Recruiting the right Medical PA for your private practice is important. You need to find the right person with the right skills but most importantly the right person for you and your patients.
Your Medical PA will act as an ambassador for your private practice and will take responsibility for the overall patient experience. The right person will make a significant contribution to the success of your practice and so it is important to choose very wisely.
One of the most important factors today is where your Medical PA will be based. Do you plan to have a virtual Medical PA who works from home, or do you require your Medical PA to be office based within your consulting rooms?
Most Medical Secretaries have now had the opportunity to work from home and they have loved it, so returning to an office-based role is less appealing to them. For those who will consider an office-based role there is demand for a higher salary to compensate for the additional time, cost and stress associated with commuting.
If your preference is for office based, then it is worth considering if you can offer some kind of flexibility, for example, part time hours, or a hybrid model with the week split between office and home.
You will also need to decide on your choice of employment model. Do you plan to employ a permanent member of staff, contract someone on a self-employed basis or subscribe to a Medical PA service. Each model has pros and cons as follows.
The benefit of employing an individual to work directly with you is potentially a greater sense of belonging and loyalty to your practice. As an employee your Medical PA may feel a greater sense of being part of your team.
If your Medical PA is your fist employee you will need to register with HMRC and take responsibility for payroll, National Insurance and potentially provision of a pension.
You will also have responsibilities as a line manager for the health and safety of your employees and for ongoing management.
Your Medial PA will be entitled to a holiday allowance of at least 20 days plus bank holidays and you will need to arrange cover for these holiday periods.
If your practice is full time, based within your own consulting rooms, and office based then employing your Medical PA will probably be your favoured option.
There are many Medical PAs who have set themselves up in a self-employed freelance capacity and this may be an option for you to consider. They generally have a great deal of experience working in private practice and have decided that they would prefer to work for themselves, based at home and to avoid commuting. You will benefit from their wealth of experience and limited responsibilities as you are not officially employing them.
You will normally pay an hourly rate for your service and your Medical PA will be responsible for handling their own tax and national insurance.
Your Medical PA will choose how much holiday they wish to take, and you will not pay for the holiday time although you might feel it is fair to do so. It is important to ask a prospective self-employed Medical PA what arrangements they have in place to cover your practice when they are on holiday or if they are unwell.
One word of warning about the self-employed model is IR35 and its implications. IR35 refers to UK tax legislation introduced in April 2000, which is designed to make sure contractors pay the right amount of income tax and National Insurance contributions (NICs). Currently the IR35 rules do not apply to small businesses but they do for medium and large companies. Your self-employed Medical PA is most likely to be considered as being outside IR 35 which means they are not considered to be your employee. Contractors operating outside IR35 are responsible for making sure they pay the right amount of tax outside the PAYE system.
Medical PA Service
A Medical PA service is different to recruiting either a permanent employee or a self-employed Medical PA in that you will receive a service which means you limit your responsibilities hugely and this can prove to be very beneficial.
Your Medical PA service provider will provide you with a nominated Medical PA who works with you and your patients and becomes the face of your practice. Your Medical PA will be available during normal working hours to answer your patient calls, book patient appointments and undertake all the normal tasks for you.
You will pay for the time your Medical PA works specifically for you and usually you will be charged an hourly rate for this. You will receive a monthly invoice and so there is no need to worry about payroll and HMRC responsibilities.
Your Medical PA will probably have one or two other clients to fill their working day so they will have other priorities, but the benefit to you is that this can be a very cost-effective solution.
You service provider will also manage holidays and sick leave so that you don’t need to worry about any of the logistics.
If you plan to employ your Medical PA then you must create a job description, but it is a good idea to spend some time articulating your expectations in writing which ever model you are planning to use.
A job description clearly states the essential requirements of the job describing the main duties and responsibilities and the skills required to perform the role. There are numerous job description templates online that you can use to help get you started.
Ideally you would share your job description with all potential candidates for the role so they can determine if they are a good fit. The job description will also be valuable when managing performance in the role.
Deciding what salary to offer to a Medical PA is a complex decision and the market has changed a great deal since the Covid pandemic. Most Medical PAs would prefer to work in a virtual role, based at home, and those who are looking for office-based positions will expect a higher salary to compensate for commuting costs and time.
A good place to start checking for information to help you decide what salary to offer is Indeed, the recruitment website. They offer information on the average salary for various professions, and you can also check out other current job adverts to get a guide.
Finding the right person
Finding the right person is the greatest challenge. It is a good idea to ask your network of colleagues for any recommendations and also to keep you in mind if they hear of a Medical PA looking for a new role.
You can engage a recruitment consultant to help manage the process for you and this is the best option if you have limited time. It is important to choose a recruiter who has direct experience of recruiting Medical PAs in private practice. You will normally be charged a percentage of salary and the terms will provide some back up if your new candidate does not work out in the first three months of working in the role.
If you want to manage the recruitment process yourself (the DIY approach) then you will need to set aside time to manage the process.
