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Uh really warm welcome to this middle education session, which we're delivering alongside the British orthopedic trainees Association on starting out in private practice. You are really warmly welcome, whether you're joining us live or whether you're watching this on demand afterwards. We're really honored to have um Cath from medical protection joining us this evening and we've got Mr David Match and who is going to be delivering his presentation about private practice. We're really honored to have the support of medical protection in this education and I'm going to hand straight over to Cath who's going to share a little bit about what the difference is that medical protection offers. C Hi everybody. Thank you very much, Phil. So it's a pleasure to be here tonight. Um On what I expect, it's gonna be a brilliant um informative introduction to private practice. Um Thank you for joining us and thank you Mr Matching for your insight this evening. So my name is Catherine Asil says, I'm one of the consultant, relationship managers for medical protection. Just a quick little bit of background about me. I've worked with medic for 23 years within finance professional risks and indemnity Um, and if you do have any questions for me, um, then please pop them into the chat or feel free to email me later. I'll, I'll pop the, the email address up a bit later on. Um, so for now, um, I'm just gonna pop up a little, um, a quick poll on the screen if you'd be so kind as just to respond so that I've got an understanding of the audience attending this evening. Um, so the poller should be coming up. Now. Um, just asking whether you've heard of medical protection, um, if you could put yes to, yes, II am a member or yes, you've heard of us, but you're not a member or no. Um, you're, er, but you are practicing in the UK or no, but you're not actually practicing in the UK. Um, so while you're doing that, um, just a couple of quick facts about medical protection. We're the world's leading member, own not for profit medical defense organization with 300,000 members around the world. We were founded in 1892 and we're here to protect the careers, reputations and finances in terms of providing you with medical indemnity for your NHS work and your private practice. Now, we provide what's called a current based membership and understanding the difference between the two is really important, especially when moving into private practice. So I'm just gonna take you straight now to a quick three minute video that explains the differences. What's the difference between claims made and occurrence based indemnity? Put simply claims made. Indemnity offers you protection for claims arising from your practice that occurred and are reported during a continuous period of membership occurrence. Space, indemnity offers you protection for incidents such as claims or complaints that occur during your period of membership even after your membership has ceased. When choosing your protection. There are three factors to consider how you are protected, your protection after membership and how subscriptions are calculated. Both products offer the same protection against claims while you are a member, the difference comes after your membership ends with a current based indemnity, you are protected for the period you are a member. So if someone makes a claim against you years later, as long as the incident occurred while you were in membership, you're protected, even though you may no longer be a member with claims made indemnity. You are protected against claims that are made in relation to incidents which arise from your practice and are reported during your membership period. Once your membership ends, you're not protected for any claims made against you. Even if the incident occurred when you were a member, claims can arise years after an incident and you may also need to purchase additional protection. Once you retire, stop practicing or change indemnity provider. A current space protection is priced in a way that predicts the expected cost and frequency of future claims based on the work you do. This also includes any claims that may come to light after you have stopped practicing. And this is reflected in the price you pay pricing for claims made protection is based on the likelihood of a claim being reported in that membership year alone and usually sees the cost build over time as the risk of a claim increases. For example, over a five year membership period in year one, you are protected against incidents arising from your practice. In that year. In year two, you are protected against incidents arising from your practice in year two, as well as year one. The same will be true for years 34 and five, every year, your subscription will increase. Although after five years, the price is likely to plateau the subscription fees you pay in the early years are often lower for claims made protection than they are for occurrence based. However, with claims made, you may need to pay for additional protection if you leave your indemnity provider or once you retire. So the overall cost of both types of protection is broadly similar over the course of your career, which option is right for. You will depend on the type of work you do your role, age location, how much you want to pay and the type and level of risk you're exposed to. We recommend you ask the right questions to ensure you are aware of any cost implications, not just now, but in the future and after you retire, uh you're just on mute cuff. Yeah, sorry. Thank you. Just bear with me a second here. I've got some slides, I'm going to put pop. OK. So I hope that video has really helped to explain the difference between the occurrence and claims made indemnity. Um If you're already working in private practice or about to start, you're more than likely, you're gonna be more than likely approached at some point by an insurer. Um about your indemnity needs, you may already have a medical defense organization membership, but often the difference between the way your indemnity is set is not always cleared by the insurer. And it's a question that I actually get daily when speaking to new members or returning members that have moved to an insurer. So as you know, it's a G MRC requirement to have appropriate indemnity in place whilst you're working with NHS, this is gonna be picked up by the trust. So that's the NHS resolutions, but it's strongly advised by the NHS as you probably know um to have additional indemnity in place in 2018. The British Medical Asses said that medical defense organizations will continue to play an important role in providing legal advice, represent representation for G MZ hearings and also for the rare occasion where a criminal case might occur and it will be essential to maintain such medical indemnity. So for private practice, of course, it's a legal requirement for you to ensure that you're properly indemnified. However, I do still see doctors um that have thought their private practice work would be picked up by trust indemnity. And when they discover this isn't the case, this can cause problems for sourcing cover in the future. So if you're ever in doubt, it's always advisable to check with the hospital. Anything that's covered in your NHS contract will be covered by your trust indemnity. Anything that's not in your contract won't be covered. So as you saw in the video, the difference between the cover you can get and the options available to you and the cost you pay now, um and in the future can, can change. So if you're with an insurer and you want to move back to an, an MD O, let's say the cost of increased with the insurer year on year, for instance, then you'll need to make sure you are covered for the past years as it said that you've been with that insurer. Um and that's through what's called a run off cover. This can be expensive. So it's something to bear in mind when comparing provision, there are, there are other considerations when choosing medical protection for your indemnity that you may not um get with your insurer. So make sure that you look into these things. So, MPS provides um NHS cover included with your private practice membership. Um And often this makes it more cost effective for you, wherever you decide to get your indemnity, it's vital, um, and your responsibility to make sure you're always updating your, um, your details, making sure that your private practice incomes updated and any of your, um, any of your surgical procedures. So if, if you do want me to look into providing you with any tailored pricing for your circumstances now in the future, or if you want to discuss, um, it's more on a 1 to 1 basis and obviously please just drop me an email or pop pop a questionnaire in the chat. Um So I mentioned about NHS membership and this slide just gives you a really quick overview of the benefits of being um an NPS member. Um As you can see it highlights where the NHS won't support you and these are all the benefits that will be included with any private practice membership you get with um with medical protection. So just to finish so that you can be sure you're in safe hands. Unique to MPS is our in house medical legal services team answering your calls and giving you advice when you need it. We've received outstanding satisfaction results from our members in 2023 which is committing to our member first value. We provide emergency advice 24 hours a day, seven days a week, free and confidential. It's a free and