My first year in private practice

NB: Congratulations, Krishna, on such a successful start in private practice. You have managed to generate over £100k of revenue to Spire Hartswood Hospital during a period when self-pay and private medically insured volumes have come under immense pressure across most specialties.

KV: It’s true, I’ve had a good first year and I’ve enjoyed it a lot. I put in a lot of up-front preparation and that seems to have paid off.

Also, I was fortunate to take on several private trauma cases last autumn for patients who contacted the hospital direct. I just happened to be in the right place at the right time and was able to help out.

NB: When you first came to see us in autumn 2008, you hadn’t long been appointed to your consultant post. Did you plan to start private practice so soon?

KV: I’d already been a locum consultant in the trust for over a year, so I was already familiar with my NHS job and knew my colleagues. I felt ready to dip my toes into private practice.

One of my colleagues, shoulder specialist Mr Ali Al-Sabti, chairs The Hartswood Medical Advisory Committee and he encouraged me to apply. Other orthopaedic surgeons recommended the hospital highly too.

I felt welcomed by the management team, who offered me lots of tips on getting started. In fact, it was you, Nicola, who gave me a copy of Independent Practitioner Today and suggested that a subscription would be a good investment.

NB: So how did you prepare for ‘going private’?

KV: It took a couple of months for the practising privileges, Criminal Records Bureau checks and so on to go through, so I used this time to set up the office side of things.

First and foremost, I needed to decide on secretarial support. I asked my NHS secretary, Jo Cronin, whether she would consider working for my private practice too. I know this hybrid arrangement doesn’t work for everyone, but, for me, it’s been great. Jo is a very experienced medical secretary and I was clear from the start that the private practice needed to be kept separate and not encroach on NHS time.

We use a mobile phone and separate email addresses for the private practice and Jo picks up calls early in the morning, at lunchtime and later in the afternoon. She finishes her NHS day at 4pm and then does my private work from home.

We make sure that the voicemail message assures patients they will get a call back the same day and they have my number as well.

One of Jo’s many strengths is the relationship she has with patients over the phone and that’s very important to me.  As I’m getting busier, I do have a concern about private patients being able to contact us quickly enough and we are presently working on alternatives.

NB: What about a practice management system – did you have this from the beginning?

KV: Yes, from reading Independent Practitioner Today, I realised this was something I needed to invest in from the start. I knew if I went down the spreadsheet route, I might get trapped there!

I looked at four systems and chose MidexPro. I take my notebook PC everywhere with me and my practice is virtually paperless. Midexpro has a good reporting module and that makes my accountant happy too.

NB: Did you choose a specialist medical accountant?

KV: I’d been using McKenzie Knight & Partners for seven years and was happy with their service. I also pay them to prepare accounts for my secretary, Jo, so that everything is above board as far as her tax and National Insurance is concerned.

NB: We published a professional profile for you on the Spire website and sent a photo-announcement to GP practices and to other Hartswood consultants. How well did these work to help launch your practice?

KV: The announcement worked well, as my foot and ankle patients are often referred by consultant colleagues. Being at The Hartswood has definitely widened my network of consultant contacts.

To supplement the mailing that the hospital did to GPs, I also sent out my own cards. I got the GP names and addresses by trawling through Yellow Pages. Early on, I wasn’t exactly overwhelmed with private patients, so I had the time to do this.

NB: What else did you do to try to build contacts with local GPs?

KV: I took the view that any contact with GPs would be helpful to my NHS and private practice. The Hartswood arranged for me to give a talk to the Havering ‘New GPs’ group and I did a pharmaceutical-sponsored seminar at one of the large local practices, which turned out to be the fourth highest referring practice to the hospital.

I also did a lecture on paediatric orthopaedics to around 60 GPs and practice nurses at the primary care trust’s (PCT) monthly education meeting.

After I joined Spire Roding Hospital, they also asked me to do a presentation at one of their GP masterclasses.

At one of these events I met Dr Atul Aggarwal, who runs the PCT’s patient information programme, and I agreed to do a talk on foot and ankle problems. I couldn’t believe it when 130 people turned up; there was standing room only – apparently it was their best attended event!

