Phil Shorvon FRCP, FRCR,FBIR Chairman of ... - MIR-Online

Phil Shorvon FRCP, FRCR,FBIR
Chairman of Association of Independent Radiologists

Do’s

Dont’s

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?
Pro’s:
• 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 shouldn’t) I
DO?
• Basic rule: don’t undertake anything I don’t do in my
NHS practice
• Ensure you feel fully trained in what you do
• Get on with your colleagues
• Don’t issue a report you are unsure of
• Don’t ‘steal’ cases
• 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 Fees % income (midpoint approx)
• 1‐7.5K £ 575 10
• 7.5 ‐15K 1845 15
• 15‐25 K 2715 13.5
• 25‐35 K 3305 11
• 35‐50K 3850 9
• 50‐75 4580 7.5
• 75‐100 5435 6.5
• 100‐125 6005 5
• 125‐175 7120 5
And remember ‐ 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‐ and so is
the inland revenue.
• 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 ASAs 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‐ do’s
• 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‐DON’TS
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

Don’t make unsubstantiated claims

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

Effect?
• Gross fees for ‘avarage’radiologist down by 3% 2007 to
2008
• Costs dropped by 7%
• Taxable profits down by 1.5%
• More ‘intervention’ (? Image guided injections??)
proteting income to some degree
• Bad debt reducing
• Expected pressure on fees will increase

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 shouldn’t I do ?
BASIC RULE
If it feels wrong‐it probably is

SO IS IT ALL WORTH IT ?
• Satisfying –private facilities ensure you work
efficiently‐ you 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