‘It’s good to talk’ to defuse disharmony

‘It’s good to talk’ to defuse disharmony

Our Managing Director writes about how to ease tensions within a private practice. First published in Independent Practitioner Today.

Tensions are not uncommon when consultants get together to form groups in private practice in the current financial climate. Our Troubleshooter Jane Braithwaite tackles an appeal for help. 

‘We have been working in a group for two years now and we are starting to experience tensions between us. How do we manage these tensions without breaking up the group?’ 

Running a busy private practice group can be rewarding but time-consuming at the best of times. If you are experiencing disagreements with the other members of your group, it can feel overwhelming.  

Tensions, disagreements or even arguments can be common, especially among the high-performing clinicians that make up your group. 

This article will look at how to approach your colleagues to diffuse this tension, how to reduce the chance of divisions going forward and what steps to take if you feel the situation is irretrievable and the group needs to be dissolved. 

There are a number of steps you can take to resolve this situation. 

Tensions are common  

The nature of a group can lead to building tensions. It is rare that everyone in the group has exactly the same goals, both professionally and personally.  

These slight differences in objective can lead to stress, which can manifest in many different ways. 

The reasons for these disputes vary from person to person and from group to group. They could be related to individual financial problems, the clinical direction that the group is moving in, the way work is allocated or how profit is distributed.  

Whatever the cause, it will be essential to see the problem from everyone’s point of view in order to come to an amicable solution. 

How to start the discussion 

The process of understanding the problems within the group and addressing them is key.  

One of the best methods is a meeting to talk through all the issues. Everyone must be present, because if someone feels excluded, it may lead to resentment and the underlying problems cannot get solved. 

At the outset, you should set the expectation that these meetings are the forum to talk through all the tensions, with no side discussions or confidential chats that do not involve all members of the group. 

This meeting aims to bring up all the problems that people feel are holding the group back, work together to find a solution and decide how it will be implemented. 

How to structure the discussion 

If you lead or manage the group, you may feel it is natural that you take charge of this meeting.  

Depending on what needs to be discussed or what the underlying issues are, the other members may find it more difficult to be open and honest if one person appears to have more sway than the rest. 

To ensure that there is no power imbalance in the discussions, you might find that having an independent person to chair the meeting can help things flow a bit better. They can help keep the meeting on topic and make certain that everyone is having their say. 

If you have significant problems within the group, it is likely that this meeting will involve a degree of confrontation.  

This is never a comfortable position to be in, both for yourself and others. Going into this meeting prepared, either by having thought through what needs to be said or bringing notes with you, will make sure that you can manage to get your point across. 

Psychologist Bruce Tuckman described the stages that teams go through when working on a project together. He named these stages ‘forming, storming, norming, performing’.  

The ‘storming’ stage is characterised by potential conflict between members as everyone tries to work out individual roles and pushes against boundaries. 

It may be that, as a group, you have entered the ‘storming’ stage, with its uncomfortable conflicts, and that you need to work through to reach ‘norming’, where everyone resolves their differences, and ‘performing’ where members work together to achieve the group’s goals. 

If you can push together through this difficult stage, you may find that you have bonded better as a team and can attain greater success in the future. 

How could the process go wrong? 

Any situation involving confrontation is fraught with pitfalls. 

If relationships within the group are already fractured, there may be considerable resistance to bringing about the meeting. Sometimes in these circumstances, there is one member of the group who can act as a ‘peacemaker’ and bring the others together. 

It can be tempting to phrase all communications about these meetings in hard-nosed business language. By humanising what you say and acknowledging your own and others’ discomfort with the situation, you might find that everyone can open up a bit more about the problems that they see. 

Some people may find this level of discomfort and confrontation intolerable and, rather than face the issues, may choose to leave the group. 

 If there is no way to bring about a meeting between members, then the business relationship, and thus the group itself, may not be salvageable. At this point, the advice of experts such as lawyers and accountants will become invaluable. 

How can we improve in the future? 

If you have managed to have these discussions, then you have taken a difficult but important step for your business. It would be a shame now to slip back into your old ways and find that the same problems and conflicts are continued. 

Look back at the contracts and agreements that you had drawn up when you formed the group. Do these still reflect the way the business is run? You may find that you have altered some of the roles, responsibilities and functions of group members and may wish to put this down in writing in new contracts. 

You will need an agreed structure for the future and this should be documented and signed by all members of the group.  

If necessary, you should seek advice about drafting these new contracts and agreements to make sure that everyone has clarity about what they can expect of others and what others will expect of them. 

