How will Brexit affect private healthcare? Jane Braithwaite examines the areas that might catch out independent practitioners.
Group of business people with team leader standing in office
There has been plenty of doom and gloom about Brexit and how it might affect healthcare, but it is entirely possible that private healthcare may see some benefits from the increased competition.
While the impact on the NHS has been keenly analysed since the referendum result was first announced, there hasn’t been as much dissection of how the private sector might fare. Of course, factors which affect the NHS could also have an impact on private healthcare.
Many commentators have highlighted the risks that Brexit poses to the UK economy, but it is somewhat impossible to predict at this point what repercussions of any Brexit-related economic downturn might have on healthcare.
By contrast, it is significantly easier to assess the following key areas of healthcare which are likely to see significant changes: the workforce, health tourism and the regulation of drugs and devices.
There is so much concern over Brexit’s impact on healthcare that a number of organisations banded together to issue a plea for the UK and EU governments to prioritise patients. This article highlights some of the issues mentioned in the policy statement that are likely to affect the private sector.
How Brexit might affect: The Workforce
Recruitment and retention have been flagged as significant problems for the NHS, but the private healthcare workforce is much more variable.
Although the NHS can exactly pinpoint how many of their staff were born overseas, similar statistics do not exist for staff working privately in the UK. Anecdotally, though, many may agree that London’s private hospitals and clinics feature international teams.
Even conservative estimates mean that there could well be issues for private practices keeping and attracting medical and administrative staff.
There were chronic shortages of doctors across all specialties even before the referendum and applications for medical school and the foundation programme continue to drop.
Around 10% of NHS doctors are EU nationals and the dramatic fall in the number of EU nurses
registering to work in the UK is additionally cause for concern – applications dropped by 87% in 2017.
The private sector needs to become an even more attractive prospect for trained and experienced staff. This might mean turning more to external recruiters and adopting more modern recruitment methods. Could your training and education plan do with a refresh to benefit current and prospective staff?
Finally, providers need to consider succession planning – if they haven’t already – to help avoid a recruitment crisis.
How Brexit might affect: Health tourism
After a strong period of growth in 2013-15, revenues from overseas patients slowed somewhat in 2016-17.
Spire Healthcare cited a reduction in health tourism as a factor in the decision to shelve plans for a private hospital in London.
But if the pound weakens further, London and other major cities could become more attractive to overseas visitors. It is already a popular destination for patients seeking world-class care and specialties not available elsewhere.
The Middle East market is a particularly important one for the Harley Street Medical Area and Birmingham’s Edgbaston Medical Quarter, who have exhibited at the Arab Health Exhibition two years running.
But it is not just Middle Eastern patients who may need to access private healthcare in coming years. If Brexit means that EU citizens can no longer receive NHS treatment, might they turn to private medical insurance instead?
Citizens of the European Economic Area (EEA) living in the UK may have little choice but to take out private medical insurance as individuals, or there may be a rise in corporate insurance for EU companies who stay in the UK.
How Brexit might affect: Regulation of drugs and devices
When Brexit finally takes effect, the UK’s influence in the approval and regulation of drugs may decline significantly. The European Medicines Agency (EMA) is currently based in London and the UK has considerable influence – 20% of the EMA’s activity comes from the UK.
The EMA will relocate to Amsterdam after Brexit and some commentators believe that the shift may mean the UK will also lose its influence in getting new drugs and devices to market. This could mean that medicines and innovative devices could reach the UK market later than they do now, which will affect private patients just as much as those in the NHS.
Another regulation issue which has had a great deal of attention is the possible disruption to cancer treatments. If the UK is no longer a part of Euratom, which regulates the European nuclear industry, it needs to find another way to access radioisotopes that are used for radiotherapy among other treatments.
This could mean significant delays for treatment, and patients will naturally be affected.
London is currently a world leader for the treatment of cancer, with many specialist private clinics in Harley Street and elsewhere. If the UK Government does not resolve these issues in time, patients may start to look to other countries for medical care and private providers could feel the impact.
Private hospitals, practitioners and clinics in London are less likely to be affected by Brexit as the capital is well-established as an international centre of excellence for healthcare.
