Covid-19: Will private practice survive?

New advice and observations for consultants from The Federation of Independent Practitioner Organisations (FIPO) 

The Coronavirus pandemic has crippled society, with blows to the economy, health and healthcare. Even if they had also practised independently, NHS-employed consultants now concentrate on their salaried commitments, while those in purely private practice are effectively cut off from their source of income.  

Available resources are dedicated to coping with the threat posed by the virus and, if only in the short term, independent practice has almost totally disappeared.  

Following the outbreak, the harsh economic climate will make it difficult to re-establish private practice and it is likely that many practitioners will face insolvency.

Another consequence for patients is that some private medical insurers (PMIs) have found that their ‘fee-assured’ consultants are no longer available to deliver medical care for their subscribers.

Mr Richard Packard, FIPO chairman

FIPO chairman Mr Richard Packard says: ‘Covid-19 has wrought dramatic changes to independent practice which we hope will not damage it permanently. 

‘In the meantime, skilled doctors who practise independently of the NHS will want to do their bit. FIPO wishes to advise those considering volunteering to make themselves aware of what they may be committing to.’

‘Patients will die prematurely’

Niall Dickson, chief executive of the NHS Confederation, has pointed out that, in February, 4.43m patients were on NHS waiting lists, (17% waiting for more than 18 weeks, against a target of no more than 8%). This was the worst monthly performance since September 2008. Heart surgery and cancer patients ‘will die prematurely’, The Times reported.  

The healthcare providers Rutherford Health, Genesis Care and HCA UK have between them the capacity to treat 5,000 NHS patients each month, according to The Times. Already, to meet that need, some private sector consultants have been approached with offers of temporary engagement.  

While this will use their professional skills, it is not clear to consultants how such arrangements will function and whether this would amount to formal employment.   

Many independent consultants already offer treatment to NHS patients in private hospitals. They are not employed and do not enjoy normal pay, sick pay or pension contributions in respect of their work.  

It would be helpful to continue discussions about how they can help the effort, while continuing to earn an income. 

Currently, in areas outside London where pressures are less intense, some hospitals are able to allow some form of access to their facilities.  

Unused areas such as consulting rooms can be utilised in a safe way without compromising other, necessary activities. It is, however, likely that any private hospitals taken over by the NHS will exclude all independent activity.

Consultants should address for themselves a number of concerns before they commit themselves to taking up any offers. They should also determine whether they, or their practices, might be eligible for any available Government help.  

Having received advice from informed sources, FIPO suggests consideration should be given to the following:

Indemnity

Will you be covered by the hospital provider’s indemnity arrangements, or indemnified under the Coronavirus Act 2020? FIPO is adding relevant advice on our website as details emerge. www.fipo.org.uk

All staff providing NHS services related to the coronavirus outbreak will be covered by this indemnity for clinical negligence where they are not already covered by an existing indemnity arrangement. 

Ensure that any indemnity would cover both clinical negligence claims and regulatory investigations/inquests arising from your temporary employment.

Clarify whether you will be covered by the provider’s indemnification arrangements or indemnity cover under the Coronavirus Act 2020.

Please note that section 11 of the Coronavirus Act would only cover a consultant for clinical negligence claims if that consultant was not otherwise covered by the Clinical Negligence Scheme for Trusts (CNST) and so please do check with your medical defence organisation or broker that your pre-existing arrangements cover you for regulatory investigations or inquests.

Role and function

Exactly what service will you be committed to provide during the emergency? Is your specialty expertise being sought or will you be required to work outside of specialty?

Sick pay and death in service benefits

Which of the usual employment benefits will be provided?

Taxation

Establish the terms of your relationship – will you be an employee or a contractor? The conditions and tax implications are profoundly different.

As we emerge from the pandemic, there are likely to be significant changes to private practice. The economic environment will be harsh: the Office of Budget Responsibility has predicted a 35% fall in GDP in the second quarter to the end of May and, during this period, unemployment is expected to rise to more than 2m. 

While there may be a surge in demand for self-pay treatment while the NHS concentrates on priority cases, it may also be that fewer employers are able to provide private medical insurance as a benefit.  

Cost constraints may lead to further restrictions and exclusions affecting both care provision and providers. 

With the near closedown of private practice, and the loss of some consultants who have been unable to maintain their practices at an economically viable level, some PMIs already find it difficult to provide comprehensive care for their subscribers.   

On the plus side, the reputation of healthcare professionals and medical skills has soared.  

Inevitably, this will lead to a change in the dynamic of healthcare provision. FIPO strongly supports all efforts to address this national emergency. 

It encourages collaboration between private hospital providers, PMIs and private practitioners to ensure that both immediate and longer-term issues are addressed, continuing to meet the needs of patients, whether cared for by the NHS or privately funded.