confidential service. Um And just so, you know, calls do not affect your subscription rates. Um, and the earlier, obviously we know the sooner we can help. Um, so that's me done. Um, I'll move on now and, um, if, if I'm happy to take any questions. Um, and yeah, thank you very much for your time this evening and I'll pass over to Mr Matching. Thank you. Thank you so much, Cath. We're really grateful to have your support and, um, I know that, um, this will be a really relevant, um, service for lots of people when they're thinking about private practice as well. So, um, so really, really great to have you along this evening. If anyone does have any questions for c please pop them into the chat. Um, we'll have some time for questions at the end if you don't have, um, if it's not in the chat now we can maybe tackle it at the end. Um, so don't, don't worry about frantically frantically typing. Um, it gives me really great pleasure to hand over to Mr David Machin, um, who is a consultant in trauma and orthopedic surgery with, um, a specialist in foot and ankle surgery. Um, he is highly experienced in this area and has gone through extensive training and has a really strong track record in, in the field of private practice. He's, um, he offers both surgical and non surgical treatment, um, for his patients and he's, um, committed to advancing the field with, er, a track record in research and professional development as well. So we're really honored to have him, er, joining us, er, this evening and I know that this is going to be a really insightful, um, talk for, er, for many of us here. So Mr Match and I'm gonna hand straight over to you. Thank you. Thanks very much. Um, so, yes, welcome everyone. Um, I believe that most people are UK registrars with some people from abroad and some of the grades as well. I think this is probably mainly aimed at the UK registrar, but it's probably useful for others. Also, I'm happy to see questions come up and probably answer them at the end. Um So yes, I'm David. M I'm a trauma orthopedic consultant and was appointed in March 2014. Um I'm a subspecialist, foot and ankle surgeon. Um My training was at Liverpool Medical School, um Mersey rotation fellowship at Arab Park. So all quite nice and local and I had the honor to be the boat of president in 2012. Um I started at mid Cheshire which is Leighton or Crew Hospital in 2014, as I said, and I've got quite an interest in management as well as medicine and surgery in private practice. Um After a year or so, I became the Associate foundation program director, moved on to be clinical director and then associate medical director. Um All of which are very, very interesting and take quite a lot of time much like private practice Um I started my private practice in the BM I South Cheshire Hospital. Um in 2050. Interestingly, neither the South Cheshire Hospital nor the BM I group exists anymore. BM. I having become Circle a year or two ago or being sold to Circle. So just before the BM I South Cheshire went under, I started at the Spy Yale, which is in Wrexham and a year or so after that, the Grove and Nuffield in Chester, um we have a clinic um that I'm um part owner of which is the Grange Clinic in Chester, predominantly plastic surgery. Um And that's due to my wife being a plastic surgeon um in 2023. So about a year and a bit ago, now I moved to the Countess of Chester Hospital from Crewe in the NHS, um predominantly due to distance of travel, um cutting my travel time down by um, well, almost an hour and a half a day. Um And as part of working at the Countess, we also work at Clatter Bridge, which is part of the Will. So as you can see, I've worked in quite a few different hospitals, both NHS and private um as a consultant and um obviously um the rotation as a, a registrar. So an overview of my talk, um I'm I'm going to try to cover all aspects of um who should do private practice, why you might want to do private practice when the best time to start is where should you practice and how to go about things. Um And if there's anything I've missed, um, there's a very good document from the BMA, um which I've put a QR code at the end of this talk. And um that takes you through much of what I've said in a little more detail. So let's jump into it. So who should do private practice? Well, the law is that any doctor who's fully registered with the General Medical Council, um in accordance with the provisions of the Medical Act, 1983 is entitled to set up in private medical practice. Doctors with provisional or limited registration, cannot practice without supervision. So essentially what that's saying is if you've gone through the usual training in the UK, once you've got through your foundation years and been signed off, you can become a private medical practitioner. Although I would point out most are consultants and the reasons for that I'll cover in a, in a bit. Why would you want to do private medical practice? Well, it's more autonomy. You have a lot more say in when you manage your patient, um not necessarily how you manage your patient because I think that's still something that the NHS leaves to the doctors. Um you'll develop business skills, it's a much more a much different environment than the NHS. You're trying to get patients or clients. You're making sure that you're advertising yourself, you're managing money and staff et cetera. The obvious one that people think about is increased income. Um And I think that's um a, a big part for, for many people, you will be working in different settings and with different systems. So all of those hospitals that I work in four of which are private, have different people, they have different ways of doing things. Um Some are good, some are bad, some are indifferent. Um But generally it's quite nice to work with lots of different people. And the other benefit for surgeons is you're likely to do more surgery, particularly in times when um the NHS is blocked up with um winter pressures, et cetera. Um You're still likely to be operating at the private hospital. So that's um quite a benefit for, for surgeons. When should you start? Well, I think most people set up practice both in the NHS and the private sector around the same time, my fellowship supervisor told me to start straight away and I wasn't 100% sure. So I waited a year. Um so that I could feel confident in the N HSI, think there's pros and cons to starting straight away or waiting. Um And I must admit, um looking back on it, I think I should have taken his advice and started straight away. Um It's quite a big change when you move from being a non consultant to a consultant. And after a year or so you settle in and then starting in private practice, you're going through that massive change all again. So it's a bit like doing both bunions at the same time. It might be a little bit worse but you get, you get the badness out of the way, um, more quickly. Um, although some people may want to wait and may find it beneficial to grow a little in the more protective NHS environment. So it would really be when you start as a consultant or a little bit afterwards. Where will you practice privately? Well, there are a number of options um as you can see in the middle. So the most common is to join one of the large private hospitals or a smaller clinic such as the ones you see there. So we've got, these are the big ones in the UK. So we've got the circle, the spire, the Nuffield ac A Ramsey and then um my clinic, the grange is just bottom right there. There's lots of smaller clinics, smaller hospitals around. Um They're probably the most common. Well, they're definitely the most common place to practice and certainly the bigger institutions offer some degree of NHS feel about them with matrons and lots of staff to help you out. Um You could get rooms now that would be more applicable for people that are not operating. So if you have rooms, then you will probably need to find somewhere to operate. Not all surgeons operate in their private practice, but most do, um, physicians obviously are less likely to be operating although they may be doing procedures that require a larger hospital to do such as scopes, et cetera. Um, and the other benefit or the use of rooms can be for medical, legal work, consulting clients in various aspects of that. Rooms can be taken pretty much anywhere depending on what you're doing. And you'll see at the bottom, I put C QC, we'll come to that in a minute. So moving on NHS setting, um, there are quite a lot of NHS hospitals, er, that have a small private wing attached to them and that can be again, good and bad. Um, when I was working at the South Cheshire, that hospital, whilst a separate organization was attached to my NHS Hospital Leighton by corridor, which does make things more straightforward. There's no travel but they can come to rely on the N HSA bit much for things like sets in theaters. So again, there's pros and cons as there is with most things in life. Um I've put home although I don't really expect many people to work from home. Um, I think this is perhaps more for physicians or GPS and I think it's becoming a little historic in the UK. Um, but it certainly is a possibility, it's mentioned fairly significantly in the BM guidance. So something to consider, possibly I personally wouldn't want to mix home life with work life, but there are people have different views on that. Now, one of the really important things to consider here is where you work has to be correctly recognized and registered. Um, if you're