Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Charges made for nail surgery UK.

Discussion in 'United Kingdom' started by Snowstorm, Aug 7, 2006.

  1. Snowstorm

    Snowstorm Active Member


    Members do not see these Ads. Sign Up.
    Hi,

    Does anyone have a "ballpark figure" for nail avulsion with matrixectomy.

    Regards
    Mark
     
  2. lgs

    lgs Active Member

    N/S charges

    When I worked for Boots we charged £165 for 1 toe, & £210 for 2 as I recall, this was 2 years ago though :)
     
  3. Lucy Hawkins

    Lucy Hawkins Active Member

    Nail surgery

    Hi

    When I looked into it about six years age the local Nuffield Hospital charger about £120 to see the consultant then £600 for a nail bed resection and additional charges for any redressings I was told about £900 in all. The local EMI Hospital was cheaper at £80 to £100 for the consultant and £450 for the surgery. I have also heard of a pod who I believe was paid £250 by the Nuffield for each patient treated. More recently, three months ago, I was told the Nuffield wanted £1800 to carry out a nail bed resection on a young person.

    So whats my point? We don't charge enough. I charge £180 for one toe. But I know of practices who only charge £75. I want to charge £250 which I believe would be a fair price but market forces come into play. I still think with the right promotion and packageing, colour brochure etc it would be achievable. Your geographical location will make a big difference. I'm on the south cost where wages are depressed and the cost of living high, if you were up north where the cost of living is lower you would, going by the general level of fees, stand a better chance.

    Regards
    Luke
     
  4. Snowstorm

    Snowstorm Active Member

    Dear Luke,
    Its true that market forces together with geographical location play an important part
    in how we decide on a fee for nail surgery. It seems that dentists have arrived at an autonomous fee structure for a variety of work which now seems somewhat universal irrespective of geographical location. Perhaps the Society Of Chiropodists & Podiatrists could speculate on what would be an appropriate fee for some of our :rolleyes: surgical proceedures!

    Regards
    Mark C
     
  5. Lucy Hawkins

    Lucy Hawkins Active Member

    snowstorm

    The dentists have been able to build their practice up on the back of the Dental Act which protects all work carried out in the mouth. We have no such protection. They also begin their practice with guaranteed work from the Health Service, so little chance of failure there.

    Luke
     
  6. Anne McLean

    Anne McLean Active Member

    Mark,

    I would agree with Luke. My local hospital charges similar rates.

    My practice is in a working class area, but I charge £275 for this procedure. This includes all post-operative dressings until the toe has healed completely.

    I still don't feel that my fees adequately reflect the time taken with dressings. Even my washing machine engineer charges more than this per hour to repair my machine.

    It's time that this profession woke up and started charging professional fees for a professional job.

    Regards

    Anne
     
  7. davidh

    davidh Podiatry Arena Veteran

    Hi everyone,
    Although I no longer carry out nail procedures, I used to do quite a lot at one time. My Practices are based in Private Hospitals and I have some experience of carrying out nail surgery in both Surgeries and Private Hospitals.

    There are several points to consider when comparing Private Hospital fees with Surgery fees.
    1. Private Hospitals carry more "altitude" - the pt expects to pay more.
    2. Fees in a Private Hospital will be based around what medical insurance will pay per procedure. This is normally calculated as:
    Consultation, procedure (including LA for nail surgery), follow-up visits.

    A High Street Surgery is not like the rarified atmosphere of a Private Hospital - patients attending a Surgery know very well they can go back to their GP if the price is too high. If they have medical insurance they will probably prefer to be seen at a Private Hospital where the care (rightly or wrongly) is perceived to be "the best".

    Regards,
    david
     
  8. Anne McLean

    Anne McLean Active Member

    Hi David,

    I’m not sure that I totally agree with your view that patients prefer to have their nail avulsions carried out in the hospital situation if they have private medical insurance.

    I find that my patients frequently opt to have such procedures carried out in my practice, which they are familiar with and under my supervision or that of my Associates, who they have faith in. An increasing number are now opting for this in preference to hospital treatment, despite the fact that the majority have to pay the full fee themselves under such circumstances.

    Many, who do not have insurance, also opt for a continuation of treatment within the practice, despite having to pay for treatment. Long waiting lists within the NHS can deter people from going down this road. Where a child is involved or the patient wants treatment at a particular time or within a particular time frame, I find an increased demand for nail surgery within private practice.

