COVID has led to dramatic changes in the way healthcare is accessed and delivered. In order for your practice to succeed and thrive, you need to move with the changes and innovate!

What are the advantages to your private practice of an online booking system?

1. This gives people an easy way to book an appointment with you. The modern patient expects and demands ease, access and convenience!
   
2. Prospective patients can book a consultation wherever they are and whatever the time of day (or night!). They can do their scheduling when it suits them, without the frustration and delay of needing to call your team during your office hours, which may not always fit in with their lifestyle and commitments. Believe me, if they can’t contact your practice to book their appointment, patients will go elsewhere.
   
3. Patients like to be able to make their own choice of appointments from your availability. They like to be able to see this for themselves rather than be told verbally by your receptionist or medical secretary of what appointment date and time they can have.
   
4. No-shows should be reduced. If the patient has selected his or her own appointment, they are more likely to attend – more on this below.
   
5. Your office phone isn’t tied up during the appointment-making process, preventing other callers from getting through, and the system can handle more than one person at a time.
   
6. Practice management software can automate the entire online booking process – and this can all happen without input from your practice staff who can be getting on with other things. You can automate your response to send:-

• A welcome message and an appointment confirmation to the patient by text or E-mail.

• An online registration form which can be completed by the patient in his or her own time and returned prior to the appointment and the patient can be registered to your practice management system before they attend. This will save time on arrival, enabling your team to give a warm welcome without a questionnaire, pen and clipboard in sight!

In addition:-

• The patient can pay for the consultation at the time of booking – and if the patient has paid up front, he or she will be so much more likely to keep the appointment.

• The patient can also receive a text or E-mail appointment reminder at a point which you determine prior to their visit.

So … an online appointment scheduling system can book the consultation, take the payment, and remind the patient to attend! Win Win!

What are the disadvantages?

I can only think of one and that’s inappropriate consultations. If the patient speaks to a real person in your practice when arranging the appointment, the patient can explain the nature of their problem and your staff can either proceed to arrange the appointment or direct the patient to another practitioner, if this is something which you don’t treat.

You do need to ward off such “misbookings” and avoid patients booking in with conditions you can’t help them with. But how can you do this?

Well, you need to be very clear – on your website and in any places where you show up online – about what conditions you can see and treat so that there can be no doubt what you can and can’t help with.

Actually, I can think of one more thing which you will need to bear in mind.

By scheduling their own appointment without speaking to someone on your practice team, if the patient has already had tests performed elsewhere the results of which would be useful to have when you see the patient, it would be easy to miss this. My suggestion for getting around this is to:-

• Include a sentence within the welcome message/appointment confirmation which asks the patient to flag this up so that your practice team can follow up on this and obtain any investigation results which they know you would find helpful to refer to in the consultation.

• Provide space for crucial information like this on your registration questionnaire – but your team must be trained to look for this and act accordingly.

Final words:-

Some private hospital groups are offering some consultants the opportunity to try out giving patients the opportunity to book their appointments online. My local BMI hospitals in Birmingham are offering this, but only if consultants have their appointments run through the BMI Healthcare patient management system. Similarly one of my local Spire hospitals has introduced a “book now button”, but again the consultant must have his or her appointments run via the hospital’s in-house appointment system. There are certain criteria that the consultant must meet, but both hospital groups are offering this free of charge, and I’ve certainly encouraged my consultants to give this a go.

Sue Wilcox is an AMSPAR qualified medical secretary. She has worked as a medical secretary in the NHS and private sectors for almost 40 years. She is the Director of The Medical Secretariat Limited which provides medical secretarial and administrative services to consultants in private practice. You can contact Sue by phone on 0121-242 3299 or 07954 433201 or via E-mail at info@med-sec.net.

I would like to thank Tom Hunt at PPM and Gary Parker at Midex Pro for allowing me to pick their brains about how cloud-based practice management systems can work with an online appointment booking system.