doing any sort of surgery, then where you're doing the place you're doing, that has to be recognized by the care quality commission C QC. Um, if you're doing things like medical, legal consulting, it does not. So I have colleagues who do medical legal consulting in all sorts of different settings, from office type buildings through the private hospitals to their own rooms. But if you're doing anything that's surgical, you must be doing that in AC QC registered site. Um If you're not sure, then you need to check the rules. Basically. Um, you don't want to be in a situation where you're found to be um operating or doing a procedure in the incorrect environment. So the big question how, um so all of those other questions are fairly small and I'm breaking how up into multiple slides. Um And so let's crack on. So, first of all, um, regulatory, well, you need to be on the GMC register. We've discussed that we've discussed the sort of standard, you know, things that you must, so you must be a registered doctor. Um, you probably are going to need to be on the specialist register as well. And the reason I say probably is because that's not the law, but nearly every, in fact, probably every large private hospital would expect you to be on the specialist register. Um When you start work at a private hospital, you are given what they call practicing privileges and that tends to be run through and controlled by their medical advisory committee. Um The rules on I think probably most private hospitals are that the clinician would need to be on, the surgeon would need to be on the specialist register. Um Clearly to stay on the specialist register and to stay on the correct side of the GMC, you have to do appraisal revalidation and follow all the duties of a doctor that's a given for the NHS and it's a given for the private sector as well. Um There are some doctors that will practice in clinics that don't require specialist registration and again, that's absolutely fine, but you need to make sure that you're on the right side of the law and the regulations and don't just presume that the clinic will know because it may well be you that gets in the bother if you're not. So we've heard about indemnity. Indemnity is a given, you must have it. You will not get practicing privilege without it. And every year, the private hospital will ask you for your renewed certificate. They keep a fairly significant file on people. And one of the things that goes in the file is the indemnity certificate, as has been said before. Earlier in this talk, there are medical defense organizations like the mps, MDU mdd us and then there's an insurance backed product. Um, I have always stayed with an MD O and in fact, I'm with the mps, but sometimes it would be reasonable to consider insurance back. I think it comes down to your need for cover your level of risk and the cost, um, it depends on your specialty as well. So some of the high risk specialties may be better covered by insurance fact, um simply from a cost point of view and certainly my wife had a situation where she was quoted a insurance premium that was 2000 lbs more than she was making in the whole year by an MD O. And that clearly isn't something that something that you can take up. So she ended up going down an insurance back route and has been happy with them so far. But of course, you've got to consider the run off and the cost of that. Um, you need to be a data controller. Um It costs 35 lbs with the information commissioner's office. Um It's not a big deal to get, but you will be expected to be registered with the IC to be a data controller. Um Just be a bit careful when you're registering because there is an option to pay. I think it's 500 lbs now and that's for people that are controlling a lot more data and the companies are a lot bigger. So I think it's 40 lbs at the moment. That's every year you can do it with direct debit. Once you've signed up and again, the most private hospitals will ask you for your certificate each year. Um, the DBS, we're all used to, uh, DBS checks. Um, if you're not already, I thoroughly recommend the next time you have a check. Um, sign up for the update service. Er, which means you don't need to do a check each time. Um If you look at the hospitals as I'm in there, each one of those needs a, a DBS update every three years. It starts to get very expensive and very tedious if you're not on the update service. So next time you get a, have to have a DBS check, I think you have a month or so afterwards, just check what the timing is to sign up for the, for the updated service and then you can just send them your details and the employer can check directly. One thing you might not have considered um up to now, particularly if you've just been in the NHS is tax. Um So you need to make sure that you calculate and pay the correct amount of tax, um, which is quite difficult sometimes. Um So most people would, would use an accountant to help with that, but don't forget about tax V at. Um, so private medical care um, does not attract V at. So you don't need to worry about that unless you go into cosmetic um surgery or cosmetic um um non surgical aesthetic work, um and medicolegal work. So the medical legal definitely attracts v at, you have to be v at registered if you make more than high eighties, low nineties 1000 lbs a year, again, check and make sure, you know, you're currently registered if you need to be. Um, the cosmetic industry is a bit more vague. Um If it's non surgical aesthetics, then that does attract the at um some surgeries might, some surgeries might not. And that's something to discuss with the vat advisor, but just don't get caught on the wrong side of that. Cos again, um you know, that could have you in quite a lot of trouble. I put C QC in brackets cos I've already spoken about it. But um and really you only need to be registered with E QC if you're setting your own clinic up. Um But just make sure that um you're absolutely happy that the place you're working is C QC registered. You don't need to be too worried about. Um You don't need to be too worried about the bigger hospitals but smaller ones and clinics you should definitely check. So there's just a question here. Would you mind explaining a bit more about data controller aspect? Um So basically the Information Commissioner's office has some rules and if you're in the NHS, then there'll be a data controller and all the data stuff, the Caldicott Guardian, and that's all just done for you. Um, when you move out and you become your own separate organization, as in you are the organization, you have to sign up to be a data controller and literally all it is, you go on the information commissioner to the IC O information commissioner office website and there'll be an option to sign up. You basically pay some money. You get a certificate and that's it. You will of course be doing mandatory training when it comes to data protection through the NHS. And if you find yourself fully private, you'd be expected to do that. Um You'd be expected to organize that yourself. Um But it's all part of the appraisal and revalidation that. But yeah, data controller is IC O office and sign up for it. Um I hope that's helpful that I've not got much more to say on that really. Uh It's just something that people maybe don't realize they have to do. Ok. So NHS duties, um so this can be a little prickly sometimes. Um It isn't normally and the reason it isn't normally is because in the 2003 consultant contract, the right to undertake private practice is an essential part of the flexibility and freedom built into it. So you do have a right to do private practice. Um There's quite a lot of responsibilities that go with that right. Um As you'd expect and, you know, that's entirely reasonable and um and should be the case. Um The most important responsibility I think is to make sure that your hospital are happy with it. Um So you should discuss it with your clinical director. You should potentially discuss it with the nonmedical management. Although clinical director is probably the first port of call, um it should be shown on your job plan or at least discussed and agreed when you would have time to do it. I have heard of some people that are told, you know, there's no time for your private practice and the job plan doesn't allow it. I think if you refer to the top paragraph there, you'll find that that wouldn't be reasonable from the hospital's point of view. And so that job plan should be rediscussed and this is where it's very handy and important to be a member of someone like the BMA who can come along and fight the issues on your part. Well, I'm going to take questions at the end now, I think because it's putting me off a little bit, please keep putting them on, but I'll answer them all at the end. And so, um, extra pa now part of the contract is that, um, if you want to do private practice, um, you have to offer the NHS an 11th PA. So, um, that's how people think it is. Uh, the actual rule is that if you want to do private practice and the NHS, er, tells you, they want you to do an extra pa a, you don't have to do that pa but in the year that you refuse it, they can refuse your pay progression. So you, it's, it's subtly different but quite important. So you can't be forced to do more than 10 pa s in the NHS on the 2003 contract, which is what people will be on. Um But they can mess around with your job, sorry, with your pay progression. If you refuse that extra pa um hospitals are different. Um uh Most hospitals