Planning a start in private practice?

Planning a start in private practice?

This article was originally posted on Independent Practitioner Today 

One of the most obvious steps for consultants looking to start a private practice is to gain practising privileges. Jane Braithwaite uses her insider knowledge to present an essential guide to help bring you success in this setting-up process.

The process of gaining practising privileges is often viewed as time-consuming and bureaucratic, but there is a lot more to think about than simply filling in a set of forms. Most consultants will need to choose which hospital or clinic they wish to work at and making this decision is complex. Having an application accepted is not guaranteed and consultants need to consider what they offer the hospital to ensure their application is successful. 

For a consultant, practising privileges are a licence permitting them to work within a hospital, clinic or independently in private practice. The consultant will be able to make use of the facilities and services provided by the hospital. Most consultants will be granted practising privileges within a large organisation operating several locations, but an individual consultant will generally be given access to work from one specific location. 

Gaining practising privileges enables a consultant to work in private practice, serving the general public and have the ability to potentially generate a substantial private practice income. For the healthcare service provider, offering practising privileges to a consultant is also an important decision. The granting of practising privileges is a formal and well-structured process requiring an applicant to pass certain checks and to demonstrate suitable indemnity cover.

A healthcare service provider invests enormously in its facilities, and also its reputation, so it needs to be certain it is granting privileges to consultants who will respect its facilities and uphold its reputation. Ultimately, though, the private service provider needs consultants to work successfully from its facilities to generate activity and income. So the relationship between the consultant and the service provider is mutually beneficial. 

Choosing where to practise

When deciding where to practice there are several key factors to consider. Location is an obvious factor, as it needs to be convenient for the consultant and ideally close to home and their NHS base, if appropriate. The facilities provided by a service provider and also the reputation of the facilities with patients will be vital. The demographics of the local area may be relevant to some medical specialities and a consultant will need to research whether their ‘target audience’ is well represented in the immediate vicinity.

Less is more

Quite often, when a consultant is starting their private practice, they are tempted to apply for practising privileges with several different service providers. Their thinking is that they will run clinics at various locations initially, determine which location is most successful for them and then focus on that particular clinic. Most consultants starting private practices are already busy with demanding schedules and the requirement to manage clinics at several different locations is time-consuming and onerous, especially in terms of travel, and difficult to manage from an administrative perspective. 

This approach often turns out to be a disappointing strategy. The consultant is spread too thinly and the experience of managing numerous clinics at different locations is stressful and ultimately not successful. This slightly scattered approach is also not welcomed by service providers. When a service provider grants privileges to a consultant, it will invest time and resources in assisting the new consultant and marketing its practice to its community of GPs and patients. A service provider will be more highly motivated to do this if they feel a consultant is committed to them, looking for a long-term partnership and demonstrating loyalty.

Research the competition

Decisions may also be affected by colleagues and potential competition at a particular hospital.If there are several very successful consultants in a given speciality at a particular location, it may be hard for a doctor of the same speciality to start a new private practice, unless the existing practices have long waiting lists. When private consultants first take the leap from solely practising with an NHS contract, they can find themselves in unknown territory when it comes to competitors and self-promotion. Never before have they had to look at themselves and their skills as a personal brand that they need to advertise like a business. 

They will need to build up a network of contacts as well as consider their online reputation. New consultants would be wise to spend time searching online for their ‘competitors’ to find out the following information to help them plan their own strategy:

 How easy are they for patients to find online?

 Are their profiles active and up to date?

 Do they have their own website?

 What is the general sentiment of their online reviews?

 Do they use social media and how often do they post online?

 Do they use bespoke branding such as logo, brand colours, specific font?

 How do they communicate their fees?

 How does your own structure compare? 

Colleagues not competitors

Though it is important for a new consultant to market their practice and to be aware of competitors in their field and local area, it is also worth them making the effort to network and connect with their peers. In less specialised areas, private consultants may not have the capacity to treat all patients and there may be a need to hand over cases that require rapid treatment or consultations.  There could be more than one reason, that a practitioner has decided to consult privately. Perhaps it is financial or simply a needed respite from the bureaucracy of the NHS. 