People are more than ever before “living their lives online”. They want goods and services to be delivered to them without having to leave the safety of their own homes, and this increasingly includes their healthcare. You need to recognise that and adapt to it, where you can.

Adapting your service to offer ‘remote’ consultations by video or telephone will:

• Allow you to keep your practice open – your hospital base may suspend in-person visits totally and immediately. “Going virtual” may be the only way you can keep your practice open.

• Maintain some income for you at a time when you have no new money coming into the practice.

• Enable you to help patients who are looking for the expertise which you have and are desperate for advice, reassurance or medication straight away, even though face-to-face consultations may not be an option for them or for you right now.

• Some patients will prefer a video or telephone consultation with you – for their safety and convenience. They don’t need to travel, it will minimise their exposure to other people, and they can “meet you” from the comfort of their own homes.

• Give you an additional fee-earning service that you can continue to offer to your patients after the COVID-19 restrictions have been lifted. Patients needing an appointment with you to discuss normal test results and who would then probably be discharged don’t need to see you in person. This is the type of consultation which would work brilliantly by video or by telephone.

Don’t be tempted to think of this as a temporary or interim measure – you can if you want, but this really would be a mistake!

The way healthcare is delivered has changed, and the way patients want to access their healthcare has also changed … and I’m not sure this will ever quite go back to the way it was pre-COVID.

Forward thinking practices should integrate virtual consultations into their future practice strategy and run these alongside their normal way of doing things. Getting this up and running in your own practice will get you ahead of the game in a world which is moving ever more online.

Like to know more? I’ve written a free eBook about this. Click here if you’d like a copy.

Sue Wilcox is an AMSPAR qualified medical secretary. She has worked as a medical secretary in the NHS and private sectors for almost 40 years. She is the Director of The Medical Secretariat Limited which provides medical secretarial and administrative services to consultants in private practice. You can contact Sue by phone on 0121-242 3299 or 07954 433201 or via E-mail at info@med-sec.net.

It’s been said many times, but your medical secretary can make or break your private practice. She (or he – but most probably she) will usually be the first point of contact for your patients or prospective patients – either on the phone, by E-mail or face-to-face – and the way she handles that contact could easily be the difference between whether the patient chooses to come to see you … or not. Your patient’s dealings with your medical secretary will also colour his or her perception of your private practice … and of you … without even meeting you and regardless of what a great doctor or surgeon you are!

It’s so important that you choose your medical secretary carefully, and I will be dealing with what you need to consider when recruiting for this important role another time.

Let’s get back to business. I’m going to assume that you’ve chosen your perfect match, that she will not be working remotely, that you will be employing her, and that she’s ready to start work for you. Now, how are you going to get the best out of her? How are you going to make her feel that this is the most amazing job she has ever had, you’re the nicest and best boss she has ever worked for, and that she’s never going to leave – if she’s really good, you’ve got to be able to hang onto her!

Say hello!

It’s really important that you don’t just leave your new medical secretary to her own devices and let her sink or swim. Try very hard to be there on her first morning to welcome her to your team. If you can’t be there yourself, nominate someone else who can do this for you and take her to her desk and show her where things are, but do see her yourself as quickly as you can – or ring her.

Make sure your medical secretary understands what you expect of her and how you like things done

Set aside some time when you can talk to her about this, face-to-face, within her first couple of days – preferably first thing on her first day. This should include how and when she can contact you, how you would like her to answer the phone, what you would like her to call you, how you want her to deal with your patients, how you would like her to respond to E-mails, where and when you see your patients, how long you allocate to new and old patient consultations and what your fees are, useful telephone numbers and E-mail addresses and your GDPR policies. If she will be typing your letters, make sure she knows how you like them to be set out. It’s also useful to have a list of your regular medical terminology or terms. If you’re a surgeon, she will need to know what are your most common procedures and how long do you need in theatre to do these, whether she needs to order in any special equipment for you and what that is, how long will the patient expect to be in hospital, what are the procedure codes, who are your preferred anaesthetists, and in what order should she approach them.

