Scale of pandemic disruption exposed

On 9 June,2020 | In Features

London Consultants’ Association survey

Covid-19’s full impact on consultants with a private practice is laid bare in Independent Practitioner Today’s front-page story this month. Rosemary Hittinger and Dr Mark Vanderpump analyse the findings of the first survey of specialists since the pandemic hit

Members of the London Cons­ultants’ Association (LCA) mainly operate as independent small businesses providing the professional services without which the hospital providers could not exist. 

Many feel that the generally productive relationships developed with the hospital providers have been damaged during this crisis by poor communication and a lack of clarity. 

A lot of our consultants offered their services to support the national effort, but, as a result their private practice was disrupted. Restoring this to pre-Covid-19 activity will be very challenging. 

This is particularly true for those who are solely working in the independent sector. There is little commonality in the manner in which the providers are relating to their consultants and only recently have they shown apparent appreciation for the practical difficulties. 

From the 15-22 May, the LCA asked its members to participate in a short online survey to establish what issues have been raised since the enforced lockdown. 

Rapid response

The LCA was seeking information on how the pandemic has impacted professional practice and business during the crisis with the aim of helping to develop a programme and strategy to support consultants.

It received a rapid response once launched. The survey remained open for five days and 238 consultants participated.

Some members have been able to continue practising, whereas others reported that their practice has reduced significantly or ceased entirely. 

There is evidence of significant difficulties trying to meet overheads when income has been so severely depleted. 

The majority of the respondents feel unsupported by the private medical insurers, their defence provider, their hospital providers, Government and, in some cases, their NHS employers.  

Importantly, there has been a major obstruction to patient care pathways. There is much uncertainty as to the future of private practice. Some are hopeful but others see it forever changed and not for the better.

About the respondents

The 238 consultants who responded had been in private practice between one and 40+ years, with more than half (69%) having been in practice between ten and 25 years. 

More than two-thirds (71%) of the respondents were surgeons, 21% were physicians, 6% anaesthetists and 2% radiologists. The majority were fully (52%) or partially fee-assured (24%).

How has practice been impacted?

Seventy-nine per cent reported having access to their consulting rooms restricted/withdrawn with a similar number (77%) having restricted access to diagnostics. Nearly everyone (89%) had experienced difficulties with booking and admitting patients.

Business continuity and support

Defence providers had offered to reduce premiums for only 30% of respondents. A further 38% of respondents had approached their indemnifier to request a reduction. The respondents were indemnified by a range of companies, but 29% were with the MDU and 17% with MPS.

Ten per cent of respondents had applied for the Coronavirus Bus­iness Interruption loan. Thirty-five have needed to furlough support staff.

The manner in which doctors consult and charge for their services has required adaptation: 

  • 79% invoiced for remote/virtual consultations;
  • 86% for phone consultations;
  • 11% for prescriptions outside consultations;
  • 6% for queries requiring email/phone response. 

Only 5% currently invoice for participation in multidisciplinary team meetings despite often considerable time commitments, with a further 10% invoicing for private medical insurance medical reports and 20% for insurance medical reports (non-PMI).

Future practice

LCA asked its members what changes were being considered for future practice. More than half (55%) said they would increase remote working and 37% stated they would work fewer hours/days. 

Twenty-four per cent said they were considering a different employment model for themselves and 3% intend to employ secretarial staff on an agency basis.

For those who intend to continue private practice, a number of operational changes to the manner in which private practice operates are planned, including using IT more effectively for patient and business management, streamlining systems and reducing patient numbers to allow social distancing, meaning fewer patients per unit of time. 

Consultants anticipate working longer hours with lower income and do not expect to return to face-to-face consultations until frequent and reliable Covid-19 testing is available. 

Some pointed out that, for certain specialties, remote consultation or phone consultation is very difficult. Inevitably, there will need to be an increase in self-pay fees as costs escalate.

Doctors’ comments

On the whole, the outlook appears gloomy, with most consultants thinking it unlikely that private practice will ever return to pre-Covid-19 volume. 

Many feel neglected and abandoned by the hospital providers with whom they had worked so successfully for years.

Many have lost most or all of their private patient income. They believe their private practice will be a lower priority for them in the future, with several saying they would either retire, reduce hours or return to full NHS employment. 

A number stated that the high overheads of private practice make it no longer viable. Some are looking at stand-alone clinics and theatres rather than in big hospitals – a move that they think might enhance patient confidence.

Opportunities were missed due to inflexible managerial arrangements. There was a lack of joined- up thinking about how the healthcare system as a whole would deal not only with the pandemic, but also its impact on healthcare provision across the system.

Conclusion

The Government’s guidance is that those people who cannot work from home should now return to work. Some private providers have cautiously started to indicate preparations for return of private practice. 

However, it is clear that loss of confidence as a consequence of the pandemic will continue to influence patient demand for some time to come. 

Mixed messages concerning access to facilities and provision of safety measures are also affecting the future viability of private practice. 

The LCA’s key principle is that specialists must always act in the best interests of the patient in front of them. Concerns have been raised that there is lack of transparency and clinical feedback from the new Pan London Panel when decisions are made to deny access to treatment for private patients.

Now the LCA urgently needs to know, on behalf of its members, what actions can be explored to address the situation so that a staged return to normal care for private patients is enacted as soon as possible.  

This survey has indicated that many consultants are seriously considering giving up private practice. The LCA will focus its activities on supporting consultants to ensure that all patients, now and in the future, have access to the high-quality care they seek. 

Rosemary Hittinger and Dr Mark Vanderpump are respectively LCA secretary and chairman and wrote this article on behalf of the LCA Committee