The guidelines issued by the CSP state:
Sickness certificates for completion by Chartered physiotherapists are available from the CSP. These were first produced in 1992 and were the result of discussions with the then Department of Social Security.
Points to note are: they can be given to patients to offer to employers or the Department of Social Security Their acceptance is discretionary, though little difficulty has been reported since they were introduced They should only be used for conditions for which the physiotherapist is taking clinical responsibility (e.g. back pain, other joint problems or the after effects of a stroke) A fixed date of expiry must be given the certificate cannot be open ended The diagnosis should be clearly stated
One pack of certificates, which contains 50 sheets are available by sending a cheque for 2.50 or 10 for 5 packs to The Chartered Society of Physiotherapy, Communications and Marketing, 14 Bedford Row, London WC1R 4ED. If you would like to pay by credit card please call the Communications and Marketing on 020 7306 6620.
Practitioners might consider the advantages of routinely informing patients of the fact that they can issue these, as patients might find it useful to seek a swift appointment in order to obtain one (and benefit from an early assessment and treatment) rather than wait for a GP appointment.
One suggestion therefore is to put a sign in your clinic to this effect. Some suggested wording would include:
Notice We are able to issue sick notes as evidence of a medical condition for use by employers, Government Depts. (e.g. DSS) or insurance claims, subject to any special conditions that may apply.
Note - There was an article in relation to this issue in Frontline 3rd Dec 2003, Vol 9 No 23.
Trading as a limited company can be more tax efficient for some individuals than trading as a sole practitioner or as a partner.
Most members only consider trading as a limited liability company when their accountant raises it and it before any such action is taken you must take the time to discuss the implications with them. There are however a few general points that you should take into account when considering whether to begin trading as a limited liability company:
- Saving taxes - firstly your accountant may be able to save you from paying such high taxes. This obviously varies according to individuals financial circumstances and consequently there is no general rule that can be applied. It is however probably worth asking your accountant about possible gains to be made here. Do however remember that tax rules change on a regular basis and what is tax efficient now may prove negative in the future and there are costs associated with changing back from a limited company.
- Preparing for Sale - there may be some advantages in trading as a limited company when preparing to sell your practice.
- Attracting investment - trading as a limited company can involve the sale and purchase of shares in your business. This offers opportunities for anyone wishing to attract investment or new partners and can be a more satisfactory way of distributing ownership (especially to more junior partners) than trying to divide up shares in a partnership.
What are the implications?
As with all changes, one has to learn the rules and the rules of trading as a limited company are not too complicated, but do have to be adhered to. The new rules require a different presentation of your accounts which can be more expensive to produce. In addition you have to keep Companies House informed of any changes in Directors and file an annual return. Professional liability insurance is another implication, as the company itself will not be insured through the your individuaio professional indemnity Insurance cover that comes with membership of the CSP and Physio First. Additional insurance cover is, therefore recommended to insure the company itself.
Gaining access to funds can also be a little more difficult than when trading as a sole practitioner or partnership. As a sole trader or partner you can stipulate what you want to take out of the practice and this is called drawings. As a company however you will be an employee and/or shareholder and so money coming out of the business must be a salary, a bonus on salary or a dividend. Such withdrawals have tax and company law implications that do not apply to a partnership or sole trader. In practical terms these problems can usually be overcome, but thought needs to be given to this in advance. If you are contemplating a change you will need to consult your accountant, but the implications can be discussed with our General Secretary.
Physio First receives questions like this very infrequently but when asked for guidance on how to make a business case to a PCT and/or a consortium of GP's, who have embraced practice based commissioning, the only honest answer that we can give at this time, is to ask you to ask yourself an even tougher question:
Do you want to work for less?
Through communications with the CSP, Physio First is informed about the increasing desire of Government to procure health services from the private sector BUT to date neither the CSP nor Physio First have been able to ascertain the basis for any guidance upon the basis upon which a PCT (or consortium of GPs for that matter) would cost such a service. It seems that almost all of the calculations of the cost of providing a Physio service have excluded specific overheads, such as premises costs, leaving many within the NHS with a totally unrealistic idea of how little they can expect to persuade a private Physio to work for.
Our stock advice at this stage is that the commissioning process will almost certainly follow some sort of tender process which amounts to a blind bid by those hoping to win the tender, i.e. the commissioning body will set out the service they want and will require the person tendering to:
- Confirm that they can meet the specified requirements
- Offer a price, which if low enough, they will accept
Expectations among commissioning bodies are likely to be based on expectations that are wholly unrealistic when compared with private patient rates i.e. if converted to an hourly rate for each service (i.e. private v NHS work hourly rate)
Those members who do take part in a tender process are likely to have to invest considerable time in preparing the tender, which will be totally wasted time if they do not succeed and, even if they win the tender, may leave them shackled to doing work that pays at a much lesser rate than the private patient rate (and remember to take into account the additional administration cost/time that will go with it) that they could have avoided.
There is a better business case for members to:
- Spend the necessary time and thought to actually produce a written business plan
- From this produce a robust and evidence lead marketing plan and budget
- Concentrating time and effort of generating more private patients
The BUPA tender process asks private practitioners whether they use a patient satisfaction survey. In response to member requests Physio First has designed one that can be downloaded from our web page and, with modification, suit individual needs as required.
The qualitative data that can be extrapolated from asking the patients to comply cannot be overlooked and reinforces all components of the practice business plan. It immediately assets with identification of % referral pathways and then further percentages within those income streams so that marketing plans flow naturally from gleaning that intelligence.
