crucial role in this process. However, in order to optimise dictation and facilitate transcription, the collaboration of the healthcare professional is essential in aspects such as:
Pace of speech;
Avoidance of unnecessary noise in the recording;
Clear pronunciation of words.
The healthcare professional must make it clear to the virtual secretary that medical information is highly sensitive, so important issues such as where the information will be stored and how it will be protected must be discussed from the outset to ensure compliance with the Gen eral Data Protection Regulation (GDPR).
Stacey Burrows, manager at Virtual Medsec Direct
private hospital
Sadly these do happen. For example, a self-pay patient reasonably wants to feel they have had value for their new patient consultation fee.
A simple diagnosis and plan delivered in a few minutes will leave a patient feeling let down, so spend the time of the consultation with them to ensure a good understanding of the problem. If complaints are received, many
will be made to your hospital, so early and constructive engagement with your hospital team is important – you are in it together.
Mr Adrian Chojnowski, consultant orthopaedic surgeon, chair of Spire Norwich Hospital Medical Advisory Committee
166
The hidden cost of unpaid invoices
Unpaid invoices create more than just cash flow issues. They add administrative strain, divert resources and risk damaging patient relationships if handled poorly.
Here are some ways unpaid invoices negatively impact practices:
Disrupted cash flow: Unpaid invoices make it harder to cover essential expenses, such as payroll, equipment and day-to-day operational costs.
Increased administrative burden: Chasing late payments is time-consuming. Practice staff often do not have the necessary resources or expertise to follow up on unpaid invoices effectively. This can divert focus from patient care and create inefficiencies.
Strained patient relationships: Handling overdue payments can be sensitive, and aggressive follow-ups or unclear communication can alienate patients. Striking a balance between financial diligence and maintaining positive patient relations is difficult but necessary.
Derek Kelly, marketing manager, Medserv
167
Promo videos: Embrace authenticity
Creating compelling video content does not require high production values such as an expensive camera, professional lighting or advanced editing software. Authenticity is key – it is your content’s ‘bedside manner’. Recognise that some viewers seek your content due to personal health issues, so treat them as you would patients.
Do not worry too much about polish; showing your personality or sharing personal connections humanises your content. By acknowledging viewers’ concerns and showing empathy, you build rapport and trust.
Professionalism is important, but it is not about choosing one over the other – authenticity also resonates and fosters meaningful connections with your audience.
David Johnson, head of business development at doctify.com
168
Ensure your tax return is submitted on time
While not an exciting form of tax planning, ensuring your tax return is submitted on time helps to reduce any unnecessary late filing penalties.
HM Revenue and Customs (HMRC) has been known to show more of an interest in late submitted returns – which potentially increases your risk of a dreaded HMRC inquiry.
On the subject of HMRC inquiries, many accountants will offer a form of tax investigation cover which covers the accountants’ fees in the event of an inquiry.
But it is worth highlighting that many of the policies will not cover if the tax return has been submitted late, which can then mean the inquiry becomes very costly.
Alec James, partner, Sandison Easson & Co, specialist medical accountants
All writers above held the posts quoted, and worked for the companies/organisations mentioned at the time of publication. Every effort has been made here to cover still relevant advice on ongoing issues. Readers should act on it only after checking with appropriate sources and/or advisers if in any doubt.
With Bupa’s recent fee and policy updates, private consultants have a prime opportunity to enhance revenue. But there are new administrative requirements. Derek Kelly shows how consultants are maximising their revenue
NEW FEE increases and policy changes effective from 1 November 2024, reported that month by Independent Practitioner Today give welcome revenueboosting possibilities for private consultants.
Surgical fees are rising by up to 23%, while consultation fees saw a 7% increase the previous December.
With the introduction of more transparent billing for missed appointments and a streamlined process for complex cases, consultants stand to benefit financially if they can navigate the complexities of these changes.
Managing updated billing codes, fee schedules and claims
submissions accurately is critical to ensuring optimal reimbursement and financial stability.
Bupa’s revised fee schedule now factors in procedure complexity, time requirements, indemnity premiums and administrative costs.
This change, based on an independent review with consultants and input from professional organisations, aims to align reimbursements with the effort required for each procedure, promoting fairer and more transparent billing practices.
Keeping pace with frequent changes can be challenging for
Managing updated billing codes, fee schedules and claims submissions accurately is critical to ensuring optimal reimbursement and financial stability
rent with policy shifts and free up valuable time for consultants to prioritise patient care.
