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Fees in the north east of england

Discussion in 'United Kingdom' started by tonywatson12, Jan 5, 2014.

  1. tonywatson12

    tonywatson12 Active Member


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    hi
    when charging fees for dom visits how do you guys work them out?
    I have had a break from podiatry and having now done agency work at all levels was planning to start home visits but was unsure of current fees in the north east.

    anyone got suggestions? Oh will be using disposable instruments to start with so have to add £5 before fee charge.
     
  2. W J Liggins

    W J Liggins Well-Known Member

    Price fixing is illegal. As general advice, determine your expected level of income - that of a dental surgeon is a good daily base, then take into account vehicle costs, travelling time, instruments/dressings etc. Divide by number of patients seen during a working day and you have your figure.

    As a final piece of advice, rent a surgery as soon as possible and save your back in old age.

    Bill Liggins
     
  3. I agree with the above, so many of my colleages doing domicillary have bad backs and knees ! I rent a room within a dr's surgery, have referrals from them, and the rest of the practioners too !

    My charges are £33 per visit, but when they initially come, their charges are £45, as it takes an hour of my time, to document their history onto my computer programme, take photos of their feet, then diagnose their problems !

    I have always been of mind, that we must "UP" our status of professional people, and like the person said above, take into account a dental practioners prices !

    I use disposable instruments DMI in Suffolk, and like you said, this must also be put into the equation of your prices !

    I realise that there is a /North / South devide, so you must consider this in your practice charges too !

    Good Luck

    Caroline the Pod from Suffolk
     
  4. tonywatson12

    tonywatson12 Active Member

    thanks for the comments
    I think I should add that i have been a NHS pod for 20 years and had a private practice many moons ago in the south of ireland.
    but that is a different system for health care provision with a standard charge at point of entry to health care (now about £50 euros per gp visit)

    Having had the break in the nhs and returned on agency working all over the uk it seems that private costs do vary and now with HPC been more open you can still find appointments for £10 or even less.

    Now to the bit that will kick off!
    If I work as a band 6/7 on the current agency rates it pays £22 (the trust costs are£28 per hour).
    given that most trusts give 30 min for new patient assessment and treatment it costs the trust £14 per patient plus the cost of instruments and other stuff.
    If I use system one for follow up bookings the admin cost is less.

    so in the grand scheme of things a 30 min new patient assessment costs the nhs using a locum around £18.00 per patient. (a lot cheaper if employed staff do them)
    dom visit should take about 30 min as most trusts will give about 16 visits per pod per day.

    so I was planning to work on this model or sort of thing!

    As for dental model we would have a set fixed fee structure mostly controlled by the nhs pct and I think (but am going to be told I am wrong!!) that dental appointments are set at 15 min slot and costings for treatments depend on how many of these you need regardless of complexity (like i said could be wrong)
     
  5. W J Liggins

    W J Liggins Well-Known Member

    Well, it's up to you, but of course the figures you quote are far from reality. The Trust has to pay for buildings/equipment/council tax/storage plus on-costs etc. etc. You can choose to ignore the NHS fees or not, but don't expect to make a reasonable living if you do!

    Bill Liggins
     
  6. tonywatson12

    tonywatson12 Active Member

    hi
    thanks for the reply
    just for example if I went to the dentist for a tooth extraction taking 30 min and involves L/A and suture it costs about £50 (nhs Dentist)
    The same dentist charges £17 for routine checkup (15 min)
    so if we look at podiatry a routine appointment and lets face it will be 1-2 soft tissue lesions with possible nail care unless you have a mass of msk and nail op ref.
    routine would be 20 min and as a dental model is around £25 nail surgery is about 40 min so would be about £70 and msk is a licence to print money!!
    Now i don't know how much the dentist gets from the nhs per patient (someone may be more wise) but the over head costs are much greater then a single chair podiatry clinic.

    I feel that if I want a full range of podiatric patients then costs need to be affordable. also as the nhs changes and jobs become harder to get with the Universities still turning out new podiatrists not to mention other HPC training schools we need to look at pricing structure so patients can choose on treatment experience and not price.

    I think in the area i live in asking over £20 -25 for home visits means you will be not using the autoclave much!