The DIY recruitment approach
1. Job advert
Your first objective will be to advertise your role and you should look to websites such as Indeed to help you do this. You can place your job advert on Indeed and use their recruitment system to help you shortlist candidates, arrange interviews etc. There are also skills tests that you can introduce as part of the application process.
If you are using social media channels such as Facebook, Instagram, and LinkedIn you can promote your job advert here to drum up more interest and this can make a huge difference.
Once you have attracted a few candidates you will need to work through them and create your shortlist of those you want to offer an interview. I would recommend an initial video interview prior to offering the opportunity for a face-to-face interview.
4. Offer letter
When you have found your ideal Medical PA, you will need to formally offer the role in the form of an offer letter. In practice you will probably offer the position verbally either in person or by phone, but the letter formalises this.
Your employment offer letter expresses your intent to employ your Medical PA and should contain a brief summary of the main terms and conditions of the position. This will include details of start date, salary and benefits. You may make your offer contingent on certain conditions such as acceptable references and if the candidate does not meet these requirements, you are able to withdraw the offer.
In most cases it is advisable to ask for two references and, in a practice regulated by CQC this is essential. You may also need your Medical PA to provide a current DBS certificate (Disclosure and Barring Service).
6. Employment Contract
Your employment contract is your detailed offer of employment to follow the initial offer letter and must be signed by both employer and employee.
If this is your first employee you would be well advised to consult an HR specialist or employment lawyer to help draft your contract, although there are numerous template contracts available on the internet.
7. Start Date
Hopefully day one is the beginning of a long and successful employment that works well for you, your patients and your employee.
If your Medical PA is your first employee then you will need to consider your responsibilities as an employer including health and safety etc, but also in terms of HMRC and payroll.
When you are establishing your new private practice, how do you ensure you set yourself up for success? It is hard to step back from your day-to-day activities and invest time in your new practice. Making sure your prospective patients receive the experience and environment you want to deliver, and they expect, requires careful thought and a solid strategy.
Your passion, values and vision are at the heart of why you are making this leap into private practice. So, how do you ensure these are understood and communicated to all your stakeholders, including potential referrers, and patients? Practically, have you covered all the elements to ensure your practice is ready to be launched to the public and your referrers?
The overarching desire is to attract new patients and referrers to your practice, but competition is fierce and with the increase in self-pay patients due to the post pandemic NHS waiting lists, your practice needs to be better than your peers to make sure you are forefront of mind and delivering an exceptional patient experience.
This is where Designated can help. Our team of experts can support you with your business strategy and plan for your practice. Utilising our experience in the industry along with our own service background, the team can help you to identify the strengths in your plans, and pinpoint the weaknesses, creating an opportunity to highlight and rectify any problems before they become ingrained.
Understanding you and your private practice
To really understand your clinic and aspirations, and for Designated to provide a comprehensive report of recommendations that identifies your ideal patients and referrers and ensures your brand messaging and values are communicated to all of your audiences and stakeholders – we recommend starting with our Designated Business Strategy Project.
This is based on a set of strategic questions which will identify your aspirations for your clinic across our private practice/clinic areas of expertise – Marketing, Accountancy, Patient/Referrer Experience, and Practice Management and processes.
From this process we can provide you with our observations and recommendations/guidance to help build your business plan and establish your new private practice.
Areas we cover:
- Business objectives
- Vision, Mission and Values
- Service offering
- Key target audience – patients and referrers
- Reputation – Marketplace perception – how do you want to be identified?
- Patient experience
- Practice Management
We will be honest in our views, but these will come from experience and the will for you and your new private practice to succeed. Some of our observations may be a difficult read as it will enable you to uncover gaps that you were completely unaware of. The process and findings can feel quite personal as your new practice is your passion and vision. The key is to thoroughly evaluate the results and make changes to your plans where necessary.
The process will broaden your view of your plans for your practice, who your new patients and referrers are and how to find them and steer you away from assumptions.
If you would like to find out more about our Designated Business Review, please do get in touch:
Marketing is an integral component of sustainable growth. Without it, there would be no influx of new patients, and even your loyal patients may slowly drop off, one-by-one.
The healthcare industry has changed. What used to be a volume-based industry centred around the consultant, has become a quality-based industry centred around the patient. Marketing shows potential patients that not only is your practice different than the competition, but it is also a much better option overall.
Marketing your private practice provides an open line of communication to your patient audience by building trust and piquing interest. It allows you to increase your patient connections and nurture those relationships to form long-term, loyal patients and therefore advocates. Successful marketing leads to successful patient engagement, and successful patient engagement leads to a booming practice.
If you have poor marketing or no marketing at all, your brand will suffer. Yes, your private practice works similarly to any other brand in any other industry. Patients drive the healthcare industry of today, so impressing the patient (customer) is an essential element that will drive your practice ahead of the others.
- 88% of those searching for health information start with search engines – Google Complete Treatment Study
- 48% before booking, patients took over 2 weeks to research before booking an appointment
– Google Complete Hospital Study
- The importance of marketing in the healthcare industry is to develop and execute marketing strategies geared toward engaging and educating patients on their healthcare journey through SEO, digital advertising, website, content marketing, and more.