Medical billing services handle every facet of billing, from updating fee schedules to submitting claims and tracking reimbursements to minimise errors and increasing efficiency.
consultants. Partnering with a medical billing company can simplify things by ensuring each invoice reflects the latest updates and it can help to reduce the risks of underpayment, delays or administrative hurdles.
Practices are enabled to stay cur-
This seamless process is especially valuable for practices aiming to take full advantage of Bupa’s updated fee structures without the time-consuming administrative effort.
Practices benefit from regular automated fee updates to ensure consultants are reimbursed at the most current rates. Billing partners’ compliance checks also min-
imise any errors that could lead to claim rejections.
Losses from missed or cancelled appointments
I find that missed appointments and last-minute cancellations represent a common source of revenue loss for consultants.
Under the latest Bupa policies, consultants can now charge for missed appointments if the policy is clearly communicated to patients.
Implementing and enforcing this can be a burden, but billing experts are simplifying this process by integrating a missed appointment policy into their systems, so charges are processed automatically for no-shows.
Consultants are recovering lost revenue efficiently and patient communication templates ensure transparency and compliance with the insurer’s guidelines.
Bupa’s streamlined process for uplift requests in difficult cases now offers response times of under five days.
Quick approval for uplift requests is essential for consultants handling complex or specialised cases and billing partners are helping by preparing, submitting and following up on these requests, ensuring doctors receive full reimbursement for the additional care required.
Long-term revenue optimisation
Bupa’s commitment to regular fees and policy reviews means consultants can expect ongoing changes. Billing companies pro-actively monitor these updates and accordingly adjust their clients’ billing systems, preventing potential revenue losses and maintaining compliance.
Many of them work closely with insurers, advocating for fair policies that support consultants’ revenue needs.
As trusted advocates, billing companies help consultants navigate these policy changes, providing both updated billing systems and educational resources to guide informed decisions.
The insurer’s 2024 fee increases and policy changes bring valuable revenue opportunities, but navigating the changes does require time, attention to detail and thorough policy knowledge.
Those who employ expert assistance can rest assured that billing is handled with accuracy and efficiency. At Medserv, we are committed to empowering consultants to focus on delivering exceptional patient care and giving them confidence that their billing operations are optimised and compliant.
Derek Kelly (right) is marketing manager at Medserv
Unlike traditional asset classes, gold produces no income stream, it does not pay dividends and usually costs owners to store and insure it
BY ITS very nature, the investing industry is full of differing views on how one ought to invest their clients’ hard-earned cash.
One of the more polarising debates is whether an investment in gold, physically or synthetically via an investment fund, makes good sense.
The debate tends to flare up each time gold experiences a rapid growth in value, such as in the last couple of years.
Gold is a standout asset class of the last three years – appreciating by around 15% annually in pound and dollar terms, 16% in Euro and Australian dollar terms and 22% in Norwegian kroner terms.
The ‘why don’t we own any gold?’ question tends to come up more frequently at these times, no doubt fuelled by the financial media.
So let us look at the pros and the cons of gold as an investment, summarising why, on balance, I believe that superior options exist.
The pros Gold is believed to form during cataclysmic events like supernovae, when massive stars exhaust their fuel and explode, or during the collision of two neutron stars – ultra-dense remnants of supernovae.
Due to its lustre and durability, gold has long been prized for jewellery; however, its uses go beyond being just a desirable accessory.
It is an excellent conductor, highly malleable, stable at high temperatures and inert, meaning it does not rust. These properties make gold invaluable in industries like electronics, medicine and aerospace.
Why don’t we own any gold? Guy Beck examines the pros and cons of the ‘golden illusion’
ditional assets such as bonds and equities, providing potential diversification benefits.
Unlike many investment opportunities, gold is a relatively simple concept – being a lump of metal with a market value – and is easily accessed via physical purchase or low-cost open-end funds.
The cons
As a commodity, gold prices are simply a function of supply and demand. Investors in gold assume that others will desire it even more avidly in the future, with each new buyer hoping that others will follow. If this sounds quite speculative, it is because it is.
Estimating what to expect from an investment in gold, even over extended periods, is difficult.
Unlike traditional asset classes, gold produces no income stream, it does not pay dividends and usually costs owners to store and insure it.