Whatever the reason, your patients, their care and treatment should always be at the heart of what you do. Keeping this in mind, makes it easier to promote, support and stay connected in the work that you do. 

Every service provider will define their own procedures, incorporating the Care Quality Commission requirements (see box, right) but potentially involving other checks and potentially including interviews with key individuals within their organisation and approval by an advisory committee. 

In the main, service providers are looking for consultants who are safe, reliable and appropriate to practice within their facilities. 

They are ideally looking for consultants who are committed to them on a long-term basis, demonstrating loyalty and therefore a good investment for the service provider. My team has experience in all areas of practice management, so whether you are building your clinic from scratch or are consulting at a larger, more estab­lished location, we can aid in the areas of accountancy, marketing and medical PA services.

 

 

Opportunities exist outside of the NHS.

Opportunities exist outside of the NHS.

Leaving the NHS

Planning to leave the NHS? For the huge number of doctors who say they are contemplating a move, Jane Braithwaite shares details of the support available that can offer a route to an alternative career path.

Article originally written for and posted on Independent Practitioner Today.

The last year has been a struggle for everyone in some respect, but for those working in the NHS the pressure of dealing with Covid-19 has been immense. 

We all vividly remember the battle to provide everyone in the health service with adequate PPE, so they felt some level of protection, closely followed by harrowing images of faces battered and bruised by long periods of wearing masks. 

Those working in primary care had to adapt to deliver a Covid-safe environment for patients and transform the provision of most services using technology to provide virtual consultations. 

As vaccines became available, GP practices and hospitals have worked something close to a miracle to ensure they can be administered throughout the population rapidly. 

We have recently seen a new campaign entitled ‘If I die, it will be your fault’, launched by the Institute of General Practice Management to call for an end to abuse from patients following their latest report, which concludes that most GP receptionists face unprecedented levels of abuse at work. 

And now the same NHS staff face the challenge of dealing with long waiting lists of patients whose treatment has been delayed by Covid.

 

Worrying report

A report earlier this summer from the BMA delivers a stark and worrying insight into how doctors are feeling right now, and the evidence is clear that many of them are unhappy and are considering leaving the NHS in the next year.

It said: ‘Thousands of exhausted doctors in the UK have told the BMA they are considering leaving the NHS in the next year, as many continue to battle stress and burnout without adequate respite from the exhaustion caused by the demands of the pandemic.’

Responses came from over 4,000 doctors and 31% of them stated they are more likely to take early retirement, which has more than doubled since the survey was done 12 months ago. Half of the respondents said they are more likely to work fewer hours and 25% more likely to take a career break. 

The survey also suggests a strong desire by many to continue to work, but in a different environment. Twenty per cent of respondents are more likely to leave the NHS for another career, with 17% considering working in another country and 14% more likely to work as a locum. 

If doctors follow through on these desires to retire, work fewer hours or leave the NHS for another career, huge resource gaps will develop in the NHS. 

 

Support available

Of course, over time, the desire for some doctors to leave the NHS may decline and the NHS pension may be an important factor, but for those who are considering alternative careers, I wanted to investigate and share details of the support and the organisations available that can offer a route to an alternative career path. 

Before considering the options, it is also helpful to understand the reasons why there is a desire to leave the NHS, as this gives useful insight into the objectives of doctors when seeking alternative careers. 

We often assume, when it comes to career choice, that money is the greatest motivator for most individuals. 

But the BMA survey showed that pay was quoted as the main reason for leaving the NHS by 29% of the respondents, while workload and personal well-being drew a much higher response. 

 

Heavy workload

Forty-four per cent of respondents looking to leave the NHS said that workload was a factor and 43% highlighted their own personal well-being. 

So in looking for alternative careers, opportunities that offer a more manageable workload and a better work-life balance will be hugely appealing. 

Of course, finances will be a significant factor for many and a great place to look for helpful information is Medics Money.

Medics money was founded by Dr Tommy Perkins and Dr Ed Cantelo to help doctors, dentists and other professionals make better financial decisions. Of particular note, Ed is a GP trainee and also a chartered accountant and tax adviser with nine years’ experience at accountancy firm PWC. 