Outside of London, the long-term economic impact of Brexit may be what makes the most difference to the private medical insurance market.
Along with other industries, private healthcare is affected by the continuing uncertainty of the Brexit negotiations.
Jane Braithwaite is Managing Director at Designated Medical and regularly contributes to the Independent Practitioner Today publication.
[plsc_button url=”https://designatedmedical.com/wp-content/uploads/2018/12/IPT-June-2018.pdf” target=”_self” color=”black” style=”flat” radius=”square” size=”st”]Download full article[/plsc_button]
Dr Elisa Astorri, Founder of Rheumatology Harley Street, leads the way in the care and treatment of inflammatory joint disorders and autoimmune rheumatic conditions. She combines clinical expertise and the latest research with an incredibly caring and supportive manner to improve patient health.
Whilst it hasn’t been headline news, Rheumatology has changed significantly since the turn of the century – that is, the 21st century. Rheumatology is the study, care and management of musculoskeletal disorders, including rheumatoid arthritis, autoimmune disease and osteoarthritis. The focus for the treatment of patients has shifted significantly, from surgical intervention to medical, with the introduction of drugs called ‘biologics’. This has meant a huge improvement for those suffering from conditions such as arthritis, Lupus or Ankylosing spondylitis. Furthermore, GPs and patients have been looking for symptoms much earlier to guarantee an early approach to treatment – what specialists call “the window of opportunity”.
Dr Elisa Astorri
Elisa Astorri is a leading Rheumatologist who uses her research knowledge to inform patient treatment – the best of all worlds. She established Rheumatology Harley Street in 2017, and offers treatment for the full range of rheumatology conditions. Dr Astorri combines her work in the Harley Street clinic with clinical research at Queen Mary University. She completed her PhD on Sjögren’s Syndrome and has since acted as Senior Investigator on several clinical trials.
The clinical trials explore biologic drugs for autoimmune conditions, to improve the range and effectiveness of treatment. In her Rheumatology breakfast tutorial for the Independent Doctors Federation, Dr Astorri said this about biologic treatments
“We used to treat patients with generic immunosuppressants, whereas now we’re able to target specific pathways of the disease”.
Patients are in good hands with Dr Astorri, who speaks French, Italian and Spanish fluently. Over 30 five-star reviews on Doctify are a testament to her quality of care and attention to detail.
Our commitment to GDPR
The European Union has taken a monumental step in protecting the fundamental right to privacy for every EU resident with the General Data Protection Regulation (GDPR) which will be effective from May 25, 2018. Simply put, EU residents will now have greater say over what, how, why, where, and when their personal data is used, processed, or disposed. This rule clarifies how the EU personal data laws apply even beyond the borders of the EU. Any organisation that works with EU residents’ personal data in any manner, irrespective of location, has obligations to protect the data. Designated Group, including Designated Medical is well aware of its role in providing the right tools and processes to support its users and customers meet their GDPR mandates.
Designated Medical’s Commitment
At Designated Medical, we have always given our clients and contacts’ the right to data privacy and protection. We have never relied on advertising as a means to generate business and we have never sent direct advertising to our contact database, and never will. This means that we have no necessity to collect and process our contact database’s personal information beyond what is required for the delivery of our services and to ensure we optimise how we can help and support them.
Over the years, we have demonstrated our commitment to data privacy and protection by meeting the industry standards for data protection. All client sensitive data is saved in an encrypted storage facility which is tightly regulated. We have also made significant investment into our IT infrastructure and we recognise that the GDPR will help us move towards the highest standards of operations in protecting customer data.
How is Designated Medical preparing for GDPR?
We have reviewed all our data and touch points where we collect data and have ensured that we are fully compliant by the time the regulation comes into effect. Designated Medical also understands its obligation to help clients and contacts get ready for the big day and has published useful information to assist them in the process.
We have thoroughly reviewed GDPR requirements and have put in place a dedicated internal team to drive our company to meet them. Some of our ongoing initiatives are:
- Identifying personal data – All our data is categorised and integrated with our marketing systems to ensure consent and accessibility. We have invested in systems to ensuring accuracy and control of data across all systems.