As a result, many assume its long-term expected return to sit somewhere near cash, which is underwhelming from a growth perspective compared to sensible alternatives.
If we look at data on the value of gold from 1926 to August 2024, we can see that one ounce of gold rose from around $20 to just over $2,500. Investing the same $20 in global equities during this period would have delivered a substantially superior outcome, nearly 50 times the cumulative gain.
It is also important to note that this time-frame includes extended periods where government policies, such as the Bretton Woods Agreement*, influenced gold prices.
Perhaps it is no wonder that humanity has coveted gold for well over 6,500 years. This enduring demand is where the value of gold comes from, and its attractiveness to investors. One impressive quality of gold is that it has retained purchasing power across the centuries.
As an Armageddon hedge, investors face a dilemma. Due to its bulk, weight and the associated costs of storage and management, many opt for synthetic products like gold-backed funds or exchange-traded funds (ETFs) instead of owning the metal directly.
For example, in gold terms, a Roman centurion of 2,000 or so years ago was paid broadly the same as a US army captain today. It is this that leads some to propose physical gold as a long-term hedge against the collapse of fiat currency and global capital markets. Other positives are that gold offers uncorrelated returns to tra-
If the goal is to hedge against a collapse of the financial system, then relying on that system to achieve exposure to gold makes little sense.
Owning physical gold comes with its own challenges too, such as storage and risk of theft.
Gold proponents may point to inflation hedging as the main
attraction, but the evidence is unconvincing.
While gold has maintained its value over millennia, across more useful time horizons to investors, the results are less impressive.
For example, after inflation in $US terms, as I write, gold has yet to get back to its February 1980 high nearly 45-years ago. It also suffered an 83% fall in value over the subsequent two decades –hardly a reliable inflation hedge.
The portfolio
Like any investment decision, gold has its pros and cons. Assessing whether it belongs in your investment portfolio is the job of your financial adviser.
Each asset class must fill a specific role in your portfolio and is weighed up against the alternatives. Gold has some favourable traits, but you must take something out to put another thing in. Superior options exist for your portfolio, such as shorter-dated high-quality bonds and inflationlinked bonds on the defensive side and developed and emerging market equity as well as commercial property on the growth side.
As Warren Buffet succinctly puts it:‘If you own one ounce of gold for eternity, you will still only own one ounce at its end’ (2012).
* In July 1944, while the Second World War continued, a conference took place in Bretton Woods, New Hampshire, US. Delegates from 44 nations met to agree a system of economic order and cooperation to help countries recover from the war and to plan global growth in the years that followed.
Guy Beck is a senior financial planner with Cavendish Medical, specialist financial planners helping consultants in private practice and the NHS
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested
Assume nothing and expect anything when it comes to sexual activity. Dr Ellie Mein (left) advises on discussing the subject with an older patient
QI’m a private GP who recently received a complaint from a widowed elderly man following a conversation in which I asked if he was sexually active when he presented with orchitis.
I am currently being assisted in responding to the complaint but I do wonder if there is an obvious age cut-off for asking about sexual activity in a medical history?
AThose aged 60 and over are set to make up 17% of the global population by 2030 and their sexual behaviours are very different to that of their counterparts from 50 years ago.
Increased lifespan and access to treatment for erectile dysfunction and HRT, among other factors, means this sector of the population is more sexually active than previously. A 2016 study found that half of men and almost a third of women aged 70 and over reported being sexually active.
Not only are they more sexually active but the risks associated with this activity in their age group has changed. Trends and statistics on sexually transmitted infections (STIs) in older adults vary by region, gender and specific disease.
However, research from the US Centers for Disease Control and
Prevention demonstrated that, in US adults aged 55 and over, the rates of chlamydia, gonorrhoea and syphilis had more than doubled in the past ten years.
England-specific figures released in an updated report by the UK Health Security Agency in June 2024 are also of interest. While the report’s main points and overall trends did not focus on STI patterns in the older age group, the raw figures support that STDs in ove-65s are not vanishingly rare. By way of example, in 2023 there were 2,278 new STI diagnoses in men aged 65 and over.
Possible drivers for increased numbers of STIs in older adults over the last few decades include:
More single older adults due to rising divorce rates;
The availability of Viagra;
A focus on no risk of pregnancy reducing condom use;
The prevalence of dating apps;
Older adults living in retirement communities or shared residences.
