5.30 to 6.15pm
REGISTRATION & RECEPTION
Chambers, Partnerships or Company Incorporation?
Mr Michael Bonehill, Solicitor
Dr Ray Stanbridge, Accountant and Management Consultant
The Competition Act and Partnership Agreements
Ms. Valentina Sloane, Barrister at Law
Chambers on a National Level
Mr Jon Ford, Head of Health Policy & Economic Research, BMA
Specific Consultant Scenarios
The Panel will discuss and advise on some different scenarios
QUESTIONS & ANSWERS
On the 19th November 2002 over two hundred consultants from around the UK attended a meeting at the Royal Society of Medicine organised by FIPO. There were several other attendees from the fields of law, accountancy and the media.
The Chairman of FIPO, Mr Geoffrey Glazer introduced the meeting with an overview of the current macro-economics of private healthcare. He described the various drivers that were pushing consultants into some form of Chambers arrangements. These included clinical requirements (i.e. multi disciplinary teams for cancers and other conditions), governance and audit issues, financial imperatives and the stringent new regulations imposed on the private sector by the Care Standards Act.
A straw poll of the audience revealed that about 10-15% were already working in some form of Chambers and that the vast majority were contemplating some form of group working relationship.
Mr Michael Bonehill, solicitor of H. Montlake & Co, then reviewed the various legal structures broadly included under the term “Chambers”. Although “Chambers” could simply describe the physical location in which individual doctors are working (as sole practitioners or in any other type of legal arrangement) it had a wider meaning. In essence Chambers are arrangements by which consultants’ work together sharing some expenses but still continue to practise independently as sole practitioners. This is a Chambers in the barrister style and it should be noted that fee arrangements are made individually with the patients and there can be no collusion over fees between consultants. Partnerships are arrangements in which expenses and income are shared by some agreed formula. Limited Liability Partnerships are a variant on this in which financial reports have to be published. Incorporation as a company is a different legal and financial structure and would only benefit a limited number of consultant groups.
Dr Ray Stanbridge, an accountant and management consultant, gave an insight into the financial benefits and pitfalls of moving into different working practice arrangements, highlighting in particular the tax element. Dr Stanbridge stressed the importance of proper financial planning and the potential impact of expected changes in national insurance contributions and corporation tax. He emphasised the need for good working relationships between all doctors who come together in any legal format.
Ms Valentina Sloane, a barrister from Monckton Chambers, which specialises in Competition Law, gave a very detailed review of the Competition Act. She outlined certain aspects of Chapter I and Chapter II prohibitions amongst other elements. In particular, she pointed out that the Act does directly affect the working practices of consultants, and that “ignorance is no defence” in law. She discussed the meaning of a “dominant trader” and abuse of the market. Ms Sloane warned of the consequences of being in breach of the Competition Act and offered some practical steps to avoid this.
A final talk by Mr Jon Ford, Head of Health Policy and Economic Research at the BMA, described possible ways in which doctors in a chambers arrangement might leave the NHS to work outside in a contracting system. He made various international comparisons but recognised that most consultants would be unlikely to leave the NHS for fear of loosing their pension and other NHS rights. Although these were not insuperable problems Mr Ford stated that his presentation was for debate and discussion only and was not official policy of either the BMA or FIPO. This talk was greeted with some interest by the audience.
There then followed a Panel discussion and the speakers were joined on the platform by Mr Derek Machin, Consultant Urologist and Chairman of the BMA Private Practice Committee (and a FIPO Board member) and Mr Derek Fawcett Consultant Urologist from the Reading Urology Partnership (an up and running formal partnership). Several case scenarios were then presented and discussed by the Panel with questions from the floor.
This meeting attracted 2 CPD points for attendees. The feedback from the audience indicated that the meeting was very well received with particular interest in the legal aspects of chambers. There was a request for more meetings and more time for discussion and questions from the audience.
At the end of the meeting it was agreed by a unanimous show of hands that FIPO should try and coordinate activities for all groups working in Chambers.