- Providing visibility and transparency – The most important aspect of GDPR is how the collected data is used. Designated Medical’s key role is to provide our clients and contacts (the data subjects) with the access to effectively manage and protect their user data. Designated PA has contacted each and every contact allowing them access to opt in and out and update their personal information.
- Enhancing data integrity and security – Data privacy and data security are two sides of the same coin. As our clients tighten their data security measures, Designated Medical would like to extend a helping hand and have a team of marketing experts who can assist with GDPR compliance. We have invested heavily in our IT infrastructure to ensure we maintain a high level of security and integrity.
- Portability and transferability of data – GDPR gives data subjects the right to either receive all the data provided and processed by the data controller or transfer it to another controller depending on technical feasibility. With this new right in mind, Designated PA is able to export data at an individual level as required.
What does this mean for our clients?
We understand that meeting the GDPR requirements will take a lot of time and effort. And as your partner, we want to help you make your process as seamless as possible, so that you don’t have to worry about compliance and can focus more on running your business. If you need assistance with implementing processes that are GDPR compliant, get in touch and our team of marketing experts can assist. The Information Commissioner’s Office (ICO) have a self assessment tool for businesses which is definitely worth a read.
What should you do to be GDPR-ready?
If you are just getting started with GDPR compliance in your business, here’s a quick to-do list to keep in mind. The ICO have also produced a 12 step process to preparing for the regulation here.
- Create a data privacy team to oversee GDPR activities and raise awareness
- Review current security and privacy processes in place & where applicable, revise your contracts with third parties & customers to meet the requirements of the GDPR
- Identify the Personally Identifiable Information (PII)/Personal data that is being collected
- Analyse how this information is being processed, stored, retained and deleted
- Assess the third parties with whom you disclose data if
- Establish procedures to respond to data subjects when they exercise their rights
- Establish & conduct Privacy Impact Assessment (PIA)
- Create processes for data breach notification activities
- Continuous employee awareness is vital to ensure continual compliance to the GDPR
Are you GDPR ready?
12 Steps to take now
Guide to General Data Protection Regulation
Key Definitions of GDPR
Data Protection Self Assessment Toolkit
Should private consultants fees be published online? Consultants, hospitals and patients all have an opinion on the issue of fee transparency. But despite a legal challenge, the Competitions and Markets Authority (CMA) have ruled that they will be published. And the burden is primarily on consultants to provide fee transparency. In March 2017, the CMA announced that fees will be published online by April 2019. The Private Healthcare Information Network (PHIN) will gather and publish information on consultant fees.
Consultants fee transparency to patients
In addition to the information PHIN will ask for, consultants working at private hospitals must also supply information directly to patients before a consultation, test or treatment. This applies to consultants who refer patients for treatment or tests and those who have practising privileges at a private hospital. Consultants must give details of fees, estimated costs and a list of recognised insurers amongst other information. Private hospitals should provide consultants with a template letter to do this.
It has been compulsory to provide this information before an outpatient consultation since December 31, 2017. From February 28, 2018, consultants must supply the relevant information to patients before further treatment or tests. All of these requirements stem from Article 22 of the Private Healthcare Market Investigation Order 2014.
Investigations into private healthcare
The shakeup of the private healthcare market has been happening for many years, and we can now see the full extent of the additional regulatory requirements for private providers. Both the Office of Fair Trading and the Competition Commission (now part of the Competitions and Markets Authority) have conducted investigations into private healthcare in recent years. Both investigations were led by concerns that private healthcare was not as accountable as the NHS. The British Orthopaedic Association’s briefing for its members provides an excellent background summary.
The Competitions and Markets Authority (CMA) reported that private patients didn’t have sufficient access to information in order to compare quality and cost. Their report in 2014 provided a number of ‘remedies’ which PHIN are putting into practice. All private healthcare providers have to provide PHIN with performance information including lengths of stay, mortality rates and readmission figures. This is all detailed in the Private Healthcare Market Investigation Order 2014.