You should really have a Practice Manual which she can refer to and which should give her all of the information she needs to do her job. If you don’t have a Practice Manual, then I would strongly urge you to make one! This can be kept digitally and can be added to as new things arise. Please get in touch if you need help with writing a Practice Manual.

Make sure she understands what it is that you do and that she can explain it to others

Your medical secretary will be the front line for enquiries to your practice from potential patients and existing patients, other healthcare professionals or members of the public. It’s vital that your secretary has the knowledge she needs so that she can represent you to others. She will need to know whether you perform a particular procedure, how long it takes you to do it, when the patient can expect to resume driving, sport, work etc, how much it costs, how quickly the patient can see you, how soon the patient can have their procedure. We’ve all spoken to companies where we have asked about a particular service and, if the person on the other end of the phone or E-mail doesn’t seem to know their stuff or has a poor telephone manner, we’ve become irritated and have moved on. The same is true for your practice. Your medical secretary must understand what you do and be able to answer questions from patients in a way that is competent and professional. If she doesn’t, you will lose work and the reputation of your practice will suffer.

Ensure that she has decent equipment so that she can do her job

If you’re responsible for providing your medical secretary’s computer, printer, wi-fi connection and software, make sure it’s of good (preferably high!) quality and that everything works. She needs proper tools to be able to do her job and to do a good job for you. Unreliable equipment and/or computer systems can be a huge source of stress and frustration for her. If she needs some training in order to be able to use your practice management systems, then ensure she gets this within her first few days.

Make sure she feels her contribution is recognised and appreciated

If you feel she is doing a good job, then tell her! If your patients pass comment to you about her, feed that back to her. A very occasional token of your appreciation, which need not be expensive and need not be frequent, would also make her feel valued. A simple but heartfelt spoken thank you goes a very long way!

Involve her

Create a working environment where your medical secretary feels that she can offer suggestions or make constructive comments about your Practice and how things are done. She will have skills and expertise which you don’t, and will probably be able to offer you ideas about how some things could be done differently or more efficiently or new initiatives which could be adopted by your Practice. She could also be a useful sounding board for ideas which you have. It’s important that your medical secretary feels that she can make suggestions and that those suggestions will be heard. It will also make her feel an important part of your team. If she feels valued and involved, she will be more inclined to go the extra mile for you and to remain loyal to your Practice.

A business not a job

It’s important that your medical secretary recognises and understands that your private practice is a business and that it needs to be run efficiently and profitably. Involve her in your Practice’s performance reviews so that she understands how well (or otherwise) you are doing. She may be able to make suggestions about how doing things slightly differently may save you money or bring in greater revenue.

Be nice!

You will get so much more out of your medical secretary if she isn’t intimidated by you!

Reward her for her hard work

Pay her a decent wage. Money isn’t everything and some statistics show that for some people things such as job satisfaction rate higher than monetary reward. However, obviously what you earn is important and you should recognise your secretary’s skills, experience and contribution to the success of your Practice by giving her a realistic salary and benefits. It would also be useful to have a structure in place for appraisals, personal development and training and annual salary increases. If in doubt, look at what the NHS pay scale for medical secretaries who are typically pegged at Band 3 or Band 4. It would be worth trying to find out how much your local private hospitals pay their medical secretarial staff, although you may struggle to find out because many of the private hospitals are often very coy about this, hiding behind the words “we pay a competitive salary” when conducting their own recruitment campaigns. Alternatively, ask your colleagues what they are paying their private practice staff.

Boundaries

Avoid texting, E-mailing or calling your secretary in the evening or at weekends unless it is critical. If you do need to encroach upon her personal time, stress that this really was unavoidable and thank her for responding.

Final words

If you find the right person to be your medical secretary and you can get the best out of her, she will be your right hand; your advocate, your helper, your gatekeeper and an ambassador for you and for your practice. If she knows what you need from her and how you like things to be done, she will be able to make administrative and logistical decisions on your behalf, and you must be able to trust her to do this in the way you would like. She must be able to make your day run more smoothly and her input will be designed to leave you free to focus on what you do best – seeing and treating your patients.