A false sense of security and lack of sex education among older adults along with the statistics on sexual activity and associated infections in their age group, therefore, does mean that it is perfectly reasonable to still include an inquiry about sexual activity when taking a history for conditions where it could be relevant.
As with any potentially awkward questions, ensuring the reason for the question is explained – and the way you ask – is appropriately sensitive will be important.
‘I don’t want to offend you, but so we cover all the necessary possibilities I do need to ask if you might be sexually active in case that could be a factor in your symptoms?’
Recognition that it might offend and explaining why it is important to ask ahead of time is often better received than a direct: ‘Are you sexually active?’
It is also understandable that when the patient is widowed, they may find the question even more uncomfortable or insulting due to perceptions about what grieving should look like and how long it should last for.
Despite sex and widowhood being taboo, some women describe a strong desire for sex after bereavement, the so called ‘widow’s fire’.
So it is important not to assume that just because someone has lost their partner that they are celibate.
With this in mind, how can these difficult conversations be made easier for all parties?
☛ Awareness that sex remains an important aspect of many older people’s lives is a good starting point.
☛ Recognising your own biases and assumptions around sex and older people can help you consider how this may influence your discussions.
☛ Leading the patient into questions about sexual activity with a recognition they may find it awkward and an explanation about why you are asking is better than trying to be businesslike.
☛ Avoid assumptions about what sex involves for the patient or what gender their partner may be, even if you were familiar with their late partner.
☛ Make it clear that sexual dysfunction or other symptoms are valid health problems for people of any age.
☛ Similarly explaining the impact that other health conditions or medications could have on sexual activity may allow the patient to express concerns they might otherwise feel unable to.
☛ While using medical terms to ask about sex may feel like a more professional way of approaching the conversation, patients may struggle to fully understand your meaning. It can be helpful to ask them what terms they are comfortable with and to check they understand what you are asking. Essentially, using the approach of ‘assume nothing and expect anything’ is wise in these cases.
Factors including advanced age, ill health, religious background or social circumstances do not necessarily imply the patient is not sexually active and making false assumptions can lead to missed diagnoses.
Being proactive and yet sensitive about initiating such discussions could also offer the opportunity to provide that patient with sex education and prevent further health issues.
Dr Ellie Mein is a medico-legal adviser at the Medical Defence Union
‘I want my money back!’ Dr Sissy Frank (below) advises on what to do if a patient asks for a refund
QI’m a sports and exercise medicine consultant who recently saw a self-funded patient who was seeking treatment following a sports injury. The initial treatment went well, but the patient failed to attend a follow-up appointment and has now called my clinic to complain of complications. However, he has declined to attend a further assessment and instead is asking for a full refund. How should I respond?
AAlthough the patient has not made a formal complaint, he is clearly dissatisfied and it is appropriate to treat this matter as a complaint.
It is important to reassure the patient that his concerns are being taken seriously and that they will be investigated in line with the clinic’s complaints procedure. It is also a good idea to include a copy of that procedure in your correspondence so the patient knows what to expect.
In the latest edition of Good Medical Practice (2024), the GMC makes clear that you should ‘put matters right if possible’ (paragraph 45) and that you must ‘respond promptly, fully and honestly to complaints’ (paragraph 46). A complaint response would
Ultimately, the decision as to whether to accede to the request for a refund is a matter for your discretion
normally include a factual account of the care provided; a clear explanation of the treatment and a response to the concerns raised.
The response should also explain what the patient can do next if he is still unhappy. The Independent Sector Complaints Adjudication Service provides a complaints review service to subscribing independent providers.
Even if the patient subsequently escalates his complaint, your ability to show that you have responded fully to his concerns can help to prevent criticism of the complaints handling process.
Ultimately, the decision as to whether to accede to the request for a refund is a matter for your discretion. Such payments can be made as an ex-gratia payment, a goodwill gesture made without an admission of liability.
Unfortunately, even if you do decide to reimburse the patient, there is no guarantee that the patient won’t make a claim for alleged clinical negligence.
However, the Compensation Act 2006 makes clear that an apology, offer of treatment or other redress does not, in and of itself, amount to an admission of negligence or breach of duty.
Remember that a professional and courteous response to a patient’s concerns may well be disarming and help to restore his trust, so it is worth seeking specific advice from your medical defence organisation about to any response you may wish to make.
