March 2023 Issue 150
INDEPENDENT PRACTITIONER TODAY
CELEBRATING 15 YEARS 4 NEWS
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Practitioner This issue of Independent of Today marks our 150th issue unrivalled news and information brought to you since 2008 June 2008 Issue 1
A certificate worth having
The head of the Expert Witness Institute outlines its new certification scheme P18
Fight to cut indemnity costs
Dr Michael Devlin takes a stark look at the future for private doctors if the clinical negligence system is not reformed P26
INDEPENDENTR PRACTITIONE Today
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PROFITS UP OR DOWN?
In this issue
Are ads better than PR? We show the difference between the two and the strengths of both P12
NHS loss is your gain The NHS diet means more for private doctors, if they take advantage P32
Don’t trip up on law Ensure disability law does not trap you as an unwary employer P30
the private organisation when up. practice income has gone per ‘From the defence body’s warned getting the Private doctors are being spective, they are not disas in, and they could risk professional right amount of money defence perspective, ter if they fail to increase from the doctors’ match rising be invali body subscriptions to their indemnity may – so it’s a incomes. dated by underpayment consultant The alert came after serious issue for all concerned.’ to receive Resources surgeons were shocked Dr Panting, of TWG of the Plastic letters asking for thousands Ltd – which administers alleged subs Sur pounds to make good Reconstructive and Aesthetic years. launched shortfalls going back geons Indemnity Scheme more than of con One was asked for last year – said a number was him £30,000, while another sultants had contacted details asked for required to give financial recently after being a decade. underpay stretching back nearly money by the MDU for Dr Gerard Defence fees expert ment of their subscriptions. Pract Panting told Independent ‘When you receive correspond appears that people itioner Today: ‘The problem ence like that, the idea have not all those to be that consultants might be trawling back defence notified their medical
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Growing your business You should spend less time working in your practice and more time on it P34
How to use your PPU Our new ‘Insider’s Guide’ series begins its focus on private patient units P28
w rse
for private business bases and two private had, by its his home office base, of the claim practice purposes, it of work. this will curtail much duality of hospitals and NHS place for motor very nature, an inherent expressed a consultant makes home. Some accountants many conpurpose – to get back referred to expenses. At present, director the taxman surprise that the judge Stanbridge Associates home office Consultants must pay by either sultants regard their this is a pounds in a tax case not considered of their priMrs Sanders said: ‘While back thousands of to a test in as the starting point genera judge’s barrister. He went back blow, as many consultants expense claims following of Mallalieu vate practice journey. their home law shown in the case mileage test there is ate large incomes from ruling on a doctor’s where Lord ‘This case now stipulates agree that v Drummond (1983) office is offices, the judge did case. an even earno dispute that this home bases was Brightman referred to purposes of travel between business The long-awaited judgment, it being an a business base for the Specialists of indelier case – despite home, then definitely allowable. affecting the majority stricter tax. But because it is at rooms means the employment case with motive for who use many consulting pendent practitioners, there is a non-business claims a home rules. that home. will still have reasonable miles they drive between the purtravelling to and from of car or operHere it was ruled that allowed for for the business element office to consulting rooms was to keep This is specifically not allowable pose of buying clothes the legislacosts.’ ating theatres are not and a tax deduction under to review a person warm, comfortable She advised doctors and excluagainst tax. whether or tion of the “wholly reasonabledeliberadecent regardless of the Income business journeys for After over six months required to sively” test found in log. first-tier tax not they were also ness and maintain a mileage tion of evidence in a of clothing Taxes Act.’ miss wear a specified article Kevin Poole Dr n Next month: don’t tribunal, Judge Mr Consultant geriatrician purpose for work purposes. of Sutton, Independent Practitioner decided there was a dual the same Samad Samadian, at the home, so Judge Poole applied the HM today’s in-depth look in travelling to and from did not disSurrey, had argued with them be allowed. principle. While he for allowarules and how to apply the expense could not between Revenue and Customs pute the journey was between Specialist medical accountant ble expenses on journeys ‘Sadly, Vanessa Sanders explained:
by Robin Stride
to give the over year on year not risen. impression income had real dan But if it had, then the who had ger was that doctors subscrip failed to pay the right not make tion, and who could could find good the difference, benefit of themselves without the needed. medical defence when Rushmer, a Accountant Howard Easson and partner at Sandison doctors to Dr Gerard Panting: warned the doctors most likely underpaying Co, said those with a may be without cover if be caught out were who would general accountant frightening, that profes years is really quite not necessarily realise to up to in line with because it can amount sional indemnity rose pounds. tens of thousands of profits. Specialist accountants that these clients ‘There’s no indication would remind their doctor any money; individuals do owe of this fact. asked to any con they are simply being He said: ‘It is vital for with provide their accounts. sultant in private practice who was their pro ‘I know one individual rising profits to inform underpay This asked to make good an fessional indemnity provider. £10k and an adequate ment of just less than ensures they have In another at all times. that was for a year. level of cover in place for over a claim is case, a surgeon was asked ‘If insufficient and because they is a pos £30k for three years, made against them, there for the will be said he’d not paid enough sibility that their policy in.’ that income band he was invalidated. Potentially, needed You could be Dr Panting said doctors would be disastrous. to be fas in to to be aware of the need talking of claims running to the tidious about accounting seven figures.’ It was easy defence organisations. ➱ continued on page 2 to roll for them to allow things
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Doctors at risk by not paying defence subs By Robin Stride
February 2013 Issue 48
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Pioneering hip op The Portland Hospital celebrates a ‘first’ for a keyhole procedure P12
£25k car tax threat
margifloate@btinternet.com
EXCLUSIVE: By Robin stride practice are Consultants in private of thousands facing shock tax bills attempts of pounds as the taxman for car to put the brake on claims expenses. indeAccountants warn that who have pendent practitioners work outside notched up 20 years’ hit for paythe NHS could now be as much as ments amounting to £25,000. folThe alert has been sounded of pollowing a dramatic change which is icy in one local tax office to disallow a suddenly attempting going back consultant’s car claims nearly a quarter of a century. If this consultant’s representaefforts to tives fail in their current decision, fight the tax officer’s patients floodgates a private hospital to visit then it is feared the travel between an nHs and tax attack has disallowed claims for could open for a mileage Backwards move: a taxman been doctors This had traditionally on thousands of private could was being penalty and interest claims, to arrive at allowed, so the matter all over the country. of up to enable the consultant ‘at the highCustoms mean one-off tax bills therefore taken up with HMRC HM Revenue and this place of work are allowed £25,000 per consultant.’ and est level’. (HMRC) has traditionally ants and deemed not to be “wholly an NHS allowed to Hospital Consult If the tax office was purpose of a claims for travel between chief execexclusively” for the interpretahospital. Specialists Association are therefore go ahead with its new hospital and a private said: ‘We medical practice and all other rigid interutive Stephen Campion tion, then he believed But, under this more with disallowed.’ – and an the tax office are currently in contact inspectors would follow pretation of case law, an urgent Mr Stanbridge, of Stanbridge a £2,000-arow is now HMRC and seeking consultaverage consultant with at the centre of the issue’. Associates, warned that 20 years and argumeeting to clarify this offices as year car claim going back challenging these costs Lang, of ants were seen by tax rejected bill. Accountant Andrew entertainwould face a £25,000 ing they should be said there ‘soft’ and, together with issue is a Sandison Lang and Co, were top Don’t miss next month’s because a private hospital tightening ers and sports players, Today seemed to be a general of Independent Practitioner place of work. But this tax targets for a tax crackdown. up-to-date up of tax-claim rules. be very when we will bring you Specialist medical accountant as a ‘hell He added: ‘This could ‘The to help office’s stance had come in private advice and information Ray Stanbridge explained: was trying to serious for many doctors in threat to of a shock’ because it to have you minimise this latest taxman is using the judgments a consultant practice if they are found dragged up disallow tax relief on expenses. your business. two tax cases, one their hosunderpaid tax on car to argue visiting patients, during expenses from over 50 years ago, from Assuming a typical motor hospital pitalisation, when travelling retrospecrobin@ip-today.co.uk that a consultant’s private claim of £1,500 a year, an NHS to a private hospital. with is his place of work. tive reassessments, together to ‘Any travel expenses incurred In association with
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reflect the The figures broadly statistics, GMC’s latest registration represent where anaesthetists the specialist 11.67% of doctors on of anaesthe register. The number practice tists entering independent 254 in 2013. rose from 90 in 2011 to saw a sig Clinical radiology also build up their businesses. have 44 new ind nificant increase, from Private healthcare analysts in 2011 – the of ‘NIPs’ – ependent consultants revealed the number – specialty – seventh most common new independent practitioners over the were sec the highest rate of increase joined the to 136 in 2013 when they has never been higher. which male anaesthetist who ten. launched last recent years. A reason, years ago. ond in that year’s top Over 3,700 doctors have the recent trend, specialty register eight practice the UK since spec may help explain Other areas of clinical a private practice in ified But while most popular within be the NHS Any Qual still grow that are traditionally strong new cohort could 2011 – and numbers are ialties among the (AQP) commissioning are trauma seek to register, Provider the private health sector ing as younger specialists as a conse broadly reflect the GMC’s ophthal programme, which incomes and under and orthopaedic surgery, boost stagnant NHS more pro women remain significantly But in quence has encouraged mology and dermatology. take on new challenges. practice.’ represented. the per shot up by viders to enter private director the three years since 2011, ‘NIPs’ numbers have for online Healthcode’s managing and rising from As the clearing house centage of new orthopaedic that the sheer 60% in just 36 months, processes Peter Connor warned each year fell last year. billing, his company on private trauma specialists in 1,008 in 2010 to 1,612 numbers now taking transactions daily to 8% in in around 15,000 slightly from 11% in 2011 Figures collated for Independent based on an work signalled that competition and its analysis is independent more 2013. Practitioner Today by private hospi the sector would become page 2 experts extensive database of years. n Women doctors: see sector online solutions intense in the coming practi tals and consultants. seen Healthcode show a typical He said: ‘We have certainly practice is a tioner entering private
By Robin Stride
consultants Competition among of is set to intensify as thousands practice new entrants into private
3,741 consultants analysis, over 60% of the According to Healthcode’s from the following in the last three years were entering private practice (5%) specialties: 6. Obstetrics and gynaecology 1. Anaesthesia (13%) (5%) surgery (10%) 7. Ophthalmology 2. Trauma & orthopaedic 8. Urology (3%) 3. General surgery (9%) 9. Paediatrics (3%) 4. Clinical radiology (6%) 10. Dermatology (3%) 5. Cardiology (6%)
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analysis for An explosive and detailed Today by Independent Practitioner accountants leading specialist medical identified 11 Stanbridge Associates has can expect to see ground-changers doctors next five years in private practice over the
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Super-group takes off By Robin Stride ‘super-group’ The first consultants’ to target a has been launched for private credit crunch boost business in central London. £5,000 for Doctors are paying of the Harley clinical memberships aims to raise Street Alliance which them their profile and market signing up overseas. They are also – covering to ten commitments developquality, excellence, staff promoment, standards, honest tion and pricing transparency.