will ask you to do that extra pa A because it's um very beneficial for them. Not all do. Um, and I think it's a case of negotiation, er, the hospital is within their rights to refuse pay progression that year, but they're also well within their rights to allow you to have pay progression. So it really depends on the, the management of the hospital as to what's gonna happen there again, if you're not sure it's something to discuss with the BMA who um, er, negotiated the contract and therefore, er, no, inside I, and certainly a lot better than me um, to move on to the final one in gold. Don't do private practice on NHS time. Um It, it's quite obvious but it can be quite difficult and it's, I think something that a lot of people can fall foul of, usually if you fall foul of it. And it's just a one off if you speak to your clinical director or nonmedical manager, um that can be ok. So for instance, you may have swapped an on call. Um You may be doing a post tape round the next day and you swap that round with someone else worth just letting the management know. Um I've always found that if you do that, people are normally quite flexible with you, particularly if you're flexible with them and other things such as covering on calls that need to be covered or swapping clinics for lists or what it may be, just be reasonable, I think is the key for this. But if you do private practice regularly in NHS time, that can be a real problem. So don't do that whatever you do. So what legal entity should you be to do private practice? So I think these are the four options. Um I pay as you earn at the bottom in brackets. Um I think that would be very uncommon, exceptionally uncommon. Um And that might possibly come about if you were doing some contracted work for a private hospital or organization, but most people would find that to be terribly tax inefficient and therefore wouldn't want to do that. Um The top is probably the most common. So you set a limited company up. The pros of that is that you have a lot of potential benefits with tax and everything is in one place. The company is not, you, you are not the company, you would be the director of the company and it's limited liability. So you're not going to lose your house if there's a terrible problem. Um, there are some coms, it's quite, there's some legal things that you have to do. You have to do a confirmation statement each year. You have to have a profit and loss account put in each year to companies house. You have to be quite careful with that and really what that means to me anyway. But I think to most people is you need a good accountant that will help you with those documents, sole traders somewhere between pa ye and limited. Um I started off as a sole trader for a few months and, and didn't like it. So I started a limited company um and then an LLP so limited liability partnership, you may well be offered to join an LLP when you become a consultant or if you're a non consultant, career grade and that's a different legal entity and has different benefits. But I think the important thing about this slide is just consider and understand that you really should get advice and see what legal entity you want to be before you start. Um because there's very significant tax implications if you get the wrong one. So support, I think, you know, your job is to be a doctor surgeon. Um your job is to work hard at that. Job because you are the best at that job. Your job is not to be someone that organizes appointments, sends out bills, liaises with the hospital at length about minutia. I that is not anything to do with the actual doing of the surgery or the diagnosing of the patient. Um I think this is my biggest text in the, in the whole presentation and it's certainly the most important in my mind. You have to have a good secretary that can be tricky. I was exceptionally lucky that one of my two NHS secretaries and both part time was interested in being my private secretary. She worked with another consultant who was actually an ophthalmologist who retired after about two years of me having started, which meant that she became my secretary and she's really, really good. You have to define what the secretary roles and responsibilities are. Um They can be anything from just typing. Although with a I, you may well actually consider just getting an ambient listening A I that types you letters for you, which is what my wife does and then the secretary just checks them. But I think really the way I think of my secretary is more of a personal assistant in private practice. Um So she's the first point of contact for patients for the hospital. I do quite a lot of medical legal. So for solicitors and solicitors firms, um she's, she's very good at doing that. Um And, and keeps all my patients happy. She also keeps me on the straight and narrow. So I'll get a message, um, the night before every private session that tells me where to go. How many patients there are, um, emails about any issues. And she really is very, very important for my practice. And the reason she's important is because she takes all those stressors off me and allows me to concentrate on treating patients, which is what I'm trained for and what I'm best at um pay structures for secretaries. It's going to depend on what you're asking them to do. So if you're asking them just to type some letters, some secretaries will charge you X pounds per letter. Um If you're asking them to be more of a personal assistance, then you may consider a percentage deal. So you pay them X percent of all of your income. Um I do that. I'm not going to tell you what percentage I pay. And I think you have to consider that carefully. It depends on many things, but not least how much you think you're going to earn and how much benefit you get from the secretary. But if you've got a good secretary treat them really, really well and you know, don't underpay them, that's a very, very big error. Um because you want them to be helping you as much as possible. If you pay them on a percentage, then all the extra work that they bring in for you, they get directly paid for. So it is quite, quite a good way of doing it. I think, um, consider things like employment rights, whether you need to pay a pension for them. If they were to come round and work in your premises. What about the health and safety at work? There's a few things there that you may not really consider and just consider their tax as well. So it depends how you employ them, but you need to be careful that you may need to pay some tax for them or if not, you at least need to make sure that they understand that you need them to pay the correct amount of tax and do what they do. You don't need to check it, but you need to be very clear that that's what they should be doing again. It's about keeping squeaky clean. You can't, you can't be seen to be in any way dodgy. It's just not acceptable. Um, so I've gone on for a little bit about the secretary because I think they're the most important, um, support. Um, and I'm talking professional support here. Um, not family or what not. Um, I think you need a good accountant. Um, they need to be an accountant that's happy in medical matters. So usually most people get advice on what accountant to use from colleagues. I've actually, in the last 10 years had three accountants and what I've found is they often start off really good but sometimes go off the boil and it's actually a really big deal. Changing accountants because you have to train them in your practice all over again. So, changing accountants is a really big deal. But having a good accountant is just so important. Um, you need to consider what your business is. So, if it's straightforward, um, private medical practice, that's fairly easy. If it's private medical practice and, um, me legal that might attract fat, that's going to be more expensive. That's going to be a bit less easy. If you're buying a premises or having a clinic or something like that, then it's again harder still and you need to be tailoring your accountant to what you're actually doing. Um, don't be afraid to move but, you know, try not to cos it is a real pain. Um, I put legal in brackets. Um, so you may potentially need a solicitor for some contracts, but you probably won't, the MPS MDU or insurance guys will deal with any legal problems from your practice. So, really the legal side of it is more, if you were doing something a little bit odd, like buying a clinic or setting up a very big contract with someone just for some advice. Um, so how do you find a place? Well, sorry, um, find a place to practice and, and sign up to that. So, um, you'll probably go to the local private hospital and talk to the executive director there. Um, and you'll be thinking about geography probably as your first, um, as your first concern, you certainly don't want to be driving, you know, an hour and a half, two hours a day. Uh, if you can help it. Um, and, um, you know, that was my primary reason in the NHS, for moving hospitals and certainly in the private side, you, you, you don't want to do that if you can help it. Um The problem is that all private hospitals, er, do have a certain capacity, they only have a certain number of referrals, they only have a certain number of clinic space and theater space. Um What's the competition like in the area? So if you're in London, that's very, very different or if you're in Cheshire where I am. Um So you need to consider that, do they need another whatever surgeon, foot and ankle surgeon, hip