All of us as GPs will likely carry out at least some paid-for services, but expansion of or an outright switch to private delivery is, obviously, a wide-reaching decision.
It’s one thing to provide HGV medicals and firearms reports that don’t conflict with NHS services and another to step into a for-profit frame of mind.
Whether you are debating joining an existing private practice or forming one yourself these six preliminary considerations may be helpful thought prompts.
1. Moral arguments
Few GPs considering branching out into offering private services will do so without some consideration of the moral arguments.
The debate is one that only individuals can come to a conclusion on but it’s worth remembering with this emotive issue that you’re likely to face strong views in opposition to your own. You may need to be patient with others and develop a thick skin.
As well as the wider conflict over whether or not private services are detrimental to the NHS, there are personal considerations around adjustments to dealing with profit being a factor in care.
If you are seeking to work for a private practice, rather than establish one, close scrutiny of procedures and practises, such as prescribing processes, will allow you to evaluate if your personal beliefs align.
2. Robust division between private and NHS work
Should you be considering running a private practice or perform private work alongside an NHS practice you’ll need to ensure you have robust procedures to keep the two distinct.
The 2019/20 NHS contract prevents signed up GP practices from hosting or advertising paid-for services that fall within the scope of NHS funded primary medical services.
3. Financial arrangements
In private practice you’re likely to need to deal with the priorities and expectations of investors or shareholders either in a direct or indirect way.
For those setting up private practice themselves, specialist accountancy and business advice may need to be tabled, not least in relation to dealing with private medical insurance companies.
Marketing also requires investment and expertise.
4. Revalidation and appraisal arrangements
In private practice you’ll have the same revalidation and appraisal obligations in order to retain and protect your registration.
Processes to allow effective completion are vital.
5. Patient expectations
Patients’ expectations among the privately funded bring different demands to those experienced in the NHS.
Some paying patients might well demand tests or treatments that may be clinically ambiguous.
6. Indemnity cover
A move into private practice brings the need for further consideration of indemnity cover for yourself and staff if you’re employing them.
While the 2019 introduction of the Clinical Negligence Scheme for GPs (CNSGP) did not negate the need for indemnity cover even in traditional, majority NHS practices, in private practice cover must be robust.
The state-backed scheme offers automatic cover for liabilities relating to acts or omissions relating to the diagnosis, care or treatment of a patient in relation to NHS services only. It’s worth remembering that even private actions that are permissible in NHS practice are not covered by this scheme, which can cause confusion where there are grey areas, in relation to travel vaccinations, for example.
Terms of engagement should be among other legal considerations.
Patients will soon have the right to access their medical records through the NHS app – which is set to bring a renewed focus on what’s actually contained within a person’s file. If it’s easier than ever for patients to request, inspect and challenge the data kept on them, then the importance of record keeping in healthcare will be thrown into an even sharper focus.
Whether it comes naturally or not, all GPs have to accept that record keeping is a key part of their role. Far from getting in the way of patient time, this part of the job is the thing that informs and guides that patient time. It’s also the thing that protects you and your judgement should this later be questioned.
This post will focus on the importance of record keeping in healthcare and offer a timely refresher of some best practice tips for GPs to ensure they and their patients are on the right track.
Record keeping in healthcare
It pays to remind yourself of the end goal when it comes to your record keeping efforts. This part of the job is all about:
- Keeping detailed information about a patient, their condition and their treatment to ensure you have all of the information you need to hand at every checkup or consultation with them.
- Providing a record that could be picked up by a colleague if they need to pick up the care of the patient for themselves.
- Creating a bank of evidence of the care given to a patient should your actions later be questioned.
Important considerations for good record keeping
The General Medical Council’s ethical guidance outlines how GPs should record their work ‘clearly, accurately and legibly’.
Its advice stresses that any records should be made as soon as possible after the events being recorded and that medical professionals should also be mindful of the laws around data protection so that this information can be safely and securely recorded and stored.
It also states that a patient’s clinical records should include:
- Your name and the date for each new entry
- Any relevant clinical findings you have made
- The decisions you have taken as a result of those findings and any action that you have agree to take as a result.
- An outline of any information you have passed on to your patient
- Details of any drugs prescribed
- Details of any further investigation to be carried out or any treatment required.