    Thank you again for your comments and advice
     
  7. I am probably selling my Surgery in the next 5 years, so a very well established Surgery in a busy Town, with the kudos of working under the professional umbrella of the NHs is something, to think about if you choose to retire yourself ?
    Regards

    Caroline
     
  8. tonywatson12

    tonywatson12 Active Member

    hi
    thanks for the reply
    not sure but are you saying I should buy a practice?
    or retire?

    tried retirement did not like it!
    the problem with taking on a practice is the cost
    thanks
    tony:confused:
     
  9. tonywatson12

    tonywatson12 Active Member

    oh
    was just a little unsure why you would take routine pictures of feet.
    what do you use them for.
    I have only used x-ray and digital wound pictures in diabetic care.

    you could go on one of them tv shows were you have to identify the patients by the photos
     
  10. Jacqui Walker

    Jacqui Walker Active Member

    Why are you basing your costs on what it costs the nhs to treat patients?:confused: I wasn't aware they were supposed to be a profit making business - YOU ARE!

    I moved shortly after qualifying and had to set up privately. Glad I did, I rent a room from a Dr's surgery and do doms for clients that are housebound - if they are able to make it to a hospital appointment they can come and see me at the surgery - look after the back!

    Basic nail care starts at £25 in clinic and £35 for home visit. In both instances the initial visit is £10 on top of that because the first appointment always takes longer. If there is more than basic nail care the costs go up, because it takes longer and involves more equipment. And if it's msk it starts at £50 for the assessment and it then depends on whether the customer wants/can afford custom or off the shelf orthotics - but always bear in mind that the orthotic may not be right first time and you have to change it - if you don't factor that into you costs you'll be out of pocket - a lesson I learned very early on. I try to earn between £50 and £60.00 an hour. If they baulk at the price refer them to someone who doesn't want to make a profit!

    Oh and if you're basing your earnings on what Dentists earn then don't use the nhs prices - you are private so compare to a private dentist - we are definitely under charging - I saw the dentist (privately) for root canal work just before xmas - an hour in the dentists chair cost me £472.00!!!!!! and the crown will cost another £350.00 minimum!!

    Good luck with the business - a piece of advice I was given when starting up - if you start cheap you'll stay cheap - realise what you're worth and charge it!
     
  11. HAHAH!!!The reason, I take Routine Photos, is that the Computer Programme that I bought, from mobilis company, requires me too !

    In actuall fact, the photos, help me with diagnosis, future patterns when dealing with infections, ulcerations, vp's etc ?

    It also, looks very impressive for the patient,s (with some of them, not seeing their plantar areas of their feet for years ! hah) On a more sadder note, I remember, my patients ( there are now over 2.500 by their conditions of their feet, than their names of faces ! hahaha)

    The other main reason, is "Litagation" problems, when someone comes into your surgery with an infection, it is photographically documented evidence, that they CAME IN with an infection and NOT WENT OUT with an infection on their files!

    Also I do Biomechanics, so having photos of the feet, in direct motion, can help with the results of the assessments !

    All in all, the computer programme, is one that I would definitely advise for all my colleages !
    Caroline
     
  12. Absolutely AGREE with everything that the previous Pod said, ! VALUE your profession, once you start charging £20, to raise this then to £35 for a home visit is pretty unlikely to result in you ever making a living !!

    So think Professional, think outside the box of the NHS, this is your Buiness, and it is at the edn of the day your living , and not a charity ! NHS and private podiatry do not in anyway collide when it comes to price checking .

    I have been told that our NHS in this part of Suffolk, only allows 15 minutes per patient, and they do not cover cutting of the nails.

    I do EVERYTHING for the same charge, and no-one evetr quibbles with the cost? They like coming to a brand new surgery, with state of the art equipment, S>U Instruments as well, clean and also computerised with Photos on the screen for them to view !

    All in all, they and I too, think that I am worth every penny of the amount quoted to them !
     
  13. tonywatson12

    tonywatson12 Active Member

    I know your all worth it:D

    I do understand the comments around nhs pricing v private costs and feeling valued as a pod.
    I have had more ups and downs in the 20 years then a yoyo.

    My costing is is looking at the mid to long term viability of private practice and the possibility of been a supplier to the nhs as services get cut.

    I am taking onboard all your comments and thank you for them.

    I was working for and nhs trust a few months ago and the podiatry service was been run by private health care provider?
    And remember some years ago been on a meeting group in the nhs regarding generating income and even then the suggestions were around part payment for patients not making the criteria as a form of revenue.

    Also a lot of trusts offer a nail cutting service at a low charge by trained health care type bods.