Dr Sissy Frank is medico-legal adviser at the Medical Defence Union
Although the patient has not made a formal complaint, he is clearly dissatisfied and it is appropriate to treat this matter as a complaint
As we approach the end of another tax year, accountant Alec James gives Independent Practitioner Today readers his top ten tax tips to ensure you have the upper hand on the tax inspectors
1 Always save for tax
As an individual, you will have tax and potentially National Insur ance liabilities on any sources of income which are received ‘gross’. This could include self-employed income, dividends from a company, interest or rental income.
If you have a limited company, then it will also need to save for the corporation tax liabilities. It is important to regularly save towards these liabilities, as there is often a long delay between you receiving the income and paying the tax. An accountant will be able to advise you the amounts you should save each month.
2 Make use of tax allowances
There are a number of schemes available for UK taxpayers which are ‘use it or lose it’. These include the personal allowance, savings allowance and dividend allowance. Any unused allowances at
the end of the tax year cannot be carried forward and are lost.
If you retain any of your personal allowance, it is likely to be set against any NHS salary. There may, however, be opportunities to involve family members in your private practice business which utilises their personal allowance. Depending on the nature of the payment, this could either be a salary for work done or a dividend distribution if they are a shareholder of your limited company. If choosing to pay a salary, it is important that they are genuinely working for the business.
Taxpayers are also entitled to a savings allowance and dividend allowance. If you are exceeding the allowances and your spouse is not, it may be worth considering restructuring your investments so that you both utilise them.
3
Make use of tax-free investments
There are currently a number of tax-free investments opportunities. In addition to the usual ISA savings accounts, there are also Stocks and Shares ISAs which allow for tax-free investing.
A change at the beginning of the current tax year allows you to have multiple accounts, providing you do not exceed the annual deposit allowances across all your accounts.
Depending on your personal circumstances, you may be eligible to make use of the Lifetime ISA. This is a long-term savings scheme which allows you to save and receive an additional 25% contribution from the Government.
The drawback of these accounts is the eligibility of applicants together with the strict terms of the reasoning for drawings funds. Any withdrawals made which are not allowable under the scheme suffer a 25% reduction, which can lead to the monies withdrawn being less than you originally contributed.
In the not too distant future, it is expected that HM Revenue and Customs will be requiring nearly all businesses to make Making Tax Digital submissions
When you have any form of business, you are required to maintain adequate and accurate records of your business’ financial performance. Currently, this can be kept in any format providing it is easily understandable.
In the not too distant future, it is expected that HM Revenue and Customs (HMRC) will be requiring nearly all businesses to make Making Tax Digital submissions. With this in mind, many doctors will need to use a form of a digital accounting package to record the financial activities of their businesses.
Speaking to an accountant prior to the commencement of Making Tax Digital allows plenty of time for you to choose the right accounting package for you and also allows plenty of time for you or your secretary to become comfortable using the software.
Many of the clinical software providers have links between their platforms and digital accounting packages which can help reduce the administrative implications of Making Tax Digital.
There will be certain expenses which will be paid at the same time each year, such as professional indemnity cover.
But for other expenses, particularly the purchase of expensive medical equipment, the timing in which the costs are incurred determines when the tax relief can be obtained.
Businesses can currently claim an Annual Investment Allowance, which allows for 100% tax relief to be claimed in the year of purchase, of up to £1m a year.
Accelerating the purchase of new equipment to before the end of your business year-end ensures you receive the earliest tax relief. If the cost is delayed until the start of the next business year, it could be over 18 months until you receive the tax relief you are entitled to, which can have cash flow implications.
While the £1m allowance is more than enough for most doctors, those who are working collaboratively with other doctors creating their own clinical facilities may need to consider delaying the purchase of equipment to another tax year if they are close to the £1m threshold.
continued on page 54
CloudRx take care of the dispensing, payment and delivery of medicines direct to your patients for more convenient access their medicines.
Prescribe within your chosen clinical system via our frictionless integration with Semble, WriteUpp, MidexPRO, eClinic, Pabau, Jelly Software, and ClinicYou. Alternatively, simply register for free and prescribe directly at www.cloudrx.co.uk. Repeat prescriptions and controlled drugs.
Prescriber fees can be charged if desired. Easy access to medicines not normally stocked by most pharmacies at great prices.
“We were struggling to keep up with the admin side of the prescriptions, not to mention storage for medication to cope with a huge increase in prescriptions. CloudRx immediately took away the strain. Since our partnership we have grown by over 200% in size. We could not have done that without their support. It has allowed for seamless scalability...”