surgeon, knee surgeon? Um And really these are the things that you're going to be asking the executive director of the hospital. Um So whenever you're ready to set up, I would say you consider where do you want to work? Most likely based on geography, perhaps based on direct recommendation by a colleague? Um and then go and speak to them, don't be offended if they say no, it's almost certainly due to lack of capacity. Hospitals want to have as many clinicians as they can because that means that they can see more people make more money and, and generally be better business. So when I looked to join the Nuffield in Chester, there was a, um, the first time I went, they said that no, we've not got any space, but we are building some new theaters. Ask us again in a year. And I asked them again in a year and they said, oh, yes, yes, please come in because they had plenty of theater space. They had the clinic space as well and they needed to fill it. Um So, um, if you, if you get a no, it won't be a no forever. Um And then just keep an eye on, you know, if there's anyone retiring, there's going to be less competition, they're going to need more people in, um, consider the terms and conditions carefully. They're fairly standard over the big players, but certainly smaller clinics and whatnot. You're definitely going to need to read them very carefully, but don't sign up to a contract if you're not happy about it. Um, speak to a colleague, take legal advice, do what you need to do but be happy. So then let's come to referrals. Um You know, where do referrals come from? Where are the patients from in the NHS? You go to clinic, there's loads and loads of patients and then you go to the theater and you've listed loads of patients and they're never ending. There's enormous weights, not like that in the private medical sector, it can be, but you have to understand things a bit better. So the first is private medical insurers. Um So you need to be signed up with the private medical insurance and I'll come to that in a slide or two. The second is um referrals from the hospital or clinic you're in. So every hospital will advertise in various different ways. Many hospitals will go out and speak to GPS, physios and relevant people in the community. And then those people will either patients directly refer themselves to the hospital or get referrals from the GP. If they're not a named referral, then they will be dished out to clinicians in, in some form of fashion. I would say that I still don't quite understand how that's done. Um But I am told by all of the hospitals that it's done fairly and it feels fair. Um but I don't quite know how they do it. So sometimes you'll see a big spike in your self pay referrals. Um And then you, you think you're amazing, but then you realize your colleagues off on holiday so he or she can't see them. Um So that's one way of getting them. If it's a named referral, then it will come directly to you as in. Um If someone says I want to see Mr Me at the Nuffield Hospital and they tell the Nuffield that um they'll er put them into one of my clinics. Um So you need to try and get your own referrals and you need to try and build your brand a bit. Um So the other way of getting them is direct referrals. Uh So my secretary will get phone calls saying I'd like to see him. Where can I see him? When can I see him? So, again, another good reason to have a good secretary, um, and then website, I've just put that down and I'll go over that in a little bit. So private medical insurers, um These are the big players, um health code at the top. There is a system which pulls some of the bigger ones together in terms of signing up for them and also billing for them. Um There's a, I think there's a free version and a paid version and you pay also per bill that you send a certain number of pennies per bill. But um, have a look at healthcare that's, that's very important. Um These are the big ones here. So Axa and Bupa, they're the first two on the, on the um slide and they're the biggest. You need to be a member of Axa and Bupa if you want to have AAA reasonable private practice, Cigna, the next one along is fairly much pulled out of the UK market about a year ago, but we do still see some Cigna International patients. Helix is quite smaller. Vitality is big and WPA is reasonably big. Aviva's big and the aet is reasonably small. Um, there's a plethora of other players, but these are the ones I think you should sign up to Axa Bupa vitality, WPA and Aviva. Um, and if you sign up to them, usually the people that come from the smaller insurers, um, you just sign up as you go along, but you actually actively need to go out, sign up with these ones when you start or just before you start in private practice, actually seeing people or you're not going to have a lot of patients and I should say they directly send you patients. Ok. So branding, I mean, we're not great at this in the UK. Um We don't like to talk about ourselves too positively. That's just a British thing. But you do need to brand yourself and you need to be positive about yourself. Um So many of us have a logo that's mine up there with the foot and the name. Um You don't have to have a logo but it's quite handy. So I have that on business cards. It's on my website, it's on my um letters uh which I send to patients as well as GPS. Um Some people will, I have a AAA good friend colleague who's got his logo printed on pens, mugs, laptop covers, anything you can think of mouse mats and he dishes them out to various people around the hospital. So I was very pleased to get one of his pens and be able to take a comedy photo with it to send him. But, you know, a logo is good thing. You can just go online and there's lots and lots of companies that will sort a logo out for you. Quite an interesting process working with someone that you probably won't normally work with a sort of a graphic artist, graphic designer and it's a few 100 lbs to have one created um photographs. Um, so that's the photo that's on most of my private stuff. I'm, I'm afraid it's from about 10 years ago when I was younger and slimmer and less gray. But, you know, it looks professional. I'm pretty happy with it and at some point I'll have to change it, but my wife has told me that I'm not to do that at the moment. So I'm sticking with that and that's on nearly all of my professional websites or anywhere that needs a photograph basically. Um, consider what's out there about you already and consider questionable social media posts. Um, I have a, another friend, uh, who's come into private practice in the last couple of years. Um, and he has some very questionable Facebook photographs probably from, I don't know, 15 years ago. Um, and he's left them up and I would be quite concerned if I was him, um, with, um, some nudity, some drinking and some stuff that you really wouldn't want to see, um, against your name as a professional, you know, you want people to see the professional side of you rather than the other side. So you may go so far as if there's a lot of stuff that isn't quite right. You may go so far as to actually cancel and resign up for accounts. Um, it depends how bad the photographs are really. Um, but just consider that because, you know, it's not uncommon that if something, if something goes wrong and you end up in the media, you'll see some questionable photographs going up around the place and that could be quite embarrassing for you. So consider what your brand is. Um And go for it, website II think you have to have a website really. Um, not all do, um, most of the younger consultants do, some of the older consultants don't, but I think it's, for me, it would be silly not to um consider what the address is going to be. That's my address there. So david.com, um some people prefer um, something that pertains to their specialty. So for a while I also had um UK Foot and Ankle surgeon.com, I think, and a few others, but I decided I'd just go with my name. Keep it easy. Um But you know, decide what you think, decide, you know, do you want.com dot co.uk dot this dot that and they all say something slightly different about you um on the website. Um Well, it needs to be clear informative and professional. It's your shop window. So you don't want any, you don't want anything dodgy on there. You don't want anything that's contentious. Er, II think you need to have contact details, details about you. So a lot of patients will look at your website beforehand and see, you know what you're about. What, what, what are your interests? Um, what's your professional, um, life about? Um, you have to have a contact section otherwise it's not worth having. And I think it's very useful to have when your clinics are. Um, more recently, I've done some brief videos. So the top right one, they're hosted on youtube and essentially there's one about me and then there's one about most of the conditions I deal with and, you know, that can be useful in both um pulling people into your website and, you know, your practice. But also you can say to patients, you know, all of those things that I've told you are also on the website. So go and watch the video and, you know, it's all there come back and, you know, speak to me if you would like to go ahead. Um II think it's good to get a website designer if you're happy to do it yourself. Fine, but just bear in mind, you know, unless that's your actual thing, someone will probably be able to do it better than you. Um I use a doctor who's a GP called Mark Baxter and he does various