    I think the nhs is run as a business these days and all aspects of treatment have a cost code.

    I am possibly old hat on this one but the two ways i remember podiatry funding is by block contract ( do all patients for one amount) and by the podiatry charging per ref direct to the fund holder (gp)

    so my price thinking was some thinking around this type of thing.

    At the end of the day if your doing well in private practice and getting 45 - 50 for patients good for you and I love the photo program you have caroline (I struggle with the nhs systems very thick on tec!) sound good though.

    think price will be governed by patients as loads of pods up here all as good as each other along with improving nhs access = patient choice made by cost.

    Could we not have a national price structure? (or has this been done?)

    thanks again for your help
    tony;)
     
  14. Hi there Tony,

    Al good for the above comments, but still feel that the NHS system, is probably shading your pricing on private patients ! mmm I agree with you, about pricing,you can only charge what the going rate is for your all in your area !

    As for fix pricing, Well, funnily enough, I have a very close relationship with Pods in this area, who are Surgery Based, and are Podiatrist, and NOT Nail Techs, and they immediately came back to me, and told me that "FIX PRICING" or "CARTELS" are completely illegal and they will not be drawn into this scenario !! mmmmm

    Well, slap my wrist for even trying to talk about this delicate subject ! hhaahah, however, you may have a different relationship with all your colleages and this might work for you up there in the north !

    good luck with your business, it is hard out there, 20 years on, I am busier now than I ever have been, so at the grand old age of 57, when MOST people, are winding down for their REtirements, I sadly have to UP the Pace, to earn more money, so that I am able to sell, and hopefully, receive some form of a Pension, so that I too can retire by the time I am 67, when my STATE PENSION comes in !

    Good Luck

    Caroline
     
  15. tonywatson12

    tonywatson12 Active Member

    thanks caroline

    Not sure of this cartel thing but don't want the hitmen around!!
    I did do some locum work in Hastings and bex hill quite nice mabey I should head south.
    hope you manage to get enough for the pension when it comes.
    I am lucky as have an army and nhs pension to fall back on.
    guess must like doing podiatry as when I am not I tend to chop the roses down a lot shorter!!!

    thanks again
    tony
     
  16. gdenbyUK

    gdenbyUK Active Member


    Another approach to charging in private practice is to start with your desired hourly rate (say £60 per hour), providing an income of 50% (£30 per hour) and overheads of 50% (£30 per hour of clinic / travel-car time). Then look at the time to prepare for, travel to, perform and travel on from an isolated domestic visit (in rural practice, easily 20-30 minutes travel, then 15 minutes for routine nails). Thus you can easily calculate an isolated home call as taking 45 minutes, justifiably charged at £45. Personally I advertise doms at £50, which allows ME the opportunity to discount down when caring for an existing client at home after a hospital stay (continuity of care). My actual chargeout rate for clinical work (clients visit ME) is £66 per hour in rural Northamptonshire. See www.footwisepodiatry.mobi for my full charging scales. Regards Gary Denby, Foot Wise Podiatry.
     
  17. gdenbyUK

    gdenbyUK Active Member


    Like Caroline, I also use digital photography on at least half of my appointments, either a 5 Megapixel camera in my clinic, or a 3G Smart phone when home visiting (clients can see what I see, on the back of its screen - only £20 per month now, including phone, all data and all calls). As well as defensive practice (incoming infections), a picture paints a thousand words... I use pictures to monitor progress with mycotic nails, verrucae and corns (is the client following treatment and footwear advice?), also with a Podoscope in clinic to demonstrate plantar pressures, also monitoring suspicious moles and freckles (extending practice to include melanoma).

    I use the digital photos in a (relatively expensive) on line (cloud-based) system called Practice Pal which performs automatic daily backups, which I download once weekly for safe keeping... A cloud-based system also allows clients to register and book their own appointments! More details on my clinics mobile web site at www.footwisepodiatry.mobi Regards Gary Denby, Owner-Practitioner, Foot Wise Podiatry.
     