The FREE and integrated digital prescribing platform used by almost 1000 private prescribers every month – Dr Louise Newson, Newson Health
In recent years, there have been a number of changes to both the pension savings annual allowance and the way growth is calculated within the NHS Pension Scheme(s). Currently, most taxpayers are entitled to a £60,000 pension savings annual allowance.
Having a larger allowance can lead to scope for you, and/or potentially your ‘significant other’, to have a pension contribution paid for by your business. If you have a limited company, tax relief is available for pension contributions for the company.
If you do not have a limited company, you are only able to claim tax relief on your own pension contributions.
While you are not able to claim tax relief for a spouse’s pension contribution on your own tax return, there are schemes available that allow you to contribute a small amount to their pension scheme each month which is given tax relief at source.
In years where you do not not utilise the full pension savings annual allowance, there is opportunity to carry forward the unused amount up to three years.
Before considering making any private pension contributions, it is very important to discuss this with your accountant and an independent financial adviser who specialises in the NHS Pension Scheme to avoid any costly mistakes.
There are four main ways to trade when working as a business: sole trader, partnership, limited company or limited liability partnership.
Limited companies are often adopted as the trading structure for a private practice, particularly where there is a spouse or partner in a lower tax bracket.
In recent years, for those companies with profits of more than £50,000, corporation tax rates have risen. It is always worth considering whether the trading structure you currently have is the best solution for you.
There are a number of different factors which need to be considered including the tax position of you and your partner/spouse, as well as considering risk mitigation and your need for the monies generated. With the cost-of-living crisis still impacting many, more doctors are in need of the income generated from their private earnings, which can lead to original tax planning solutions needing to be revisited. An accountant who understands the NHS and private healthcare sectors will be able to advise on the best structure for you.
If either parent living in the same household’s threshold income is over £100,000, you cease to be entitled to the enhanced free number of hours or eligibility to the tax free childcare system
As a parent of young children myself, I know all too well the financial pressures of childcare costs. For working parents, there are allowances in place which help reduce these costs.
Depending on your ‘threshold income’, you may be able to access HMRC’s tax-free childcare system as well as an increased number of free nursery hours.
Threshold income is your taxable income less any Gift Aid and private pension contributions you may have paid personally during the tax year.
If either parent living in the same household’s threshold income is over £100,000, then you cease to be entitled to the enhanced free number of hours or eligibility to the tax free childcare system.
If you have received any benefits from the scheme and you are not entitled to them, these need to be repaid to HMRC.
For those taxpayers close to the
threshold income levels, there are options which can be considered to help you retain your entitlements.
These include utilising salary sacrifice arrangements, making private pension contributions or Gift Aid donations or transferring a source of income into a limited company.
Many are guilty of assuming that because their employer deducts and pays the tax on a salary – or a pension – then the tax paid on your salary is correct.
The deductions your employer –if you have one – makes are based on your tax code. This is a code given by HMRC which tells your employer what rates of tax to deduct. These range between one to four digits and a letter.
Many are guilty of assuming that because their employer deducts and pays the tax on a salary – or a pension – then the tax paid on your salary is correct
increases your risk of a dreaded HMRC inquiry.
On the subject of HMRC inquiries, many accountants will offer a form of tax investigation cover which covers the accountants’ fees in the event of an inquiry. But it is worth highlighting that many of the policies will not cover if the tax return has been submitted late, which can then mean the inquiry becomes very costly. Next time: Make tax savings before they expire
This is especially important if you have more than one source of income with tax deducted at source.
HMRC issues a tax code and you should also receive a calculation of how your tax code has been made up. Having this checked by an accountant can help ensure that any incorrect codes are rectified early to avoid an unexpected tax liability.
While not an exciting form of tax planning, ensuring your tax return is submitted on time helps to reduce any unnecessary late filing penalties.
HMRC has been known to show more of an interest in late submitted returns – which potentially
The driver’s display is 11.9 inches and the central display is 14.5 inches. There is even the option of a separate screen for the passenger
The Q6 failed to excite Independent Practitioner Today’s motoring correspondent Dr Tony Rimmer (left), but if you are after a highquality comfortable EV for the family then he says it’s worth a closer look
EVERY YEAR in the world of medicine there are significant advances made in the treatment and management of many conditions. In the world of cars, it is no different. The major manufacturers have taken on the whole new technology of electric propulsion over just the last several years and every new EV car that comes to market offers a bit more refinement and efficiency as the R&D departments gain more knowledge and experience.