    What experience do others have?

    Regards

    Anne
     
  9. davidh

    davidh Podiatry Arena Veteran

    Hi Anne,
    I'm not aware of any data which shows specifically where pts go, or prefer to go. Take your point about your existing pts......
    However, I suspect that many pts who have never had foot problems before will tend visit the GP with his/her ingrown toenail.

    The GP, being heavily marketed to by Private Hospitals (Golf-days, subsidised meetings, Consultant handbooks, easily accessible websites etc) will, in all probability, send their insured pts to Private Hospital for treatment.
    This is certainly my experience for musculoskeletal problems which require orthoses intervention.
    Cheers,
    david
     
  10. Anne McLean

    Anne McLean Active Member

    Hi David,

    I think that we are looking at this from different perspectives. I would agree that most GPs would probably be the first port of call for new patients with ingrown toenails. Where such patients have private insurance the private hospital is probably the first line of call, for the very reasons you suggest.

    Many patients now want to try conservative treatment first and, in such instances, most of my local GPs refer to me. Once I develop a rapport with patients, I find that the majority elect to have avulsions carried out by me, whether or not their insurance companies will carry the cost.

    I do always offer NHS/private alternatives, but they are frequently turned down, on the basis of 'better the devil you know'.

    Why do we as a profession balk at the cost of avulsions, when opticians think nothing of charging £300-£500 for handing over a pair of spectacles?

    As to where patients 'prefer to go for nail surgery', many are not given the option. Insurance companies are tightly tied in with private hospitals and it is a ransom situation. Hopefully, we will soon see some liaison between the insurance companies and podiatrists as in other countries - it is certainly long overdue.

    Regards

    Anne
     
  11. davidh

    davidh Podiatry Arena Veteran

    Anne,
    I absolutely agree with you there. 20-odd years ago I was working from a typical Podiatry Surgery and charging over £200 for an all inclusive nail surgery service (procedure, dressing, final checkup etc).

    In practice today I don't charge what BUPA (for example) would allow me as a top rate for an initial consultation, but I still charge £90.00. It's about right for 30 minutes of my time + time dictating letters, taking notes, and secretarial time. If I wanted to perform a NWR I guess my fee would be around £600, and perhaps a little more for a bi-lat.

    I talked with Alex Catto a little while back (talking at the SCP Convention this year). Bright guy. He seems to have a thriving Practice, and I notice he embraces a fairly robust fee scale.
    Regards,
    david
     
  12. Anne McLean

    Anne McLean Active Member

    David,

    You and I both trained together in Glasgow. Can you recall how much in the way of business training we got? As I recall, it was frowned upon, because we were a 'profession' and not a business.

    It is hard to believe that, almost forty years on, this outmoded belief still appears to be held by training institutions today.

    Is this one of the reasons for the reticence of colleagues to charge realistic fees for our services?

    Regards

    Anne
     
  13. davidh

    davidh Podiatry Arena Veteran

    Hi again Anne,

    Ah, the halcyon days of Windsor Terrace :eek:

    As I recall, a Mr Borthwick came and gave a half-hour talk on Private Practice in 3rd Year. That was it!

    You said:
    "It is hard to believe that, almost forty years on, this outmoded belief still appears to be held by training institutions today.

    Is this one of the reasons for the reticence of colleagues to charge realistic fees for our services?"


    I'm sure it is. The question is - what can be done?
    I'm more than happy to share information on this forum BTW.
    Regards,
    david
     
  14. Anne McLean

    Anne McLean Active Member

    Hi again David,

    Yes, I remember Bob well - Alas he is no longer with us. I attended his funeral a few years ago. He was 93 when he died.

    We need to start business courses for podiatrists. To do this throughout their training would be a good place to start, but we also need postgrad courses.

    Perhaps forging links with Business Gateway, Business Link, SkillPath or similar organisations would help to achieve this?

    Regards,

    Anne
     
  15. davidh

    davidh Podiatry Arena Veteran

    Luke,
    You said:
    "More recently, three months ago, I was told the Nuffield wanted £1800 to carry out a nail bed resection on a young person.

    So whats my point? We don't charge enough. "

    Why don't you organise consulting rights yourself at the Nuffield?
    As long as you've been in practice for 5 years, and have a degree it should be fairly easy. PM me if you want further info.

    Anne,
    You said:
    "Perhaps forging links with Business Gateway, Business Link, SkillPath or similar organisations would help to achieve this?"