The "professional" part of the survey is not solely about the patients experience but can assist a practice principal in understanding self-employed associates strengths and weaknesses almost as well as peer review groups and audit of notes. Patient feedback regarding interaction and perception/understanding/explanation of their problem can be extrapolated together with response to treatment very quickly identifying any shortfalls in physiotherapeutic skill-base.
CPD requirements can then be addressed quite naturally creating positive, not negative, critical reflection which further enhances competencies, further increasing word of mouth referrals and protected revenue stream
I am sure those that use patient satisfaction surveys gain considerable insight into all the advantages of perpetual scrutiny from our clients taking satisfaction ourselves from knowing we do create an "ambient but wholly professional atmosphere", that they thoroughly enjoy reading the "excellent quality of reading material", whilst enjoining a cup of coffee from "superlative china" and "getting better too!"
Data collection, at whatever level, is not onerous when insight into practice development, marketing, PR and client referral pathways highlighted ultimately equating to the longevity of practice success.
The recent BUPA tender process asked all private practitioners whether they had a complaints procedure in place. In response to member requests Physio First have designed one that can be downloaded from the web page with modifications to suit individual needs as required.
There are often problems and uncertainty surrounding what members call their practice, but there seems to be a resurgence in the number of queries coming into our office about practice names and about what happens if you discover that someone else is using your practice name, or a name that is very close to it, or if you would like to use such a name.
Anyone can call their business whatever they want to, subject to a few restrictions within the Code of Conduct (e.g. they should be professionally restrained, accurate, legal, decent, honest and truthful) and by law (e.g. you are not allowed to use either Government or Royal in the title). How, or whether a name is protected can depend upon how you trade. If you trade as a sole trader or as a partnership, the law provides no specific protection except to allow you to stop someone else calling their practice the same name or a similar name to yours in circumstances that will have the effect of making potential patients think that they are you. In other words, you have the right to stop others passing themselves off as you and for that reason this right is known as a Passing Off action.
If you trade as a company, you have the additional protection of the Companies Register. The protection is, however merely that Companies House will not allow two companies to be called the same name, but will not prevent very similar names being registered. Beyond this brief overview, one would need to speak to our General Secretary or your solicitor.
How to deal with this problem should it arise
It may be due to the increase of limited company registrations that this problem seems to be arising more often but whatever the reason, the steps to resolving a Passing Off action are always the same. Here are a number of points to consider if you are faced with the problem of discovering that someone else is using either the name of your practice or a similar name:
Establish whether the person is a member of Physio First. Remember that Physio First does not monitor practice names as we do not have the resources to police this. But if the individual is a member, they are likely to be more law abiding and therefore more amenable to a polite approach.
Consider and test whether the location of the practice that is using your name is likely to be confused with your practice to the extent that new and/or existing patients may actually think that this practice is yours, i.e. is your belief that the practice is actually stealing patients from you an accurate one? You must approach it in this way because your right in law protects only this aspect. In other words, if someone were to call their practice the same or a similar name to yours but, for example, were far enough away as to make it highly unlikely that your business could be confused with theirs, then any legal Passing Off action that you brought would fail as you would not be able to prove the damage to your business.
Finally on a practical note, if you find that this has occurred, start with the human touch. Give the person a call, try to meet for a coffee, try to sort it out amicably. Starting with a solicitor's letter, or a threatening approach often has the effect of escalating an issue which, if handled in the right way at the start, could be resolved. Litigation must be viewed as the absolutely last resort!
The banking industry has recently re-affirmed a policy that can make online banking customers responsible for losses.
The banking code makes it clear that banks will not be responsible for losses on online bank accounts if consumers do not have up-to-date anti-virus, anti-spyware and firewall software installed on their machines, i.e. If you act without reasonable care, and this causes losses, you may be responsible for them.
Section 12.9 states that you should: "keep your PC secure. Use up-to-date anti-virus and spyware software and a personal firewall". That said, the British Banking Association said that it was not aware that any bank had ever invoked that clause of the code to avoid covering a consumers online banking losses.
Physiotherapists should have a sign, a note on an appointment card or in a practice brochure, saying that missed appointments will be charged for.
Insurance companies do not usually pay for missed appointments. They should be invoiced separately.
Some machines used by physiotherapists as part of their treatment modalities can affect pacemakers.
Each machine varies with regard to the distance considered to be within a harmful range of pacemakers and so we advise that you contact the manufacturers of the any machine you are concerned about for accurate information.
The patient also should have advice from the hospital where their pacemaker was fitted, and this should be obtained and heeded. Generally, however advice relates to how a patient with a pacemaker, and in direct use of such a machine might be affected and not how machinery may affect people in the environment of your clinic as, normally, you would need to be very close to a machine for it to have any affect on a pacemaker.
Machines that may have a potentially harmful affect on the general public, such as those emitting radiation, should be shielded appropriately.
Many members have received letters from the Performing Right Society seeking payment for the playing of music in their clinics.
Some members have interpreted the letter as amounting to a demand rather than a request and have found it somewhat unclear as to how much one might have to pay.
For clarity, if you do play music in your practice either on record, CD, tape, or mp3, etc. or through the radio, then you do have to pay for a licence to do so.
Having made enquiries of the Performing Right Society, and having made it clear that the letter is most unwelcome and the information regarding payment unclear, the following points were offered by way of clarification:
- The website to which the recipient of the letter is referred to for details of the tariffs is not clear, something that it was acknowledged is the complaint of almost every enquirer
- The tariff is determined by the number of seats in a waiting area
- For radio The most relevant tariff for most members is probably that of the small premises tariff. This is a tariff that applies to premises of between 1-19 seats. For the small premises tariff there are two different charges:
- Higher rate is for those who have been playing music in a waiting area but who have not had a licence to do so in the past. It is presumably higher to allow for any misdemeanour in the past through not having paid for a licence when one should have
- Standard Rate is for those who have either had a licence to play the radio in the past, or who have only just started to do so.