The Designated Medical marketing team, are highly skilled in healthcare marketing. They have extensive marketing experience, across multiple industry sectors, and are a senior marketing team with ability across the spectrum from strategy through to implementation delivering only the best in class for our clients.
The private healthcare world is competitive. Get in touch with Jane now and stand out from the crowd.
Invoicing and credit control in private practice can be a time-consuming task, but it is essential for obvious reasons, and yet it is the area of practice management that is most often overlooked.
Doctors and medical secretaries are quite rightly highly focused on delivering the highest quality patient care, and therefore billing patients and collecting the money owed becomes the lowest priority.
It is not natural for a doctor to switch conversations with a patient from their symptoms and care plan to a discussion about invoices. Likewise, a medical secretary has often chosen to work in the field of healthcare due to a desire to care for patients and is less comfortable handling the billing side and chasing money.
Private consultants can sometimes struggle with the contrast between private practice and working for the NHS and it can feel uncomfortable charging for your medical services after years of NHS work, which is ‘free’ to patients.
But managing payments and debts is crucial for any business and you will not thrive or grow as a private consultant without a robust credit control strategy from the outset.
In a bigger clinic or hospital, there is often a department that handles invoicing and billing, and this team will often be more aligned with the finance team, and this makes total sense.
In a smaller practice, billing must be the responsibility of somebody within the practice team and I will refer to them here as the “billing manager”.
It is well reported in business that cash flow is king, especially in the first years of a new business and this is just as true for a consultant working in the private world as it is for a clinic or hospital.
Delays in receiving payment can put a great deal of strain on cash flow in a private medical practice and we need to ensure this is avoided.
Systems and processes
Using good systems will help alleviate and automate much of the process relating to invoicing and collection. It is also key for your billing manager to define good processes and ensure the system is set up to support these.
Invoice templates can be created by your billing manager, with pick lists of the most commonly used treatments. Invoices can be sent to patients via email or by post if preferred, but I would use email as widely as possible to reduce costs and eliminate delays.
Most private clinics will be invoicing both insurance companies and self-pay patients. They may also be invoicing embassies and legal companies.
A good practice management system (PMS) will offer the functionality needed to handle the creation of invoices, patient reminders and management accounts. Most will also integrate with a good finance system such as Xero to ease booking and accountancy for the practice.
The use of technology is imperative, particularly for invoicing insurance companies.
The PMS will also make it much easier to send invoices electronically to insurance companies, using the Healthcode system. Submitting invoices electronically will also speed up payment settlement, which should greatly help with credit control.
A good practice management system will link to Healthcode and allow electronic billing. All private doctors can use this Healthcode, and it ensures that insurance invoices are dealt with very quickly and smoothly, but there is a cost for doing so and some practices avoid using it for this reason. The alternative is to send your invoices directly to insurance companies. My instinct is that it is cheaper overall to use Healthcode when compared to the additional cost of sending and chasing invoices with each individual company.
A good practice management system will also ensure that invoicing self-pay patients is simple and easy including the option to send a payment link to patients and allow online payment.
Shortfalls from insurance payments will need to be dealt with in the same way as self-pay patients. It seems that many aged debts are due to a lack of transparency over insurance shortfalls.
Patients simply are not aware that their insurance will not cover the entire cost of the consultation, treatment, or procedure. This could be remedied by improving communications with patients.
It might mean incorporating a short discussion about payment in the consultation itself, reworking the written information given to patients prior to their initial appointment and/ or following up appointments with a short email to clarify information.
If you are sending invoices to embassies these will be created in the same way as for self-pay patients, but a greater focus will be needed. Prior to an appointment with a patient sponsored by an embassy, it is imperative to have a letter of guarantee from the embassy which guarantees they will cover the costs. Without this letter, getting paid will be much harder. Even with a letter of guarantee, some embassies are notoriously bad at making payments to the point that some doctors will not treat their patients.
You may also be invoicing law firms for medico-legal work, and again these are raised in the same way as a self-pay patient. Most law firms have robust payment processes in place, but your billing manager should be ready to chase if needed.
My advice with both embassies and law firms is to attempt to build relationships with key contacts within the organisations to smooth the process.
The next step in the invoicing process is to reconcile payments received against the invoices issued. If you are using electronic billing via Healthcode for insurance patients, this process will be easier for your billing manager.
Insurance companies will regularly send remittance advice notes that need to be checked against the invoices on the system, but you can also view live updates via Healthcode.
If self-pay patients are paying by credit card, the payments should be marked as paid on the day payment is made. There is nothing worse than chasing a patient for payment when they have already paid.
Bankers’ Automated Clearing Services (BACS) payments will need to be reconciled with bank statements and that is a harder task than it sounds. Encourage patients to quote their invoice number when making a payment to ease the process.
Payments should be reconciled regularly so that you have an accurate picture of your current debt. I would suggest that a reconciliation is done at least weekly.
