Implications of AQP for privatre practice V's NHS

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Hi all

I've been to many meeting regarding the Health and Social care bill and the implimentation of Any Qualified Provider for podiatry services.

After having a letter from a local NHS podiatry dept advertising that they can now do cut price orthotic milling as they now have a new and high tec milling machine, I was quite concerned that this sort of practice will become more wide spread.

I.E NHS under AQP will be touting for privately funded customers. The problem here is that, as with the example above, it would be a totally uneven and unfair playing field.

This is because the NHS dept will have all the equipment, and infrastrucrure and work force already in place and paid for by public funding. There is no capitial outlay made by any private person, there is no risk by any private person, there are very few of the usual business risks involved in starting and running a viable profit making business.

If all my training, infrastructure overheads were paid for and all my equipment paid for by someone else and all I had to pay for was running costs and some profit then of course my charges could be much lower, as were the charges advertised by the aforementioned NHS dept milling orthoses.

Is this a concern considered by anyone else?

Regards Dave Smith

 

I don't understand... Are the NHS advertising for private patients?

 

In the case of the NHS pod dept orthotic milling they are advertising for customers to use the milling service, i.e. podiatrists, and undercutting other private providers like Salts, Langer etc.. I have heard rumours of other NHS pod dept doing paid for chiropody appointments very cheap e.g.for £10 or so. It's all just extra pocket money when you don't have to pay your way in the normal business sense.
I did write to my MP about this but was referred to the office of fair trading. I have yet to take it further.

Dave

 

.......Yep

 

Wouldn`t it be great if we had a representative body who could/would support private practitioners in this?

 

I think we have to take this to our MPs and trading standards otherwise every NHS pod dept will be offering cut price chiropody with completely unfair advantages.


Dave

 

You don't have to be brilliant at maths to realise that if the average NHS pod is earning 30k/annum and a receptionist is earning 15k/annum the even if you charge £10/treatment and do 3 per hour then this doesn't even cover wages and employment costs.

 

David, very interesting point that.

I remember the case of a Podiatric surgeon who got booted off the HCPC register for pushing his private practice at his place of work instead of the NHS. In other words, the chap said to pts I can do it for you privately - its better, etc. etc. etc. The thing is, he used the NHS operations theatre, their staff and their equipment, and obviously had to pay them for the services. If I recalll correctly the NHS were not happy with this and whatsmore he was outstanding on paying the NHS for the use of the overheads.

So David, my nose is itching at the moment - something is amiss. If I was you, I would do some more legwork, send a friend there for the experience, and to gain some info, e.g. name of Podiatrists, etc. Also, with regard to the Freedom of Information Act, you can request to find out exactly how this private milling thigymebob works, i.e. is it 1 Podiatrist, how much do they pay to rent the stuff, is the Head of the NHS in your county aware of the situation, etc. etc. etc.

If I was you I would also write a letter to your local newspaper, this will then get published, the local folk maybe up in arms about the matter, etc......You could also contact a solicitor for advice....

Good luck!!!

 

IF Dave has the time and the money... Its a lot for one person to do unsupported.

But it might help to put the wind up the department concerned if news of what they are doing starts to get around. Any way of distributing this advert to other forum members who have responded to your thread? Do Langer, Salts and the other labs know what going on?

 

Hi Dave

If its the same as the one I heard a couple of months ago, its one of the Kent PCT's that are producing this milled orthotics and it would appear to be offered to all the NHS and they will kindly make some for you at a price which I believe was quoted at @ £6.00. By all accounts they are an acceptable design and quality.

So I'm not sure if anyone can compete with that as an IPP unless you join em ??

Having had several letters from private medical insurers of late that are " re- designing their systems and their register of providers. In the conditions they inform me THEY will pay what THEY feel is a fair rate for a particular procedure. Looking at my crystal ball I can hazard a guess as to what they will make a fair price for orthotics in the future.

Seems the IPP is under attack from all sides and I have not seen ANY professional body supporting us in public.

Cheers
D

 

I still don't think I'm understanding the implications this.. Under the umbrella of AQP, the NHS are undercutting private labs and local private practitioners?