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have benefit from it. It should focus on were impressed by the McDonald huge success.’ desire to Project executive Tam executive patient care and the Toby Shannon, chief 260 clinics as a brand said he saw half of the company re-establish Harley Street members. of the area’s property excellence. in the area as potential Estates, representing clinical threatowners Howard de Walden would But he denied the venture to have We felt alliance membership said: ‘We are fortunate marketing ened non-members’ futures. practitioners also permit greater cannibalismany highly-skilled than could He said: ‘We are not and, in our exposure at a lesser cost business working in the area ing existing healthcare Alliance be gained individually.’ view, the Harley Street a much bigBelinda but working to create continued Marketing specialist initiative to ensure the of recession son Dodd ger market. At a time treatLawson, of Law highest standards of medical worry at all when there is any help to Communications Management, to sell to ment in the area should buy brands about what the UK has this reputacommented: ‘People to shout protect and enhance brand is one other countries, it is time and the Harley Street world-class tion.’ is in the out the benefits of our month of the greatest there n More details next and healthcare sector.’ world. It’s time to maximise said: ‘We One alliance member
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nt doctors truly independe meeting in (formerly Forum) inhabit’. the gaps in a Pract would slip through that London told Independent excluBut Dr Edmonds promised but was now system originally designed how to help itioner Today he was 58 the IDF would look at due to the sively for the NHS. its own fear thinking of retiring early interdoctors, perhaps provide Independent practitioners workload. Specialists on the floor the GMC, expected revalidation plans could farce’ RO, and liaise with current revalidation Edmonds jected with cries of ‘absolute Healthfuture IDF chairman Dr Jack DoH, and the Independent Department jeopardise their practices’ reaction and ‘ridiculous’ as a And it the necessaid the overwhelming tried to care Advisory Services. and leave them without anxiety that of Health (DoH) speaker with royal from the audience was might would use its links sary support. omitted explain how private doctors members. alarm and non-NHS doctors were colleges to represent Doctors expressed to enable work with the still-mysterious all others, picture from processes proposed who are Private doctors, like dismay as a confusing responsible officers (ROs) as registrameeting to them to continue practising. success. need a licence as well emerged at a packed the inforcrucial for revalidation November comHe believed much of think prition to practise from 16 explain how the imminent College The official seemed to and notify the mation given by a Royal by 2009. Doctors must pulsory five-yearly relicensing speaker vate doctors were employed one by 14 will work of Surgeons of England GMC if they want had no firm recertification process consultants private hospitals and website at ‘seemed to be news’ to could ever August. See the GMC for them. had ‘little or answers on how some GPs, and he said the DoH www.gmc-uk.org/licensinghelp Many, especially private of the access an RO. and page 6 they would no clear understanding at the n See page 3 editorial fear they are at risk, as which One disgruntled doctor alien scope and environment Federation have to provide credentials Independent Doctors lives and to their professional
In this issue Swindler’s list
new Fraudsters are finding So ways to target doctors. P14 how do you fight back?
Personality goes a long
Doctors’ companies ‘exposed to claims’
Dr James Medico-legal adviser are Armstrong added: ‘Companies for the staff also vicariously liable could, for they employ and nurse failed defence body has warned. instance, be sued if a Union’s The Medical Defence correct protocols when business to follow resulting in (MDU) head of corporate immunising a patient, ‘There’s no of a wrong Nick Gleeson said: the administration in terms of doubt they are at risk They will vaccine.’ to the their corporate exposure. The MDU has responded but of companies by have individual indemnity, be sued growing number the corporate body could a corporate indemnity of wrong- launching their firms, or pursued in the event to cover doctors and put sharedoing and this could managers and nurses. holders at risk.’
are riskMany doctors’ companies they only ing costly claims because liabilities, a have cover for clinical
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fault
Private doctors with employees risks need to be aware of the of vicarious liability P28
could well cost you thousands
optimistic, ues to be cautiously continued to increase if the pound including for NHS PPUs. may be offset down, but this again uncerfall against other currencies. ‘Despite general market impact on by more self-pay. domestic But he foresaw little the promtainty, international and would con‘Around the country, unafstand to embassy work, as they to the NHS trade will continue largely Private doctors in London medical ised £350m per week investin the tinue to use the UK-based to have disfected – although some lose thousands of pounds following Brexit seems postponed. fear. expertise. it ever was a ment decisions may be wake of Brexit, accountants marappeared in a haze – if individHe thought the UK self-pay for Indepen to con‘So, in that climate, will Financial projections to grow as it reality. Things are likely renew PMI based on ket would continue uals and companies dent Practitioner Today, there was tinue as they were before.’ earnto self-pay has done recently unless conand will we see a hit independent practitioners’ Private practice marketing a 2-3% I doubt it, as significant NHS investment. said: growth? Personally, ings from the City, predict (PPU) sultant Malcolm McCoskery pretty much practice NHS private patient units at the the PMI market has average drop in private said: ‘This ‘There is much uncertainty following expert Philip Housden centre of the continues reduced to a core already gross incomes in the through moment, but if Sterling is more job losses. will take years to work more the recession, and self-pay capital for every 10,000 needs to go to fall, this could attract pressures of £3,500and life and business especially likely to respond to NHS That represents a drop international patients, ones.’ on. figures could than macro-economic £4,500, although the for prithose from outside Europe. for ‘Therefore, the outlook ➱ continued on page 6 to be nearer £35,000-£45,000 contin‘If the Eurozone continues pessimistic vate healthcare provision some if forecasts by disband, then the international even more commentators are realised. markets will fluctuate Stanbridge collapses, But the analysis, by and if the Euro currency that a profcould Associates, highlighted then more opportunities by more its fall could be offset arise. coming to ability of international patients ‘In the longer term, the as a centre of work here be treated in London European doctors to But, there world medical excellence. could be restricted. easier for Specialist medical accountant again, it may become ‘Optimists to work Ray Stanbridge added: Commonwealth doctors be 10,000 be a neutral are saying there could here, so this could have said City job losses. Pessimists situation. believe. But if there is 100,000, which I don’t ‘As for the UK market, their prithen perwhoever leaves, they take a significant downturn, as subscribvate medical insurance-covered sonal PMI may suffer too. named Private Hospital if their (PMI) families with them HCA Healthcare UK was ers – especially the elderly l t a n t s to RETAINING THE CROWN: repeating its success interest – ‘ I ’d a d v i s e c o n s u HealthInvestor Awards 2016, savings hit zero per cent (left), and the and level of Group of the Year at the increase their prices Bridge Hospital chief executive feel the pinch.’ of 2015. John Reay, London the gong at a director at service to self-pay patients. officer Andrew Gore, collected Gary Nials, managing are company’s chief operating Collection, ‘Outer-London consultants House Hotel. See page 3 Medical Billing and off in the ceremony at London’s Grosvenor might likely to see some fall said overseas self-pay slows business as the economy
By Robin Stride
In this issue
It’s not all plane sailing
going or Treating patients either abroad returning from treatment P14 has its medico-legal implications
To
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fee consultants to declare details as to loca- asking England’s vide additional a n d income. respond to the NHS Dr Keith cope of practice of Interest t i o n , s BMA consultants’ leader report Managing Conflicts procedures undertaken. vast majority of conincome Brent said the A Consultation. ‘The publication of gross out at NHS in the NHS: gave beyond their aimed to Consultants have hit practice, sultants already It claimed the proposals do try and force accrued from private hours. If wishing to England proposals to existence of private of NHS con- contracted practice ensure the had to offer which is done outside private work, they first them to reveal their private is well known ‘in keeping and in the doctor’s idea is point- duties time. They made an transpar- tracted hours earnings, warning the specific extra NHS with wider moves towards time is not of any of substantial ludicrous. conflicts can be own less, unworkable and is unwork- annual declaration the ency, and so that accordance interest to anybody and conflicts of interest in Doctors’ bodies, including managed or avoided’. Federation either be asked able.’ Independent Doctors then all with legislation. Doctors would also and If mandatory for doctors, ➱ continued on page 3 in (IDF), the Hospital Consultants they practise, when, with influence on NHS (HCSA) and where major individuals Specialists Association specialty and what trust board patient care, such as Independent which LONDON BRIDGE EXTENDS be the Federation of they perform. and managers, should (FIPO), procedures say they members HCA is expanding its London Practitioner Organisations Specialists’ organisations to declare all their income into a new openness obliged Bridge Hospital campus all expressed strong criticism. ground). the pro- support transparency,IDF said it too. cancer centre (middle fore Accountants also joined of honesty, but the page 4 He added that full disclosure which would and our n Read the full story on test against the plan the views of most of public sector income n o f g r o s s ‘shared was all private and require declaratio colleagues’ that there key NHS decisuggested medical by those involved in incomes within three to be achieved by requirwould allay any public £50,000- nothing private prac- sion-making bands: under £50,000, of interest. ing doctors to publish anxieties about conflicts £100,000 and over £100,000. to single Today col- tice earnings. ‘It would seem ludicrous chairIndependent Practitioner Its specialists committee a small minority of of Stan‘The out consultants, umnist Ray Stanbridge, Brian O’Connor said: such transthe bands man Dr the NHS workforce, for bridge Associates, called