A ton of advice


100 anniversaryWe’ve hit a century!

So to celebrate our 100 big issues, we’ve compiled advice on 100 big issues that independent practitioners need to be aware of to boost business performance – that’s one vital subject from every issue we’ve published since our launch in June 2008

1 Drive up your business performance

Tickertape panel 2How many phone calls does your practice receive? Are the number of calls increasing?

How many of those calls are answered and how quickly? The accessibility of your practice is ever more important.

How many calls go to voicemail? Patients do not like leaving messages.

How quickly are your letters produced?

Alison Ryan, practice management specialists PHF Services Ltd


2 Be proactive for your business

The market is changing rapidly. So, develop a strategic plan now to shape your company’s future and ensure its continued good health.

Don’t be outperformed or outwitted by your competitors. A robust plan will make sure your organisation is able to quickly adapt to market change now and for years to come.

Darren Clare, Create Marketing Ltd


3 Negotiating tips

Know the objective, listen, keep it simple. Do not use judgmental language that will just annoy, antagonise and polarise.

Don’t get personal, beware stubborn intransigence that can stifle you from considering your options or being open to new approaches.

Tickertape panel 2Seek common ground; allow your opposite to walk away with dignity. Take a break if you need time to reflect or wish to consult with your colleagues.

But be prepared to say no and to know when to walk away. If it is a good deal, another opportunity will arise.

Asking pleasantly for that order or discount often works wonders.

Alasdair Muir, director, Horsetiger Ltd, business consultant specialists in the management and marketing of healthcare services


4 Know your profit per patient

Many independent practitioners may not accurately know how much it really costs to see one private patient.

Cost analysis is not the exclusive domain of the manufacturing industry. All businesses need a clear understanding of their cost base. Private practice is not, and should not be, any different.

In testing times such as these and with fees being squeezed, look to drive profit not just through business development but by analysing your cost base and identifying areas where costs can be reduced and where the benefits of any given expense can be enhanced.

So, how much does it cost you to see one patient?

Marc Rickard, PHF Services Ltd


5 Steps for private success

Tickertape panel 2Regard all you do as a long-term investment. Network hard and give quick feedback to your referrers. Take time to get to know potential referrers and let them know you are in the market. No one will otherwise come and find you.

Work with your hospital staff and clinic personnel as a team. Private hospital processes can be frustrating. Do give feedback, but don’t make it personal.

Always make clinical and administrative personnel feel they are on the same team as you and contribute to your success.

John Reay, chief executive, London Bridge Hospital


6 Foster staff teamwork

Your practice staff should know more about managing a practice than you do. Involve them, ask them for ways the practice can improve its service or grow.

Try and take decisions together and encourage them to take responsibility for outcomes. This way, they will feel part of your 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

Tickertape panel 2There 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 Tickertape panel 2actively 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

100 front pages

11 Form a group

Tickertape panel 2The 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.

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


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.

Tickertape panel 2Avoid 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

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 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

Tickertape panel 2 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

Tickertape panel 2Check 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.

Tickertape panel 2Holding 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


19 Be a smart entrepreneur


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



Tickertape panel 220 Survive an acquisition


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, 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

100 front pages

21 Write a press release

Tickertape panel 21. 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 open-mindedness to adjust the strategy to fit the world as it is, not as it could or should be.

Tickertape panel 2Too 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.

This can only be done by understanding what competition exists 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

Get to know the team at your local private hospital. Greet everyone by name and they will respond positively;

Tickertape panel 2 Subscribe to Independent Practitioner Today – it’s a great resource for information and advice (Editor’s note: just ring 01752 312140 or see page 59. A subscription by direct debit costs doctors just £75 a year before tax);

Get a professionally-designed website;

Send out all bills promptly;

Remember, it’s all about Availability, Ability and Affability.

Mr Krishna Vemulapalli, orthopaedic surgeon, Spire’s Hartswood and Roding hospitals


24 Retain and attract international patients

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 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


25 Business plan!

Business plans should be regularly updated and provide logical, clear rationale for funding requests.

Tickertape panel 2Provide 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


26 Use social media

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


Tickertape panel 227 Really commun­icate with your patients

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


28 Avoid partnership profit grievances

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 Tickertape panel 2a 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.

Tickertape panel 2Bringing 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 teach-ins

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

100 front pages

31 Let in the cameras

Tickertape panel 2A documentary team followed consultant bariatric surgeon Mr Shaw Somers for 18 months to create just a one-hour 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 Tickertape panel 2think that because an image is freely available on the internet, it can be reused without permission.