  18. tonywatson12

    tonywatson12 Active Member

    hi
    do you get consent as When photos used in NHS notes written consent is needed?
    are photos submissible in litigation?
    I seem to remember someone pointing out the legalities of photos.
    I agree that photos are excellent for showing changes in condition of wounds when the patient sees a wider MDT.
    think for me would prob only use for wounds and possible pre post nail op but only if client wanted.

    what sort of fees do you charge as still working out costs.
    would not be using comp system but would be using MS works for letters etc

    tony
     
  19. tonywatson12

    tonywatson12 Active Member

    do you get many patients at £66 ?
    seems a lot.
    the average rate looking on the internet seems to be about £26
     
  20. Jacky Nowle

    Jacky Nowle Member

    When the patient first attends, the form that they fill out with name, address, DOB etc includes a photos consent aspect in accordance with SCP guidelines. I firmly believe that (providing you have been doing things correctly) taking photos is one of THE best ways of preventing a complaint escalating to litigation.
     
  21. Jacqui Walker

    Jacqui Walker Active Member

    If everyone is basing their costs on what other podiatrists charge, then there will never be a decent living to be made. Forget what income you may have from pensions from other jobs, that only clouds the issue.

    When setting up in business you have to brutal about what you value yourself at. Dentists don't think oh, I have some money coming in from this and that and the wife's also got a decent income, SO I CAN AFFORD TO CHARGE LESS THAN I'M WORTH!

    Don't forget you too did a degree to get to this position.

    When deciding on what your going to charge you have to decide several things:

    How many hours a day are you prepared to work?
    How many weeks a year do you want to take off for holidays? And don't say you won't - Easter and Christmas come along regularly every year!

    (That will then give you your total working hours per year)

    What do you need to earn to live? - what do you pay for your personal outgoings - mortgage, insurance, utilities etc (this is for your home not your business). If you were working for someone else what salary would you need to cover this?

    What are your business overheads- rent, rates, utlities, (car and it's overheads if you're domiciliary). Don't forget to also factor in your start -up costs - what have you had to buy so that you can treat your first patient - Computer/laptop, printer, stationery (including cost of logo design for business cards/letterheads), uniform, clinical equipment - doppler, tuning fork etc, gloves, aprons, dressings, scalpel blades, couch roll, they all add up and they all have a cost per client treated, so you need to work that out.

    Now you know how much you need to earn to pay for all of that and how many weeks/hours you have to earn it in.


    If you approach it from the other end as in what are people prepared to pay - then you'll never make enough to make a decent living, because people always underestimate what someone will pay them. If a beauty salon is charging £27 for a pedicure - you need to charge MORE! They don't use sterilised instruments, just clippers that have been soaking in barbicide, and the drill is the same one they use on everyone. A pot of nail lacquer can varnish a lot of nails!

    And don't forget that if you want to compare us to dentists, think about how much you pay for not to have anything done - a check up usually only takes about 5 minutes they use one pair of gloves and one probe - I pay £36! So clients are always prepared to pay, you just have to make them realise you are worth it! You have to discover your unique selling point and make them realise that they won't get that level of service any where else, they may get cheaper but not better!
     
  22. Jacky Nowle

    Jacky Nowle Member

    As Akbal Randhawa one said on TFS to someone,

    "do yourself a huge favour..........never ever accuse another practitioner of being a rip off or over charging, until you have one very good idea of the service that that person provides at that fee!".

    I have an outside contract and one day did one of the staff members there. He had moderately OX B/1st nails. He had been to a degree trained pod who had just used nippers to reduce them and had not been at all satisfied. I used a drill and two different burr sizes, and significantly reduced the nail, and he was well chuffed.

    I had another customer at this establishment who had been in another in the chain in which the chiropodist does not use a drill, just nippers for nails. I did a far better job at reducing the nails in thickness.


    We undervalue ourselves in this profession because others do. People set up in business and undercut the competitor to get customers.

    The memory of good service is remembered well after the price has been paid!
     
  23. tonywatson12

    tonywatson12 Active Member

    i think you will find i have not called any one a rip off!!

    Look in the REAL world some of you get load of patients with big fees but most just get by.
    And yes you can value yourself as much as you want but people will only pay what they perceive to be value.

    Unlike dentists we have many people doing podiatry/chiropody foot care or what ever you want to call it.
    this means people will under cut(pardon the pun) each other.

    unlike dentists the nhs provide 100's of people with FREE podiatry and lets be real diabetic foot ulcers and complex care tends not to be done in the private sector.

    I may be wrong but I suspect as a private pod you see lots of older patients who require foot maintenance for routine nail problems.