On its website, you will find a wealth of resources in the form of articles and eBooks, but its most valuable offering is a series of podcasts in which it covers a huge range of topics of relevance to the profession. 

It’s latest offering, called ‘Episode 44 – The NHS pensions trap with salary sacrifice’, would be a good listen as would ‘Episode 25 – Using a limited company to save tax and invest to retire early. 

 

Private practice

One obvious option for doctors looking for a career outside the NHS is, of course, private practice, and with a greater desire for improved well-being and a more manageable workload, this is most definitely an option that may appeal to many. 

The aim of Private Practice Pro is to help doctors launch, run and grow their own private medical practice. It is founded by Mr Giles Davies, consultant oncoplastic breast surgeon, and Tom Davies who is a lawyer and former chief investment officer of Seedrs. 

Private Practice Pro offers a video-based course for doctors looking to set up in private practice with Giles acting as medical coach and Tom as a business coach.

The course is made up of over 55 on-demand videos complemented by 30 templates and guides and, for interested doctors, Private Practice Pro regularly runs webinars and small-group workshops. 

 

Entrepreneurial doctors

For the more entrepreneurial doctors, Doctorpreneurs is a global community of doctors, medical students and other interested individuals focusing on healthcare innovation and entrepreneurship.

In its most recent newsletter, it includes an inspiring interview with the chief executive and founder of Tympa Health, which is a London based start-up that has created the world’s first, all in one, hearing health assessment system. 

It also includes details of job opportunities across a wide range of sectors. This is a good place to start to understand the type of job opportunities that are currently available and it is an exciting discovery.

It is free to join, and you simply sign up on its website.

Changing career

My final suggestion is Medic Footprints, who provide ‘The world’s biggest gateway to alternative careers for doctors’.

This is again an organisation led by doctors, providing a wealth of information on their website regarding changing careers and connecting doctors with career coaches who can help manage the process. 

Their job board presents several exciting opportunities including some overseas roles that will appeal to those doctors interested in working outside the UK. 

You can join their community for free on their website or upgrade to their premium package for access to their series of webinars and a free CV review.  

In my search for supportive organisations for doctors when looking for a career change, I also discovered that the NHS provides further information on its website. 

Back in 2017, NHS England published a paper offering guidance for doctors looking to leave the NHS, which included a selection of organisations including Medic Footprints. 

In an ideal world, we would all like doctors to enjoy their career within the NHS and to want to stay, but right now it seems the best approach may be to ensure that the wealth of talent is not lost and is engaged in other rewarding healthcare careers that ultimately benefit the UK population now and in the future. 

In my role as MD at Designated Medical, I work with many doctors pursuing either a full- or part-time career in private practice and I would be happy to help anyone who would like to know more about getting started.

 

 

Nurture your staff’s mental well-being.

Nurture your staff’s mental well-being.

Mental Health

From the start of the Covid pandemic, we have been very aware of concerns relating to mental health and the increased number of people suffering from mental health problems.

This has largely been due to lockdown and the impact that has had, and we have heard how it has affected everybody, both young and old. More lately, we are hearing about the enormous toll on healthcare workers and some very concerning discussions relating to this.

As people who work in healthcare, we need to be very aware of the mental health issues employees – and we ourselves – may be experiencing.

It is important that we gain the best understanding so that as leaders, managers and role models, we can help and support our people – and to know what support is available for those who need it.

Before Covid, we knew mental health-related issues were the most common cause of long-term sickness in UK workplaces.

Surveys performed by the Chart­ered Institute of Personnel and Develop­ment (CIPD) in 2019 reported that the impact of stress, in particular, had increased, with 37% of respondents saying that stress-related absence had increased in the last year. They concluded: ‘Work-related stress, depression or anxiety accounts for 44% of work-related ill health and 54% of working days lost in 2018-19.’

As well as sickness absence, poor mental health at work can lead to increased staff turnover, reduced engagement and high absenteeism.

Mental health problems affect around one in four people in the UK in any given year.