I once worked in a department who for a time licensed their clinicians rather than employing any. Those licensed practitioners rented out the NHS rooms were obliged to see so many NHS patients in a session, and then could use the premises to treat private patients. Are we going back to something like that?

 

They`re not necessarily using the cloak of AQP to undercut private practitioners. The link I provided http://www.solent.nhs.uk/ServiceCatInfo.asp?id=209 is to an NHS dept that have been offering `low cost podiatry` for a couple of years now. We just can`t compete.

 

I think that is making some sort of sense to me now......click on the below link:-

http://www.cqc.org.uk/directory/r1c

It clearly states that NHS Solent provide personal care and in the CQC Scope of Registation - cutting toenails comes under personal care.

If you also look at the Solent link BLinda provided, at the bottom of their advert they can refer patients to NHS Podiatry if appropriate (i.e. possibly if the person not have the money to pay for nail surgery or for insoles, etc, they can go to free NHS Podiatry)

So not impressed......:sinking:

 

OK, so I just sent a message to my friend who is an NHS manager... Not in Kent or Solent!

"Supplementary income generated for patients not eligable for NHS care... Clinics closed evenings and weekends, often with the heating left on!!! So its all paid for already including the equipment... Rooms occasionally rented out to private practitioners but usually to NHS staff doing supplementary private work. (This description doesn't quite match the Mon-Fri 9-5 service offered at Solent in the link provided by Blinda!)

I said to him, Isn't the NHS subsidising the overheads, the CPD, the holiday, sickness etc?? Do we all get fair and equal access to these cheap, heated fully equipped rooms?

But I couldn't give him a hard time over it because he is my friend and I am just asking him as a favour.

Does strike me as quite unfair but I wouldn't have a clue how to go about stopping it. I think, like Dave, I will start with a letter to the MP. Maybe mine will be more helpful or maybe he'll send me to trading standards too. I think we need to point out there isn't a level playing field here.

 

Jonix, thanks for speaking to your mate and letting us know what he said. To be honest with you, am usually quite positive, but in this case am not. Do not think you can stop it.

Also, Jonnix, (I forgot about this story) but last year I contacted a GP surgery to see if I could hire a room from them one day a week, they agreed, but I decided against it - it worked out to be £40 per day to hire. So in the NHS Solent case, instead of it been a GP surgery, its a Podiatry Dept.

 

Love feet

Why not close the whole hospital at night and hire it out to private practitioners, or have a bed and breakfast Guest House section in the closed wards, cheap beds for a tenner a night when they are spare. How about the Trust's accountant's doing cheap work on the side between 1900 and midnight. Oh that's sounds like privatisation of the NHS but with public funded subsidies to make competition unfair.

This statement from Andy Burman (Labour party) highlights a huge area of concern.

The coalition's Health and Social Care Act also in effect allows hospitals to treat as many private patients as NHS patients – raising fears that the "paying ill" may be able to jump the queue in healthcare. Burnham said the government had created a "financial climate that will incentivise hospitals to look at the new rules on private patients as a source of much-needed income". http://www.guardian.co.uk/society/2012/oct/03/private-contracts-signed-nhs-privatisation

I kind of agree with you in terms of looking at the positive, It goes against my ethos to focus on such a negative situation (on the basis of 'what you focus on the most comes to you the quickest' but I fear we may have no alternative but to fight for our businesses or loose them to ridiculously unfair business practice.

Who would like to get together to write to MP's and trading standards. I can be a bit of a bull in a china shop once I get fixated :butcher:but I know there are some out there who can be very eloquent and diplomatic in this area.:empathy:

Regards dave

 

So as an example and a caution: If we/I persue this and it goes against us then this gives the green light to other NHS depts to go ahead with a president set in their favour hence the fear we focus on comes to us more quickly. Also while we take time to fight this case we are leaving less time to make our practises better and we get discouraged and loose faith in our future because of apparent hopelessness. Grim picture :deadhorse::bang:but you get the gist.

Dave

 

Exactly, where do I sign up to get all my capital expenditure and fixed costs paid for by the state coz I'd like to be at the head of the queue for that.

Dave

 

You? Bull in a china shop? Never.

We can but try. I`m happy to help if I can.