Ongoing communication will be essential, perhaps in the form of a monthly group meeting. This will provide a forum for issues to be aired while they are still small and easily solvable and allow them to be dealt with before they become a threat to the group. 

What if the group cannot be salvaged? 

Sadly, it is not uncommon for dis­agreements to snowball, ending up with a break-up of the group.  

If your founding agreements included provisions for dissolving the group, then this process will be much easier. 

If the initial contracts did not cover this, then it will be necessary to negotiate with the other members of the group to find an amicable way to split the assets. This could be complicated and having the advice and input of experts as early as possible is advised. 

Managing conflicts, tensions and disagreements in a group can be difficult. If you can find a way to bring everyone together as a team, where each individual is empowered to raise problems, you may find that the resulting group functions much better than before. 

If you have any specific questions that you would like answered in upcoming editions, please do feel free to get in touch. 

Info@designatedmedical.com or call 020 7952 1008

 

The big benefits of banding together

The big benefits of banding together

Consultants’ groups may be an increasingly attractive option for those in private practice in the current financial climate. Our Managing Director Jane Braithwaite has written an article for Independent Practitioner Today which tackles a question on the lips of many.

I have been happy as a solo independent practitioner, but with pressure on costs and other factors, I am thinking of setting up a group. What advice would you give me?

A lot of doctors in private practice choose to form groups with like-minded colleagues. Some decide to go down this path soon after starting independent work, while others transition into it with a large amount of private practice experience. 

There are myriad reasons to form a group, ranging from personal to financial. Let’s look at why you might want to form a private practice group and examine some of the important issues you might want to consider.

There are a number of benefits to group formation, which I explain more fully below:

Income benefits

As a solo practitioner, you only have so many hours in a day. You might find that the number of tasks you have to complete seems overwhelming.

Not only do you have to undertake all the clinical tasks that caring for your patients involves, but you are responsible for all the necessary, but not always exciting, activities that a thriving business throws up.

When working by yourself, your income is directly related to the number of patients that you can see and treat. If you want to increase your income, generally speaking, you have to work more. 

The number of hours can add up quickly, risking burnout and making it difficult to provide the same high-quality care to each patient.

Additional complications include the expense or lost income related to taking holidays and how to find clinical cover in the event of your absence.

Working as part of a group can negate some of these problems. Clinical work can be evenly distributed and, overall, you can see more patients. You might even be able to take a holiday or two.

Personal and professional benefits

Being a solo practitioner has the potential to be a lonely experience. 

Those working in the NHS may be used to large departments with many peers and juniors. Getting a second opinion before making a decision, asking for help or even just socialising with colleagues can be rewarding.

For some, working alone may be isolating. Forming a group has the potential to negate some of these problems and maybe a positive experience.

Having peers who are working towards the same collaborative goal as you can provide a support system. 

This can be valuable when things are going well, but essential when there are difficulties. Having a sense of community can be really important when dealing with the trials and tribulations of modern clinical practice.

A group can allow collaboration when working on specific projects that will benefit your clinical service. Together you might be able to provide investigations or treatments that would not be viable, either practically or financially as a solo practitioner.

The colleagues that you bring together to form your group may well have different, but complementary, skill sets. This ability to offer a wider range of treatments will ensure that the pool of patients that you can manage is greatly expanded and that a greater part of each patient’s treatment journey can be spent with the group.

Financial benefits

It is no secret that the costs of practice are increasing. The bills for rooms and premises, secretarial support, indemnity cover, marketing and accountancy are all steadily going up. 

The fees paid by medical insurers, like Bupa, are not increasing in step with the rising costs of medical practice. 

The self-pay market is becoming more prominent, but patients without insurance are likely to be much more price-sensitive than those using other payment methods.

A group can help offset some of these cost increases by allowing much greater efficiency in the business side of your practice. This can include money invested in advertising your practice, accountancy and book-keeping and medical secretarial costs.

Some insurers may have a preference for dealing with groups rather than solo practitioners, and you might find this reflected in increased patient referrals or ease of dealing with re-imbursement.

The realities of setting up a group

Setting up a group is a significant commitment. As the one who is initiating this, you may find that, naturally, you will act as the leader and manager of your peers.

Running a group requires a different set of skills than managing a solo practice and there can be a steep learning curve.

Before starting, you will need to be prepared for the extra time required to run the group practice, both due to increased administration and also from managing the other people involved in your endeavour.

When starting this new business, it is easy to get carried away with thoughts of all the possibilities, from more patients to better treatments and perhaps even greater profits. 

It is easy to focus on the excitement and not to have the difficult but essential conversations and agreements that have to happen right at the beginning.