- For CDs or tapes The charges are exactly the same as for radio save that to qualify as small premises one can have up to a maximum of 30 seats (as opposed to 19 in the case of the radio).
The Performing Right Society is a commercial organisation to which composers of music subscribe and to whom they allocate the copyright of their music and authorise to collect payment for usage on their behalf. The legal authority is apparently based upon the Copyright Design and Patent Act which essentially upholds requiremtn of anyone playing music publicly to seek the permission of the composer and ensure that payment is made for their work.
For further information and for details of the current fees, please contact the Performing Right Society on 01294 475237 or go to https://www.prsformusic.com/Pages/default.aspx
A major aspect of the responsibility usually of the local District Council is the control of the use of land and buildings to make sure that the policies and proposals in their development plan are carried through successfully so that development is carried out in an effective way without causing undue harm to the locality.
The question of what needs planning permission can be quite a complex matter. New buildings, such as houses, shops or factories, require planning permission and so do many changes of use of buildings and land. Extensions to buildings may also need planning permission, depending on such matters as their size. The display of certain types of advertisement needs consent under the advertisement regulations. For details you will need to contact your local body that is responsible for planning. Details can often be found on the internet for your area, but most will have a listed phone number.
Change of use
Prior planning permission may well be needed if you wish to change the use of land or a building and that may be required if you wish to work from home. As a rule of thumb any change in the use of land unless it is to agriculture, almost invariably requires permission. However, in many council areas, if you live in a mixed commercial residential area and only intend to use one room for part time work, you may not need to seek change of use consent, particularly if you have neighbours who are likely to support what you are doing. If you live in an exclusively residential area, change of use consent seems increasingly unlikely to be given, especially if parking is limited. If you intend to use several rooms, you will have to seek change of use if the building is currently in use as residential, industrial, shop or office premises. A physiotherapy practice comes under Surgeries use and many councils require that you have 3 car parking spaces per treatment room plus one per full time member of staff. Additionally, for a new conversion you will almost certainly be expected to offer disabled access and ramping as a rule of thumb takes up the equivalent of two car parking spaces. Also remember many doorways are not wide enough for wheelchair access, and consider this if you are looking at property with the intention of working there.
How to enquire?
One needs to be a little careful about making enquiries, i.e. if you were to ask your local planning authority as to whether you need change of use planning permission having already established your practice from home this may be akin to asking a policeman if it is alright to punch someone having already punched them i.e. he simply arrests you or, in a planning context, serves an enforcement notice on you to stop trading.
Also if you enquire about a change of use to them in specific terms, they may well mark your intentions and investigate at some point in the future.
So it is probably best to:
- Enquire of your local planning authority as to what the rules are anonymously or research them through their website
- Seek professional advice from a knowledgeable expert their details can often be relayed by the planning office themselves i.e. they will not recommend anyone, but may have a list.
- Ideally, enquire from someone who has done it in your area for a recommendation.
For those of you who did, you will appreciate the sheer size of the form that you had to complete, but other than the time that it takes to complete the form compliance with the act is not onerous.
For those of you have not as yet registered and think that you should have or are not sure you can telephone the Notification Helpline at the Data Protection Agency which is entirely confidential and where you will be assisted by an operator between 9am and 5pm. Telephone number 01625 545740.
You can also obtain an application form and guidance from the Data Protection Agency's website onhttp://www.ico.gov.uk/.
The act exists to protect members of the public from having their personal details either inaccurately stored on a computer or from having these details passed on to other organisations without their consent and to a large extent it controls the selling of personal information to others.
In practice it means that you have to:
Re-register every year at a current cost of 35.00 you normally have the renewal sent to you
If a patient requests details whether stored on a computer or within manual clinical records, you must be able to provide them with these within 40 days at a maximum cost of 50.00
It is important to say that the experience of many members is that once you have overcome the task of completing the original registration form, it really is business as usual!
It is clear that Physio First members continue to be targeted by companies offering special advertising or promotional opportunities. These may take the form of television advertising, privilege cards, international directories, high profiling on search engines etc. and whilst some of these will be above board and represent reasonable value for money, the majority are little more than trick schemes designed to part you from your money.
Questions to satisfy yourself about before you sign any papers or commit yourself are;
Am I committing myself for a long time?
What proof is being provided that it will work?
What recourse have I got if a third party e.g. a GP decides not to show a video or display leaflets?
The advert or entry appears to be free, is it, or is there, a hidden charge? Have you actually seen a previous copy of the publication?
Can I talk to previous advertisers?
How quickly will the publication be produced?
If the sale is completed via the telephone the contract is deemed to be between two businesses. This is no cooling off period.
Physio First periodically issues alerts to members on scams so keep your email contact up to date. See also the FAQ in membership & benefits scams and Physio First members. If in doubt, contact Physio First.
The Act places three duties on service providers:
(1) Not to treat a disabled person less favourably than other members of the public, without good reason;
(2) To undertake reasonable changes to practices, policies and procedures to make it easier for disabled people to use services; and
(3) To make physical adjustments to premises to enable disabled people to use those services.
Where a physical feature makes it impossible or unreasonably difficult for a disabled person to use a service, service providers must take reasonable steps to either remove or alter the feature or provide alternative means of avoiding it.