Bel

 

Hi David,

I know exactly what you mean and yes it does frustrate me, the situation that the private Podiatrist finds themselves in, and David, I usually fight for the things I believe in, and I do agree with you that the NHS Pod dept should be open to all Pods working there privately out of hours, or during office hours, if there are spare chairs. Perhaps this can be achieved, if the correct information is acquired by FOI.

David, our main problem is The Society of Chiropodists and Podiatrists, they do absolutely F.A. to assist private Podiatrists. They have changed their website, and guess what nothing on their website explains to the public what the difference is between Pods and FHPs. That is just one of the things that annoys me about them.

David, I know you want to write to your MP, but what about this idea. Starting a campaign going on the Houses of Parliaments website. All you do is propose a campaign, and then folk can add their names and address to it if they agree. ALL campaigns are then looked at and commented on by someone in the Houses of Parliament. The campaign and comments all get done online (no paper). Anyone can put a campaign on that website, and anyone can support it (as long as they in the UK)

I can't quite remember how to access it/ find it on the Houses of Parliament website, but if you leave it with me.....I can tinker with it sometime this week and get back to you, if you interested....

 

Love feet

I'll look into your suggestions

Blinda

A Bull and Tiger ooh that could get messy Grrr!

Dave

 

Here we go David......click on link below:-

http://www.parliament.uk/get-involved/have-your-say/petitioning/

and then click on the below link:-

http://www.parliament.uk/get-involved/have-your-say/petitioning/public-petitions/

Good luck!!!

 

Happy to be in on this.

I was drafting a letter last night, though I realised as I was doing so that it would need a few more "facts" than I have to hand in order to make it sound like I know what I am talking about!

Even though this has not come to my locality yet, I feel quite strongly after reading your stories. In addition to taking on all those invoices and responsibilities, private practitioners take a huge personal risk when they set themselves loose of the monthly guaranteed wage that was theirs when they had a "proper" job.

All this could be given up to a lucky few podiatrists who do have the safety net of monthly wages, working for "extras" on evenings and weekends, with no personal risk and little responsibility to maintain the rooms.

And although it is good in the short term for patients to get their feet done extremely cheaply, and it makes a good sound-bite to mention income-generation, it is likely it would be unsustainable in the long run. And it doesn't say much for or profession that we are happy to value ourselves that low.

I think we need to be cc'ing the Society in on this, even if they haven't been much help in the past. How about finding out what Langer's take is on it also?

 

FYI attached are My letter / email and the reply letters from My MP Damien Collins and Kent NHS.

Dave

NB for some reason when saved in attachment extra blank pages appear so keep scrolling down to see the complete set of documents.

 

Done that at the weekend, obviously no reply yet.

Dave

 

Been there. Done that. Here`s hoping igs:

 

Dave, I can`t open the doc (Probably my connection at work, which is pants...). Could you please email it to me?

Cheers,
Bel

 

Maybe dropping a letter to these folk may help the cause as well:-

Jeremy Hunt, Secretary of State for Health can be contacted at the Dept of Health:-

http://www.dh.gov.uk/health/contact-dh/

for those Podiatrists living in the South West Surrey area, they can also put local pressure on Jeremy Hunt as he is their local MP, they can do this by clicking on the below link:-

http://www.jeremyhunt.org/contact

You may want to contact private Podiatrists in the South West Area and explain your situation to them and see if they and then friends and family in the local area will write to Jeremy, at the end of the day, they are politicians and they want votes, so the more local pressure put on them, the harder he would probably work for the cause....

Good luck!!!

 

Dave et al.

All of the concerns you highlight here have been raised repeatedly at Council (SCP) over the last four or five years but have landed on ears packed tight with cotton wool. Council are well aware of the implications for the private practictitioner, but the driving force for AQP is, I am led to believe, not so much the DoH but the Prime Minister's Downing Street policy unit. Whether it has been championed by one of the podiatry advisors, I have no idea, but the lack of enthusiasm for any form of opposition by the Society can best be summarised by a recent statement, "We support members regardless of their workplace".

The government do not wish to see claims of patients being denied care so the NHS is being encouraged to develop services for private patients within its own environs. Facilities can be used by any person who fulfils the criteria under AQP - including NHS Partners. In Podiatry, this means Age Concern or Age UK volunteers or non-HCPC clinicians. Corporate entities will also be able to use clinical facilities without restrictions on qualifications or experience.

