Good Doctors Safer Patients - The Chief Medical Officers Consultation Document
The Chief Medical Officer set out in his consultation document a large number of proposals which if all implemented would lead to dramatic changes in medical regulation and training. The Independent Sector has responded and various professional bodies and providers have sent in their responses. FIPO met with main hospital providers and took in their views before submitting the following document. Some independent hospital groups will have sent in their own replies.
FIPO Consultant Questionnaire and MORI Poll
In 2003 FIPO carried out a detailed questionnaire of consultant views about different aspects of private and NHS healthcare. Over a hundred consultants responded and there were clear and strong views expressed. Opinions about the services offered by certain medical insurance companies revealed some interesting data with trends rather than clear-cut differences between the companies. There was also evidence that practice expenses are rising at a greater rate than income.
In view of the fact that the FIPO questionnaire could be criticised for being internally organised and with results based on a self selected consultant base, the Board of FIPO commissioned an independent MORI Poll of consultant opinion which was completed in March 2004. The results were announced in a Press release thereafter and these, together with a further analysis of the results, are given in the links below.
The Economics of Private Practice 2004
There is constant reference made in the Press and elsewhere to the fact that some consultants in private practice are earning vast sums of money. Behind this assertion is also the veiled or revealed suggestion that most of these consultants are doing this at the expense of their NHS work or indeed are encouraging long waiting lists in order to advance their private practice. This type of allegation is normally made by those with an interest in undermining independent practice for political or other reasons.
There is in fact very little evidence about consultant earnings although some facts have been revealed in meetings held by FIPO and others. For example, Mr Jon Ford of the BMA Health Policy and Economic Research Unit when speaking at a recent FIPO meeting noted that 30% of all consultants do no private practice and that 20% earn no more than £10,000 per annum.
The precise numbers of consultants in the UK and thus those engaged in private practice is not clear but assuming that this is 20,000 then, knowing that about £1 billion a year is spent on consultant fees this would make average gross earnings about £50,000 per annum. Net average earnings (after tax at 40% and running costs at about 30%) would thus be around £15,000. However, it is known that earnings are not evenly distributed and thus simple averages are misleading. There are many more doctors at the lower end of the earnings scale and these are counterbalanced by very few high earners.
These broad figures on private practice income may well mean that for many consultants the rising cost of practice (particularly medical indemnity) coupled with the new NHS contract and the “hassle” factor of private practice are enough to make them give up all independent work. There are obviously very mixed views from consultants about the new NHS contract (click here for MORI Poll analysis) and whether this will affect private practice but this, taken with possible shifts of consultants out of private practice, will have an impact on prices in the private sector. The independent sector is not however a simple market driven by supply and demand as the fee reimbursements are largely, but not totally, restrained by insurer determined rates.
Apart from income, the expenses incurred in private practice have not been accurately quantified. Information is largely anecdotal with reports from accountants and from surveys such as the FIPO MORI poll which has certain limitations. There is a general consensus from previous ad-hoc consultant surveys that expenses are rising disproportionately to income. If this is true and if the trend continues then private practice will become even less attractive for those at the lower end of the earnings scale.
In order to assess the situation further FIPO has asked two leading accountants to give their thoughts as at July 2004 on the economics of private practice. Ray Stanbridge is well known as a financial consultant and journalist and Martin Murray is from Sandison and Easson, an accountancy firm which deals only with the profession.
The FIPO/LCA Dinner Welcomed The Rt Hon Stephen Dorrell MP, Member of Parliament for Charnwood and Chair of the Health Select Committee
5 November 2013, The Athenaeum, London –
This dinner at the Athenaeum with some 70 guests heard Mr Dorrell talk about the changes in Health Care taking a long-term political overview. He noted the need to better integrate NHS Primary and Secondary care but this objective maybe hampered by the current structure.
A Professional Indemnity Update
16 October 2013, King's Fund, London –
Speakers at this meeting included a senior QC, representatives of MDU, MPS and from the smaller insurance groups as well the legal representative of Spire Hospitals. There was an active discussion about indemnity costs, changes in litigation and the sustainability of independent practice in the face of indemnity premium rises.
The Competition Commission Initial Report, What now for Private Healthcare?
11 September 2013, King's Fund, London –
This meeting discussed various aspects of the Competition Commission report with presentations by FIPO board members, legal representatives and others. Information about the meeting can be obtained from FIPO.
Current Issues in Independent Practice
FIPO National MAC Meeting held at the Royal College of Obstetricians and Gynaecologists on the 24th October 2012.
This meeting was attended by some 40 people, the majority MAC chairmen. The meeting heard an update on the current situation regarding the Competition Commission Inquiry in to independent healthcare and discussed various other insurance and quality issues in the independent sector. There was agreement with the FIPO Board that an economic survey of consultants should be carried out. There was further discussion about clinical outcomes and quality data and various proposals were put forward and agreed by MAC Chairmen.
Meeting held at the Royal College of Obstetricians and Gynaecologists on the 24th October 2012.
This meeting was attended by some 70 people. There were wide ranging presentations on "significant events" and "concerns" and the role of the Responsible Officer, GMC employment liaison officer, appraiser, governance team, medical director and managers. There were presentations from the GMC about the current state of revalidation and further discussions on remediation from the London Deanery. There was intense panel discussion with active audience participation over a variety of clinical scenarios which demonstrated the great difficulty that appraisers, medical directors and responsible officers will have in assessing fairly what constitutes a "significant event". This will become an ongoing issue as revalidation rolls forward.