    This may be a good place to start, but UK Pod is a specialist area which would benefit from specialist UK Pod advice.
    For example: How many pods know that it is worth doing a demographic survey of their proposed patch before spending money on leases and equipment? Very easy to do by the way, and costs nothing.
    How many pods know that, broadly, the same pattern of "ups and downs" podiatry treatments per month is repeated year after year?
    The relevance of this info should be obvious - site your Practice in the right area and you increase your chances of success.
    If you know that October is likely to be your best month for gross income you don't borrow money based on that month alone.

    Anne, I'm delighted someone else sees that FHPs are not the cause of the world's woes. Luke mentioned pods charging £75 for NWR's. These people are, IMO, doing the profession much more harm.

    Anyway, happy to help if I can - whoever, whatever professonal organisation they belong to.
    Regards,
    david
     
  16. davidh

    davidh Podiatry Arena Veteran

    Back to pricing.......

    As of yesterday The Nuffield in Leicester charges £600.00 for a unilateral nail op, and £700.00 for a bi-lateral nail op.

    These are fixed-cost (ie - the cost is discounted for non-insured patients), and are for procedures under LA. For GA add about £100.

    Regards,
    david
     
    Last edited: Sep 9, 2006
  17. Anne McLean

    Anne McLean Active Member

    Hi David,

    Many thanks for this information. Have you any idea how much the discount is for non-insured patients?

    Anne
     
  18. davidh

    davidh Podiatry Arena Veteran

    Hi Anne,
    I think about £100 per procedure, but I'd have to check with the Nuffield on that....
    Cheers,
    david
     
  19. Anne McLean

    Anne McLean Active Member

    Charges made for nail surgery

    Hi David,


    That sounds about right and proves my point. Why should they charge about double what the average podiatrist charges?

    Regards

    Anne
     
  20. Cameron

    Cameron Well-Known Member

    Dave and Anne

    I remember Bob fondly. I definately think it was he and Colin Dagnall who inspired me to write and draw. By Jove they have a lot to answer for. AS a student I remember seeing them at a conference carrying on like two wee boys, jibing each other and having in-jokes at the expense of all around. I thought to myself that behaviour will do for me and have been like that ever since. Now you know.

    Moons ago I had a paper published in the British journal about costing nail resections (comparing pods to surgeons) and there were certainly others which followed. A cost benefit analysis is comparitively easy to do but having the confidence to put it to operation may be quite different (as the previous correspondence has illustrated)

    At Curtin University (Perth WA), we tried to introduce a joint degree ie podiatry with business, so students could have a double major. Following a national survey we discovered the vast majority of practitioners were more interested in becoming better business managers rather than expanding current scope of practice into areas such as surgical podiatry. There was a small group who had clear intention to do so and although they were much in the minority we felt there was ample post graduate oportunity and professional education programs to cater for this stream.

    The feeling of the team was students with a business degree would be more able to contribute to their profession by bringing these specific skills to their new employers. Unfortuatley before we could progress the university closed down the department and I am not aware of any other developments in this area.

    Cheers
    Cameron
     
  21. Anne McLean

    Anne McLean Active Member

    Hi Cameron,

    Bob kept the same sense of humour right to the very end. For someone who had been a church elder for most of his life, he even insisted on a humanist funeral, which reflected his life to a T. He was indeed a very special person and ran a practice way ahead of its time.

    Having said that, he was the first to admit that his one half hour lecture was by no means adequate preparation for private practice.

    It's interesting to hear that you have tried to incorporate a joint degree in podiatry with business at Curtin University. What a pity the department closed down before you could progress from here. How long did you run the courses for, before the department was axed?

    Kind Regards

    Anne
     
  22. Cameron

    Cameron Well-Known Member

    Anne

    We were just in the planning phase and poised to develop the new program with the co-operation of the professional association and registration board when quite unconnected the university declared there was no future for a podiatry program at the university. Long story and rather convoluted but the course was wound down before we could introduce a new double degree.

    Cheers
    Cameron
     
  23. Anne McLean

    Anne McLean Active Member

    Cameron,

    What a pity. Training in the UK has traditionally been geared towards NHS employment. As a student, I can well remember having it drilled into me that chiropody was a 'profession' and not a business.