‘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


Tickertape panel 235 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…

Tickertape panel 2The 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


How much you are owed, how old your debt is and how much is collectable or needs to be written off;

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.

Tickertape panel 2Then 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 upper-GI surgeon and director of www.privatepractice-expert.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 (CPD) 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.

100 anniversaryThese 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.

With the team having quite literally hundreds of consultants to support, you need to keep your name out there.

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

100 front pages

41 Make time for yourself

Tickertape panel 2Define 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 time-wasters 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


42 Giving a refund

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.

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.

Tickertape panel 2Offering a refund may even appear insensitive, unless you can 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 thepeople 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, Tickertape panel 2by ensuring that partnership agreements are comprehensive and up to date.’

Independent Practitioner Today news story


45 Avoid tax evasion

Tax evasion can only be expressed in one way – illegal. This is when you deliberately and knowingly defraud the tax authorities. It may land you in prison, it will certainly cost you in taxes lost, interest owed and penalties charged.

Similarly, overly aggressive tax avoidance may result in the same action if you lose in a battle against HM Revenue and Customs.

Vanessa Sanders, partner with Stanbridge Associates, an accountancy, finance and tax advisory service specialising in the medical profession


46 Consider your retirement needs

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 fee-based independent financial practice helping doctors in private practice and the NHS


Tickertape panel 247 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, medico-legal 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;
Tickertape panel 2 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, co-founder, 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, medico-legal adviser, Medical Defence Union


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

100 front pages

52 Don’t ruin your appraisal

Tickertape panel 2Why 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;
  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 real-time 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.

Tickertape panel 2The 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.

Tickertape panel 2Source: 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


56 Agree terms before writing insurers report

Tickertape panel 2Doctors 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.

Tickertape panel 2So, 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 tax-deductible;

Travel expenses for journeys between places of business for purely business purposes – such as two private hospitals – is tax-deductible;

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.

Tickertape panel 2If you have performed a ground-breaking 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

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61Plan your succession

Tickertape panel 2Succession 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 Tickertape panel 2consultants 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 efficient. 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


Tickertape panel 2 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.

There is normally a set of terms and conditions covering the LOG and you must Tickertape panel 2always 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


66 Consider spouse pension contributions

Making employer pension contributions on behalf of a spouse Tickertape panel 2may 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


67 Care for family elders

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.

Listen to their opinion and act accordingly.

Chris Miller, head of development at The Good Care Group, London


68 Check out leasing deals

Tickertape panel 2For 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.

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 See the price is right

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


70 Mediators – cheaper than lawyers

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

100 front pages


71 Moving into aesthetics

100 anniversaryMake 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.

Tickertape panel 2Creating 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, ex-patients, 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


Tickertape panel 273 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)

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.

Tickertape panel 2Susan Hutter, partner, Shelley Stock Hutter


75 Handling complaints

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 turn-offs


Tickertape panel 2 Lack of information to explain treatments;

 General look and feel 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, co-founder, 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.

Tickertape panel 2The 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 anti-trust 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 up-to-date 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

100 anniversaryThere 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

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81 Protect your pension

Tickertape panel 2Take 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?
Tickertape panel 2 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

Tickertape panel 2And 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


Tickertape panel 286 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 Vaughan-Jones, telephone answering specialist, Moneypenny


87 Don’t wait a year for accounts

Ask your accountant for more regular reports in the form of a set of management accounts – for example, monthly or quarterly.

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;
  • Tickertape panel 2Boosting 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 Tickertape panel 2warn of treatment risks.

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 Carmichael-Drage, 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’.

100 anniversaryIt’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

100 front pages

92Install data safeguards

Tickertape panel 2Your 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


93 Invest in private healthcare facilities

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 Incor-porated 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.

He said schemes could be ‘very profitable’ and a typical investment might be £25,000-£70,000.

‘If they had the opportunity, I think there would be about 2,000 doctors willing Tickertape panel 2to 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 high-performing health professionals whom I’ve worked with.

Tickertape panel 2I 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

Tickertape panel 2Certain 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


98 Avoid undercharging

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


99 Send out fee letters

Are you aware? Under Article 22.2 of the Compet­ition and Tickertape panel 2Markets 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


100 Carry on reading us!

You’ve come with us this far – thank you!

Now make sure you don’t miss the big issues, and much more, that we will be covering in exciting future editions of Independent Practitioner Today.

Every subscription will help us continue bringing you important coverage in the fast-changing world of private practice. Subscriptions for our ten issues a year are only £75 for doctors if you pay by direct debit.

 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.