Private Practice and Fee Paying Work Policy. Martin Kuper, Medical Director Justin Betts, Deputy Director of Finance Version 2.0

Transcription

1 Private Practice and Fee Paying Work Policy Author(s) Martin Kuper, Medical Director Justin Betts, Deputy Director of Finance Version 2.0 Version Date May 2017 Implementation/approval Date May 2017 Review Date May 2020 Review Body Audit Committee Policy Reference Number Table of Contents 1. Purpose Introduction Scope Roles and Responsibilities Policy Statements Private Practice Disclosure of information about Private Practice Doctors with an NHS contract and practising privileges Fee Paying Work Use of NHS Resources Collection of Charges Job Plan Medical Indemnity Training and awareness Review Monitoring/Audit Sources of Evidence; References / Bibliography Related Policies Equality Impact Assessment Appendices Appendix A- Equality Impact Assessment Appendix B - Policy Submission Form

2 1. Purpose This policy sets out the Trust s current position on private practice and describes the arrangements and control mechanisms for fee paying work at the Trust. Staff are expected to have a proper level of awareness of the Terms and Conditions of the contracts they have entered into and the conditions they impose in relation to private practice and fee paying work. 2. Introduction A Code of Conduct for Private Practice published in 2003 makes it clear that NHS staff may not use NHS facilities for the provision of private services without the agreement of their NHS employer and that entitlement to use NHS facilities, staff and resources for private purposes is at the discretion of the responsible NHS body. The same principles which apply to private practice generally apply to fee paying work. Fees should only be retained if a staff member provides services for which he or she is not remunerated as part of basic salary. 3. Scope This policy applies to all staff working in the Trust, in whatever capacity. A failure to follow the requirements of the policy may result in investigation and management action being taken as considered appropriate. This may include formal action in line with the Trust's disciplinary or capability procedures for Trust employees; and other action in relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary arrangement. 4. Roles and Responsibilities All staff undertaking private or fee paying work have a responsibility to adhere to this policy. Managers have a responsibility to ensure their staff adhere to the policy and investigate issues as required. It is up to the individual to declare any fee paying work being undertaken. Anyone found to be acting fraudulently i.e. undertaking private work in NHS contracted hours and not declaring this to the Trust may be subject to criminal and/or disciplinary action and investigation by the Trust s Local Counter Fraud Specialist. 5. Policy Statements 5.1. This document outlines the local policy and local arrangements to be followed in the provision of fee paying work (schedules 9, 10 and 11) including Category 2 work (paragraphs and paragraph 37 of the pre 2003 terms and conditions of service). The policy is in line with the Department of Health guidance A Code of Conduct for Private Practice published in April The same principles which apply to private practice generally apply to fee paying work All Staff (including consultants remaining on the old contract) must adopt and comply with the Code of Conduct. 6. Private Practice Private practice is defined for consultants and other hospital staff as the diagnosis or treatment of patients by private arrangement. Staff can only see private patients at Homerton with the employer s written agreement. The Trust has no dedicated resources such as NHS secretarial services or facilities for private patients. Should the Trust s position change, a separate framework will be drawn up setting out the arrangements that will apply for dealing with private patients. 6

3 7. Disclosure of information about Private Practice 7.1. All staff should declare any private practice which may give rise to any actual or perceived conflict of interest, or which is otherwise relevant to the practitioner s proper performance of their contractual duties For consultants and other levels of doctors providing fee paying services; as part of the annual Job Planning process (section 12) should disclose details of regular private practice commitments, including timing, location and broad type of activity, to facilitate effective planning of NHS work in hours and for out-of-hours cover. 8. Doctors with an NHS contract and practising privileges Doctors undertaking private practice, who also hold an NHS contract, will need to participate in whole practice appraisal within their NHS appraisal, to cover all elements of their practice. Appraisal of this nature takes place in the NHS, using NHS appraisal forms, together with relevant data provided from the independent sector provider, and a certificate to confirm the renewal of practising privileges. Where a doctor has practising privileges with more than one independent provider, this information will need to be provided from each independent hospital. If the private hospital wants confirmation of annual appraisal, this can be provided by the revalidation administration team. Full details of private practice must be disclosed in each annual appraisal scope of practice. The medical director or responsible officer of a private hospital will be routinely contacted before a doctor is revalidated, to provide information and assurance around any significant incidents, complaints or concerns. 9. Fee Paying Work 9.1. In line with NHS guidance, where fee paying work is undertaken within an individual s programmed activities, the fee should be remitted to the Trust, or an authorised account held within the Trust. The Trust will re-invest these monies for the hospital and where possible ensure that a proportion is allocated to the relevant specialty or into a departmental fund subject to the agreement of the Medical Director In line with NHS guidance, where fee paying work is carried out in the individual s own time or in annual or unpaid leave, the member of staff may retain the fee Participation in fee paying work should not result in detriment to NHS patients or services or diminish the public resources available for the NHS. The Trust therefore requires time in excess of one hour per week devoted to fee paying services to be notified to the Associate Medical Director. Time under this limit should be discussed as a matter of good practice, but it is recognised that very infrequent fee paying work may not need to be formally discussed. 10. Use of NHS Resources The Trust will not provide any administrative facility or consultation space for fee paying activities without formal Executive Director approval of the activity concerned NHS secretarial support staff will not be used to support fee paying activities during the contracted working day including lunch breaks. 7