medical websites. And if I need something doing, I just let him know which is very, is very useful. So I can spend my time again dealing with patients doing what I do. So that's websites. You, you probably best to look around and see some of your colleagues websites, see what they've got on. Um And everyone's different, you'll find something that you like and um you know, go down that, but again, you can see the logo and all of these. It's just a really easy thing if you've got a logo and you can brand everything quite nicely, social media. Um There's nothing wrong with social media as long as you use it correctly. Um So my first comment is be cautious. Um There are people um usually more junior doctors cos I think by the time you're getting to be near consultant, you've, you've been able to um pick up on what you should and shouldn't do and, and see people make mistakes and think, oh, I'm not gonna do that. Um But you have to be careful, you know, you don't want patients identifiable data on. Um There are some caveats to that, certainly some of the cosmetic um practices um will put patients on, but with their consent, you need to have written consent. I mean, you know, all about this, just be careful. Um I don't use it at all um for my practice because I'm worried that I might make a mistake and put something on that shouldn't be there. Um Put an X ray on that then gets identified or something like that. Um But, you know, it's up to you, you're all professionals just be cautious with it. Um I'd also try to avoid if you can becoming a, um, a social media ranter. Um And I think you'll all know what I mean. You'll see some people on that are, they're always making like, really significant statements now that might draw people's attention to you in a good way, but equally it might draw attention to you in a bad way. So, be cautious rating sites. Now, um, these are the sort of three main ones that you'll see. Um, so Google, I guess is probably, well, is the biggest but you can't be on Google unless you have an address. So most doctors aren't on Google as a rating site. Um, although one or two will give an address and, you know, do it from there. Um, the two common ones are doctor five, which I think is probably the most common. That's the one I'm on top writers, my or some of my doctor five dashboard. So it gives you a, a number. Um, you know, and it's a bit like, um, everything, you, you know, if you're anything less than about 4.7 you're pretty bad. Um, there's lots of people on fives. Um, the more reviews you get, the better, the more links you get with colleagues, the better, the more recommendations from colleagues you get the better. Um But you know, my 4.97 I think it's 0.97 because two people gave me a four which I don't think is actually a bad thing. It makes it look a bit more realistic, I think than having fives across the board. But um yeah, so consider just consider rating sites. I think top doctors you have to be invited to. Um I, I've been invited a few times but, you know, they all cost money and, and actually I think you really just need to be on one of them. Um And, and the way you get invited to top doctors, I think is they ask, they ask your colleagues to recommend you. So it's, you know, it's not quite as top as it might seem perhaps um bottom right's interesting. So I want great care. Um I searched myself um before the talk and um and I've got no reviews on that, which isn't a bad thing but note I am on there. I'm not signed up for it. Every doctor in the country is on there. Um Search yourself and just check no one's put anything on about you. Um because there might be some really good stuff, there might be some bad stuff but people can put stuff on there without you knowing. Um It's a bit like doing a Google search for yourself. Every now and again, just to check there's nothing um untoward, so just something to consider. Um OK, so other marketing, well, you'll see the top left BPA Finder. So once you're a member of BUPA, er or one of their doctors, I should say, um they will give you a, a page like this. Uh they'll ask you for, you know, stuff to put on it. You can go and have a look at the BPA Finder, search someone new a consultant that, you know, is um doing private and you'll see what's on there. Um You provide the content and that content I would say and mine is basically, it's pretty much copy and paste from the website. Although there are some things that you'll put on differently, you'll also say what you do. So a patient can type in bunions and Cheshire and I should pop up fairly near the top. Um If they type in hip replacement in Cheshire, then I shouldn't be there at all. Um And it can work, it works pretty well, but sometimes it doesn't quite work as well as it should. Top right is what I get from Spire Healthcare. I think that's the only professional photograph that's different. Um And, and then bottom right is what I get from Nel. Um But basically you need a bit of a bio of yourself that you give to all these webmasters that will stick it on and get your name out there. Um, excuse me, you could consider advertising in other ways, most people don't. So if you go abroad and Dubai is a good example, you'll see photographs of doctors on billboards and lampposts and all sorts with their clinics and whatnot. We're not, we don't really do that very much in the UK. You will see one or two doing that something to consider. Um, but I think pretty much now most advertising would be done online through social media and that would be what I would expect really. The cost of advertising, for instance, on the back of a bus is very expensive. Um, maybe 5000 lbs or so. Um for a year. And is it worth it? I don't know, something to consider anyway, if you want your face on the back of a bus. Um Right now how do you set what fees to charge? Um So in gold again, because it's important CMA competition and markets authority, you can get yourself in a lot of trouble if you don't know about these guys. So it's illegal to conclude on fees. So you can't go along to your other foot and ankle surgeon colleague or whatever and say, how much do you charge or charge a right. I'm gonna charge the same as you that is illegal. Um I had to deal with some doctors when I was um, associate medical director that had done that. Um It, it wasn't even that blatant, I don't think they thought they'd broken the rules. But my rule of thumb is don't talk to any other doctor about how much you charge. Um, when it comes to the private medical insured patients, they'll tell you what you charge. So for example, Bupa, a new patient at 100 and 50 lbs, um, a, an Aviva new patient I think is 204 lbs. Um, the only thing I'll say about what you should charge for self pay is, um, most people charge a little bit more than the um, private medically insured patients because there's a little bit more to do with those self pay patients and it costs a bit more, but it's entirely up to you. What you charge if you want to charge someone 10,000 lbs for a first appointment, you can, you won't get it and you won't get any patients. But if you want to, you can, um, if you want to charge someone 5 lbs again, that's fine. Um, but it's up to you to set your fees, the same applies for surgery. So when it comes to private medically insured, there will be a code, uh, for example, um W 03 30 is a first MTP Fusion and you'll put that into the op CS code section on that private medical um insurer. So, Bupa for instance, um, and that'll tell you what you can charge what the anesthetist can charge and then the hospital charges separately with the self pay patients, the hospital charges um um for you and you tell the hospital what to charge for you. Um So in the spire, um there's a an engine, a fee engine that does it. So you put what you want to charge into the fee engine and it pops it up. Um in other hospitals, you might tell them each time, but that's up to you to charge the hospital when or shouldn't tell you what to charge. But don't, don't collude. It's so, so important that those doctors that we had to deal with had to go to the JMC for a slap on the wrist. It wasn't the end of the world but it, you know, and it can actually end up with, I think it's a fine of four percent of your annual turnover. So stay away from that problem. Um There's a legal responsibility from the CMA for us to lay out charges. Most hospitals have a letter um that they will populate for you, but you need to know about that includes follow up charges and um charges for operations or tests and things. So just know that that letter should go out and the hospitals tend to help you with it. So I'm coming towards the end um of the presentation, uh just a few more slides left. Um This slide I think is quite important. So um scope of practice II would say to you that unless you're a plastic surgeon, your scope of practice should be exactly the same in the private sector as it is in the NHS. That way nobody's gonna accuse you of doing something you shouldn't do. You won't be stepping outside your area of expertise and it's all very safe. So, as a foot and ankle surgeon, II mean, I do trauma in various other bits of the body as you'd expect. Um, but as a foot and ankle surgeon in the private sector, I will only do foot and ankle. Um, I'll do tibial stuff because I do that in the, in the NHS as well. Um And occasionally if someone comes and they have a knee problem, I'll organize some tests and refer to a colleague, but I wouldn't do even an injection into the knee. Um There are