Your billing manager should circulate a monthly finance report to the practice team showing the total amount of invoices raised and invoices paid during the previous month. Most importantly the report should also track aged debt levels. It is always best to address issues early and therefore avoid aged debt growing into a significant number.
Credit control process
Each practice needs to define their credit control process. An invoice sent to an insurance company or self-pay patient may be paid promptly, but often this is not the case and the debt will need to be chased.
There will always be patients who do not pay on time and standard protocols to collect payment owed will need to be created and followed by your billing manager.
A robust monitoring system must be in place so that you can keep track of reminders sent. This can be managed within your practice management system.
A good practice management system will allow you to set up a process for chasing debt, but your billing manager will need to define the parameters. You can set up standard template letters to be sent after certain periods of time.
The time allowed may differ depending on your practice, for example, you may feel that patients should be allowed a month to pay before receiving their first reminder. This might be the case in a practice where you are seeing the patients regularly and have every confidence that they will pay at their next appointment. In another practice, you may want the reminder to be sent seven days after the initial invoice.
You can set up a series of reminder letters to be sent by email to patients to chase their payment. These letter templates must be created and while the first might be a very gentle reminder, the third reminder needs to be a little sterner.
Eventually, someone will need to pick up the phone to chase payment and that is not a task liked by most. If a patient is ignoring your letters, then a phone call may be just what is needed to prompt payment.
Again, you need to decide at what stage this occurs. Do you wait one month or three months before taking such a step? What feels right in your practice?
Thankfully, most patients do pay what is owed, but there will be a small percentage who ignore emails, letters, and phone calls.
You need to be clear on how you will handle this. Are you happy to accept a certain percentage of non-payment and simply write this off? Or do you want to take this further and involve a debt collection agency? Obviously, this is the last resort, but one you will need to consider. Whatever you decide, it needs to be stated in your terms and conditions provided to your patient when they book their first appointment.
In-house billing and collection
Whether you are running a large hospital or a small clinic, you have a choice whether to manage invoicing and credit management in-house or to outsource to a specialist company.
Many consultants choose to handle invoicing themselves when they first start out in private practice, in partnership with their medical secretary. This can be a workable solution in the earliest stage, while the practice builds, but care needs to be taken to ensure it is scalable once the practice becomes busier.
You may need to employ additional members of staff to manage the invoicing workload. You may employ a medical secretary and a billing manager who are able to work closely together, but both have clearly defined roles. As always, effective, and clear procedures need to be in place from the very start.
It is imperative that administrative and financial processes are reviewed regularly and documented to avoid key person dependency. You do not want to find yourself in a situation where someone is sick and no one else knows how the systems and processes work.
Consultants and their secretaries often find chasing debts to be an uncomfortable task and not one that fits easily within the culture of a healthcare company.
You will need to ensure that you and your team stay informed about technological advances so that you and your patients can benefit from them.
On the positive side, handling invoicing in-house means that you have complete control and can feel comfortable that every communication with your patients is made by a member of your team.
Many consultants, clinics and hospitals engage an external specialist billing company to manage their invoicing and payment on their behalf. Most of these companies charge a percentage fee for the invoices they process and collect on your behalf. They can also chase aged debts and provide a variety of management reports such as insurance breakdowns and bank reconciliation information.
Some firms have their own custom software for this, while others integrate with industry-standard practice management software. It is always better to use standard systems to avoid being tied to one company long-term. It is good practice to keep your options open.
The primary advantage of outsourcing billing and collection is that consultants can spend more time concentrating on their patients and developing the medical side of the business. It is also hugely reassuring to know that such an important aspect of your practice is managed by a team with expertise and the value of this should not be underestimated.
The downside is the additional cost, although this should be weighed against the potential savings outsourcing may provide. For most organisations the cost is less than the money that can be lost due to bad debt recovery.
Following the tips provided in this article will hopefully mean you are able to establish an excellent invoicing and credit control function for your practice resulting in fewer debts.
If you need any advice, please do contact the team at Designed Medical.
Setting up a private medical practice should be an uplifting experience, but the reality can often feel somewhat overwhelming.
The most important advice we can offer you is to embrace the concept that starting a new private practice is launching a new business. This will require you to involve yourself in all business aspects, including finance, marketing, and operations. Most doctors are new to these aspects of business management, having received little guidance at medical school and limited practical experience. Still, it is possible to gain the knowledge needed with an investment of time and seeking the right expertise from advisors with a proven track record in private practice management.
Our structured process will guide you through the steps to establishing a new private practice.
- 1. Business Strategy
- 2. Company formation
- 3. Marketing
- 4. Choose your clinic location
- 5. Financial Operations
- 6. Medico-legal considerations, including CQC
- 7. Review and develop
1. Business Strategy
Developing your Business Strategy for your new private practice
Writing down your business strategy helps to formalise your thoughts into a structured approach, setting out your goals and objectives with a realistic timeline for launch and beyond. Producing a clear business plan at the outset pays dividends at every step as it clarifies what needs to be achieved. It builds the foundation of your practice.