    In today's competitive market, sending private practitioners out and expecting them to survive in the real world on their podiatric qualifications alone, is expecting too much. It's 'a dog eat dog world' and we need to prepare podiatrists to be able to cope with the cut and thrust of everyday life.

    I have been in private practice for 35 years and, feel that instead of getting easier, it is becoming more difficult with each passing year – and that’s not just because I’m nearing retrial age!

    Kind Regards

    Anne
     
  24. Cameron

    Cameron Well-Known Member

    Anne

    > I’m nearing retrial age!

    I youngster like yourself .

    >As a student, I can well remember having it drilled into me that chiropody was a 'profession' and not a business.

    Different era. We really fell into that time when great expectations were made of the NHS (UK) and State Registration. Health service schools were breading grounds for public servants.

    > It's 'a dog eat dog world' and we need to prepare podiatrists to be able to cope with the cut and thrust of everyday life.

    Different times. If the new edition of Neale's Disorders can be taken as a litmus to core syllabi in centres of podiatric education (UK),then it appears not much has changed in thrity years with the emphaisis still on public service.

    >I have been in private practice for 35 years and, feel that instead of getting easier, it is becoming more difficult with each passing year

    I can symathise.

    Othewise hopeyou are in the pink

    Cheers
    Syd
     
  25. davidh

    davidh Podiatry Arena Veteran

    Hi Anne, Cameron, and other alumni of Windsor Terrace (and anyone else interested too),

    Anne,
    you said:
    "That sounds about right and proves my point. Why should they charge about double what the average podiatrist charges?"
    Certainly. Or to put it another way, why should the average podiatrist only charge half of what the Nuffield charges?

    Then you said:
    ">I have been in private practice for 35 years and, feel that instead of getting easier, it is becoming more difficult with each passing year "

    I contend that it isn't becoming more difficult.
    However I agree that keeping to the same traditional chiropody/podiatry model may well be. Looking at my own practice I see quite clearly that my administration time and costs are far higher than they would have been, say 20 years ago.

    I teach that niche marketing is the way to make your practice prosper.
    This may be specialising, either in biomech or pod surgery, or it may simply require that you read your position in the marketplace, and fine-tune your generalist practice accordingly (assuming good clinical skills, obviously, and that an element of biomech and surgery are already incorporated). For example, for a while now I've seen FHPs as a great addition to an existing practice. They can bring in a whole new strata of work (nail-cuts who may go on to develop foot symptomology at some stage), and carry out tasks which leave the pod time to do other, more involved work.

    I don't want to debate the pro's and con's of FHP's, or FHP training levels, but from a purely selfish pod point of view, I can't understand why more pods don't utilise FHP's.

    By the way, Luke mentioned the Nuffield nail surgery fees (which I thought about right). I invited him to come back to me so that I could tell him how to do some work at the Nuffield.
    Luke, if you're reading this my offer was quite genuine - PM me.

    Regards,
    david
     
  26. Nick Curry

    Nick Curry Member

    Dear David,

    On the basis that Luke hasn't contacted you about how to do some work at the Nuffield, I would be delighted if you would tell me!!

    Kind Regards,

    Nick Curry
     
  27. davidh

    davidh Podiatry Arena Veteran

    Hi Nick,

    Delighted to help.

    You should be 5-years post qual, and have at least one degree. If you are trained in Pod Surgery so much the better.

    Find your local Nuffield and make an appointment to see the Manager. He/she will be interested in your quals, but more interested in what you can offer the Hospital and other Consultants.
    Pod Surgery and Biomech/Orthoses are the two which tend to grab their attention. Pod surgery may get the door slammed in your face if the resident orthopods are protective of their patch, nothing much you can do about that.

    Having jumped through the relevant hoops your application will go before the Consultants Committee (different hospitals have different titles for this) and subject to their approval (which, having come this far is almost a cert) you are in.

    Then its simply a question of visiting the Orthopods and Rheumatologists (+ Radiologists if you are going to be using x-ray facilities) and telling them what you do.
    Your profile will go on the Hospital website, and GP referrals will start to come your way, albeit slowly at first. You should also, at this point, register with as many Private Medical Insurance Companies as a Provider.

    Manke sure you go in on the same terms as the other Consultants (ie pay rent and take a Consulting Room for a session a week or every other week). Don't go down the route of taking some space in Physio because it seems easier to do - you won't make much money that way, and its hard to retain autonomy of treatment.

    Hope this is useful..
    Regards,

    David
     
Loading...

Share This Page