New independent practitioners will want to avoid attracting unwanted attention from the GMC and other regulators. Mr Jerard Ross looks at the most important considerations.
There has been an explosion of interest in setting up in private practice, judging by the popularity of the MDU’s latest virtual course on the subject.
After the spring event rapidly sold out, there is now a waiting list for future dates which will be announced soon.
The course covers everything you need to know for your practice to thrive, including identifying your unique selling point, billing, marketing and accounting. But while it is important to get the business side right, you should not overlook your professional and ethical responsibilities.
Here are the MDU’s six medico-legal ‘must dos’ for anyone setting up in private practice:
1 Register with the relevant regulators
As a doctor in independent practice, you will almost certainly hold records for your patients. If that is the case, you will need to notify the Information Commissioner’s Office and be added to the register of data controllers (see point 5).
Also, check whether you need to register with the Care Quality Commission (CQC), which monitors, inspects and regulates independent health and social care services, including private clinics, GPs and independent hospitals.
Failure to register with the CQC, when this is a requirement, can amount to a criminal offence, but this is a complex area. For example, if you will be consulting in a private hospital, it may not be necessary to register separately if the hospital is appropriately registered, is a responsible body and consultations are carried out under the organisation’s management and policies, including those relating to clinical governance, audit and complaints handling.
You may also be exempt if you are employed by the NHS alongside your private practice. However, this does not apply in all cases. Seek advice from your medical defence body about whether you need to register or visit the CQC website.
2 Ensure you have adequate indemnity
NHS indemnity only applies to clinical negligence claims against NHS bodies and not your independent practice or private medico-legal work, so talk to your medical defence body about your indemnity requirements.
The GMC says: ‘If you carry out any private or independent practice, you must arrange adequate and appropriate insurance or indemnity. This applies even if the work is in addition to work you do for an NHS or health and social care body.’
You should also ensure that the healthcare professionals you employ, such as nurses, are suitably indemnified in their own right, where appropriate, and that you confirm their registration status.
Traditionally, claims for clinical negligence have been made against individual healthcare professionals. However, a claim may be made against a limited company, so consider whether you need to obtain a corporate policy.
3 Be up-front about fees
The GMC expects doctors to be honest and open in any financial dealings with patients, including the fees you set and any commercial arrangements and conflicts of interest.
It says: ‘You must tell patients about your fees, if possible before seeking their consent to treatment, including whether any part of the fee goes to another healthcare professional.’
Many practices and clinics chose to publish information about consultation fees on their practice website to assist patients.
The CQC requires registered providers to ‘give timely and accurate information about the cost of their care and treatment to people who use services’. Where a service user will be responsible for paying all or some of the costs of their care or treatment, the CQC says they must be given a statement specifying terms and conditions and expected costs before treatment begins.
Finally, take care when offering or providing private treatment to patients you have already seen on the NHS, so others do not misinterpret your actions. Perceived conflicts of interest are a source of concern for patients, employers and the GMC.
4 Comply with advertising rules
When promoting your services, the GMC says ‘you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge.’
Check your website and marketing material complies with the code published by the Committee of Advertising Practice (CAP). You may also need to consider the Medicines and Healthcare products Regulatory Agency’s guidance on the advertising of medicines: The Blue Guide.
If you are registered with the CQC, you need to apply for permission to use its logo and must abide by its terms and conditions. You will need informed, written consent before using patient testimonials or photographs.
When setting up your practice website, you must take reasonable steps to make it accessible to people with disabilities. The RNIB has a website accessibility scheme for businesses.
If you include links to other websites, state that you cannot guarantee that these sites are secure and you do not necessarily endorse their contents.
5 Protect patient data
You can register and find specific guidance for healthcare organisations on the Information Commis- sioner’s Office (ICO) website.
In addition to keeping medical records safe and confidential, consider how long to retain records and who will handle them if you are no longer able to do so.
Although there are no guidelines for retention of clinical records in private practice, the GMC’s Confidentiality guidance [paragraph 130] states: ‘The UK health departments publish guidance on how long health records should be kept and how they should be disposed of. You should follow the guidance whether or not you work in the NHS.’
Remote consultations have become increasingly popular during the pandemic, but if you plan to offer this service or communicate with patients by email you must warn them that it may not be secure. Further guidance on remote consulting can be found on the GMC’s ethical hub.
6 Set up a complaints procedure
If you have practising privileges at an independent hospital, there will be an existing complaints procedure to follow, but you will need your own in-house complaints procedure if you see patients in other settings.
It makes sense to follow the principles in the Health Service Ombudsman’s guide to complaints handling and your policy should be clearly communicated to staff and patients.
Unlike complaints related to patients receiving NHS-funded care, there is no statutory framework for independent review of complaints from the independent sector.
Some independent healthcare organisations are members of the Independent Sector Complaints Adjudication Service, which publishes a Complaints Code of Practice for its members and offers an independent review service for cases where local resolution and complaints review within the organisation fails to resolve the complaint.
Registered independent practitioners are legally required to submit an annual summary of complaints to the CQC.
The Setting up in Private Practice course costs cost £149 for MDU members and £249 for non-members. To learn more, visit www.themdu.com/learn-and-develop/course-listing/setting-up-in-private-practice
Mr Jerard Ross (right) is a medico-legal adviser at the MDU