Sue Wilcox is an AMSPAR qualified medical secretary. She has worked as a medical secretary in the NHS and private sectors for almost 40 years. She is the Director of The Medical Secretariat Limited which provides medical secretarial and administrative services to consultants in private practice. You can contact Sue by phone on 0121-242 3299 or 07954 433201 or via E-mail at info@med-sec.net.

If you think you might like to take on medico-legal work, you must first ask yourself three very important questions. Here’s a big hint. Unless you can answer “Yes” to all three questions, don’t do it!

1. Do I have the time to do this?
2. Can I afford it?
3. Am I prepared to find myself in the witness box, being cross-examined about my opinion and report?

Before we start, you need to know where your work will come from. Requests for medico-legal reports, otherwise known as ‘instructions’, usually come either from medico-legal reporting agencies who handle the appointment process and procurement of the consultant’s report (and sometimes any follow-up work on a case) or directly from solicitors. Agency and solicitor instructions bring different considerations for a consultant.

Medico-legal reporting agencies will have very strict ‘service level agreements’ or SLAs which you must agree to meet before you will be accepted onto that company’s Panel of Experts and be eligible to receive instructions from them. You’ll have to agree to meet very strict deadlines for providing an appointment, submitting your report, and responding to any requests for follow-up work on a case. These deadlines are short – typically 24 hours after you’ve received all of the paperwork for an appointment date to be offered, and 7 to 10 days from the patient (or client as the patient will now be known) seeing you for assessment for your completed report to be in the hands of the agency.

Believe me, the medico-legal reporting agencies take their SLAs very seriously indeed and you (or most probably your medical secretary) will be chased regularly and relentlessly if you’re late. I’ve been on the receiving end of this if any of my own medico-legal consultants run late with their work and, guess what, it’s utterly miserable!

If you don’t think you can meet these deadlines, my advice to you is … find another way to develop your practice.

That said, you may fare better with a direct instruction from a solicitor and my experience has shown that, when dealing directly with a solicitor, you may be able to negotiate a longer turnaround time for your medico-legal report.

Can you afford it?

What a strange thing to say, I hear you say! You will be introducing a new revenue stream and making more money, so of course you can afford it. Right? Well, not necessarily! I have to tell you up front that you’re not going to be paid any time soon for the medico-legal work which you do. This will expose you to real cashflow problems, especially if you invest a lot of your time and effort into this kind of work.

If you receive your cases directly from solicitors, they may ask you to wait until the settlement of the case before they pay you any of your fees. Beware! This may take years and you’ve still got to pay tax on this! If your cases are sent to you via a medico-legal reporting agency, you may be able to negotiate your payment time, but this is unlikely to be anything less than 3 months from their receipt of your report, and could easily be longer.

I do need to say that if your expertise is very niche and, once your reputation as a medico-legal expert in your field is cemented, you may be able to negotiate a deal for yourself where you’ll be paid before you release your report, either to the solicitor or medico-legal agency. However, you’ve got to be really good at this work and your opinion must be very highly valued indeed by those sending you cases.

You do need to keep in the forefront of your mind that you may find yourself appearing in Court as an expert witness with any of your medico-legal cases. I have no direct experience of this, but I’m sure it’s stressful and it’s definitely time-consuming.

If you’ve decided that you do have time to devote to having a medico-legal practice and you can accept the financial implications, let’s get down to the nitty gritty. What do you have to do next? Here are my suggestions:-

Get some training in report writing skills

You will need to know how to construct a medico-legal report and ‘the legals’ which need to be included to make your reports CPR (Civil Procedure Rules) compliant. Bond Solon run day courses for medico-legal report writing in a number of locations and some of the medico-legal reporting agencies have software which, depending on your speciality, can be used to help you to ‘write’ your report.