still some, the, the older fashioned way of doing it is you just do anything that comes, I mean, I can do a carpal tunnel. It's not difficult. But if you go through a nerve or if you cause a problem and you get sued, you're gonna be on the other end of a barrister saying how many carpal tunnels do you do in the NHS every year? And your answer is gonna be none. When did you last do one in the NHS when I was a registrar? Um And, and that's not, that's really not a good idea. Um So my strong advice would be keep your scope of practice the same. NHS. And private, the reason I say that plastic surgeons are different is because, um, almost exclusively, um, they do not do or you're not allowed to do aesthetic surgery in the private sector. Sorry, in the NHS. So if they did only what they did in the NHS, no one would do aesthetic surgery. Um, I guess the same would therefore apply perhaps to breast surgeons, max Frax and ophthalmology because they do some aesthetic work as well. But certainly if we're talking general surgery or, or orthopedics, and I understand that most of us are general surgeons and orthopods on this talk. Just keep it the same as the NHS um family. Um, so family um can be, well, family takes a lot of time up. Family is also um your supporter and will keep you happy when things aren't going so well elsewhere, family is really important. Don't get carried away and, um, let family down. Um, having said that, um, you may need to put some things into process to help with family life. Um, so my wife and I are both surgeons. We have a full time living in nanny because we couldn't do private practice. Um, if we didn't and we'd actually struggled fairly significantly to do NHS practice as well. So that's just an example of where you need to make some alterations to your life. But, you know, don't let your family down by doing too much work, holidays, spare time and cover w when you're doing private practice or when you're in private practice, you always really have to be somewhat on call. So some people will say no, I'm going away. I don't want to hear anything at all about the private side or the NHS. And in that case, you have to have someone cover you to that level. Um What I tend to do is um, I'm happy to hear from my secretary. All my private patients have her details. And so it's not uncommon that at five in the morning in the US, I'll be talking to a patient about one of their concerns. Um It tends to be POSTOP concerns and they only have that seem to happen when you go away sod's law being what it is. Um You also need to have some formal cover when you're away in case there's a significant POSTOP concern and it actually needs to be seen and treated that normally works out very easily because your colleagues need cover as well. So you just cross cover each other work harmony, um jealousy. Um You, you have to be cautious here. So um there is a risk of you becoming jealous that someone does loads of private practice or them becoming jealous that you've come in and you're taking or they perceive you taking their practice. Um I think really the way I look at this is um you want to try to build the size of the pie rather than um see it as someone is taking a slice of your pie if that makes sense. Um You've got to be careful though and you've got to understand some of these complex interpersonal issues, try to avoid it because the last thing you want is a really horrible work environment in the NHS hospital because you've irritated someone from the private side equally. Don't get pushed around because somebody doesn't want you doing private. That's not fair either. It has to be reasonable both ways. Um, consider the employment responsibilities to your staff. I touched on that on the secretary side. Um, if you have other staff that help you as well, you need to consider that and, you know, really, you're paying quite a lot of people to help you do what you do, which I think is quite cool. You're generating wealth for people, but it's also a little bit stressful at times and you need to just consider that before you make the decision to do something, employ somebody et cetera and then patient groups. Um, so what I mean by patient groups is patient types. Really? Um, I think when I started, I thought the private patient, the self pay would be quite scary. They'd want to know absolutely everything. They'd be much, much worse than the NHS patients and, you know, they'd be really difficult. Um, my experience and that of people I talk to is actually the exact opposite um, the people who can be the most difficult are the NHS, patients who are being seen on the private sector in the private sector and you need to just work out how to deal with those. Essentially. It's just the same as you do in the NHS. But when it comes to self pay patients, there's money involved as well, which makes it a little bit more difficult. Um, I, I've limited this talk to private patients as in people that are paying for themselves and people who are insured, there's a sort of in brackets group of NHS patients that you're seeing in the private hospital. Um, they're not really private patients. Um, and, um, and you've got to think of them slightly differently. I don't see any now. I used to at my first hospital, but they're quite difficult sometimes and there's quite a lot of the difficulty is not the patient, but the way the NHS expects the contract to be fulfilled and you'll get quite a lot of pressure to do to get things you pushed through and sometimes you'll struggle to get your self paid private patients through because the hospital's putting those NH ones on instead. So that's a bit tricky, but I'll just leave it at that from the patient group point of view. So, coming to my conclusions, um, it's really hard but rewarding work. It takes quite a lot of time and significant effort to set up your practice properly. And to build your work up. Um, one of the best bits of advice I had is that you need to be, um, well, it's a three A, I can't remember the third one, but available and affable are two of them. Someone will probably tell me the third. Um, but essentially you, you need to be available. In other words, if you only have one patient on your clinic, you still have to go in for that. You can't just say, oh, it's only one patient. I can't be bothered that that's not gonna fly and you're not gonna get your reputation building. You're able. Thank you. Perfect. Um, you're not gonna build your reputation, you're gonna build your reputation as someone that can't be bothered and you do not want that, um, carefully think how you set it up. I've gone through all of my thoughts on it. Um, I think if you asked 10 private practicing, er, surgeons they'd have, er, 10 different views. Um, but this has worked well for me so far. Um, II think it, it is a case of work life balance rather than life, work balance. Um, and you have to be ready for the fact that you'll be doing a lot of work. Um, you'll be doing a lot more work than you would if you just do NHS stuff. But it's good work and it's useful for you. I think it's really good private practice for the right person. Um, and terribly, terribly stressful for the wrong person. So, don't be pushed into it. It's a bit like when you get to medicine in the first place, you know, if you, if you think you're gonna enjoy medicine and you, you're keen on it and what not, you'll be fine if someone's pushing you into it or you feel it's what you should do. You know, all orthopods have to do private practice. So I better do it. Otherwise that would be the odd one out. Don't do it. It's just not worth it. You're gonna stress yourself out. And I, I've certainly seen two or three of my colleagues get extremely stressed to the point of almost um you know, having to take, well, in fact, one case, taking time off all work, give up private practice and then the stress just goes. So if you're not the right person don't do it, but if you are go for it, um it's been good for me. I really enjoy it. Um And it's, you know, it's a good challenge. So second to last slide, I'm gonna leave this up for a while. I'm gonna leave this up while the questions come through if you have any. Um I can see one already, but this is a QR code that will take you to the BMA setting up in private practice. Um um sub website. Um Most of what I've talked about has been referenced from that and from my personal experience, um, just take a photograph of that and go and have a look. Um, and um, you know, there's further reading elsewhere but you know, that that really is Tip top and it's nice and up to date, um, it's June 24 that it's been updated. Um I do have one more slide but I'll take questions first. Um Yeah, thank you so much, er, Mr Mason for an incredible overview. Um I think you've covered absolutely everything in the, in, in kind of uh about an hour, which is incredible. We've got some questions here. Um And if you've got questions, please, please keep them coming and, and we'll uh we'll pop them in here. We've probably got about 5 to 10 minutes for, for questions. Um uh One question is from Jason George. Um and, and he's asking, would you mind explaining a bit more about the data controller aspect? It's not a term that I'm familiar with. So II covered that at the beginning. Um As I said at the beginning, I think it really is a case of going onto the ICA website, um having a little read through of what they say it, it's, it's a sort of, it's sort of just a mandatory thing that you have to do and you have to pay for. Um, so I see a