What should be included: –
- Clarify your objectives
- State your vision and mission
- Describe your patient offering – your niche
- Articulate your target audience, including patients and referrers
- Financial modelling to set effective pricing
- Financial plan for first three years
Once your business strategy is complete you can create your short-term detailed action plans, including timescales: –
- Short-term plan – three months
- Medium-term plan – one year
2. Company formation
Before setting up your new private practice, you must decide on your company’s legal structure. Will you operate as a sole trader, a partnership, or a limited company?
It would be wise to make this decision with the support of an accountant who specialises in the private healthcare sector and healthcare accounting. Specialist medical accountants can advise on the most tax-efficient solution for you. For a limited company, you will need to register with Companies House.
You should also research the best business bank account to suit your business and open an account. Keeping your business transactions separate from your personal transactions from day one is wise.
Your marketing strategy sets out how the outside world will see you and how you will communicate your message effectively. Most importantly, it articulates how you will achieve your business objectives.
Your medical marketing strategy ensures you understand who your patients and referrers are and that you create messaging that they will relate to.
You need to investigate their behaviours and scope how to communicate with them to raise awareness of your new practice. Healthcare Marketing expertise is essential to deliver an effective strategy and to avoid costly mistakes.
Some particular areas to focus on are: –
Branding – Creating a professional, recognisable and memorable brand is imperative and this can be developed with the support of a specialist in healthcare branding.
Patient journey – A full understanding of your patient journey is vital to developing your marketing plan, especially your website. Will your patients book online? Will they also pay online for appointments? Your patient journey will map out every interaction your patient has with your practice and will identify any gaps in your processes.
Website – Your website is your opportunity to share your new practice’s capabilities and attract patients. Your chosen healthcare branding will ensure your website looks professional and conveys the right impression to your prospective patients and referrers. You should aim to include testimonials, images, and videos to maximise the potential of your website.
Digital marketing for healthcare – Use social media to attract potential patients to visit your website. It takes time to build up an organic following and you may invest in paid advertising, especially during the early months, as you build your reputation. You can also employ Search Engine Optimisation (SEO) to ensure your website is easily found by patients.
4. Choose your clinic location
Choosing a clinic location that provides a five-star patient experience is very important or alternatively, you can look to obtain practising privileges at a chosen facility which can be more cost-effective.
There are also other practical considerations such as how far is it from your home so you don’t spend long periods of time commuting , access to public transport and parking, access to other medical facilities e.g. diagnosis, testing etc.
Delivering the highest level of patient experience must be at the heart of your practice. The first person your patient will likely interact with is your Medical PA, so choosing an experienced medical secretary dedicated to delivering excellent patient care is essential.
You can choose from engaging a remote medical secretary via a medical support service or employing a private medical secretary directly. Ideally, you need to find a company that specialises in private practice management and has a strong track record in delivering healthcare business solutions.
You will also need a team to manage the financial aspects of your new practice.
The invoicing for your patients will need to be accurate and invoices must be raised in a timely manner. You must focus intensely on credit control to ensure payments are received promptly and avoid aged debt. Several companies offer medical billing services and patient billing services, and you might choose to outsource your invoicing to one of these medical billing specialists.
A medical bookkeeper will save you money in the longer term by ensuring all expenditure is recorded for tax purposes. Engaging a virtual bookkeeper using a cloud-based system such as Xero is cost-effective.
Your accountant should play a key role at year-end and throughout the year, keeping you abreast of the financial performance of your new practice with a close eye on cash flow, especially in the early months.
6. Medico-legal considerations including CQC
For good reason there are several responsibilities from a medico-legal perspective when starting a new private practice.
For consultants setting up their clinic within a CQC-approved facility, such as those operated by Nuffield Health, Spire Healthcare, HCA Healthcare, etc., there will be no need for CQC registration. But for clinicians setting up a new clinic or service outside these facilities, CQC registration is a legal requirement.
There are CQC consultants who help with the registration process, and you would be well advised to seek expert guidance to ensure a successful registration in a timely manner. The process will take at least three months from the date of application, and it takes most clinicians several weeks to complete the application paperwork, so build this into your project plan.
Other responsibilities include data protection, medical indemnity and business insurance, registration with PHIN and medical insurance company recognition.
7. Review and develop
Once your new practice is up and running, you will have increased pressure on your time, but you must make time to review and evaluate how your practice is performing. A monthly check-in and a deeper quarterly review are advisable. You can assess financial performance and the effectiveness of your marketing strategy. You will learn what works well and can adapt your plans to build on this.
Here at Designated Medical, we aim to help doctors succeed in private practice, and we are committed to sharing our expertise and experience with the broader medical community. In this article, we have shared the experience we have gained setting up private practices over the last twenty years, and we hope you find it helpful. Please get in touch with us if we can provide you with any additional support.
For further information, please refer to the more detailed chapters in our guide to Setting up a private practice.