As we recover from Covid, there is much evidence to suggest that the pandemic and measures taken to manage it, such as lockdown and social distancing, will have a significant impact upon the mental health of employees and the impact may be felt for months or even years.

How will Covid-19 affect our mental health?
We do not yet know what the exact impacts of the pandemic on our mental health will be. People have been affected in different ways: many feeling isolated, others are fearful about catching the virus themselves and also anxious about their family and friends.

Employees in healthcare have been working long hours with few rest periods in very difficult circumstances throughout the pandemic and have possibly not had the time or opportunity to reflect on their own well-being.

The workload in the healthcare sector is destined to remain high. As Covid numbers have decreased, many individuals have been involved in the vaccine roll-out and are now facing the pressure of addressing long waiting lists of patients requiring non-Covid treatment.

This long-term stress has taken a toll and continues to do so. Our best defence against mental health is resilience, but, to maintain resilience, individuals need time to recuperate and this has not been possible in healthcare and is unlikely to be possible in the near future.

Lockdown’s impact
Mind, the mental health charity, reported that over half of adults and over two-thirds of young people said their mental health declined during lockdown. Young people and those with pre-existing mental health conditions were particularly affected.

The health impacts of lockdown include findings of fatigue, musculoskeletal conditions, poor work-life balance, reduced exercise and increased alcohol consumption. In relation to workplace mental health specifically, employees were reporting reduced motivation, loss of purpose, anxiety and isolation.

Evidence from previous quarantine situations also suggest that there are long-lasting effects on mental health.

Independent Practitioner Today is currently serialising parts of the book called Beneath the White Coat – Doctors, their minds and mental health, edited by Dr Clare Gerada, first published in 2020 (see page 42). In the book, the stress experienced by doctors is examined using supporting evidence and real-life case studies and offers practical steps for doctors to recover and thrive in their roles.

The book also demands policy-makers, government and hospital management ensure doctors are looked after and have access to the resources needed to ensure they remain healthy.

Working from home
Many people have been working from home during the pandemic and while most have found this to be more productive, still one-in-three people have found the opposite, according to research by MetLife UK.

Almost one-in-three (32%) workers admit that their productivity has declined as a result of the shift to home working. Of these employees, two in five (41%) believe that their mental well-being has impacted their productivity levels. The impact is understood to have been more apparent for younger groups aged below 30 and also older women aged 50 plus.

There is also a marked difference between the statistics reported by employees and those reported by employers. Employers believe there has been a greater decline in productivity, with 56% of employers reporting that they perceive their employees’ personal well-being has impacted their productivity levels. This is significantly higher than the 32% of workers who reported their productivity has declined.

Productivity is absolutely key in any business, including healthcare, and therefore it follows that we should be concerned about our employees’ mental health and how this affects the productivity of our teams.

We need to do our best to understand the issues that our teams are facing and support them by implementing management strategies to reduce the impact in the workplace.

Understanding the issue
As mentioned previously, there seems to be a huge amount of information stating the enormity of the mental health problem caused by Covid, but there does not appear to be much research yet giving us useful data to understand the specifics of the issues and indeed how to address them.

One of the greatest challenges is that individuals are often unlikely to ask for help when they need it, and this is perhaps more extreme for those working in healthcare, who feel they should be able to manage their own well-being.

As managers and leaders, we need to work hard to encourage openness and make it easier and more comfortable for people to ask for help.

HR management
Most larger healthcare companies will have in-house HR departments providing expert support and who will be defining organisational strategies to help their managers and leaders deal with mental health issues in the workplace.

For smaller organisations, there is less support available and managers will need to address these issues themselves.

In an attempt to provide a useful guide, our HR managers have provided some input that I hope will be of value.

What is workplace mental health?
Obviously, healthcare professionals have a much greater awareness of mental health illness, but it is still useful to define what we are dealing with in relation to the workplace.

Mental health, like physical health, fluctuates over time and there are degrees of severity. Symptoms include struggling with low mood, anxiety and stress, and we know stress can contribute to other illnesses.

Conditions include depression, anxiety, phobias and bipolar, which tend to continue over a prolonged period.

