Phil Shorvon Chairman of Association of Independent Radiologists

Dos

Donts

Types of independent practice for radiologists

Private patients in NHS trust Locum work Sessional work in private facility Individual case work in private facility Group practice direct referral Stand alone units Teleradiology Medico legal work

Getting Started

Should I do private practice?

Pros:
Financial- slice of UK private healthcare market of 4bn with 7.5 million insured patients (13% population) Satisfaction- different ethos Independence

Cons
Hassle Commitment Insecurity Indemnity Time Providing year round service

Getting Started
Most do private work in NHS facility Look at locums at private facilities Consider teleradiological work Let clinicians you work with know where you can do private patients/ clinicians will try to help you Ensure you have admitting rights where you do private work

Its important to keep to the rules

Legal framework
Sole practice Chambers: group working from same office/sharing office expenditure but independent practitioners. No fee sharing. No liability for other members Partnership liability for other partners, share profit and loss Limited liability partnership- publish financial statements/more flexibility/protection from other parties negligence Limited Company- No personal liability for company debts

WHAT SHOULD (or shouldnt) I DO?

Basic rule: dont undertake anything I dont do in my NHS practice Get on with your colleagues Ensure you feel fully trained in what you do Dont issue a report you are unsure of Dont steal case Meet GMC guidance on practice. Always act in the patients interest Ensure your private work is included in your job plan

Must haves to do private practice

Medical degree Certificate of completion of training Entry in GMC specialist register Professional indemnity

Indemnity fees-example
Earnings 1-7.5K 7.5 -15K 15-25 K 25-35 K 35-50K 50-75 75-100 100-125 125-175 And remember Fees 575 1845 2715 3305 3850 4580 5435 6005 7120 % income (midpoint approx) 10 15 13.5 11 9 7.5 6.5 5 5

The tax man takes 40% soon to be 50% Accountants fees Expenses

Practicing Privileges for private hospital

Meet standards of local MAC Meet clinical governance requirements (CRB check, appraisal up to date, indemnity insurance, GMC registration etc) Hospitals can refuse no right just because meet standards

Benefits versus your Fees

Most radiologists do not collect fees but are paid by the private facility If separate fees are charged then: Benefits are what insurance companies will pay/fees are what you charge Avoid agreeing fees with others (anticompetitive) unless part of legal partnership Patients should know in advance if fees will be more than benefit.

BILLING-SEPARATE BILLING
ACCURATE RECORDS ESSENTIAL-INSURERS OBSESSED WITH FRAUD AT MOMENT Keep record full details of patient/their insurance and authorisation/the procedure/ complications etc Electronic records require Data Protection Act registration

ADVERTISING

ADVERTISING
The GMC is now in favour of doctors providing accurate information about services to patients as long as both their own guidance, and that of the Advertising Standards Authority (ASA), is heeded. The ASA s Codes require that all advertisements ARE legal, decent, honest and truthful and prepared with a sense of responsibility to customers and society. All advertisements respect the principles of fair competition, and should not bring advertising into disrepute.

Advertising- dos
Key facts about the practice Names and qualifications of the doctors and other healthcare professionals. Biographical details and any special interests Contact details, Opening times and any other factual patients may need to know. No restriction on media eg websites, newspapers or magazines , leaflets

ADVERTISING-DONTS
Unjustifiable claims Putting fear into public Phone marketing No cure claims No taking advantage of lack of medical knowledge No undermining colleagues No unfounded criticism

GMC guidance
Good clinical care doctors must provide good standards of clinical care, must practise within the limits of their competence, and must ensure that patients are not put at unnecessary risk.

GMC
Maintaining good medical practice doctors must keep up to date with developments in their field, maintain their skills and audit their performance Relationships with patients doctors must develop and maintain successful relationships with their patients, by respecting patients autonomy and other rights. Working with colleagues doctors must work effectively with their colleagues.

GMC
. Probity doctors must be honest and trustworthy.

Health doctors must not allow their own health condition to endanger patients.

GMC -conflicts of interest

You must act in your patients best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues. If you have financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe for, treat or refer patients. If you have a financial or commercial interest in an organisation to which you plan to refer a patient for treatment or investigation, you must tell the patient about your interest. When treating NHS patients you must also tell the healthcare purchaser.

A Charter for Patients and their Doctors- FIPO

The patient's best interests are always the primary concern of all doctors, whether practising in the National Health Service or Independent Sector. However, the immediacy of payment and the varying types of reimbursements and funding arrangements in the Independent Sector have the potential to create additional ethical difficulties. All registered medical practitioners must adhere to the guidance issued by the General Medical Council in http://www.fipo.org.uk/pdfs/FIPO_Patient_Charter.pdf

Current threats
Networks- industry view -ensuring quality/low prices -Doctors view-restrictive practice Delisting of consultants-insurance companies can do this unilaterally Unilateral fee setting by providers-no consultant direct billing Insurers setting themselves as setting standards Teleradiology

Response?
Do keep within the law Avoid any restrictive or anti competitive behaviour Emphasis on patient interests/quality and compliance with good practice and statutory regulations

What shouldnt I do ?
BASIC RULE

If it feels wrong-it probably is

SO IS IT ALL WORTH IT ?
Satisfying private facilities ensure you work efficientlyyou are their source of income Satisfying- the patient choses you as an expert Rewarding- but it takes a lot of hard work Direct relationship between your effort and what you get from it

Dont make unsubstantiated claims