Think of it as an extension of the State monopoly on healthcare provision using the banner of the NHS to make it more acceptable to a sceptical public - bringing in private care through in-house commissioning, before securing payments from private consortia for running the services directly. Worth bearing in mind that the present chair of Council works, I understand, for Virgin Health. Prior to that as a NHS Manager and Dean of Faculty of Management.

Will it impact on the existing independent practitioner? Probably, yes. At least in the short term. Will it work? Probably not.

Kindest

 

Hi DTT and All

We picked up on this 6 months ago and actually complained to the Mods on here as "they" were advertising in posts without paying for advertsing slots on the arena here.

DTT the fee scale for the product depends upon type and level of finish i have been told. Milling is also different to designed and finished product.

In honesty i do have several INSOLES from Kent in my possesion. They are not Bespoke orthoses and are not a quality orthoses product as the majority of Private Practitioners, that i know, would use for fee paying patients.

Sure they have the kit, but the ability and the 30 minutes of CAD design Time for a full volumetric orthoses to be designed..... Not for £6. A sized and rough shaped insole for £20 maybe :boxing:

We all get what we pay for, when all said and done.

The issue is that the public sector would be funding the product for the private sector, even at 3 times that £6 cost.

A 30k batch of plastic in the dimension/thicknesss to manufacture bespoke Orthoses, direct from Manufacturers (even China) will work at more than that per unit when handling is considered. And i firmly believe that you can not produce something for nothing!

Steve

 

Hi Steve
In my area the NHS are turning out insoles that are 7mm Felt stuck onto a slimflex ,secured with mefix which are about as much good to the patient as a matchbox full of frogs !!.
On top of which they bring the profession into disrepute and ridicule from the patients and their relatives :bash:

ANYTHING the NHS can turn out MUST be an improvement on that so therin lies the precedent for moving to these new NHS produced ( OTC) type.

I agree that you wouldn't use them for fee paying patients BUT will the insurance companies worry about that ?? a lot wont pay for orthotics anyway and or the diagnostics as everyone and their mother are on the orthotic bandwagon and advertising them as a cure all appliance.

I am watching many of my colleagues who once had thriving practices and are very competent professional pods sitting around with reduced patient flow in all aspects of podiatry ( my yearly figures are around 100 patients down on the previous year) because the work is being usurped by other professions / organisations including the NHS, and everything now revolves around cost rather than quality in many cases.

I still insist on quality at a fair cost in my practice and am not particularly bothered by the reduction in numbers as I am established but I really feel sorry for newly qualified pods with no NHS jobs and trying to set up as an IPP with no help from any professional body of any description supporting them or making any attempt to protect them.

I'm with you on this Steve but with some misgivings as to the future.
Cheers
D

 

AQP is the nhs it will have no impact on private practice pts having aqp podiatry do not pay for treatment. however private practitioners with aqp contracts can secure an income stream from the nhs if they get any referals. this i know cos im doing it. will it work very well probably not . and this route to income is not for the faint hearted its very difficult to deal with and become an aqp provider.

 

Fishpod
Whoever you are you must be one crazy SoB, Besides having done much research and going to meeting about these things, I've just printed off and read thru the "AQP any one doing it" thread and all here are some adjectives that come to mind or rather leap out at me -
dangerous alarming, bad, breakneck, chancy, critical, dangersome, deadly, delicate, dynamite, exposed, fatal, formidable, hairy*, heavy*, hot*, impending, impregnable, insecure, jeopardous, loaded, malignant, menacing, mortal, nasty, on collision course, parlous, perilous, portentous, precarious, pressing, queasy, risky, serious, serpentine, shaky, speculative, terrible, thorny, threatening, ticklish, touch-and-go, touchy, treacherous, ugly*, unhealthy, unsafe, unstable, urgent, viperous, vulnerable, wicked.
and these
absurd, illogical, irrational, ridiculous, unsound, extreme, outrageous, unreasonable, groundless, objectionable, unacceptable, unfounded, inexplicable, unexplainable, indefensible, insupportable, unjustifiable, unsustainable, untenable, debatable, disprovable, disputable, refutable, indemonstrable, unprovable, unsupportable, unverifiable, agonizing, appalling, awful, bad, cruel, dire, dreadful, excruciating, frightful, ghastly, grisly, gruesome, harrowing, harsh, hideous, horrendous, horrible, horrid, horrifying, lurid, macabre, monstrous, nasty, nightmarish, painful, rotten, shocking, terrible, tormenting, torturous, unfortunate, vicious, vile, wretched, acute, intense, piercing, abhorrent, deplorable, disgusting, distasteful, loathsome, nauseating, obnoxious, offensive, repugnant, repulsive, revolting, sickening, abominable, evil, foul, heinous, noxious, odious, unspeakable, insufferable, intolerable, unbearable, unendurable.