The extent to which service providers have to comply with the duties is limited in two respects. First, service providers are only required to do what is reasonable and this will take into account such matters as the practicability of the adjustment, any disruption that may be caused and the financial costs to and resources of the service provider.
Secondly, a service provider is entitled to fail to comply with a duty if it considers - reasonably - that its failure is justified. The duties under the Act and their cost implications should be a serious consideration to anyone acquiring property that may be open to the public.
Specific advice can be obtained free of charge from the Equality and Human Rights Commission on Tel. 0845 604 6610, Textphone. 0800 444 206, Post. FREEPOST, Equality Advisory Support Service, Web. http://www.equalityhumanrights.com/
Having clear terms and conditions can be very helpful when it comes to disputes with patients over paying for treatment but they are not the panacea or the silver bullet to cure all problems over non-payment for treatment fees.
The recommended terms and conditions below have been drafted in direct response to the collapse of the commercial intermediary, Remedy Matters in November 2008, which left a large number of members with unpaid invoices that could only really be pursued against Remedy Matters (who went into administration and for all practical purposes had no money to pay) rather than directly against the patient who had received the treatment.
Please note that any business coach, bank manager or accountant will tell you that cash is king and moving away from the patient paying for the treatment that they receive either before or immediately after they receive it is never a good idea unless there are no alternatives.
Please do not justify any move to allow third parties rather than the patient to pay for their treatment on the basis that if asked patients would prefer me to bill a third party e.g. a private medical insurer, rather than pay me as this is akin to if asked people would like free money the answer is always predictably affirmative.
If however any one of the following reasons apply to you, you will find yourself having to bill a third party i.e.
- If I do not bill a third party, the evidence that I have gathered about my customer base supports the view that they will prefer my competitors over me please note the word evidence.
- My business plan has led me to conclude that I need to be a preferred provider of particular private medical insurers or a commercial intermediary and to do so I am required to bill them directly or run the risk of losing this status without which I cannot treat patients insured/referred by them.
So below is a first draft of terms and conditions that you could use. Please remember that having terms and conditions in place is only the first step. If a patient or third party does not pay then enforcement of this contract is a whole new process that involves the following steps:
1. Writing the 3 debt collection letters that Physio First recommends one uses (see your Members Manual) to try to persuade the person or organisation to pay.
2. If these fail, then using the Physio First members Debt Recovery Assistance Service to try to persuade payment (again see www.physiofirst.org.uk) for details.
3. Issuing proceedings through the Small Claims Court brief details of which are that:
- One has to pay a fee to initiate often 30 - 50
- Is designed to keep lawyers out of the process to make it less expensive
- Does require your time to:
Read and understand how it works
Complete the necessary forms
Possibly attend a hearing
- You will not be able to claim anything for the time that you spend using this process, so there comes a point where most people have to decide (and this is best done before you start) whether the time and aggravation investment is worth it.
So to get to step one, it is helpful to have terms and conditions and they are infinitely better than nothing!
Having these in place may have alleviated the problem caused by the collapse of Remedy Matters in that Physio First members who have terms within their terms and conditions that require the patient to agree that they will be directly liable for treatment fees not paid by the third party, would mean that the Physio First member has a case that could be pursued in the Small Claims Court if necessary.
But even with terms and conditions in place, there are still obstacles to over come is it worth the time and aggravation (e.g. as each individual amount due for patient treatment fees will be relatively small); might a claim be defended (even if the defence ultimately fails) or does the patient have the money to pay?
Finally, with the exception of the demise of Remedy Matters the incidence of non-payment for patient treatment is relatively rare within the private physiotherapy sector. This is not to say that individuals have not had significant problems in obtaining payment for large amounts but that as a sector the non-payment of treatment fees (or bad debts) as a percentage of annual turnover, is not a major sector wide problem at the moment.
That is not to say that as things change within the sector that this will not change, but just an observation. If you find yourself with significant non-payment by patients then you may need to seek the advice of your accountant or the Physio First General Secretary (for details please contact the administration office 01327 354 441) as there is something rare about how you practise.
Please note that these recommended terms and conditions:
- Have been drafted in plain English so that Physio First members can explain them to patients who want them explained and legalese has where possible been avoided.
- Are the first draft of recommended terms and conditions by Physio First and will be updated from time to time and members will be notified by Physio First e-alert when they are. Please ensure your email address is kept up to date via www.physiofirst.org.uk or by notifying Physio First in writing.
- Should not be used as the basis for any arrangement that is likely to generate very significant treatment fees (e.g. over 5,000) as such cases should be dealt with much more formally and will require greater legal input.
Terms and Conditions
These are the terms and conditions of [Business Name].
I/We the patient(s) who have signed these terms and conditions (below) agree with [Business Name] (hereinafter referred to as the business) that :
1. A Physiotherapist from the business may provide treatment for me.
2. I am personally liable to pay the treatment fees of the business and any surcharges incurred (e.g. as a result of a failure to attend an appointment where I have failed to give the business at least 24 hours notice).
3. If the business does agree by prior arrangement with a third party to invoice and seek payment from that third party (e.g. a Private Medical Insurer or a company who has referred me for treatment) and allows them some additional time to pay, then I agree to pay the business upon it demanding payment of me by letter within 7 days of being asked to do so. I understand that this is only likely to arise if the third party ceases to trade for any reason or fails to honour an agreement to pay the business within a specified timescale (and that this may occur whether or not the third party has reimbursed me as the patient or has agreed to do so).
4. The business accepts no responsibility or liability for any indirect, special or consequential loss or other damages howsoever caused or any liability arising from the services or treatment provided or made available to me except in the case of personal injury or death caused solely by negligence of the business, its servants or agents.
