Dr Paul Charlson, a GP in East Yorkshire, on how taking on private work could be an ideal way to bolster failing practice income.
The income for most GPs will fall as the UK national debt takes hold. Some principals will be looking at new ways to increase their income. One such method is developing new services.
Many GPs feel that they are already working flat out and do not have the capacity to work harder. Others may need to earn extra income due to increasing financial burdens..
The problem many practices face is that partners are a mixed bunch. Some would prefer to work less and earn less and others would prefer to work harder and earn more. Many practice agreements are based on everybody doing roughly the same amount of work for the same amount of pay. Any changes in this equable arrangement lead to tensions between partners. Similarly some doctors feel that doing any private work outside of medicals is unacceptable. There are also significant differences in the work rates and abilities of different partners.
If you are lucky enough to be in a partnership that is flexible and able to cope with significant diversity then you are off to a good start when it comes to developing new services and increasing your income.
My first tip when thinking about developing a new service is that you must have a genuine interest in the service you are planning to develop. Making money is a welcome by-product of a successful business but if you are not interested in the service area then you are unlikely to sustain the business long term.
Say you are in a 6 partner practice in a large market time with 2 part time partners both women with husbands who are consultants and a senior partner who is winding down. You are in your early forties and need some extra income a fairly common scenario. You have become interested in the idea of setting up a private weight reduction clinic. Your first step is to decide how you might do this. Would the other partners be interested? Would they be happy for you to do this yourself and if so would it be from the practice premises or elsewhere? The problem is broaching this at a practice meeting is bound to raise antibodies from some of your partners. If you do this on your own will you be spending time doing this rather than doing NHS work which they will have to do? What are the ethics of this? Some partners might simply disagree with the whole concept. Will it impact on notional rent from the PCT or will it simply be a lot of hassle which they cannot be bothered with? Only you can predict what will happen and try to pre-empt problems.
You need to do two things. The first is to research your chosen business. This means looking at what others are doing around the country. Are there any models you can copy? Could you be part of a franchise? Good research will allow you to form the basis for your model. This will be influenced by your target market which depends on the demographics and the relative affluence of your local population. Weight reduction is big business and there are already many players in the market. Some of whom are national companies with huge advertising budgets. What GPs have as an advantage is that they are trusted and have the NHS label attached to them. This gives them a credibility which is prized by competitors. This credibility is further enhanced by local reputation. Added to this if your practice decides to set up the business in house then you have the advantage of footfall through the building which is very useful. A private weight reduction clinic run by GPs has to have a medical element to it with some health assessment perhaps including blood taking and prescribing. It is likely to be a premium service charging more than basic services in return with higher perceived expertise. It would be unlikely that you would be able to compete with the many commercial companies which work on relatively small margins and high volumes.
Once you have researched your clinic you need to write a business plan. I think it is at this stage that you need to enlist the help of fellow partners, try to enthuse at least one other partner either to join you or at least be on your side. The practice manager will also be of major help in deciding how and when to launch the idea. Probably chatting informally to all partners before unleashing your plan is a good idea to test the water. If things seem favourable the next step is to decide what the issues are likely to be and pre-empt them. One issue is likely to be whether this is going to be run as a practice business service and whether all partners wish to be involved? You need to decide how this will work both in terms of workload, time and how costs and profits will be allocated. In this particular case it might be better to set up a limited company even if all partners are part of it. If all partners are involved it is much easier as there will be less conflict. . If you run the clinic during office hours there will be receptionists doing both NHS and private work simultaneously. You will need to employ staff such as nurses and phlebotomists and this is another area of potential problems especially if practice staff are involved.. The ideal scenario would be a limited company with all partners involved operating from the practice premises in an evening when the surgery is not busy. This is not always going to happen and you have to be prepared for a variety of scenarios. . Another thing that often happens to dynamic Doctors who shape services is that the work required in setting up a service is undervalued by others and this is quite de-motivating and leads to resentment. You need to spell out the time involved and negotiate accordingly.
All potential areas of conflict need to be discussed honestly before you can develop the service further.
Another problem is treating your own patients and the potential conflict of interest. The short answer is it is better not to treat your own patients and then you will never fall foul of the GMC.. However in doing this you massively reduce the number of potential customers for your business. You need to explore this with your local LMC and PCT, If you are offering a service that is not available within the NHS and this is being supplied by a private company which the patient chooses that is acceptable. This is of course provided that you have not been shown to encourage or coerce the patient to use your service. This is a grey area with potential and one which you need to be clear about before starting your service.
Regulatory bodies such as the Care Quality Commission may also wish to be involved especially if you are prescribing weight reduction medication. Registration is not a pleasurable experience and is quite time consuming.
The above illustrates the first steps in setting up a business. It is hard work and not for the faint hearted but the rewards in terms of satisfaction, learning new skills and financially gain make it worth pursuing. However doing out of hours sessions or additional medicals are less hassle.
Dr Paul Charlson is a portfolio GP in East Yorkshire
Paul Charlson