In these chapters we will cover:
- Chapter 1 – How to produce your Business Strategy for your new medical practice
- Chapter 2 – How to set up your new medical practice as a company
- Chapter 3 – How to create your Marketing strategy for your medical practice
- Chapter 4 – How to choose your Clinic Location
- Chapter 5 – How to invoice your patients in your private practice
- Chapter 6 – How to handle your Medico-legal responsibilities in your private practice
Writing down your medical practice strategy helps to formalise your thoughts into a structured approach, setting out your goals and objectives for setting up a private practice with a realistic timeline for launch and beyond.
An essential factor is how much time you can commit to setting up your new private practice. Establishing any new business demands the investment of a considerable chunk of time and energy in the earliest stages to launch it successfully. It is also good advice to set clear parameters about how much private work you want to do in the short and long term. If you plan to balance your NHS commitments with your new private practice, without clear boundaries, it is very easy to be overwhelmed.
The first part of your medical practice strategy will describe your ambitions for your practice, including your Vision and Mission statements. Articulating your objectives very clearly and setting timescales for each one is essential. You may choose to set out your five-year plan or feel this is too long-term, but we recommend at least a three-year plan including a financial plan.
Once you set your three-year objectives, you can work back to your one-year objectives and, finally, your three-month implementation plan, which will need to be very detailed, describing the tasks and activities that need to be undertaken. You may have set an unrealistic launch date for your practice once you articulate how much needs to be achieved before then.
The planning stage of your medical practice strategy
The planning stage of your medical practice strategy also provides an opportunity to identify the expertise and support that you will need. There may be areas where you need professional expertise, for example, from an accountant.
Other tasks may need to be delegated as you do not have the time to complete them. Starting to build a support team at this early stage will enable you to increase your business knowledge and help you to avoid problems down the line.
Your medical practice strategy must also detail the costs associated with setting up your private practice including the costs to launch successfully and the ongoing operational costs. Most consultants we meet plan to launch their new practice with minimal expenditure, but some real costs need to be understood and a budget assigned.
Many aspects of marketing, including the production of business cards and your website, will require a real financial investment. You may also need to commit a budget to clinic rooms that are not 100% utilised in the first few months as your practice builds up. Predicting these costs at the earliest stage will ensure you have the budget set aside and avoid unexpected invoices.
Attention to detail
Detailing your offering to patients is the most critical part of your medical practice strategy, as it will describe precisely who your patients are and what treatments you will offer them. Many doctors attempt to appeal to a vast audience of patients, offering a range of treatments.
Still, experience has taught us that identifying and focusing on a niche is often more successful, especially in the short and medium term. Your marketing advisors will wisely talk about your Unique Selling Point (USP), and this is much easier to define when targeting a niche group of patients with a specific set of treatments.
Once you have described your offering, developing your marketing plan will be much easier, but more on that to follow in later chapters.
There are numerous systems, tools, and templates available on the internet, to help you formulate your business strategy and plan, and it is important to choose a structure that you feel comfortable with.
If you want more information about how Designated Medical helps our clients develop their medical practice strategy and guides them in setting up their private practice contact us
An important decision you will need to make is the legal structure of your new practice. Will you operate alone as a sole trader, or with one or more others and create a partnership or limited liability partnership (LLP), or register as a limited company?
Many doctors start their private practice working as sole traders. It is the simplest structure, you are self-employed, you and the business are viewed as one legal entity, and you pay tax on your profits. Be warned though that as a sole trader, you are responsible for both personal and business debts so personal assets could be at risk if something goes wrong. Starting as a sole trader has very little paperwork and few formalities hence its popularity. There may become a time when it would be more sensible for you to move from being a sole trader to a limited company and the transition can be made when appropriate.
If you are starting your practice with one or more colleagues, then you will most likely opt for a partnership or limited liability partnership. A partnership is like a sole trader but differs in that it has more than one owner. Each partner owns a specific percentage of the profits and the liabilities, and they must pay tax on that percentage.
With a limited company, you will become a shareholder and director, potentially among others, and the business is seen as a separate legal entity from its shareholders and directors. This means that a limited company’s finances are separate from the shareholders’ or directors’ finances, so you are only responsible for the money that you put into the business. Limited companies have more responsibilities than a sole trader, requiring you to follow strict record keeping and prepare and submit annual accounts.
If you decide to create a limited company, you must register with companies’ house which can usually be completed online via their website. You will need to provide some personal information and there is a small fee. You will also be required to create a government gateway user ID. If you plan to employ people, you can also register for PAYE.
Your decision about which type of legal entity to choose will depend on your personal circumstances and it would be wise to discuss this with an accountant with a good understanding of the private healthcare industry.
To run your business, you will also need a bank account. As a sole trader, you do not need a business bank account and you can use a personal bank account. Most business bank accounts charge a monthly fee and fees for certain transactions, so they can be more expensive, but they also offer more services that may benefit you in running an efficient practice, so the cost may be justified. If you decide to use a personal account it would be sensible to set up a new account, to separate transactions from your personal transactions for ease of bookkeeping and accounting. Whomever you choose to manage your patient invoicing will need to reconcile your bank account, as will your accountant, and running separate accounts will allow you to keep your private life private.