4 11. Collection of Charges Staff may not use NHS facilities, staff and resources for fee paying work without the explicit agreement of the Trust. The Trust will set the charges for the use of its services, accommodation and facilities including any associated administrative costs where appropriate, used in connection with fee paying work. The Paying Patient Officer will take responsibility for co-ordinating fee paying activities but this will be with the explicit agreement and authorisation of the finance department. Once formal agreement has been received the conditions set out in sections 11.2 to 11.6 below must be met In undertaking fee paying work where hospital facilities are used, the charge made by the doctor to the person or third party shall represent two elements: payment for professional services and payment for NHS services, accommodation and facilities Named individuals will be authorised to invoice and obtain payment for fee paying work directly from patients or other parties The Trust will collect its charge from the relevant member of staff who in turn will take responsibility for collecting the charge from the third party commissioning the work and make an administrative charge to the authority where appropriate. The trust will collect its charge from the individual regardless of whether or not the individual receives payment for the provision of the service Should a member of staff undertake fee paying work for other organisations using Homerton facilities, it is the individual s responsibility to ensure that staff are made aware of the patient s status Income classified as fee paying income (i.e. where a charge is made for use of NHS resources) should be reported to the Finance Department on an annual basis by the doctor The Trust is not limited to charges which seek to cover costs only The Trust reserves the right not to make a charge where minimal costs are involved. 12. Job Plan All scheduled and unscheduled fee paying work should be detailed by description, location and time involved. Where fee paying activities do not occur regularly, an annual assessment and declaration of activity is appropriate The member of staff and the Associate Medical Director should agree as part of the job plan and job plan review how and when any fee paying work should be carried out Where fee paying work is likely to affect the performance of duties set out in the job plan, the member of staff should agree with the Associate Medical Director at least two months in advance how this should be handled and where necessary, agree a revised schedule of private practice Programmed NHS commitments must take precedence over private work. Consultants must ensure that, except in emergencies, private commitments do not conflict with NHS activities included in their NHS Job Plan and ensure appropriate cover is planned for private work/ patients when NHS programmed activities are scheduled. Consultants should ensure in particular that: private commitments, including on-call duties, are not scheduled during times at which they are scheduled to be working for the NHS there are clear arrangements to prevent any significant risk of private 8

5 commitment disrupting NHS commitments, e.g. by causing NHS activities to begin late or to be cancelled; private commitments are rearranged where there is regular disruption of this kind to NHS work; and private commitments do not prevent them from being able to attend a NHS emergency while they are on call for the NHS, including any emergency cover that they agree to provide for NHS colleagues. In particular, private commitments that prevent an immediate response should not be undertaken at these times. 13. Medical Indemnity Consultants must ensure that fee paying work is covered either by NHS indemnity or by their Medical Defence Organisation, taking out additional cover if necessary. 14. Training and awareness There is no training required for this policy 15. Review This policy will be reviewed in 3 years time. Earlier review may be required in response to exceptional circumstances, organisational change or relevant changes in legislation or guidance. 16. Monitoring/Audit Monitoring of compliance with this policy will be the responsibility of the Audit Committee. Staff who become aware of breaches of this policy should immediately notify Local Counter Fraud Specialist or their manager. Measurable Policy Objective To ensure that the arrangements and control mechanisms for private and fee paying work are compliant with the Trust policy. Monitoring/Audit Frequency of monitoring Responsibility for performing the monitoring Monitoring reported to which groups/ committees, inc responsibility for reviewing action plans Internal Audit Annually Justin Betts Audit Committee 9