To welcome in its latest generation of EV platform and drivetrain, the VW group has used the Audi brand to run with it first and has launched the Q6. As the name suggests, it fits in between the smaller Q4, which I have a soft spot for, and the larger Q8, which I feel is too big and too expensive.
The new Q6 is pretty much identical in size to the petrol Q5 SUV and, indeed, the new EV platform will be used on the all-electric Porsche Macan. All good so far. However, more worrying for Audi is the wide choice of very capable competitors – particularly the BMW iX , the Mercedes EQE, the slightly lower-priced Tesla Model Y and Hyundai’s excellent Ionic 5.
Prices start from £59,975 for the entry 252bhp rear-wheel drive model with an 83kWh battery and work up to the top model: the £92,950 SQ6, which has a 100kWh battery, quattro four-wheel drive and 490bhp.
The model that represents best overall value for most of us sensible medic buyers is the mid-range
£66,475 S-line Performance which is rear-wheel drive, has a 100kWh battery and 322bhp.
It also claims a range of up to 361 miles, which means, in the real world, it should manage a typical long journey of 250 miles without a recharge. This was the model that I had on test.
First things first. This is a pretty unobtrusive car in appearance. It looks like any other Audi SUV and will not be turning heads as you cruise by.
Melt into background
The design is not helped by the lack of a Sportback option that normally lends a little style to its sibling SUVs. At least it doesn’t look as odd as BMW’s iX. If you like to melt into the urban background without attracting attention, then this is the car for you.
Things are a bit more exciting when you step inside. The typical high quality of all Audis is there and enhanced by a large set of infotainment screens.
The driver’s display is 11.9 inches and the central display is 14.5 inches. There is even the option of a separate screen for the passenger, but I think that the number of customers who ask for this facility must be very few. This is a typical example of ‘just because you can does not mean that you should’.
Interior room is, as expected, plenty for four or five adults and their luggage. The boot is spacious and there is a very useful ‘frunk’ at the front of the car where you can store the recharging cables and any dirty items like walking shoes
– something that BMW and Mercedes do not offer.
So, how does this new Audi EV with its all new electric platform actually perform on the road?
To cut to the chase, the Q6 is at its best on the motorway. It is quiet and smooth and the standard airsuspension mops up most bumps and undulations at a 70mph cruise.
Wind noise is minimal, but road noise from the wide tyres can intrude. However, once you get onto winding ‘A’ or ‘B’ roads, the car feels a little out of its depth.
The steering lacks feel and the body’s high weight is not convincingly controlled effectively enough by the suspension.
Keen medic drivers among you will not appreciate this and would be better served by the BMW iX, which can be fun on a twisty road. Perhaps VW has deliberately left it for Porsche and the new Macan to deliver driver thrills from the same platform.
So, the Q6 is a well made, efficient, family-friendly, electric SUV. It is certainly a step forward technically from the Q4 and Q8 but it just lacks a bit of character and charisma.
I like cars that make you feel that doing any trip will deliver a bit of fun and interest along the way. However, as a high-quality comfortable EV for the family that is practical and efficient, I would suggest it deserves your consideration.
Dr Tony Rimmer is a former NHS GP practising in Guildford, Surrey
Independent Practitioner Today features an online advertising directory to complement our journal and website.
Split into ‘business’ and ‘lifestyle’ directories, they list the services private doctors need to run their practices or spend their well-earned money on.
ADVERTISERS: The deadline for booking adverts in our February 2025 issue is 24 January
Published by Healthcare Today Ltd. Healthcare Today is editorially independent.
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
Our sponsors
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.
© Healthcare Today Ltd 2025 Registered office: Connect 38, 1 Dover Place, Ashford, Kent TN23 1FB
WRITE TO
Healthcare Today Connect 38, 1 Dover Place, Ashford, Kent TN23 1FB
TELL US YOUR NEWS Glen Ferris, editor-in-chief
Email: glen.ferris@healthcaretoday. com
Phone: 07780 298825
ADVERTISE WITH US
To advertise in the digital journal, on our website or in our business directory, contact advertising manager Andrew Schofield at Spot On Media. Phone: 0161 408 3912
Email: andrew@spotonmedia.co.uk