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Marketing is the aspect of running a business that consultants often feel most uncomfortable with, although it should be an exciting part of the journey.
In its simplest form, marketing is communication. It’s about how you communicate with potential patients, referrers, and the wider community, through whatever medium including your patient letters, videos you produce and your website.
The starting point is to create your brand which sets the personality and the look and feel of your practice. Ideally, you want every communication from your practice to be consistent with your brand. This will include simple things like the font and colours you use but ideally would also include a logo that symbolises your practice. Once you have chosen these aspects, you can use them to create your letterheads, business cards and your website.
Most doctors understand that a website is essential in private practice, and we would support this wholeheartedly. A website is your best tool to describe who you are and what your practice does, and you are 100% in charge of the content. Even if you do not plan to promote your website to attract patients you need to have a website for validation. Research has proved that most patients will validate their decision to book with a doctor by doing a Google search on the doctor’s name before they book an appointment to see them. Your website is the most positive way to ensure that the patient is convinced that you are the right doctor for them. Without a website, you are relying on the wonders of the internet to give you a glowing reference. The starting point will be finding a domain for your website, and we would advise you to use the same domain for your practice emails, never a Gmail address.
How are you going to attract patients to your new practice? You may be confident that your network of referrers will keep you busy, in which case, your main marketing activity will be nurturing your network. If you are planning to attract patients directly to your practice, you may want to consider the use of social media and paid advertising to engage your audience. Using social media can be incredibly powerful but it is also very time-consuming. It will take a lot of effort and time to grow a considerable following organically on social media channels and paid advertising may be needed, at least in the early months. Choosing which platforms to invest in is key and the choice will depend largely on who your patients are. Each platform has slightly different audiences, requiring a specific approach.
An important aspect of your marketing plan should be the collection of patient feedback and testimonials. Again, research has shown that patients read patient reviews to help inform their decision about which doctor to book an appointment with. There are numerous ways to do this including general online review services such as Google reviews and Trust Pilot, and also some industry-specific review sites such as Doctify. Each system has pros and cons including cost, and you will need to choose the best fit for you, but it is advisable to set this up from day one and start to build up the number of reviews published for your practice.
The marketing team at Designated has a wealth of experience in private healthcare and is happy to share their expertise with you in the following articles.
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Your greatest concern when choosing a clinic location will be to ensure that it delivers a five-star experience for your patients. Patients will need to feel that your clinic location is safe and clean and that the supporting services are of the highest quality. The location should be easily accessible by car or public transport and parking should be readily available.
From a practical perspective, a good clinic location should also be convenient for you, ideally easy to reach from your home and your NHS practice so that you can avoid spending too greater a proportion of your valuable time travelling.
Most consultants are clear about where they want to treat their private patients from the outset. This might be a private unit at their NHS hospital or a private hospital that they know well. The model of working that is most commonly used nowadays is to gain practising privileges at the chosen facility and to use consulting rooms on a sessional basis. This is cost-effective, and more clinic sessions can be included as patient demand increases.
If your objective is to create your own facility, then location will be a more complex decision. You will need to allow plenty of time for assessing the ideal location and then considering specific buildings in the proximity of the chosen location, ensuring they have the necessary consent for medical use.
For more guidance on obtaining practising privileges at your chosen location
How to gain Insurance Company Recognition for your private practice
In private practice, you are likely to treat patients who are self-pay, insured and those sponsored by an embassy or another similar organisation. You can choose to treat only self-pay if that is your preference and in doing so you have more flexibility with your fee schedule as you can set your fees at a level you are comfortable with, of course ensuring that the fees are acceptable to your patients.
If you plan to treat insured patients, you will need to register with the insurance companies and follow the fee schedule you agree with them. Fortunately, a system for doing this centrally saves you from dealing with each insurance company separately. Healthcode provides a service called The Private Practice Register (PPR) which enables you to upload your documentation and apply for registration with most of the major insurance companies. Once your registration is approved you can also benefit from electronic billing via the Healthcode service.
Many doctors are concerned about working with embassies and it is fair to say that receiving payment promptly can be challenging with some embassies but not all. Generally speaking, it is possible to work well with embassies if you keep very tight control over approvals and payments. Before seeing a patient, you must get a Letter of Guarantee (LOG) in which the embassy gives you a guarantee that they will make payment for the services you provide. Once you submit your invoice to the embassy you may need to chase regularly to ensure payment is made. In our experience embassies will generally take longer to settle invoices than insurance companies so you need to be prepared for a delay.
How to manage the administration of your private medical practice
Business operations is a term used to describe all the activities an organisation does each day, to keep running successfully. In healthcare, we tend to refer to operations as administration which possibly understates the importance and value of the activities involved. In your private practice, your operations will largely be centred around caring for your patients and delivering a high-quality patient experience. To achieve this you will need systems, processes, and a strong team.