6 17. Sources of Evidence; References / Bibliography The Code of Conduct for Private Practice (2003) 18. Related Policies Standards of Business Conduct - Declaration of Interests, Hospitality and Gifts 10

7 19. Equality Impact Assessment The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. An Equality Impact Assessment Screening has been undertaken and there are no adverse or positive impacts 20. Appendices Appendix A Equality Impact Assessment Appendix B Policy submission Form Fraud & Corruption Policy Page 11 of 11 April 2009

8 Appendix A- Equality Impact Assessment Policy/Service Name: Author: Role: Directorate: Private Practice and Fee Paying Work Policy Martin Kuper Medical Director Corporate Date May 2017 Equalities Impact Assessment Question 1. How does the attached policy/service fit into the trusts overall aims? 2. How will the policy/service be implemented? 3. What outcomes are intended by implementing the policy/delivering the 4. How will the above outcomes be measured? Yes No Comment Sets out the Trust's policy and advice to relevant staff regarding private practice and fee paying. Through dissemination to staff at induction and monitored by the Audit Committee Standardisation of the arrangements for the management of private practice. Monitored and evaluated by the Audit Committee. 5. Who are they key stakeholders in respect of this policy/service and how have they been involved? 6. Does this policy/service impact on other policies or services and is that impact understood? 7. Does this policy/service impact on other agencies and is that impact understood? 8. Is there any data on the policy or service that will help inform the EqIA? 9. Are there are information gaps, and how will they be addressed/what additional information is required? 10. Does the policy or service development have an adverse impact on any group? All Staff Private Practice & Fee Paying Work Policy Page 11 May 2017

9 11. Could the way the policy is carried out have an adverse impact on equality of opportunity or good relations between 12. Where an adverse impact has been identified can changes be made to minimise it? 13. Is the policy directly or indirectly discriminatory, and can the latter be justified? 14. Is the policy intended to increase equality of opportunity by permitting Positive Action or Reasonable Adjustment? If Note 1 If any of the questions are answered yes, then the proposed policy is likely to be relevant to the Trust s responsibilities under the equalities duties. Please provide the ratifying Committee with information (the form ) on why yes answers were given and whether this is justifiable for clinical reasons. The author should consult with the Director of Workforce & Education to develop a more detailed assessment of the Policy s impact and, where appropriate, design monitoring and reporting systems if there is any uncertainty. Note 2 A copy of the completed form should be submitted to the ratifying committee when submitting the document for ratification. The Committee will inform you if they perceive the impact to be sufficient that a more detailed assessment is required. In this instance, the result of this impact assessment and any further work should be summarised in the body of the Policy and support will be given to ensure that the policy promotes equality. Private Practice & Fee Paying Work Policy Page 11 May 2017

10 Appendix B - Policy Submission Form To be completed and attached to any policy or procedure submitted to the Trust Policy Group 1 Details of policy 1.1 Title of Policy: Private Practice and Fee Paying Work Policy 1.2 Lead Executive Director Medical Director 1.3 Author/Title Martin Kuper, Medical Director 1.4 Lead Sub Committee Audit Committee 1.5 Reason for Policy Compliance with Code of Conduct for Private Practice 1.6 Who does policy affect? All Staff working in the Trust 1.7 Are national guidelines/codes of practice incorporated? 1.8 Has an Equality Impact Assessment been carried out? 2 Information Collation 2.1 Where was Policy information obtained from? 3 Policy Management 3.1 Is there a requirement for a new or revised management structure if the policy is implemented? 3.2 If YES attach a copy to this form Yes- The Code of conduct for Private Practice (2003) Yes Existing Policy - The Code of conduct for Private Practice (2003) No 3.3 If NO explain why Complies with existing management structure 4 Consultation Process 4.1 Was there internal/external consultation? Yes 4.2 List groups/persons involved LNC Audit Committee 4.3 Have internal/external comments been duly considered? Yes 4.4 Date approved by relevant Subcommittee 4.5 Signature of Sub-committee chair May Implementation 5.1 How and to whom will the policy be distributed All staff via the intranet Private Practice & Fee Paying Work Policy Page 11 May 2017

11 5.2 If there are any implementation requirements such as training, please provide details. 5.3 What is the cost of implementation and how will this be funded? None None 6 Monitoring 6.1 List the performance indicators e.g. core standards 6.2 How will this be monitored and/or audited? N/A 6.3 Frequency of monitoring / audit Private Practice & Fee Paying Work Policy Page 11 May 2017