Professional Malpractice Medical Indemnity
A meeting was held at the Royal Society of Medicine on 18 October with a presentation on the FIPO independent review on professional medical indemnity.
Dinner with Mr Niall Dickson, CEO GMC
A dinner was held at the Athenaeum with the principle speaker Mr. Niall Dickson, CEO of the GMC who discussed revalidation and answered detailed questions from the floor.
Developing your Private Practice
This meeting was devoted to aspects of practice development. It was a well-attended meeting with both young and more senior consultants in the audience.
Private Dinner at the Athenaeum with Mr Andrew Lansley CBE MP, Shadow Secretary of Sate for Health
The LCA, in conjunction with FIPO, held a dinner at which the guest speaker was Mr Andrew Lansley, CBE MP, Shadow Secretary of State for Health who discussed NHS reform, the working time directive, training, revalidation and other consultant issues.
Consultant Revalidation in the Independent Sector
A large well attended meeting was held on 24th November at the Royal College of Physicians, in London at which all aspects of Revalidation in the Independent Sector were discussed. There are many challenges ahead and at this stage many unanswered questions.
Private dinner with Professor, the Lord Darzi of Denham KBE
Parliamentary Under Secretary of State (Lords), Department of Health
Professor the Lord Darzi of Denham KBE spoke to a large gathering of consultants and hospital managers at Chandos House, London W1 on the 9th June 2009. Lord Darzi discussed the impact of professionalism and the changes in the NHS and answered detailed questions about the impact the profession might have in affecting change.
A Meeting for Consultants
At this meeting, held in the Kings Fund in London various speakers from the UK and USA described some of the problems of managed care and updated the audience on HICFG (Health Insurance Counter Fraud Group) and changes in the business aspects of independent practice.
Health Insurance Counter Fraud Group
A consultant meeting was held at the King’s Fund on Tuesday 18th November at which speakers gave an up to date review of HICFG (Health Insurance Counter Fraud Group), insurance networks and other issues relating to the Managed Care agenda. A further series of meetings on this were planned.
Insurers Agree to a Forum with the Profession
Several insurers (Norwich Union, PruHealth, Standard Life and WPA) discussed various themes at an open meeting held by the London Consultants’ Association at the Kings Fund on 4th June 2008. One emerging theme was the need for a Forum between insurers and the profession to try and improve relationships. This was welcomed by all sides and will be pursued by FIPO.
“Meet the Insurers”
This meeting held on the 23rd May 2007 in conjunction with the London Consultants’’ Association was extremely well attended and gave rise to a lively debate. The meeting has been reported in a press release from FIPO and has also been reported in various publications:
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FIPO Council Meeting
23rd May 2007
Speakers at this meeting included John Billings, Head of the Independent Sector at the Healthcare Commission, Gerard Panting Chairman of CGAC and other Board members. The discussion was a detailed review of professional regulation, MAC and Chambers functions, Clinical Governance, the Macro-economics of the Market and Managed Care. Subscribing members can obtain details of this meeting from the FIPO administrator.
Consultant Ophthalmologist and Anaesthetists Meeting
A meeting of Ophthalmologists and Anaesthetists was held on 17th October 2006 at the Kings Fund, London. Consultant ophthalmologists and anaesthetists discussed aspects of the BUPA Approved Ophthalmology Network and the PPP strategy of a similar network via certain independent hospitals.
Professional Quality and Patient Outcomes in the Independent Sector and NHS
Tuesday 20th June
A successful meeting was held with the Forum on Quality in Healthcare at the Royal Society of Medicine on 20th June 2006...
Quality Assurance in the Independent Sector:
The Role of the Profession and the Medical Advisory Committee (MAC)
November 9th 2005
A stimulating meeting was held at the Royal Society of Medicine in London. The audience comprised MAC chairmen, hospital managers and governance personnel from the private sector and Healthcare Commission and GMC officials.
FIPO Road Show Meeting at BJBraun - Sheffield
March 10th 2005
A small but select audience heard three presentations at this road show organised by FIPO at BJBraun close to Sheffield. The Chairman of FIPO presented some of the economic features facing the profession. Mr Glazer outlined the historical developmental of the independent sector and the impact of governmental changes in terms of ISTC’s, NHS contracting and HRGs.
UK Independent Medicine - Explosion Or Implosion?
This meeting, held at the Royal College of Obstetricians and Gynaecologists, Regent’s Park, London on November 10th 2004, discussed the major changes in healthcare delivery and the impact on consultant practice.
Contracting or Employment of Consultants
The thrust of the meeting, held on 10 March 2004, was to discuss the future status of Consultants in the Independent and NHS Sector in terms of employment and contracting in the light of changes of acute healthcare delivery and the introduction of ISTC’s (Independent Sector Treatment Centres)...
Diagnostic & Treatment Centres
A major meeting to discuss the implications of DTCs on the NHS, training of surgeons and anaesthetists an in the independent sector was held on 7th October at the Royal College of Obstetricians & Gynaecologists, Sussex Place, Regent's Park, London with major speakers...