Creating a solid plan for the administration of your practice from day one will ensure that you create strong foundations for the future as your practice grows. There are some key activities to consider: –
Telephones and call answering – Your patients need to be able to reach your practice. One of the biggest frustrations for patients is not being able to get through to speak to someone on the phone. You will need someone to reliably answer your calls for you and this is typically done by your Medical PA, whom you may wish to employ, or you may choose to use a Medical PA service. An important piece of advice is to ensure that you have a telephone number that belongs to you. Technically it should be possible to “port” your number to be answered wherever you choose but you must make sure that the number is registered to you from day one. Changing your telephone number part-way through your private practice career is painful and costly.
Practice Management System (PMS) – Many consultants start their practice without a PMS, usually to reduce costs, but if you are serious about your private practice then this is an investment that you should make. A good PMS will pay dividends in the efficiencies it brings to your practice and will help to ensure your patient records remain secure and that you are GDPR compliant. There are several PMS systems available and each one has pros and cons. For a deeper look at how to choose a PMS system please read the following article.
How to work with a Medical PA in your private practice
In most private practices, a Medical PA is responsible for the day-to-day operations/ administration of the practice, and we would strongly argue that your Medical PA will have an enormous impact on the success of your practice. Your Medical PA will be the first point of contact for your new patients and will talk to your patients more often than you do. The relationship that a good Medical PA develops with your patients will make a big impact on your patient’s views of how good your practice is and will affect your reputation.
The role of your Medical PA is to manage the administration of your practice, including answering patients’ telephone calls and emails, and booking appointments and surgeries if relevant. Doing this well require great attention to detail and good communication skills with patients, hospitals, and other colleagues with whom you work.
For more detail on the role of the Medical PA read here
At launch, the prospect of employing a Medical PA to support you may seem too costly. You may prefer to consider a Medical PA service where a company such as Designated Medical, provides you with an experienced Medical PA to support you and your patients. Our service provides you with a specific PA to work with you on an ongoing basis and is based on a virtual model of working. You choose a “package” of hours that meets your needs on day one with the ability to increase over time as your practice gets busier. For more details on our Medical PA service ….
If you do decide to employ a Medical PA directly, and the cost is justified, then you will need to start your recruitment drive. Allow plenty of time, as it can take time to find the right person, and any applicants who are currently employed will typically need to give their current employer at least one month’s notice.
When recruiting your Medical PA, a major consideration will be offering a salary that attracts a good calibre of candidates. For guidance on salaries for Medical PAs
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Like marketing, invoicing is an area that most doctors feel uncomfortable with when they enter private practice as it is an area that they are not familiar with. Most doctors dislike talking to patients about money and understandably so as their objective is to deliver great care.
But to succeed in private practice your patient invoicing needs to be managed well. On day one some doctors plan to manage their own invoicing or ask a family member to assist them. This seems like a good solution to keep costs at a minimum but as this is such a specialist activity there is a strong argument that paying for expert help pays dividends in the longer term. The first realisation for this usually occurs when a doctor realises how much bad debt they accumulated.
If you are looking for a sustainable solution to invoicing, you can employ a Medical PA who has experience in managing invoicing or engage a professional medical billing company. Whichever option you choose you need to ensure a thorough understanding of working with insurance companies and embassies and a strong focus on collecting payments.
There are several specialist medical billing companies to choose from and you should explore their credentials in detail before making your decision on whom to work with. Ask for references from other clients, check out what management reports you will receive each month and of course the fee structure. Most companies charge a percentage of the monies received. Check that the percentage is based on monies received and not monies invoiced. You do not want to be paying for invoices that are raised but not paid! If you have built up a degree of bad debt that needs collecting, you may pay a premium for this.
How to manage the finances of your medical practice
You will have chosen the legal structure of your practice which has a direct impact on your financial responsibilities. For a sole trader or partnership, your responsibilities are relatively minimal, but they are far greater for a limited company with the need to submit annual accounts. Of course, your accountant will advise you, but you can do much to reduce your annual accountancy bill if you manage your finances wisely throughout the year.
Whichever structure you are using, your main concerns will be income and expenditure and you will need to keep accurate records of both. Initially, you may choose to do this using excel spreadsheets, but you should consider using a professional finance system such as Xero early in the development of your practice if not from day one. A good finance system will automatically link with your bank account and your practice management system reducing the time spent manually updating your records and so far less time-consuming and fewer errors. You should also check that your chosen accountant uses a good finance system to avoid costly manual bookkeeping.
You may have chosen for your Medical PA or a professional billing company to manage your patient invoicing on your behalf. Whichever method you choose you should be able to download accurate reports from your practice management system (PMS) into excel or if you are using Xero, you can set up a direct link from most PMS systems.
You must keep track of your expenses throughout the year. Many doctors spend money within their practice that they do not include in their expenses, and this costs them dearly in taxes. Your Medical PA or a bookkeeper can track your expenses for you and ideally you would review your expenses each month to ensure everything is being reported.
If you are an employer, you have additional responsibilities for payroll, national insurance, PAYE and pensions. Your accountant will advise you on this.
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