    I also would suspect that your caseloads involve residential care homes and i again could be wrong but i don't think the residents pay anything like £26-30 for a visit?

    for my penny worth we have NHS grades for a reason so my private charges will be inline to that of a band 7 as that is the nhs level i work at.

    don't want to be a pain but lets be real in this!!!
     
  24. horseman

    horseman Active Member


    Just a thought, but I have had his argument with both BUPA and th local PCT: I charge more than the national average... I live and work in the southern home counties where a house for a family starts at £400K, my staff have to live somewhere, and both both business rents and rates are high. If the NHS wants to pay me to treat a patient I HAVE to make a profit. Even working on a 'modest' 40hour week for a 47 week year it is quite simple to work out your fixed costs as an hourly rate, you then need to add profit as this is what you live on (don't forget this is the bit you are taxed on :eek:. The same process applies again for home/peronal money. House, rates, utilities, food etc. You are running a business, good business is where both parties get a fair deal. You won't if you undercharge. It's a pain :bang:but I go through the whole process every time I change the fees and at least twice a year to check things are on track. As I said in another post you win by being better. For a Dom practice remember to factor in car maintainance and replacement, it's not just fuel.
    Further advice from Business Link in your area and I've found the Federation of Small Businesses very useful too.

    Good luck:D
    Incidently cartels and price fixing with other practice ARE a criminal offence
     
  25. tonywatson12

    tonywatson12 Active Member

    ah
    think I will just stay in agency and nhs don't think this private thing is for me
    thanks for all your comments
     
  26. tonywatson12

    tonywatson12 Active Member

    did not know there was a national adervage what is it?
     
  27. tonywatson12

    tonywatson12 Active Member

    sorry should have read average
     
  28. Jacky Nowle

    Jacky Nowle Member

    It was not my intention of accusing you or anyone of calling someone a rip off. It was just a comment from the past about charging/fees, that is all. Sorry if you or anyone interpreted it that way, I didn't intend to!
     
  29. gdenbyUK

    gdenbyUK Active Member

    do you get many patients at £66 ? seems a lot. the average rate looking on the internet seems to be about £26


    My chargeout rate of £66 per hour equates two 3x 20 mins short treatments at £23 each, or 2x regular treatments at £35 each, or 1x initial assessment at £45 + 1x short treatment at £23... Into my eigth year, I have a fairly regular two days per week (a full Tuesday with its £1 discounted Pensioner Specials, plus two other half days). Gross takings from my Podiatry income has been £24,000 over each of the past three years of recession, closer to £30,000 this present year. I aim to get to three days per week rural practice with Podiatry clients, two days per week on other things... (not too much eye strain, RSI or back problems that way, LOL!). I may not be a rich man, but I have a comfortable work - life balance.
     
  30. horseman

    horseman Active Member

    Sorry I have no idea, I was told by BUPA and local PCT that my fees were higher...

    Another thought, if the NHS is £££££ in debt they can't be charging enough.
     
  31. tonywatson12

    tonywatson12 Active Member

    malpractice or treatment risk

    hi
    patient is in clinic for routine podiatry
    high risk with poor controlled diabetes and PVD
    during treatment of plantar cal you flap hem them
    you put the appropriate dressing and review in i week
    at this appointment the area is showing no improvement.

    despite dressings and vascular referral the patient ends with a BKA.

    you get the letter from the patients solicitor with the line "before I seen ........ I had no problems" and the malpractice case starts!!!!

    what do you think
    as all debridement carries risk in the high risk patient with pvd should we get formal consent?

    Routine podiatry in the high risk patient is part of general car and by patient attending is consenting to any treatment risks?

    is this malpractice?
    look forward to you opinions
     
  32. tonywatson12

    tonywatson12 Active Member

    hi
    some advice' have been looking at price and settled on £20 per visit seems about the rate here.

    Was thinking of offering a discount for patients ref by gp and would target gp surgeries with a ref pad and forms via socp.

    was hoping to tap into the nhs waiting list lot as always complain at gp when unable to get seen!
    what do you think?
     
  33. Fliss

    Fliss Active Member


    Hi Tony

    What you say is true, most dom/residential care home visits are routine nail problems, and you usually offer a discounted rate for seeing patients in the same location (homes). At the end of the day, you need to see what other pods are charging in your area to make an informed decision on what you charge, because if you over charge they will just go elsewhere. It is difficult to get the price right because you don't want to under value your service. Doms/homes are far less 'glamourous' than working in a clinic. Hope all goes well for you. :D
     
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