The impact on private consultants
Whilst private hospitals are responsible for ensuring their consultants provide information to patients, the primary burden falls on consultants. Medical support staff such as medical secretaries should be able to assist with additional paperwork, as they are already familiar with other regulatory tasks.
Designated Medical can provide flexible medical secretary support on a monthly plan or PAYG basis, so let us help!
This year has seen some significant IT security breaches in both the public and private sectors. From the WannaCry ransomware attack on the NHS to smaller, but no less distressing, attacks on private medical practices, these stories have received heavy media coverage. As a result, it’s likely that public awareness of these kinds of cyber attacks has increased and that patients will quite rightly expect clinics to have effective IT security systems in place to protect their data. This week, we’ll be taking a look at why hackers target medical information, and what practitioners should be doing to make sure their practices are safe.
Why is personal medical data so valuable?
Hackers target healthcare organisations for a number of reasons. For a start, large healthcare organisations – such as the NHS – are considered an easy target due to the sheer number of email accounts associated with it. In addition to this, the type of personal information held by these companies and organisations can be used to demand a hefty ransom. Earlier this year hackers stole over 25,000 photographs, and other personal information such as passport scans and National Insurance numbers, from the database of a Lithuanian cosmetic surgery clinic. The ransom demanded was up to €2,000 (in bitcoin). This information can also command a high price on the black market. “On the black market, medical record information can cost up to 50 times more than credit card information,” says David Schluter, Managing Director at Fluid IT . “Unlike credit card information, it can’t be changed easily and can be key in staging ID fraud,” he continues. “It can be used in a broad range of fraud; fake insurance claims, financial fraud, and cyber criminals can even use it to purchase drugs online and then sell these on the black market.”
How can practices improve IT security?
There are many things practices can do to improve IT and data security, and education is a huge part of this.
“Medical practice staff need to really understand the value of this kind of data,” says Schluter. “It’s important to take data security very seriously as the risks can be enormous, but there are many excellent resources available to help managers support and educate their staff.” There are frameworks and toolkits available through online sources such as the ICO, or Cyber Essentials, all of which can guide the development of company policies and training. These resources can also help prepare staff for the enforcement of new data protection regulations next May (the EU’s General Data Protection Regulation).
In addition to this, there are other ways to improve IT security:
- Communicate regularly with staff regarding potential threats. For example, discuss how to spot suspicious links from unknown sources, explain the impact an attack could have on the practice, and emphasise staff obligations in relation to company equipment.
- Cyber liability insurance will provide cover for various scenarios; mandatory data breach notifications, investigating an incident, notifying data subjects, legal costs and regulatory fines.
- Work together with law enforcement agencies. This will help to disrupt hackers’ plans, and sharing threats and vulnerabilities means that others can benefit from this information.
- Encrypting emails and documentation containing personal information. “Devices should also be encrypted,” offers Schulter. “This offers an additional layer of protection, and makes it much harder for criminals to steal information. However, an encryption expert should be consulted before a practice implements this to ensure it has been designed in a way that suits the business.”
Beyond cyber crime
Cyber criminals are becoming more effective and more organised, so it’s a good idea to think beyond the capabilities of your IT systems to combat the threat. An all-inclusive approach to IT security is required. Secure systems need to be backed up with policies and procedures, so staff know what their responsibilities are in terms of data protection and security.
The risk of security breaches does not only come from cyber criminals, as a prestigious US cosmetic clinic found out earlier this year. A member of staff stole as many as 15,000 medical records, including medical photographs. Whilst the team member’s actions are now the subject of a police investigation and it is not clear what became of the information, this case goes to prove that data safety is not just a matter of having the most up-to-date antivirus software in place.
Cyberattacks are unfortunately not preventable, and it is sadly a threat that all companies – not just those in the healthcare sector – face. They can affect thousands of people (this year’s major WannaCry attack impacted around a quarter of a million computers across the globe) and can disrupt vital services. It’s crucial for anybody working in the healthcare sector to recognise this danger, and working in line with their organisation’s IT policies can help to minimise the risk of being hacked.