Everyone needs to be clear about what expectations they have going into this enterprise, both of themselves and of each other. Will everyone commit the same amount of time to the group? How will profits be distributed? Does everyone have an equal say in the running of the group?

All of these questions need to be addressed and agreed upon before the group can start work.

One item that is often not discussed is what will happen if the group is not the success that you hope. The reasons for this could vary from the costs being too high, not bringing in enough patients or disagreements among members of the group. 

Dissolving the group

If you have to make the difficult decision to dissolve the group, how will the financial obligations be dealt with and how will any remaining profit be distributed? 

It is important to consider how each member of the group would transition back to independent practice if they wish to leave the group or if the group was to come to an end.

You may find that embedding routine or regular reviews, where you each openly discuss issues within the group and follow up on past decisions, makes sure that everyone feels involved in the management of the business. 

These meetings have to allow all partners to freely bring up problems, as having issues fester can cause significant problems down the road.

Your patients come to you for specialist advice and you should do the same when forming your group. 

Accountants and legal professionals will be able to steer you in the right direction, be it the requisite contracts with your colleagues, whether your business should be a limited company or a partnership, or how to ensure you are paying the correct taxes.

Forming a new group should be exciting, both professionally and personally. Careful planning at the outset, backed up with expert professional advice, will hopefully lead to your future success.

If you have any specific questions that you would like answered in upcoming editions, please do feel free to get in touch. 

Jane has written a follow up article looking at how a consultant group may have developed over time. Read more here.

 

If you have any specific questions that you would like answered in upcoming editions, please do feel free to get in touch. 

Info@designatedmedical.com or call on 02079521008

 

September Edition of Stay Connected

September Edition of Stay Connected

Stay Connected

In this month’s edition of Stay Connected, our Head of Accountancy has taken the work out of the Government’s mini budget and gives you the salient details of how it will affect you and your practice.

When was the last time you analysed your patient journey or even how your business functions in general? This month we look at how you can best do this to ensure your practice thrives!

We have examined how you can streamline and improve your patient journey to make onboarding new patients easier and ensure that they return to your practice long-term, helping boost patient retention and increase profits.

Our specialists have examined how strategic reviews can benefit your practice, helping you identify your strengths and weaknesses. Conducting a well-rounded evaluation across all elements of your business can help you adapt and grow and remove any issues before they become detrimental.

And finally, we know that NHS wait times are encouraging people to turn to private medical care. We have looked at 5 things private practices should consider to meet the needs of self-pay patients to help grow your practice and ensure their needs can be met.

Best wishes,

Designated Medical Team.

2022’s mini budget update & what it means for you

2022’s mini budget update & what it means for you

Here at Designated, we aim to help our clients succeed and to support this we are committed to sharing our expertise and experience. This week our team of accountants are available to help you make sense of last week’s budget and how it may affect you and your practice.

If you’d like to have a more in-depth discussion with our finance team, get in touch with Vicky at: Vicky.garbett@designatedgroup.com 

Here is a quick budget overview from Vicky: 

The mini budget has come as a surprise to some, and a real shock to others. Reading all the newspaper coverage can cloud the raw details of the Government’s announcement, so here they are, with no fluff and straight to the point!

 

  • AIA will remain at £1,000,000
  • IR35 rules will be reformed, and tax codes will be reviewed
  • Income tax rate of 45% to be abolished next year, and income tax (lower threshold) to be 19p in the £1 from April 2023.
  • End of the 45p tax rate, paid by those earning more than £150,000, from April 2023.
  • 1p cut to the basic rate of income tax brought forward by a year to April 2023
  • No stamp duty to be paid on property purchases up to £250,000 and up to £425,000 for first-time buyers
  • Scrapping of the bankers’ bonus cap in a bid to boost the city
  • Reintroduction of VAT-free shopping for overseas tourists
  • Businesses based in 38 new ‘investment zones’ will have taxes slashed and will benefit from the scrapping of planning rules
  • Alcohol duty frozen from next year (estimated to be worth 7p on a pint of beer and 38p on a bottle of wine)
  • National Insurance contributions increase of 1.2% to be cancelled from 6th November 22
  • Cancellation of next year’s planned rise in Corporation Tax, will now remain at 19%

Designated are always here to support you, across all our services. Get in touch with the team to start your conversation. 

Phone: 020 7952 1008 Email: info@designatedgroup.com

How to help your staff financially

How to help your staff financially

This article was written by Jane Braithwaite and originally posted on Independent Practitioner Today.

