After a torrid two years, Prof Mark Whiteley’s clinic has gone from the depths of despair and through a consolidation process to emerge flourishing and expanding to new geographical areas. Here he reflects on the lessons learned since the first lockdown.
The new Whiteley Clinic in Bournemouth, Dorset
Pre-Covid, my focus in running The Whiteley Clinic was to provide the best quality venous treatments possible. Any spare money was pumped back into research and development.
This was excellent for providing research-based high-quality patient care, publishing research papers and getting students through higher degrees, but left the business with no cash reserves. Before Covid I did not worry about this.
On the 23 March 2020, Prime Minister Boris Johnson announced the national lockdown. One of the exemptions was medical facilities, but pressure from the media forced us to close our clinics (see www.dailymail.co.uk/femailarticle-8147079/Vein-doctor-stars-defies-government-advice.html).
Indeed, many doctors found their private practices disappearing as network hospitals rented their beds to the NHS during this lockdown.
Prof Mark Whiteley
The sudden closure of our clinics, without any cash reserves, could have been an utter disaster. Like most businesses, we applied for Covid loans, but apart from the furlough scheme, did not get any Government or bank help.
With things looking pretty hopeless, I quickly sold my house to support the business and we had an offer in April and moved out in July. Fortunately, however, this turned out to be our lowest point.
As the guidelines still excluded medical services from the lockdown, I phoned Public Health England to ask if we should have closed. Unfortunately, it would not give me a definitive answer.
Over the weeks, increasing numbers of patients were contacting us through our emergency phone number and website with infected ulcers, painful legs, swollen ankles and other concerns.
They were getting desperate for assessment, as they were finding it very difficult to get medical advice from their GPs and A&E departments.
At this time, I heard a Government minister interviewed on the BBC as saying that many businesses that had closed down had not needed to by the rules, and hence should not be supported financially!
This led us to explore how to re-open quickly and safely, providing a Covid-secure environment.
During April and May 2020, we worked towards providing a Covid-secure environment, with Cordell Health providing excellent advice and inspections.
We had regular communications with the Care Quality Commission (CQC), informing it of what we were doing every step of the way. By taking these steps, we were able to set up a skeleton service in June 2020, ten weeks after the onset of the lockdown.
With regular staff testing, initially by PCR and then lateral flow tests, and imposing restrictions on our patients, which have since become routine for most medical clinics, we were soon back to fairly normal working.
Of course, there are still disruptions when a clinical member of staff tests positive for Covid, but we have now become used to these and try to build in some flexibility to keep our service as good as possible for patients.
On the business side, we had to take several emergency measures. We appointed a financial director who was very good in the short-term at crisis management, and who negotiated with all our creditors to repay outstanding credit over 12 months.
We had discussions with all employees as to which jobs were essential, and which were non-essential and could be made redundant. Following these discussions, several of our staff were happy to undergo voluntary redundancy.
Naturally, there were a couple of staff who did not feel their jobs were redundant, but analysis persuaded them otherwise.
Finally, a review of all of our contracts highlighted several areas where money was not being spent wisely, or was frankly wasted, and these contracts were terminated.
By September 2020, our income had reached pre-pandemic levels, and with a much more efficient business structure, we started to have profitable months.
With the reduction of international travel for vein conferences, and by concentrating on the business itself, we ended up with an end-of-year profit higher than we had ever had before.
Now into our second year, and without the repeat of a lockdown and restart, our second year has shown even more business growth as well as increased profits.
Although we were able to keep on a basic level of research during lockdown, we have been able to grow our research department again, maintaining our position as innovators in the venous world.
Sonographer Judy Holdstock, chief vascular scientist at the Whiteley Clinic
The result of this is that despite Covid and the lockdowns, we are expanding the number of our clinics. We have just opened our fourth clinic in Bournemouth and are looking to open Whiteley Clinics elsewhere in the country.
As such, we are now looking to recruit more consultant surgeons or consultant interventional radiologists who wish to have a good private practice in venous disease, and we are employing more full-time clinical vascular scientists (vascular technologists) to train in our protocols.
Comparing our experience of the pandemic with other doctors and healthcare providers has shown a variety of different experiences.
Many NHS consultants who have admitting rights to network private hospitals found themselves left ‘high and dry’ when those private hospitals rented their beds to the NHS during the pandemic.
We were fortunate that, by having our own ambulatory clinics, we were in charge of our own facilities and so our consultants did not have these problems.
Dr David Beckett, an interventional radiologist with a specialist interest in minimally invasive vascular procedures
Several other clinics kept to the Government guidelines and did not close at all during the pandemic. Although these might have been held up as irresponsible early in the pandemic, history has now shown that this was the best thing to do and it was important to have kept medical clinics open, provided they had good Covid-secure protocols.
Although doctors often think that they are different from business people, and medicine is different from business, stressful times such as an unexpected pandemic go to show that to keep medical facilities open for patients, basic business principles need to be followed.
Understandably, coming out of the pandemic, private health should be seeing a resurgence. There is rarely a week where the news does not feature the incredible NHS waiting lists and the lack of staff.
Moreover, the public continue to research their own health issues and there appears to be increasing acceptance of private healthcare.
Data on 1,131 private hospitals and clinics by the business analysis company Plimsoll UK (Plimsoll.co.uk) states that, in the last year, there has been a 6.6% growth in sales, but this is not fairly distributed over all private hospitals and clinics.
It quotes 176 (15.6%) are serial loss-makers and although the private health market is growing, 392 (34.7%) companies are in decline and 295 (26.1%) companies are in danger.
So, looking back over the pandemic, health has been the main focus of most news outlets over the last two years. The NHS has a huge backlog of patients on waiting lists and so opportunities for working in the private sector should be rosy.
However, business analysis shows that not all private hospitals and clinics are being successful, and hence not all doctors doing private practice are going to see the benefit of their labours.
The Whiteley Clinic has always aimed to be the premier vein clinic in the UK, and potentially abroad, based on our research-led protocols and medium- to long-term results.
In practice, this means that patients are not only happy with their results in the short-term, but have the lowest chance of recurrence in the medium and long term.
This separates us from clinics that compete on price but fail to adopt the new approaches to venous diagnosis and treatment that attains these benefits.
With patients and other funders of healthcare becoming more sophisticated at checking outcomes, we believe that this approach will prove to be not only beneficial for patients but prove to be cost-effective in the medium to long term.
Prof Mark Whiteley’s clinics are at Guildford, London, Bristol and Bournemouth