This record shouldn’t just be a note of face-to-face appointments, it should also contain important details such as:
- X-rays and scans
- Test results
- Notes from telephone conversations
- Discussions with your colleagues about the patient
- Letters sent or copied in to the patient
- Records of any surgery or hospital visit
Top tips on record keeping
How do you ensure you follow all of the above advice when working on a patient’s medical record?
- Don’t try to alter a file. This is a key point to remember at all times. If you’ve made a mistake then you should correct this with a new entry that clearly outlines what has changed. It’s always best to make a new note, even when you’ve made an error, especially because the GMC frowns upon people who try to delete or change notes.
- Use a good pen if you need to write anything by hand. GP handwriting is notorious – and you don’t want to conform to the stereotype. You don’t need to engage in beautiful calligraphy, but you do need to be understood and a good pen can assist with that.
- Don’t be too personal. These records are professional, factual files and there’s no need to try to write in flowery prose or insert personal comments.
- Check everything. It’s surprisingly easy to log notes against the wrong patient, for example. Check you’ve got the right person – and that all the details you’ve written are correct – before you submit your entry.
If you have any concerns about keeping accurate records, get in touch with MDS to see how we can support you.
The nation is set to go to the polls on December 12 for a rare winter General Election that pundits are saying will be crucial for the future of the country.
The Medical Defense Society is strictly neutral on political matters – we’re proud to represent GPs of any political persuasion – but we know that you’ll all be keen to see what the parties are proposing.
In a bid to help you to cut through the noise, we’ve laid out what the major UK-wide parties have said in their manifestos about GP services and their plans for the next five years.
The Conservative Party, led by ex London Mayor Boris Johnson, is bidding to earn a majority in Parliament, after governing with the support of the Democratic Unionist Party of Northern Ireland since 2017.
GPs should note:
- The manifesto promises 6,000 more GPs and add 50 million extra GP appointments a year (a 15% increase). The party says its plan would involve upping the number of GPs in training by about 500 a year. In 2015, then health secretary Jeremy Hunt promised 5,000 more GPs by 2020. However, numbers have actually declined in the past four years.
- It also adds: “We also want to make sure that doctors spend as much time as possible treating patients, so we will address the ‘taper problem’ in doctors’ pensions, which causes many to turn down extra shifts for fear of high tax bills. Within our first 30 days, we will hold an urgent review, working with the British Medical Association and Academy of Medical Royal Colleges to solve the problem.
If you wish to read the full manifesto, you can download it here.
Jeremy Corbyn is looking to build on the party’s performance two years ago – and has set out a radical manifesto to increase public spending.
GPs should note that:
- The party says, in general, it wants to increase NHS spending by 4.3% a year, abolish prescription charges and end ‘privatisation’.
- The manifesto states: “To support our transition to community health care services, we will expand GP training places to provide resources for 27 million more appointments each year and ensure community pharmacy is supported.”
To read the Labour Party’s full manifesto, follow this link.
Jo Swinson is leading the Liberal Democrats into the 2019 General Election and will hope to hold the balance of power.
For GPs, the manifesto states:
- The party wants to: “End the GP shortfall by 2025 by both training more GPs and making greater appropriate use of nurses, physiotherapists and pharmacists, and also phone or video appointments, where clinically suitable.”
- The party also pledged to support GPs to ‘work with nurses, physiotherapists, mental health and other professionals’ to offer multi-disciplinary services and to improve out of hours and mobile appointments.
Read the full Liberal Democrat manifesto here.
The Green Party will be wanting to build on its one MP, after securing more than two million votes at the recent European elections.
From a GP’s perspective, the party’s manifesto states:
- NHS services to be planned and provided through Health Boards – and increase funding by at least £6 billion a year.
- It also states: “Focus funding to enable the construction of new community health centres, bringing health services closer to people’s homes. These health centres will pioneer preventative healthcare, helping people live healthier lifestyles so that they are less likely to fall ill.”
Read the full manifesto for yourself here.
Nigel Farage’s Brexit Party is standing in more than 300 seats across the country.
Its manifesto – which it calls a ‘contract’ – states:
- A desire to ‘introduce 24-hour GP surgeries to relieve the strain in A&E departments’.
- It also calls for ‘national debate’ on the NHS involving doctors, experts and the public, including a discussion on the ring-fending of the NHS budget and tax revenues that fund it.
Read the full document for yourself here.
Hopefully the above should help you to understand what the parties are saying about GP services as we approach polling day.
Keep an eye on the MDS site for news of any new policies or legislation that is introduced that impacts on GPs.