For the last few months, one of the top news stories each day relates to the increasing cost of living in the UK. The headline as I write is that inflation has hit the highest rate in 40 years and reached 9% in April 2022. Maybe by the time you read this it has gone even higher. Energy prices are increasing drastically as well as the cost of food, clothing and many other household items. As a result of the increase in inflation, the Bank of England raised the base rate of interest for the first time in many years, putting more pressure on homeowners with higher mortgage payments. 

With the additional increase in National Insurance, this is all putting a significant number of people in the UK under financial pressure. I think it is safe to assume that most employees would like a pay rise in their current job or they will start to look for a new role with a higher salary. As employers, there is a risk that we will lose staff if we do not take action to support our current employees.

Pay demand 

Most employees will be demanding a pay increase at least in line with inflation so that they feel they are at least standing still in terms of their financial well-being. But for most employers, the prospect of giving every individual within their company an inflation-based increase is simply not a possibility. Offering every employee a pay rise in line with inflation is not only difficult for most employers to deliver, but economists would warn us against doing so for other reasons.  

Now, I am no expert when it comes to economics, but my understanding is that economists caution us against increasing salaries across the board, as it would allow spending to continue at current levels, which will cause inflation to continue to rise resulting in a vicious circle. I am happy for anyone to question this, of course, as many readers of Independent Practitioner Today will have a far deeper understanding of the issue than I can claim to have. Research shows us that one of the most common causes of stress for individuals is their financial well-being and this is going to become a major concern for many more in the coming months and potentially years. 

Extreme stress 

As employers, we also appreciate that if our teams are feeling stressed in their personal lives, they are not going to be able to perform to the best of their abilities in the workplace and extreme stress can also lead to a higher absence rate from work due to ill health. 

So, what do we do to support our employees through this difficult time? If increasing salaries in line with inflation are not possible and not advisable, then what do we do as employers? Maybe the answer is to increase salaries where possible by a margin not in keeping with inflation but enough to try to alleviate the situation for individuals, especially for those on lower salaries. There may be other ways in which employers can help by thinking beyond the immediate issue of salaries. 

Several schemes may be relevant to our employees, including season ticket loan schemes which aim to help employees where the cost of commuting is a major budget item. Research by the company Employee Benefits confirms that this is one of the most common benefits offered by employers, with 59% of employers doing so. 

The season ticket loan is an interest-free loan for employees to cover the cost of travelling to and from the workplace via modes such as tram, rail or bus. Some schemes can also be used to cover parking costs too. The loan repayments are paid monthly through the employee’s net pay over a set period.

For keen cyclists, the cycle-to-work scheme could be an attractive possibility. It allows employees to save 26 to 40% on their bikes and accessories. The employee has no up-front payment and the monthly payments are taken tax-efficiently from the employee’s salary by their employer. 

Tax breaks

During the Covid pandemic, when we were all advised to work from home if possible, the Government introduced tax breaks to help alleviate high energy bills. From April 2022, this tax break has been tightened and while some employees can claim, for many this is no longer possible. Without a doubt, heating costs are higher for those working from home and next winter this will become more of an issue. If the Government is not going to provide support for home workers, then employers may need to step up. 

For companies who have introduced a working-from-home strategy, there will be cost benefits associated with reducing the need for office space and a proportion of this saving could be passed on to employees to help with higher energy costs. A different type of approach would be to offer an Employee Discount Scheme to help employees save money on their purchases. These schemes offer employees discounts for products and services that they are likely to buy regularly. For example, one company called PerkBox offers discounts at Sainsbury’s and M&S.

The final suggestion is to help employees manage their finances more effectively by offering access to support services and financial training. There are lots of organisations and training providers offering such support and these could prove to be very helpful to some employees. But this type of approach needs to be handled with extreme care to avoid any suggestion that employees are being judged or criticised.

Tone deaf

In recent times, we have seen numerous politicians slated for their comments regarding individuals being unable to budget and unable to cook. It was even suggested that individuals solve the issue by taking on extra hours or an extra job. All of these comments appear tone-deaf to people who are working hard just to keep their heads above water. Everything I hear and read suggests that the cost-of-living crisis is going to be a long-term issue and so, as employers, we must do what we can to support our employees. 

One obvious solution for our employees will be to move to a better-paid job and so, if we do not take action, our biggest issue will be a recruitment crisis, which is time-consuming and expensive. Retaining our employees by supporting them will prove to be the best option for both employer and employee. 

If you have any specific questions that you would like answered in coming editions, please do get in touch. 

Companies that a doctor can use to implant the Cycle to Work scheme include:

www.bike2workscheme.co.uk
www.cyclescheme.co.uk

January Stay Connected

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