website and um, and just get that sorted. Um Another question is I've heard um some hospitals require a reference from a consultant who's currently working at that hospital. What do you do? If none of your colleagues and I'm guessing NHS colleagues are active in private practice and working at the hospital, you're interested. Um I would go along to the, to the hospital, I'd ask to have an interview with their executive director, um speak with them about it. Um I mean, I'm sure I'm sure that's right. I've not had to have that myself. They normally ask for two references from colleagues that you're working with at the moment. And so, you know, just to say that, so normally it's like your clinical lead, clinical director and another colleague, much like any job really. Um I II think it would be tricky for them to say that you, you know, they wouldn't consider you if you didn't know anyone in the hospital that would be would, would not really seem very fair, would it? Um And Harry Benjamin L has said great talk. Do you contact the private hospitals first or register with the private insurers? Are they independent or linked? Hello, Harry. Um So I the f so yeah, everything that I've covered that does not have to be done in sequence. It should be done sort of together. Um What I'd be doing is I'd be contacting the private hospital first. Um but only just first, you know, don't, don't go down the whole route of getting um privileges and then contact all of the PMIS and then do the website, try and do as much as you can together. But the bottom line is, the private medical insurers are going to need to know where you're practicing from. So if you contact the hospital and they say, look sorry, there's definitely no space here, you're gonna need to contact someone else. So I'd go with the private hospital first. Um, they're not linked. Um, bupa used to um, own quite a lot of hospitals but, um, I think the competitions and Markets Authority, er, said they couldn't do that so they're not linked anymore. Um, uh Basil has asked our l of consultants who are not on the specialist register are allowed to do private work and you did touch on that a little bit. Right. Yeah. And there was another question earlier about, um, non consultant, career grades. Um, so I touched on it in a slide earlier and so legally. Yes. Um, but I think most private hospitals, the big ones aren't gonna let you in because they're looking for someone that's gonna be working with them. Um, for, you know, a long time basically. And if you're a local consultant, you're likely um only to be working for a little while in that same place before you go on to your actual consultancy and then when it comes to non consultant, career grades. Yes, you can do private practice. I think it probably is similar though. I think they probably want consultants in general, but there's always exceptions and I would certainly ask, um, really interesting question, um, from Eliana, er, Gille, which is private practice is a crux for uncomfortable atmosphere in a department. How could one mitigate this, please? Great talk. Thank you. Thank you. Um, do you know it's really different, depending on what department, what hospital you're in? Um, in the North West? My experience has been fairly relaxed. Um, I've never had anyone try to block me. I've never had unpleasant discussions with any colleagues. Um, but if you're in a more highly competitive and perhaps an environment like London where you actually need to be earning quite a lot of money to have certain things, you know, that might not cost as much housing, for instance, cheaper in the north. Yeah, I think it can be difficult. I think the bottom line is behaving like a normal human being and trying to be friendly. Um, you can address any issues straight on, but I think the harder things are when people don't actually say what they're upset about. And if you get a unit where there's a lot of backstabbing going on, that is that is really tricky and I don't have a lot of advice unfortunately, because it's not an easy thing to deal with and I'm pleased to say it's not something I've ever had to deal with. Jason's asking. What does fee assured mean in the context of insurers? I recall a consultant saying that you should become fee assured when you start writing in private practice. Yeah, free assured. Sounds great, but it's good for the insurers. What it means is that you won't charge any more than what the insurers cover. So, um, so prior to the concept of fee assured, um which was probably just a little bit before I started. Um, if the insurer said we'll pay 100 and 50 lbs renew, but you charge 200 lbs for renew, then the insurance would pay 100 and 50 the patient would pay 50 fee assured means I'm not allowed to charge the patient that extra 50 if you see what I mean. Um It's a way of keeping fees down, which is interesting. It's not something that people like particularly, but it's probably good for the patients because they don't have any surprises. But that's what it means. Basically, you have to sign up to their fee schedule and that includes that surgery as well as appointments. Question from Amar, how will the situation of the recent COVID pandemic affect the work of a private clinic? Talking about workload there perhaps? Well, gosh, I could do a whole hour on this alone. I won't. So COVID was interesting while it was happening in private health care cos essentially all the private hospitals said. Oh, right. Um What we'll do is we'll help the NHS and then they proceeded to do virtually nothing, which was really not great. Um So there was a massive drop off. Um And basically a few months of not doing any private, pretty much. Um And then now because COVID has led to such an enormous waiting list. Um The, there's an increase in numbers of people with insurance and self pay. So it sort of increased it and how it actually worked in private hospitals, you know, when we were doing the COVID precautions, it was just the same as in the NHS. So you'd wear the same PPE and do the same things. Some of them are quite like NHS. Hospitals, particularly in theaters. Usually a bit more streamlined though. And I think we're out of questions. Um, Mr Machin. Oh, we got one more from, uh, from Adrian, er, ra bit like Indiana Jones there right at the last moment. Um, are there any certain private hospitals where there is a joining fee as a new consultant expanding on this? What are the pros and cons of becoming an equity partner in that? Um, so, yes. No, not as far as I'm aware, none of the big ones. In fact, I'm almost sure none of the big ones. There are some smaller clinics and, and, you know, well, small hospital, big clinic or whatever that, that will get you to pay some money to be an equity partner. Pros and cons, um, you've gotta give them quite a lot of money pro as long as it does. Well, you will benefit as that business flourishes and your work, you'll get paid for your work and you'll also get paid for part of the hospitals work if that makes sense. Um So, yeah, I mean, I think that's a good question. If you've got a very specific incidence, then, well, if you're asked to put money into somewhere you need to consider what the investment is worth, whether it's worth you doing it. Um I'm just going to put the final slide up, which I was chatting with my good friend Dan Parry, who's a professor in Liverpool and Oxford. And he said, oh, you're always going on about private practice, just do research instead. And then he said, tell them all to contribute to my studies, please. So here's a photo of us when we were Sh Os and here's some of the studies. So please contribute to them and, and he'll be very pleased with me and you. Thank you. Thank you so much Mr Match and we have got uh literally 30 to 60 seconds left. Although um Cath is also still on the call with us from er medical er protection. So if anyone has any specific questions about medical protection, you're also very welcome to pop them in the chat and we will er pass this across to Cath as well. So please please do that if you have any questions, just lead me to say thank you so much. Um Mr Machin for joining us this evening. Amazing summary and you've tackled lots of really great questions as well. So we're really grateful. Thank you. My pleasure. Thank you very much. Um, what I'm gonna do is I'm gonna pop a feedback form, link into the chat as well. Um, there will be a link there. You'll also get uh, a link via email after the event and it will also allow you to claim an attendance certificate if it's important for your CPD. Um, and um, there will be some, er, questions on there, which we'd really appreciate you answering because it allows us to improve what we're doing. It takes 30 seconds, um, and it really helps us to keep getting better. So I'd really love it if you could click on that button and give us some feedback. Um, there'll be a, a button in the email that you receive afterwards. You'll also be able to claim an attendance certificate automatically if you need it for your CPD. Um ACI think you might have got off lightly here. So there aren't any questions in the chat at the moment, but I'm sure you're more than happy to take, er, questions um, remotely if, if folks have them. Um, so, II hope you have a really wonderful evening everyone and it has been a pleasure having you and we're really looking forward to seeing you at one of our next events. Thank you so much. Thank you. Thanks a lot. Thank you. Thanks Mr Mason. Thanks everyone. Have a nice day. Thanks. Bye.