The life of a medical receptionist can be very demanding. Being the first point of contact means often having to deal with patients who are stressed and emotional about their health. Patients are of course well within their rights to feel this way, but this does mean that receptionists have to sometimes deal with tough situations.
There is a perception that the medical receptionist is the only untrained staff member at a surgery, but this could not be more wrong. Clerical staff will often have years of experience behind them, and the training available for medical administration staff is comprehensive and accredited. The British Society of Medical Secretaries and Administrators (BSMSA) has courses on dealing with difficult situations and customer care, and there are of course the nationally-recognised AMSPAR qualifications.
Medical receptionists provide more than just an appointment booking service, and the role is now set to evolve even more.
The medical receptionist as a care navigator
NHS England has recently set aside funding for the development of practice staff. This funding is to be used by practices in the training of their reception and clerical staff, and will support a new aspect to the receptionist role – that of “care navigator”.
The £45 million fund is being allocated over a period of 5 years until 2021. This is to be used to support training reception staff in the area of “active signposting”. This new scheme, whereby patients will be screened by the practice receptionist, will help to direct patients to the most appropriate source of care. This could be through the use of web or app-based portals, self-management, or by signposting to the most relevant healthcare professional.
The care navigator approach is expected to ease demand for GP consultations by 5 percent. It will also help receptionists develop their skills so they can be confident in their assessment of a patient’s needs.
Some surgeries are already finding that implementing this “triage” stage into the appointment booking process is helping to direct people to the most appropriate facility and, as a result, is easing pressure on GP appointment waiting times. In a West Yorkshire group covering around 65,000 people, one scheme found that 930 hours of GPs’ time were saved by this initiative. However, this new approach will not be without its challenges. A recent Cancer Research survey found that 40% of people dislike having to describe their symptoms to a GP receptionist in order to get an appointment. But this is often simply part of practice policy. “Receptionists are told to follow the instructions of the GP, and are not being nosey,” says Joanne Packwood, a Designated Medical Secretary. “They are asked to triage patients so they can figure out where to fit them in, usually in what is an already overbooked clinic.”
Some work needs to be done, therefore, to overcome this challenge.
Can it work in private health?
Private practices will not be under the same pressures experienced by NHS GPs. However, this does not mean that the idea can’t be successfully implemented in a private medical space. Some practices may even use similar systems already, but others may want to think about a similar training scheme before staff take on these additional responsibilities. “I think that training for this in the private sector would be helpful,” says Monique Van Der Berg, a Designated Medical Secretary. “Depending on the job role, it may be very useful – some staff members may not have had this responsibility before.”
If, as expected, this results in making a practice more efficient then it is a great time-saving exercise for all involved. The patient may need urgent care, in which case they can be directed to another appropriate facility, or they may need simple treatment that can be provided by a pharmacist.
Can anything else be done?
Despite all the training mentioned above, there will still be scenarios that are less than ideal. Conversations between medical receptionists and patients may be overhead in waiting rooms, and some staff may deal with situations in a less than sensitive manner. To deal with these challenges, managers need to evaluate performance to ensure that staff actively use their training, and perhaps even reconsider practice procedures in relation to screening patients. For example, telephone screenings could take place away from waiting room areas to avoid conversations being overhead.
Another issue for NHS practices is that the funding made available through the NHS England scheme does not cover all the skills needed to provide a good service. Customer service, safeguarding and information governance training is not covered under the scheme, so practices need to find funding for this elsewhere. In an area of healthcare that is already under pressure, this may be difficult for practice managers.
Whether in the private or public sector, the patient’s needs should be the first concern of any team member. “The medical receptionist or secretary should always be polite and calm, but assertive,” says Joanne Packwood. “They should also feedback what the patient is telling them so they feel understood and reassured.” In addition to this, team members need to have a good knowledge of the specialty they are working in. “If the patient knows that the secretary knows what they’re talking about and understands what the patient is going through, this will reassure them appropriately,” offers Monique Van Der Berg.
Above all, there is the need for the sensitivity and confidentiality that all patients rightly expect from any healthcare provider and facility. Patients need to be confident that their care is being dealt with efficiently and by a team member who is appropriately trained and dedicated to their role.