of NHS consultants said. earnings vast majority parency,’ Dr O’Connor illogical. He said gross well beyond their contractual The Federation of Independent tax was paid work were irrelevant since Organisations (FIPO) it would be obligations. subjected Practitioners on net profit. And worked ‘Despite this, they are from the said provided consultants ‘impossible’ to file figures annual appraisal, close NHS contracts as proposed. to rigorous appropriately within ‘previous 12 months’, of their NHS commitments then private problems scrutiny and job descriptions, He added: ‘The main appraisal and, of course, outside and viewpoint is at annual practice arrangements from an accounting down by managers within time should not not identi- as laid job within their own that the proposals have implementing specific of analysis. practice”. the NHS be subject to this type fied what is “private Glazer is plans. Chairman Mr Geoffrey that all Until a uniform definition exactly ‘It is now a requirement it was difficult to see be subject to time spent in said agreed, any figure will doctors declare their there would be be in pro- what benefit major error.’ practice and, indeed October to private Parties have until 31
By Robin Stride
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n See page 4 Litigation risk of falling between two stones
The problems of caring for patients who move between NHS and private care P36
Fees rise by up to 20%
By Robin Stride
Consultants are increasing their fees by up to one fifth in the runup to the new financial year. Rampant inflation – higher in the medical sector than the UK’s national double-digit rate – has prompted a widespread review of pricing structures for self-pay work. Many specialists are attempting to catch up after realising they have fallen far behind because they usually never considered annual adjustments. Some reacted after specialist medical accountants recommended last month that Independent Practitioner Today readers should check their charges to see they at least kept pace with escalating costs. But the advisers warned them to be careful about discussing pricing with colleagues, because the Competition and Markets Auth ority has been scrutinising the medical sector and has fined businesses where it believes uncompetitive practices have taken place. A payments expert at Civica Medical Billing and Collection said many consultants who had not previously reviewed their fees were now doing so, citing increased practice costs from staffing and indemnity. According to head of sales Simon Brignall, double-digit inflation figIn association with
ures had been a tipping point and were often being matched by similar fee rises from consultants. Increased patient footfall in their practices, especially from self-pay growth due to the NHS’s current challenges, had given them scope to implement higher fees and the confidence to do so. He warns in this issue (page 32) that consultants typically do not set their fees effectively due to not doing enough research at the outset – ‘or it may have been many years since they last looked at them’. Practice management support company Designated Medical reported many consultant customers had raised self-pay prices from between 5% and 20%.
Managing director Jane Braith waite said: ‘We have not seen patients complain. Mostly, the increases have been accepted with no comment. The sense is that they expected this and understand the reasons. ‘My personal experience is that costs have increased and this has to be absorbed or passed on. Most people are running very efficient practices and there is little room for reducing costs further. ‘The frustration, of course, is the lack of recognition by the insurance companies. Many consultants who signed up to fee assured status are really questioning the value of continuing.’ Alec James, a partner at Sandison Easson specialist medical account-
ants, said: ‘It is not surprising to see the fees rising like they are, given the cost of living and inflation rates. ‘I would envisage costs will increase for consultants, particularly in relation to clinic and staff costs. Ensuring their fees are increased accordingly in preparation of this is important.’ Meanwhile research is currently underway to examine and analyse price movements in hospitals’ selfpay packages. One participant said increased self-pay volume could limit fee rises here, but some consultants were reportedly being charged more per hour for the consulting rooms they used for this work. n See more on page 6
DON’T FORGET TO UPDATE YOUR FEES WITH ‘TRANSPARENCY BODY’ Consultants who revise their fees are being asked to ensure they update their pricing information held by the Private Healthcare Information Network (PHIN). Its consultant relationship manager Anne Coyne said: ‘We contact consultants routinely to request they update the fee information they have submitted to PHIN. We are aware that, with the new financial year imminent, this may be a time when some consultants review and revise their fees. ‘We would remind anyone doing so to Anne Coyne, consultant please update that information on the PHIN portal, https://portal.phin.org.uk, so relationship manager at PHIN
it is available to patients. We thank those who have already made the necessary amends.’ Specialists needing help with the process should contact consultants@phin. org.uk. PHIN regularly reminds consultants of their responsibility to keep their data current. But it told Independent Practitioner Today it did not currently evaluate and report on individual updates to fees, so could not say what percentage of consultants were currently updating their records in line with any fee changes.