As employers, one of our objectives should be to help individuals feel comfortable in talking about how they feel. In doing so, we must avoid attempting to diagnose and instead focus on discussing how the issues impact the employee’s work and their work life with a view to agreeing a plan to provide additional support.

A range of measures will need to be introduced and a good starting point for any manager developing their strategy is to understand our legal responsibilities as an employer.

Legal duties
These legal duties set the minimum requirements and must be adhered to, but there is a wealth of evidence arguing that employers who go above and beyond will benefit from improvements in employee engagement, reduced absence, reduction in staff turn-over and improved organisational culture.

Employers have a duty to protect the health, safety and welfare of their employees, including mental health and well-being.

The UK Health and Safety Executive defines work-related stress as a reaction to excessive pressure or other type of demand placed on an individual at work. It is the employer’s duty to assess the risk of stress-related mental health issues arising from work and to take measures to control the risk.

Employees who have a mental health condition may be disabled and will therefore be protected from discrimination during employment as defined by the Equality Act 2010.

Employers are required to make reasonable adjustments for employees with disabilities, which may include amendments to working hours, location of work, changes to duties and the provision of additional equipment.

Prevention is always better than cure, but obviously, in the case of mental health issues, prevention is not necessarily within the employer’s control; however, there are early actions that can be taken.

Supporting the mental health of employees in healthcare, many of whom continue to work under significantly increased pressure making them more vulnerable to stress and other mental health conditions, is vital and it is warranted to take a pro-active approach.

Preventative measures largely relate to improving organisational culture by increased communication so that mental health issues can be more easily addressed and supporting managers by ensuring they are well informed, as they will play a pivotal role in the handling of any issues. (See box below).

Providing support
Managers need to know the typical signs and symptoms of poor or declining mental health exhibited in the working environment.

These can include the following:

  • Workaholic tendencies: Working long hours without breaks;
  • Increased absence due to sickness;
  • Any uncharacteristic behaviour: Emotional responses to situations which could include tearfulness or anger;
  • Withdrawing from others on the team.

Any of these behaviours in isolation clearly do not imply that an individual has a mental health issue, but they do provide an opportunity for a manager to discuss well-being with an individual, which could prove to be valuable in preventing a potential issue.

When a manager holds a one-to-one discussion with an individual, it is important they do not jump to any conclusions. Ideally, the conversation will start with an open discussion about how the employee is feeling, although we know that people are often reluctant to talk openly.

Within an organisation where mental health and well-being are discussed regularly, hopefully the employee will feel more able to be open and honest.

When an individual asks for help, it is important that help and support is made available in a timely manner.

In a large organisation, the HR department may become involved to provide support and potentially the occupational health team, if needed.

In a smaller organisation, it may be relevant to seek advice from outside organisations and there are many suitable providers.

Throughout any discussion of this nature, the manager must be non-judgemental. It is very clear that all people managers have a serious responsibility in their employees’ well-being, and they will also need to be supported and guided through this process.

Support available
The Chartered Institute of Person­nel Directors provides a wealth of information on its website and while it is not specific to healthcare, it is a valuable resource for all managers dealing with HR issues.

Specific to Covid, it is valuable to access the most up-to-date information and Cochrane produced a report, which was updated in January 2021, entitled ‘Supporting resilience and mental well-being in frontline healthcare professionals during and after a pandemic’.

The International Labour Organ­isation has also recently produced a report entitled ‘Protect the mental health of health and care workers in the Covid-19 pandemic’.

Finally, the Academy of Medical Royal Colleges has a page on its website summarising all of the organisations available to provide support in relation to mental health matters for those working in the healthcare sector.

Over the coming months, we will have access to much more data regarding the long-term impacts of the Covid-19 pandemic. As leaders, we will need to learn and evolve to ensure we provide the best support possible so that we can continue to lead successful, high-performing companies and teams.

If you would like any further information in relation to this article, please do get in touch. I am always very happy to help and I am sure that my team of HR professionals will also be able to help with most workplace well-being questions.

 

 

Furlough going forward, what you have to pay from July 1st, 2021.

