Now ‘get real’ on fees
By Robin Stride
Independent practitioners are being exhorted to go to work on their fees for 2024 and ‘get real’ about their charges.
According to the chairman of the BMA professional fees committee, many are undercharging and have not fully assessed what they should be asking for.
Peter Holden said NHS pay rates were dictating private doctors’ fees. © BMA. Dr Holden pictured speaking in 2019
Dr Peter Holden told a record number of 285 delegates at the association’s annual private practice conference in London: ‘We’ve allowed NHS pay rates to dictate our fees but that is not comparing apples with apples.
‘We have got to stop asking for fees and start telling what the fees are going to be. We are in a marketplace. The market is running in our favour now. Doctors are emigrating faster than training.’
Stressing that the views in his speech were his own, he told his mixed audience of established and would-be private consultants and GPs that doctors had got to be paid properly in future.
Playing hard ball
Dr Holden, who helped negotiate the new contract for NHS GPs under Labour in 2004 which gave them a reported average 30% increase the following year, said: ‘I think we have got to start playing hard ball now.’
He challenged his audience to ‘start telling patients the contractual relationship when you see me privately is between me and you – how you settle my bill is your problem. And the insurers need to get this.’
Insurers had got to stop the ‘nonsense’ of telling patients ‘this doctor is not on our approved list.’ That was tantamount to defamation. What they needed to tell patients was: ‘We wont pay your fees.’
It was the patient who had come to the doctor and the consultant’s contract was with the patient, not with the insurance company.
He told the audience, which included 100 online, the message to insurers should be: ‘We are open to negotiation but we are not going to be imposed on.’
BMA calculation tool
Dr Holden recommended doctors use a BMA fees calculation tool designed to show them how much it costs to provide their services so they can decide what to charge and do not lose money.
The fundamental principle behind the calculator is that each doctor must decide what take home pay they desire on an individual basis.
He urged them to look at the difference between working time and remunerative time. In salaried employment, all the hours they worked was remunerative time and they were paid to be there.
But, as an independent contractor, they were paid for what they did. If they were kept waiting on an NHS waiting list, they were paid; but if that happened on a private list. they would not be earning. ‘Working time is not remunerative time and you have got to calculate your remunerative time and the fee calculator will do that for you.’
He suggested most of the audience knew their gross annual salary, but said a majority of them would not know their net hourly rate. The fee engine could work that out for them.
In answer to his probing from the rostrum, only two of the audience indicated they had got written terms of business.
He remarked that this sort of failure was why so many doctors got into trouble from non- payers and he urged everyone to start behaving like they were running a business.
‘Tell patients your business terms’
Doctors were told at the BMA Private Practice Conference to publish their terms of business and ensure their fees reflected all the overheads of their business.
Dr Holden, a BMA Council member, advised doctors to put their fees on their websites and remember to quote VAT, where applicable, as not all private work was VAT-free.
They should ensure that their terms of business stated payment timings and clients should sign this and return a copy to them.
Every procedure had ‘to wash its own face economically’, but he warned that specialists were sometimes working and taking someone’s life into their hands for as little as £1.34 an hour after tax.
When assessing what their fees should be, he advised private doctors to remember the days they were not earning anything.
And he urged them to include holidays, sick pay and days for continuing professional development (CPD), plus all their costs, including defence, equipment, subscriptions, medical books and journals when calculating their fees.
Dr Holden warned tax rates were punitive and the medical profession’s standards of living were crashing.
While the top of the NHS pay scale for consultants was £126,281, which was a lot of money to the man in the street, they were supposed to be compared with their peers and were well behind what their benchmark colleagues in regional solicitors and accountancy firms were earning.