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 020 7952 1008

‘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

Accountancy vs Bookkeeping

Accountancy vs Bookkeeping

For somebody who doesn’t work in finance, it can be difficult to distinguish the difference between accounting and bookkeeping, as there are some administrative areas that can overlap depending on the structure of a business and how many employees it has working in its finance department.

However, while bookkeepers and accountants share common goals, they do support your business in different stages of the financial cycle.

Bookkeeping is more administrative, recording financial transactions. Accounting is more subjective, giving you insights into your business’s financial health based on the information provided by bookkeepers.

If you’ve ever wanted a clear definition between accountancy and bookkeeping, keep reading.

What is a Bookkeeper?

Bookkeeping is a legal requirement for all businesses of any size to carry out, and it refers to the recording of the financial transactions of a business, whether a sole trader, a partnership, or a limited company.

A bookkeeper will record all transactions either manually or within an ERP system like XERO and keep copies of all invoices, receipts and evidence of these incomings and outgoings.

The role of a bookkeeper will include:

  • Recording financial transactions
  • Posting debits and credits
  • Producing invoices
  • Preparation of financial statements (balance sheet, cash flow statement, and income statement)
  • Maintaining and balancing subsidiaries, general ledgers, and historical accounts
  • Completing payroll

What is an Accountant?

An accountant has expert knowledge surrounding taxes and accountancy. A business needs to consider more than just the in’s and out’s calculated by a bookkeeper, the right accountant will guide and act as financial business partner, ensuring all allowable expenses are claimed and all decisions are tax efficient to not only the business but the owners, directors, and partners.

The role of an Accountant will include:

  • Preparing adjusting entries (recording expenses that have occurred but aren’t yet recorded in the bookkeeping process)
  • Reviewing company financial statements
  • Analysing costs of operations
  • Completing income tax returns
  • Aiding the business owner in understanding the impact of financial decisions

Designated Accountancy Services

All business owners want to have complete control of their business finances and have an up-to-date view of their financial performance. Our team of Designated accountants are experts who work with you on a flexible basis, whether you need support one day a month, one day each week or more.

Designated is a Xero Bronze Partner and our finance team are Xero certified advisors, trained by Xero to deliver you the best financial support.

Do you wish you had answers to questions like these?

  • How much tax will I need to pay next year?
  • How much profit did we make last month?
  • What do you mean by Tax Digital?
  • Am I managing payroll in the most effective way?

If so, then our Accountancy services may be your solution, please get in touch:

Vicky Garbett, Head Of Accountancy vicky@designatedgroup.com 020 7952 1460 

How can a strategic business review help your practice excel?

How can a strategic business review help your practice excel?

When you are running your own private practice, how do you take a step back? To stop and evaluate, and to listen and learn from your patients and team? 

 

Are the values and vision you hold dear, understood and communicated to all your stakeholders, referrers and patients? 

 

Doing this is hard within your own practice. Taking time away from the demands and stresses of “business as usual”, to pause and evaluate whether you are offering the best experience to your patients and your team is important but also challenging. So how do you achieve this? 

 

This is where a strategic business review comes into its own. Undertaking such a review will immediately help you to identify the strengths of your practice, and pinpoint the weaknesses, creating an opportunity to highlight and rectify any problems before they become ingrained. 

 

Most businesses conduct annual employee performance 360 reviews and find them extremely helpful with staff development and management, however, much greater value is to be had from running a whole business review, covering both your patient’s and employees’ experience of working with your practice. The process of looking at every aspect of your practice by reviewing each part of the structure from the top down, will reveal exactly how it is perceived, and identify any gap between your view of how you want to be perceived and reality. 

 

What is a business review? 

A business review evaluates key aspects within your practice that are the pillars of its success, through an in-depth audit and interviews with key stakeholders. 

 

The process is usually managed by an external partner, covering areas such as: 

Business objectives 

Vision, Mission and Values 

Service offering 

Key sectors, target patients 

New patient/referrers strategy 

Marketplace perception 

Your people – staff engagement 

Patient experience/journey 

 

The output of the review is a comprehensive report, providing evaluations and recommendations that engage your team, identify your ideal patients and referrers and ensures your brand messaging and values are woven throughout all of your practice communications and patient journey.  

One of the benefits gained by a business review is the feeling of inclusion amongst your employees while contributing to creating a more positive workplace. 

 

The report 

From the answers obtained in the interviews, the review of supporting documentation, clarifications and from research, an extensive report is produced, which addresses all of the areas above and summarises your successes and challenges in each area and provides recommendations to improve, including, but not limited to:  

Competitor analysis  

A review of your brand messaging and story and suggestions on your messaging going forward  

A full website audit  

A review of all your communications, social media, marketing collateral, pitch/presentation documents  

Development of user personas for your target patients and referrers  

A ‘secret shop’ to experience your patient journey  

Results from a staff engagement survey to inform Values and identify any areas for improvement  

The report concludes with recommendations for all of the key areas: – Business strategy, patient experience, your people, brand messaging and marketing strategy and activity.  

It will also provide a 3-month marketing plan that incorporates your Brand Strategy which can be implemented at your own pace.  

 

Tough read 

Any review you undertake can be a difficult read as it will enable you to uncover issues of which you were completely unaware. The process and findings can feel quite personal as your practice is your passion. The key is to thoroughly evaluate the results and make changes where necessary.  

 

A review can broaden your view of your practice, patients, referrers, workplace and employees and steer you away from assumptions. It will allow you to identify the improvement opportunities and create a strategy to implement them. 

The idea of any review can seem daunting, and the results can be brutal and difficult to accept, but it can be an especially useful way of identifying issues and weaknesses before they become a real problem affecting practice performance. When managed properly, the results can lead to changes that ingrain best practices within every layer and ensure that your employees and patients feel listened to and valued. The most important part of any business is the employees and ensuring they are all on board with the values and ethos of the business allows the company to develop and flourish in its given field.  

 

If you would like to find out more about our Designated Business Review, please do get in touch: 

Michelle Wheeler, Marketing Director 

michelle@designatedgroup.com 

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

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