Junior consultants moving to the private sector

Here are some frequently asked questions about making the big move into private practice, answered by Medicolegal Consultant, Dr Karen Ellison.

So, you want to do private work? Entering private practice for the first time can be an exciting time for a clinician, but it can also be a minefield if you are not prepared. Worrying about how to go about it and what you need to be aware of is natural. Dr Karen Ellison, Medicolegal Advisor at Medical Protection, provides a handy round-up to help answer some of your questions.

What does private practice mean for me and the GMC?

The GMC requires all doctors to be registered and to hold a license to practice whether they work in the NHS or private practice. Independent practitioners must still have regular appraisals, be subjected to revalidation, and must remain resolutely fit to practice. It goes without saying that your ethical, clinical, and professional standards must withstand scrutiny by the regulator. The GMC guidance within Good Medical Practice from 2013^[1] applies to all doctors, no matter where they practise in the UK.

What do I need to look out for with regards to indemnity for private practice?

The GMC in Good Medical Practice (2013) says ‘you must make sure you have adequate indemnity or insurance cover so that your patients are not disadvantaged if you make a claim about the clinical care you have provided in the UK.’

Indemnity is provided in the NHS for claims arising out of NHS work. It will not cover you for claims arising from your private work. Nor will it cover you for assistance with referral to the regulator, any disciplinary proceedings, complaints, inquests, criminal investigations, ethical dilemmas, or general medicolegal advice.

Make sure your indemnity cover is in place before you start seeing private patients and that it is adequate for the whole of your scope of practice, including any expert reports you undertake. If you are unsure if you have adequate protection, or you need to update us on the type of work you are doing, please contact Medical Protection.

Will I have to employ staff?

Most major private hospitals employ their own staff, but you may be responsible for paying for your secretary, or other specialist technicians you may need to use. Check with individual providers what your practising privileges include. You must make sure that any other healthcare professionals involved with your patients have adequate indemnity, and always check their qualifications if you are involved in their recruitment.

If you do become an employer, you will be bound by the relevant legislation, and it may be wise to seek employment law advice from a suitable qualified solicitor. Sandison Easson can offer expert guidance with this.

Can I advertise?

The short answer is ‘yes,’ but care is needed. Good Medical Practice (2013), paragraph 69, states ‘when advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerabilities or lack of medical knowledge.’

Most private hospitals will arrange advertising for their doctors in a brochure of services available. If choosing to advertise personally, be aware that you must comply with Advertising Codes enforced by the Advertising Standards Authority. If you advertise medical devises, or medicines, you may need to refer to the ‘Blue Guide’^[2] on the government website.

If your place of work advertises on your behalf, make sure they abide by advertising standards and that the brochure refers to the availability of the document in Braille for the partially sighted. In areas where a particular language is in widespread use, the brochure should also be available in this language.^[3]

What about medical records? How should I store them and how long do I need to keep them?

You must keep records safely and securely and the private hospital will usually have provision for this. Patient information must always be protected from improper disclosure. Medical records can be destroyed after a certain period, but there is no set guidance relating to this in the private sector. Medical Protection suggests that you follow the same recommendations as those that apply in the NHS You must also comply with the UK GDPR and Data Protection Act 2018.^[4]

What can I charge for my services?

In general, doctors find the business side of private practice rather daunting at the start. None the less, private practice is a business and the GMC states that you must be open and honest in any financial dealings you have with patients. You must tell patients what your fees are before treating them and gain their consent to agree to pay. Most insurance companies will have a set tariff for each ICD code. You must retain financial records for inspection by HMRC and seek consent to disclose patient identifiable information if they request it.

Will I need a DRB check?

To protect vulnerable adults and children, all employees must agree to a check on their records in relation to criminal activity. This is now called the Disclosure and Barring Service check (DRB) and is required at each hospital you practice in.

What if I have a complaint?

Your medical defence organisation can assist with the handling of complaints and responses. The GMC in Good Medical Practice (2013) says that if you have a complaint you must put matters right if you can. You must apologise, explain what has happened, and what steps have been taken to prevent a recurrence. There is no statutory framework for dealing with complaints in the private sector, but hospitals will have their own procedures which will generally fall in line with the NHS complaints procedure. The Care Quality Commission (CQC) monitors complaints in the private sector and each hospital will be required to compile a summary of complaints yearly for inspection.

1 http://www.gmc-uk.org/guidance/good_medical_practice.asp

2 https://www.gov.uk/government/publications/blue-guide-advertising-and-promoting-medicines

³ https://www.nhsx.nhs.uk/information-governance/guidance/records-management-code/

[4]https://ico.org.uk/for-organisations/guide-to-data-protection/