Bond Solon also offer a course on courtroom skills and giving evidence which might be worth investing in a little further down the line.

Think about what sort of cases you could help with

By this I mean what sort of injury or condition you are highly familiar with and can provide a clear opinion and prognosis about in terms which a layperson can understand.

Start to assemble the documentation which you will be asked for by the medico-legal reporting agencies or solicitors

… so that you have this ready to send when you approach them for inclusion on their Panel of Experts.

Depending on the agency, this will include some of the following:-

• Your full CV
• A brief medico-legal CV – this should be no more than 2 pages long
• Your medico-legal Terms and Conditions – this will need to be personalised to the ‘deal’ which you have been offered with the individual medico-legal reporting agency or solicitor
• Your Indemnity Certificate
• Your ICO certificate – you do have one, don’t you? If you are not registered as a Data Controller with the Information Commissioner’s Office, do it straight away
• Your DBS certificate
• Details of where you will be seeing your medico-legal cases
• A sample report (if you have one) which is redacted
• What your waiting list is for an appointment
• Contact details for E-mails, post and telephone calls

If you need any advice with constructing a medico-legal CV from your main CV or would like a hand with writing your medico-legal Terms and Conditions, please get in touch with me.

Contact the medico-legal reporting agencies and apply for inclusion on their Panel of Experts

You will need to spell out very carefully exactly the sort of cases which would be appropriate to send to you. You might say something like this:

Mr Your Name is able to provide a medico-legal opinion in the following areas:-

• Burns
• Cutaneous scarring
• Facial injuries
• Hand injuries
• Traumatic amputation
• Cosmetic surgery of the face, body and breast

Don’t expect a medico-legal reporting agency to understand what you do just from your job title. They won’t. You must tell them.

I can provide you with the details for the major medico-legal reporting agencies. Please get in touch if you’d find this helpful.

If you want to pursue instructions directly from solicitors, you will need to research which firms handle the sort of cases which you could help with and who are the solicitors who handle those cases – and contact them directly.

Once you have done your training and got yourself registered with the main medico-legal reporting agencies, hopefully you will start to receive instructions and your medico-legal practice will be up and running.

I will talk about how to run a medico-legal practice another time.

Final Words

If your medico-legal service really takes off, you will find yourself required to register for VAT on your medico-legal work. Currently the threshold is £85,000 invoiced on medico-legal work over the course of a rolling 12 month period. This will mean that you need to add 20% to your fees and have in place an appropriate system for keeping accurate records of your VAT liability and that you make your payment(s) to HM Revenue and Customs at the due time.

You need to think about where you will keep the papers or digital files from your medico-legal cases. Although more medico-legal reporting agencies will send their instructions and medical records electronically (or grant you access to a virtual portal where you can view medical records, imaging and any other documentation associated with your case(s)), solicitors and some medico-legal reporting agencies still send paper instructions including medical records – and these can be bulky.

It is essential that you have a safe and secure location to store these physical notes (and for any digital records of course), and you may be required to retain these for many years after the case has settled. I’ve found some advice on the MDU’s website which suggests that records should be retained for 10 years after the case was closed or the last correspondence was received from the solicitor about the case.

You must also ensure that, after this time, you dispose of the papers securely. Appropriate methods may be by incineration or cross-cut shredding which you can do yourself, or you could engage a commercial company to do this for you, but you must make sure that they hold the necessary accreditations first.

You also need to retain a copy of your report and any work you have done on your cases in a very secure and GDPR complaint manner on your computer system (which you should back-up) again for the timescale recommended by the MDU, and I would also advise that your reports, external hard drive and PC or MAC are encrypted and protected with a password.

Sue Wilcox is an AMSPAR qualified medical secretary. She has worked as a medical secretary in the NHS and private sectors for almost 40 years. She is the Director of The Medical Secretariat Limited which provides medical secretarial and administrative services to consultants in private practice. You can contact Sue by phone on 0121-242 3299 or 07954 433201 or via E-mail at info@med-sec.net.