5. I or the business may terminate this contract by mutual agreement or by either I or the business giving the other immediate notice of termination in writing to the last known address.
6. Where this agreement (and/or a termination notice under 5 above) has been signed by a person on my behalf, that the person so signing warrants to pay all charges incurred up to the date of termination (unless already paid).
7. The business shall not be liable to me or be deemed to be in breach of this agreement by reason of any delay in performing or any failure to perform any of its obligations in relation to services or treatment if the delay or failure is due to any Act of God.
8. If the whole or part of any of this agreement shall be held void or unenforceable by any Court or competent authority then any such term or condition or the relevant part thereof (as the case may be) shall be deleted and the remaining terms and conditions (or part or parts of such terms and conditions shall continue in full force and effect.
9. A person who is not party to this agreement (including any employee, officer, agent, representative or sub-contractor of either party) has no right under the Contracts (Rights of Third Parties) Act 1999 to enforce any part of this agreement. This does not affect any right or remedy of a third party which exists or is available to that person apart from that Act.
10. We agree that any dispute arising from this agreement will be determined in accordance with English Law and will be deemed for all purposes to have arisen within the jurisdiction of the County Court.
I the patient, or the person signing on behalf of the patient, agree to these terms and conditions which I have read and understood
These Terms & Conditions can be downloaded - Click here.
Yes. Photograph and video/audio recordings made for clinical purposes form part of the clinical record.
Such recordings that are made for treating or assessing a patient must not be used for any purpose other than the patients care or the audit of that care, without the express consent of the patient or a person with parental responsibility for the patient.
Photographic and video recordings, made for treating or assessing a patient and from which there is no possibility that the patient might be recognised, may be used within the clinical setting for education or research purposes without the express consent from the patient as long as this policy is well publicised.
However, express consent must be obtained for any form of publication.
If you wish to make a photographic or video recording of a patient specifically for education, publication or research purposes, you must first seek their written consent (or where appropriate, that of a person with parental responsibility to make the recording and then seek their consent to use it.
Yes. The physiotherapist carrying out the consultation should explain to the patient that an observer would like to sit in on the consultation, who that person is and why he or she wishes to observe.
Patients should feel able to refuse consent to the presence of physiotherapy or work observation students during their examination and treatment. They should be reassured that their decision will, in no way affect their treatment. Wherever possible, patients should be given the option of considering this request prior to the arrival of the observer/students.
There is nothing to prevent anyone setting up a private practice near to one that is already existing - if there were any such rule, it would be a breach of the anti-competitive legislation.
The only restrictions that can be applied to anyone contemplating setting up a practice within close proximity are those that have been agreed to within a contract not to do so, i.e. where the person who is proposing to set up the practice either was employed by or was a self-employed associate of the person with the established practice. These tend to be called "restrictive covenants" and they usually have to be "reasonable in time and area" to be enforceable. To determine what is reasonable, one needs to take individual legal advice.
If you find that someone has set up a new practice close by (or if you are proposing to set up a practice close to other Physio First members) here are a few points to consider;
There are real advantages in trying to meet to discuss future plans and existing services as there may be opportunities for collaboration, locuming, etc
Even if there are no such opportunities;
It is often best to meet the competition, as finding out that they too are a real person who is not necessarily out to damage your business, is helpful
Finding out that they are helpful too!
They may not be useful in the short-term but they may have potential use in the longer term e.g. they could be a candidate to buy or sell your practice to
Remember examining the "competition" is a business fundamental and so all informaiton gathered should help inform the steps you can take to continue to be succesful in such a situation.
In line with the competition commission rulings, we are unable to give specicfic advice on this matter.
The fee is up to the individual practice or practitioner to decide. A number of factors can be taken into account such as region, client base, the charges of other physiotherapists in the area.
There are two sources of information on the process of buying and selling a practice.
Here are the links to them:
Anne-Marie Samuel article in In Touch June 2008.
Click here to access Anne-Marie''s article.
Paper by Paul Donnelly written in 2004 - updated 2007.
Click here to access Paul''s paper.
At this stage, this does not affect physiotherapists directly, but if we achieve our goal of Independent prescribing (IP), it will allow physiotherapist IP''s to use unlicensed products and may indeed serve as an incentive for physio''s to take up IP rights.
The mixing of medicines (i.e. the use of unlicensed medicines) is to be allowed in all clinical areas by:
- Doctors - who can also delegate mixing ( currently allowed)
- Supplementary prescribers - who can also delegate mixing (currently allowed)
- Nurse and Pharmacist IP''s - who will also be allowed to delegate - (new law)
- Mixing of medicines (i.e. unlicensed medicines use) remains prohibited under a PGD framework- although this is being reviewed under the separate MHRA review of UK medicines law, where it has already been accepted that the PGD framework does not work well in all areas.
How do I prevent private hospitals from persuading my patient to attend their in-house physio department?
It would seem that many of us have a story to tell about referring a patient to a consultant based in a private hospital, only to find that they are not heard from again!
Some private hospitals are either putting increased pressure upon consultants to persuade them to refer patients to the hospital physio department or the hospitals are deploying staff to try to recruit our patients either way the result from our perspective is the same some of our hard won patients may simply disappear!
In an effort to help tackle this sort of business problem we have produced two professionally written letters designed to address this problem by making it the problem of both the CEO of the hospital and the consultant. This approach makes it easier to address, especially by the consultant with whom members usually have the professional working relationship.
Read the letters below. If you wish to use them as a template, click on the hyperlinks to download.