Furlough going forward, what you have to pay from July 1st, 2021.

Furlough doctors july

Furlough has been somewhat of a saving grace to both employers and employees since the beginning of the pandemic. Now as coronavirus cases begin to ease, with the help of the nationwide vaccination programme, the UK government has announced changes to the scheme which come into effect July 1st, 2021, with subsequent changes also from August 1st, 2021.

The current scheme: The Furlough funds that are currently available to businesses in the UK allow for a grant of up to 80% to cover an employees pay, up to a maximum of £2,500 per month. Employers can choose to top up to 100% if they wish.

Flexible Furlough is also an option. An employee will work only some hours, which their employer will pay them for in full, the grant will cover 80% of pay for the employees unworked hours subject to a cap of £2,500.

What will change for employers as of 1st July 2021?
From the 1st of July 2021, the Government’s grant will reduce to pay 70% of a Furloughed employees wages instead of 80%. However, monthly pay for Furloughed staff must remain at 80%, (at a cap of £2,500) so employers must contribute 10%, up to £312.50 each month.

What will change for employers as of 1st August 2021? From 1 August 2021 until the scheme ends, the Government’s grant will reduce a final time to 60% of Furloughed employees’ wages for their unworked hours (capped at £1,875 per month).

With the 80% pay still required for employees, the employer’s contributions will increase to 20% (up to £625.)

So from July until September employers will need to plan to be able to cover the cost of 10% – 20% of their employees’ wages, national insurance and pension contributions.

If you would like any assistance as we move into this next phase, the Accountancy team at Designated Medical would be more than happy to work with you to ensure you are meeting new requirements and responsibilities as an employer.

Our Head of Accountancy services Vicky, would be more than happy to discuss this in more detail with you, get in touch: vicky.garbett@designatedgroup.com.

 

 

 

 

 

Did you know your team can claim up to £250 for working from home in 2020/2021?

Did you know your team can claim up to £250 for working from home in 2020/2021?

working from home

If like many private practices you have had to take some work online, remotely with your staff from home during 2020 and 2021, they can submit a tax claim of up to £125.00 for 2021/22 tax year. If they also worked from home last year (tax year 2020/21) then they could be eligible for up to £250.00 tax relief for both years.

Are they eligible?

  • They will need to have started working from home during the pandemic.
  • Encountered higher costs due to home working.
  • Working from home costs not already been covered by you, the employer.

How can they claim?

With so many of the UK population still working from home to some degree, the government set up an easy to use website making It easier than before to claim back tax relief: https://www.gov.uk/tax-relief-for-employees/working-at-home

If their application is successful their PAYE tax code will be changed and they will be able to take home more of your income tax.

The tax relief they will receive depends on their income tax band. All taxpayers can get a flat-rate of tax relief on £6 a week; basic-rate taxpayers will gain £1.20 a week (20% of £6), which equates to £60 a year. Higher-rate taxpayers can gain £2.40 a week, which is 40% of £6. This equates to £125 a year.

They can claim more and submit evidence if they have incurred more costs working from home.

 

Business owners and self-employed.

Self-employed workers can claim for more costs when working from home, such as a proportion of the costs when lighting, heating, cleaning, insurance, mortgage interest, water rates and general maintenance are used for work.

To work out the proportion, you’ll need to account for the amount of time you’re using your home for work, and in some cases the size of the area within the home that’s used for work purposes.

For example, if you work in a study you’d only be able to claim for the costs of heating that room while you work.

2021 Budget Announcement

Earlier this year Rishi Sunak announced a number of schemes and support plans for small businesses, these include:

• Restart Grant
• Help to Grow scheme
• Self-Employment Income Support Scheme
• Recovery Loan Scheme
• Super-deduction tax break for investment
• Business rates holiday
• Reduced VAT for tourism and hospitality
• Relief as no increase to Capital Gains Tax

You can find out more about these schemes and how they could apply to you and your business here.

https://smallbusiness.co.uk/budget-2021-and-what-it-means-for-small-business-2552090/

 

 

 

 

 

 

 

 

 

 

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