My theory is that this will also raise awareness among GPs – as people who attended the event may go back to their GP asking to be referred to me – unless my talk put them off completely!

You also got me to write an article on ankle replacement in the hospital’s GP newsletter. And I was invited to your networking dinner for new consultants to meet about 12 senior partners from key GP practices.

NB: I think this demonstrates that launching a new private practice needs sustained effort from several angles. The one thing I haven’t yet persuaded you to do is a local radio interview on the weekly health programme that we sponsor. I’m hoping you’ll agree to that soon.

KV: Well, I admit I was hesitant about the radio idea, but, after my experience with the public audience of 130, I guess I should be able to cope with an interview now!

NB: Spire Hartswood was your first private hospital and is your main base. Early in 2009 you also started working at Spire Roding Hospital. How have you found working for us?

KV: The Hartswood offered a bespoke approach to my needs and found consulting time to fit my schedule.

Generally, the hospital has been able to give me theatre time, even though I don’t have a regular operating session yet. Theatre is well organised and the equipment is good.  

For anaesthetics I use PEAP (Partners of Essex Anaesthetic Plexus). It’s easy to arrange an anaes­thetist with just one phone call: ideal for someone like me who doesn’t have fixed operating time.

If I need special instrumentation, the theatre team organises all that, whereas in the NHS I have to fight for small things. For example, when I started consulting at The Hartswood, the outpatient sister ordered new foot and ankle models for me; one even had skin and soft tissues on – which fascinates the patients!  

The only downside has been difficulty in admitting patients at the weekend. This is because insurers are not contactable to authorise treatment. I’d like the hospital to be a bit more flexible – perhaps by taking a deposit from the patient as a precaution. After all, I’m willing to treat the patient without the admission being pre-authorised.  

NB: How do you approach the clinical aspects of your private practice?

KV: It’s just the same as my NHS practice except that I can spend more time with each patient. I try to give a professional and sympathetic service, using the best possible evidence-based treatment.

NB: And what about billing and insurers?

KV: For insured patients I invoice everything to the insurer. I consult privately on Thursday and Friday and Jo makes sure all the invoices go out by the following Monday.  

I’ve only had a few self-pay patients who have defaulted, but I don’t regard this as a major problem. The ‘take it or leave it’ attitude of some insurers is an irritant. They will happily pay for surgery but will refuse outpatient treatments, saying that they are not cost-effective. Where’s the logic in that?

On the fee front, I sometimes feel discriminated against just because I’m a new consultant, but what choice do I have?

NB: In summary, what would you say have been the highlights of your first year in private practice?

KV: The biggest joy has been to be able to work without any strings or ‘target-driven madness’.

The biggest challenge has been trying to please everyone – including my family – and managing the work-life balance.

Finishing my first year in the top 40 consultants at Spire Hartswood was a landmark for me. Originally, I had hoped the hospital would give me some NHS-funded patients to kick-start my practice, but they were not prepared to take on any more Choose & Book work.

In the end, I was glad I had not gone down that road and that I’d been able to concentrate fully on developing private patients. I do see some NHS-funded patients at Spire Roding, but I can see myself cutting back on that soon.

NB: Do you have specific targets for your private practice in 2010?

KV: My first objective is to reach the level where I’ll have my own operating session at Spire Hartswood. Kevin Finlinson, the theatre manager, has been fantastic at conjuring up time when I need it, but it’s very ad hoc. It would be great to be able to say to a patient sitting in front of me in my clinic ‘I can do your operation next Thursday or the following. Which would you prefer?’

My second objective is to launch my own website. I’ve taken note of Independent Practitioner Today’s advice and know I need to take the plunge. I’ve relied on the Spire website until now and many patients come clutching a printout of my Spire profile.

I’ve bought two domain names and now need to find time to produce the content. Look out for yourfootandankle.co.uk and yourbones.co.uk coming online later this year!

Nicola Brown is business development manager at Spire Hartswood Hospital, Brentwood, Essex – one of 37 hospitals in the Spire Healthcare group

• See 'Off to a flying start'