These letters provide a means by which we can have the issue aired but the solution is really to use our business power in this relationship and ultimately refer our patients to Consultants where this does not occur and where they reciprocate by referring patients back to us.
- Letter to CEO of Hospital
Re: Inappropriate Patient Approaches
I am writing to you as a self employed, private physiotherapy practitioner as a result of a problem that I have encountered in my referrals to Consultants at your Hospital.
In short, it has come to light that patients that I refer to Consultants based at your Hospital are routinely approached by members of your staff or otherwise directed to offers of post operative physiotherapy at your hospital.
Whilst the offer to such patients is not a professional matter and at the end of the day a matter for the patient to choose, it is from the perspective of private physiotherapy practitioners who refer our patients to Consultants at your hospital, wholly inappropriate.
In short, patients come to private physiotherapy practitioners because they have been treated by us in the past (and as a result trust us), have been referred by other patients or healthcare professionals (who have been happy with our services) or as a result of our own business marketing initiatives.
However those patients have come to us, before they have been referred to a Consultant at your establishment, each patient will have been assessed and treated by us and will have been directed to a Consultant at your establishment because we (as experienced independent healthcare professionals) have assessed that they should be. It has always been, and remains our expectation (and indeed that of our patient), that they would then return to us for post operative treatment.
For your business to then activate a sales process with the specific aim of converting them from our patient to your customer is plainly inappropriate in a business context and highly confusing to the patient who is happy to accept my recommendation of which Consultant to attend, but with the expectation that he or she will then return to me for their post operative physiotherapy. In short this is something that private physiotherapy practitioners cannot tolerate.
I must therefore advise you that unless you confirm to me by letter within 7 days that such sales practices, however deployed, will cease, I will cease all referrals to Consultants located at your establishment.
I look forward to your response.
Cc Mr XXX, Consultant Orthopaedic Surgeon
- Letter to the Consultant at the Hospital
Dear Mr XXXX
Re: Inappropriate Patient Approaches
I am sorry to have to write to you in these terms but I feel that it would be helpful to let you see a copy of a letter that I have sent to the CEO of Hospital.
If you do have any points to make to me, please do not hesitate to do so, but I obviously do hope that this problem can be overcome and that I remain in a position to continue to refer patients to you.
To download in Word click here.
ERUS is the CSP''s Employment Relations and Union Services function. ERUS staff provide advice, support and representation to CSP members who encounter difficulties in the course of their work. There has long been some understandable confusion amongst members working in private practice as to which ERUS services are relevant and available to them and which aren''t. The main test where this is concerned is what their employment status is.
Some of the advice and representation provided by ERUS is only relevant to members who are employed, rather than those who are self-employed and may also be employers. This is largely due to the fact that many workplace procedures and legal routes of redress are only available to people who are "employees". These include many workplace grievance procedures and access to employment tribunals to make claims for unfair dismissal or discrimination, for example. Although employers have a range of legal obligations towards members of the public, patients and volunteers, their greater legal duties are the ones they have to the people they actually employ.
CSP members who work in private practice and are employees have access to the same ERUS services as those employed in any other sector, be it the NHS, an independent hospital, or a voluntary organisation.
It is not uncommon for members to contact the CSP for advice because they are not sure whether they are employed or self-employed. When this situation arises, ERUS staff will advise and assist members while clarifying their employment status. If the member appears to be an employee in terms of the legal tests for this, we will continue to advise them and if it becomes clear that they are self-employed, we will explain to the member concerned why we cant assist them further and also refer them to any other sources of help, including Physiofirst if they are a member.
However, there are a range of ERUS services that are relevant to all members, whether employed or self-employed:
- HCPC cases: all self-employed CSP members have access to full ERUS representation if they have a complaint made about them to the Health and Care Professions Council (the body that has the legal responsibility for regulating the physiotherapy profession). Any member contacting the CSP for help in this situation will be referred to the Senior Negotiating Officer for the region in which they work, who will then assist them with preparing their case. Anyone wanting to know more about this may like to look at the CSPs HCPC briefing, which can be found on the CSP website.
- Work-related criminal cases: this is thankfully rare; however, anyone facing criminal charges arising directly out of their work can access the CSPs legal advice and assistance scheme. This includes a specialist solicitor to accompany the member to police interviews and specialist legal representation in all matters covered by legal aid, which currently includes all Crown Court cases. Anyone in this position can access advice 24 hours a day by calling 0800-587-7530
- Personal Injuries: if members are injured at work or if members or any of their family members are injured outside work, it may be possible to make a claim for the injury sustained. This is at no cost to the member or family member concerned and anyone needing to access this service can do so by calling 0800-587-7519
- Other legal advice: the CSPs solicitors (Thompsons) also offer 30 minutes free legal advice on any non work-related matter and discounted rates for drawing up a will and for conveyancing. These services are all accessed by the same freephone number - 0880-587-7519
- Briefings: a wide range of ERUS briefings is available on the CSP website. Some of these may not be directly relevant to members of Physio First, such as NHS redundancy provisions or on-call rates, although even these may be of general interest to people who are self-employed or who are employing others. Others will have more direct relevance, such as our briefings covering the Small Claims Court, HCPC, legal services and the new Independent Safeguarding Authority and our wide range of health and safety briefings, all of which are available on the CSP websitewww.csp.org.uk
We now have in place a way for Physio First members to obtain an enhanced DBS check that will satisfy the requirements of any contractor or other body that may require you to have one e.g. nursing home, sports clubs, school.
For more details and to apply please click on this link: Resources
In our November 2014 Update we communicated that “… as Physio First we always try to pass on what we have learned to our members …” and we articulated there what we knew about this new pension legislation.
