Speed of access compared to the NHS
The reforms of previous UK governments have led to reductions in waiting times for NHS patients, with the supposed maximum referral-to-treatment time being 18 weeks in England and 26 weeks in Wales. This still represents a significant delay for patients and many are naturally keen for swifter resolution of their medical problems than the NHS allows. Many companies offer their employees membership of private healthcare schemes in order to speed their return to work, rather than paying for sick leave and waiting for NHS treatments.
Jumping NHS queues?
Waiting for NHS treatments generally comprises two periods of time: (i) waiting for a consultant assessment; and (ii) waiting for treatment itself (the “waiting list”). Until the introduction of the pathways described above, arranging to see a consultant privately for an assessment led to rapid access to the waiting list, bypassing the wait for a clinic appointment. With the treatment pathways in place, patients who opt for an initial private assessment should no longer be able to access NHS treatments faster than NHS patients, as it is the referral-to-treatment times that are measured. The BMA, however, has previously recommended that patients should be given the same date for NHS treatment that they would have received, had they been seen in an NHS clinic, rather than a private clinic, that day.
Guaranteeing a subsequent consultant-delivered NHS treatment?
Many patients, who opt for an initial private consultation and then choose NHS treatment, expect that the chosen consultant will then carry out their NHS treatment, possibly out of gratitude for the initial consultation. You should make it explicit to patients that within the NHS setting, except in cases of clinical need, it is not possible to guarantee that a particular consultant will carry out a procedure, and that an initial private assessment cannot curry favour within the NHS setting. On occasions, this fact will then lead to patients choosing private treatments instead.
Time with you
Many patients simply want time with their consultant, more than is possible within the NHS. This may simply be to allow them to relax and talk more openly about their problems, but also allows deeper questioning of the consultant regarding their condition. Many patients have led fascinating lives and the benefits of a longer consultation are often felt on both sides.
NHS dissatisfaction
The NHS receives far more compliments than it does complaints, but nevertheless is often the target of media stories regarding alleged poor care. Aggrieved patients and their relatives and friends may choose to boycott certain hospitals as a result, which often drives them into the private sector. For consultants practising in both the NHS and private sectors, this can lead to difficult conversations, defending colleagues and, on occasion, your local NHS service while at the same time offering more time – and potentially (perceived) better quality – in the private sector.
Quality
Quality in healthcare is a somewhat nebulous concept, but goes beyond the Darzi definition of safe, effective and personal. In many cases, patients are simply seeking medicine within a particular brand, be that a true brand such as Nuffield Health, or simply within the ‘brand’ of private medicine in general, which they perceive as being of better quality than the alternative.
Perceptions
Patient perception is key and one’s reputation follows from delivering to patients’ expectations, although the quality of the medical care on offer will clearly – eventually - underpin the reputation of a brand.
The patient experience – as perceived by them – is key to success; it must be emphasised that this is not equivalent to the medical care delivered. Being seen promptly by a smartly dressed, clearly spoken doctor, who has plenty of time to discuss a patient’s problems will be perceived as of greater quality than a less polished experience, even if the medical care is equivalent. When things go wrong, for example in surgery, if the patient experience to that point has been flawless, it may be easier to retrieve the situation than had it been suboptimal to that point.
Remember that patient perception is of paramount importance under local anaesthesia, when anxieties may be running high. Your theatre team – who may be more used to unconscious patients – may not be aware of this and will need extra coaching to deliver a high quality patient experience.
The medical care per se
The guarantee of consultant care – avoiding the possibility of a trainee surgical disaster at least– is a poor level of quality to aspire to, but is often the sole reason for patients choosing private treatment. While many trainees are superb, by definition they are less experienced than consultants, and moreover, patients prefer to see the same experienced consultant at every visit – something that is usually impossible within the NHS.
It is important that you audit your results and are able to inform patients of your outcomes. Many consultants now choose to publish their results online in order to help patients choose between rivals’ services, using these surrogate markers of quality. If you choose to do so, it is important to explain the concepts involved, as well as clearly stating if you provide services to groups of patients with particular medical conditions (e.g. diabetic patients), who potentially may have higher complication rates. In many cases, it is also useful to include figures concerning patients’ happiness with their results, as this may be more meaningful to the public than other data.
At the time of writing, the Private Healthcare Information Network (PHIN) has not yet started collecting data on individual consultant outcomes, however, by April 2018 it is anticipated that some form of information will be available online for consumers. This may simply initially be data on volumes of procedures and fees, but will no doubt eventually include meaningful outcome data.
Facilities and equipment
Brands are superb façades. Many patients would be horrified to learn that the equipment inside many private hospitals is inferior to their NHS rivals, but nevertheless excellent results are of course still achievable with older equipment: new does not always mean better. Again, patients’ perceptions of older equipment is important and maintaining kit in a presentable – and clean – fashion is crucial.
If you have the luxury to help a patient choose between facilities, it is helpful to be able to reassure them concerning the equipment in each location. In most cases, a consultant-delivered care episode in an NHS hospital will be hard to rival, although getting this message across to a patient can be difficult!
Procedures unavailable on the NHS
There are many treatments, both purely medical and cosmetic, that are not available on the NHS, including certain cancer drugs, cosmetic dentistry, refractive eye surgery, as well as some psychological treatments, to name but a few.
Other procedures within the NHS setting are subject to low priority treatment criteria, criteria, which often differ between areas and clinical commissioning groups. Examples include visual acuity levels for cataract, varicose vein treatments and removal of non-malignant lesions.
Because they’re insured…
It might seem obvious that privately insured patients would want to be seen privately, however, many find themselves in NHS clinics. New consultants often struggle to understand why this should occur and there are many reasons, including:
• Their insurance carries a prohibitive excess
• Their insurance only pays out if the NHS waiting time is beyond a certain figure
• They have a no claims bonus or receive a cash figure for not using their insurance
• Their insurance does not cover outpatient attendances
• They have a limit on the number of outpatient consultations that they can attend in a period, typically an annual figure
• They forgot!
• They “wanted to support the NHS…”
• Their insurance covers only acute conditions, not chronic conditions, and to date they have been attending your clinic for the latter
• The referral had already been made to the NHS and there seemed little point in changing it
• Their referrer had advised them to use the NHS instead, possibly due to poor reputation of local private hospital, or they did not know you practiced privately.
While you are clearly not permitted to introduce your private services within an NHS clinic, if a patient specifically asks whether there are any alternatives to a long waiting list, mentioning the existence of the private sector is a perfectly reasonable retort] You should be careful, however, to talk in general terms unless specifically led by the patient to your own practice.