In the form it is in now that is my thought on AQP - apart from one option that may be a route to making real profit from your admirable efforts so far. It came to my attention a while ago and you may be able to take advantage of it. You could contact me on david@foothouse.co.uk

Regards Dave Smith

 

So you're up for it then?

 

Dunno about that Mark But it sounds like Dave's on a roll :drinks

Cheers
D

 

sent u a pm dave hope to make a profit do,1 40 min appt followed by 2, 10 minute dressing appts get 150 quid for this episode of care. wait to see figures april 2014

 

unfortunatly aqp is the only game in town to get nhs funds some pods can make local arrangments with ccgs pcts pod depts but these arrangments are few and far between but they do exist. the powers that be made the application almost immpossible they were not going to drop thier trousers and let us give em a spanking .by completing the tender document i have learned more than in the last 20 years i have looked into things i did not even know existed my wife who helped me also gained a great deal from this fustrating game. i am quite proud i got the letter saying you have been successful felt like framing it and putting it on my office wall at home.not sure now how its all going to work you have to make it up as it goes along and hope for the best.

 

That's not bad but I charge £160-£180 many private pods currently charge almost double that for the same. I doubt that the 40 minute appointment includes initial assessment, history, informing/educating patient and consent plus note writing and after care forms and GP letters. From my experience I reckon probably there's a lot of extra hidden time in there. And then you have a lot of consumables in the mix like, syringes, LA, sharps disposal, disposable sterile tools, dressings and other paraphenalia, which I cost at about £14 per each procedure. By the time you take out the cost of gaining AQP and the extra costs of admin (didn't you say you've had to employ an extra person to run the admin?) to run AQP and normal fixed cost overheads I'll bet there's not a lot of fat left in that £150.

Mark wrote

Well even tho I'm roasting Fishpod a bit, I really don't know on this one. I've spent quite a bit of time and money looking into the AQP pit but so far can't find a really convincing argument to get into it but on the other hand what will the future bring if NHS pod departments are also offering cut price private care using public funded centres. If many pods are prepared to go the AQP route and accept ridiculously low fees (tariffs) then how will the real private practitioner compete in that market.
After all the bemoaning by Pods of FHP,s who offer low cost treatment it amazes and bemuses me that some are prepared to accept low tariffs (£20 for routine chiropody has been mentioned) for NHS work. I have to say that while I admire fishpod for the huge amount of work he/she (we don't know coz he/she is anonymous, oh we do know its a man since he has mentioned his wife [could be a civil partnership tho :dizzy]) has done and been successful in terms of his objectives, I think that £150 for nail surgery with all the extra work and costs involved is a very low fee, especially when you consider consultants get that for 15 mins private consultation or your plumber will charge half that for just showing up and the local pharmacy get £40 per patient for doing a 5 minute blood test.

Regards Dave

 

Hi Dave et al

Hmm I'm with you on this Dave.

£150 for nail surgery is not a workable amount if you work it out ?

£150 less tax & insurance is a minimum third gone ( if your on the 20 % band obviously more if your 40%) Phones , business rates , insurance , professional fee's, consumables ,waste disposal ,( assistant Fee) if you have one and lots more Fishpod reckons whoever can do the procedure and dressings in 1 hour total time ? I'm not sure that applies in some cases which may take longer.

So I don't think you will have a lot left out of the £150 ??

Can I ask Fishpod , how many procedures are you getting regularly per week ??

Any hope of a reasonable living from just that I would of thought have to be at least 10 per week ???

Just my thoughts
Cheers
D