Since then we have, as Physio First, completed what we need to do to comply with the new legislation and how to best communicate what we had to do. We thought that we would simply publish the letter that was sent from our Office Manager Julia Costello, to every member of our office team on the 21 January 2015:
Dear Team Member
As we were previously made aware by a memo from Chris on the 15 January 2014 there are new pension rules in place which mean every organisation that employs one or more people will have to provide a pension scheme for their employees. Part of the legislation also confirms that the employer will have to contribute to this pension scheme from the start date (which is called the “staging date”).
Physio First, as our employer, is starting to look at implementing these pension changes and I would like to update us all as to the discussions that have taken place to date.
We have agreed to appoint Hawsons Wealth Management Ltd, who are a company attached to our accountants Hawsons, to help us through the whole process which is really quite complex.
Part of the process required Physio First, as our employer, to take advice and then choose a pension provider and having listened to all of the options, a pension scheme that is provided by a Pension company called Royal London (formally known as Scottish Life) has been chosen.
Royal London was selected because what they have to offer best met all our requirements based upon the type of organisation we are (i.e. a Trade Association) with our Culture whilst at the same time providing each of us, as employees, with a pension scheme that offers numerous investment funds which will meet everyone’s needs.
As our “staging date” (i.e. starting date) is 1 February 2016, which is not that far away, and as it takes some time to set up a scheme we are actually looking to get an “Auto-enrolment ready” scheme in place by the 1 April 2015. Simply put this means that any one of us could individually /voluntarily choose to join the pension scheme and contribute to it early if we wanted to.
If any of us are considering joining in April 2015, this will be on a voluntary basis and therefore we will be required to sign forms to join.
Physio First will begin contributing to our pension scheme from the “staging date” (i.e. from 1 February 2016) and will be contributing on a “total pay” basis starting at 1%. In simple terms this means that Physio First, as our employer, will contribute 1% of our gross salary towards our pension from that date.
Everybody who is 21 and over will be automatically enrolled. If, as an individual, we do not choose to opt out of the scheme altogether then from the “staging date” (i.e. the date upon which we all have to join) we will be required to pay a minimum of 1% of our gross salary in the first year which then increases to 2% in year two (from October 2017) and which peaks at 4% by year three following the Auto-enrolment date i.e. from October 2018.
Finally, the process makes provision for each one of us to have a meeting with a very nice lady who is guiding us through the whole process called Erica Dietsch who is from Hawsons Wealth Management should any of us want this. Erica will be making an initial presentation to us as a group on 22 January 2015 @ 10:00hrs.
For any questions about this new legislation please read the article in our November 2014 Update or please take any questions to our LinkedIn Forum where we can discuss our experiences together as this is a piece of legislation that we all need to be aware of.
Remember we all need to take advice from our accountants, at least initially!
In the article in our March 2015 Update: “The USA … A Version Of Our Future?” we explained that “… none of our executive has had the full story yet – but we have heard enough to share Paul’s excitement!”
Well now our executive has heard the full story and it is mind blowing!
Our executive have now commissioned Paul to report our executive’s views to his US contacts so that they are aware of just how valuable we regard their information and just how grateful we are for it and, of course, to see where we might go from here.
We obviously greatly respect both commercial confidences and integrity is the essence of our organisational culture – so we will report what we can when we can, which we know is a little frustrating, but our executive can be trusted to do what is right to nurture the sort of relationships that will enable us to meet our Intent.
Can someone tell me why I should pay >£100 for a discussion meeting about voluntarily setting up a possible group that will take away our professional autonomy with the introduction of care pathways?
Wendy’s Question - Can someone tell me why I should pay >£100 for a discussion meeting about voluntarily setting up a possible group that will take away our professional autonomy with the introduction of care pathways?
You may be asking one question about two things, so to make sure that I am hitting the right points, I will set both out – but please do come back to me if I have missed the point.
Rich Katz will be talking upon 2 separate but related things i.e.
- He will be our main guest speaker at our symposium on Friday 31st March (Education Day) where he will contribute to the symposium upon our investigation of the feasibility of a private physiotherapists’ cooperative i.e. a self-owned self-employed private physio business
- He will be a conference speaker on Saturday morning, where he will be talking about his network’s experience of care pathways
The two are separate but related. Separate in the sense that at the Friday Education Day symposium, he is unlikely to address anything to do with Care Pathways, save possibly in passing, but they have been a feature of his network. In his Saturday morning conference slot he will talk about his, and his network’s experience, of using care pathways in is 20+ years of frontline negotiations with private medical insurers.
So, back to the question, but to each specific part – Can someone tell me why I should pay >£100 for a discussion meeting about voluntarily setting up a possible group that will take away our professional autonomy with the introduction of care pathways?
Why pay to attend?
Essentially, in charging for this event, our executive have had to take into account our need to try to ensure that this event self-funds and fits into the overall use of Physio First finances as we deploy our strategy and meet our goals.
This whole Goal 9 endeavour, of which our groundbreaking symposium is a part, is premised on “no guarantees” that it will work and so we have to budget responsibly to cover our costs. If it fails, it is unlikely to leave a substantial financial hole in our organisation whereas if it succeeds it will help to replenish some of Physio First’s reserve which has been invested in our pursuit of our Goals 1 to 9 and without which we could not have even contemplated this development.
Even our volunteer post holders who already contribute so much of their own time, energy and money (to include our executive committee and even members of our education subcommittee who are responsible for delivering our whole Education day), will have to pay to attend.
I hope this provides some more context to this aspect.
Back to the question … voluntarily setting up a possible group that will take away our professional autonomy with the introduction of care pathways?
The symposium’s learning outcomes are:
- What a self-owned private physiotherapy business entity is
- Why Physio First thinks that this is something that Physio First members should contemplate now
- What the first one might look like
- When the first one is likely to be established
- Whether you should plan to become involved or not
and are absolutely not about setting up a group that will take away professional autonomy but rather about whether there is sufficient appetite among members to become involved in setting up their own self-owned business – most probably as a cooperative – through which to trade and seek to impact upon the current and future healthcare marketplace.
The reasons for considering this now are set out in our FAQs around this event: http://www.physiofirst.org.uk/asset/25523CB1-8CC2-4B7A-9AAB55CDC626036E.2AA0FD77-9DD5-43DD-977B238E1B44120D/
In overall terms however, the exploration within the symposium will be about “protecting” professional autonomy on 2 counts:
- From its de facto erosion by private medical insurers and commercial intermediaries who impose restraints upon the number of treatments that providers who join their networks, can provide based upon their own metrics which are really only around cost with absolutely no reference to quality.
Those private medical insurers and commercial intermediaries that are honest will agree that they have no validated ways of measuring quality of any provider (from surgeon to physio to any other healthcare professional) nor indeed of the services that they, as businesses, provide i.e. how can a customer tell which private medical insurer or intermediary is of better quality than another – they simply cannot!
- By enabling self-employed private physios to do it yourselves! Up until now, there has been no legitimate way of articulating how good you are – save by saying “my patients would not come back, if I were not good enough” – which is a very credible position to hold, but one that we think has an increasingly short life span – our reasons for thinking this are summarised in our lead article in our November Update i.e.
Why do we need this scheme?
Society and the healthcare marketplace in 2016 demand authenticity. Validated data can be turned into evidence of authenticity in so many ways.
In everyday life, we give and share data everywhere we go – from interactive fitness apps to retail reward cards and hotel loyalty discounts. In the healthcare marketplace, authenticity means being able to prove our cost effectiveness – our value for money. In our world as self-employed private practitioners, this is demonstrated by measurable quality treatment with outcomes. Please see our article, page 7, on quality and how it is becoming critical in the private healthcare marketplace.
Our reasons for believing that our healthcare marketplace “will” (not “may”) be subjected to scrutiny about quality, takes into account Physio First’s discussions with marketplace stakeholders – from private medical insurers, to commercial intermediaries, to members who are ambitious to expand – as these discussions have helped us to understand that they are all looking for objective ways of measuring and then commercialising “quality”.
The reasons these stakeholders include:
- The 2014 Competition and Markets Authority repot on their investigation of theprivate healthcare market which concluded that “… patients considering private healthcare did not have sufficient information available to them to make informed choices” and as a result forced the establishment of The Private Healthcare Information Network (PHIN) whose remit is to “… publish trustworthy, comprehensive data to help patients make informed decisions regarding their treatment options, and to help providers improve standards” – see link http://www.privatehealth.co.uk/industry/industry-organisations/the-private-healthcare-information-network-phin/
- This currently only applies to private hospitals and consultants who work within them, but the direction of travel in the healthcare market is clear – we all have to be able to provide “… trustworthy, comprehensive data to help patients make informed decisions regarding their treatment options, and to help providers improve standards” – and this means standardised data collection that is validated by much more than ourselves.
- Some marketplace stakeholders have already looked to create a “TripAdvisor” consumer type quality measure – see an example from an on-line commercial intermediary https://www.zesty.co.uk/ and click on the very short video about “How does Zesty Work?”
Obviously Physio First has been working away, with the University of Brighton and our anonymous and selfless members on our Data for Impact project that now provides enough validated and standardised data to enable our Physio First Quality Assured Practitioner scheme to be launched and which is fully described in the lead article in our November Update, “QAP scheme launch”- http://www.physiofirst.org.uk/resource-library/novemebr-2016-now-is-the-time-not-to-miss-out-2.html – which as the article says, has “delighted and worried marketplace stakeholders in equal proportion “.
So back to care pathways?
For those of you who are Bupa providers, you have been asked year on year about your need to use care pathways. We even understand that Nuffield Fusion used to (and perhaps still do – we would love to know) mandate the use of care pathways that they have developed for their Nuffield Physio outpatient Depts and Nuffield Fusion members, but apart from these there are very few if any Care Pathways that are regularly used in private practice.
Might care pathways be used in the future – the chances are that they might well be – but this then begs the question as to who will create them and what use will they put them to?
Currently we have detected little activity in the marketplace around Care Pathways – but rather a lot of activity around being able to demonstrate quality – but this does not mean that we can ignore them or the fact that they can be a sword as well as a shield. The question is, who will wield them?
This is why our Education subcommittee asked Rich Katz to talk about his experience with care pathways over his 20 plus years of experience i.e. giving us the benefit of his hindsight in their use in helping him to enable his network to survive and prosper in the US healthcare market where many others have not as it is a very harsh environment within which to compete!
Obviously there is an awful lot going on within Physio First just now – from the launch of our QAP scheme to our Goal 9 Symposium to our Patient On-line Booking facility (due to be launched in January). But they are all connected.
They are all about “not standing still” and allowing other marketplace stakeholders to make the running and then merely on impact us and over which we would have very little say. These developments are about “Championing private physiotherapy” which means they are about big bold steps where we do not know the answers but without which we cannot expect to have much impact on our own marketplace.
So do continue to ask questions – and if I am involved in any of the answers – I promise to try to be “briefer” than I have been here!!!
Apologies and thanks!