Private Practice & Fee Paying Work For Medical Staff

Transcription

1 Private Practice & Fee Paying Work For Medical Staff Policy: HR69 Policy Descriptor This document sets out standards for Medical Staff employed by the Trust about their conduct in relation to private practice and fee paying work. This policy covers all private work, whether undertaken in non-nhs or NHS facilities. Do you need this document in a different format? Contact PALS or dpn-tr.pals@nhs.net If you require further help in the interpretation of this policy please contact the HR Helpdesk on If this document has been printed please note that it may not be the most up-to-date version. For current guidance please refer to the Trust Website. Document Control Policy Ref No & Title: HR 69 Private Practice & Fee Paying Work for Medical Staff Version: 2.0 Replaces / dated: Previous policy dated July 2015 Author(s) Names / Job Title responsible / Louise Hay, Medical Workforce Lead, louise.hay@nhs.net Ratifying committee: LNC Director / Sponsor: Dr Helen Smith, Medical Director Primary Readers: All staff Additional Readers: Date ratified: 22 January 2018 Date issued: February 2018 Date for review: February 2020 Date archived:

2 Contents 1. Introduction Purpose Duties within the Organisation Definitions General Standards of Practice Part 1 - Private Practice Part 2 Fee Paying Work (Schedule 10 Work) Acknowledgements Workforce Planning & Development Considerations... 7

3 1. Introduction 1.1. This policy applies to all doctors working for Devon Partnership NHS Trust, in whatever capacity. A failure to follow the requirements of this policy may result in investigation and management action being taken as appropriate. This may include formal action in accordance with Maintaining High Professional Standards, or the Trust s disciplinary or capability procedures; and other action in relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary arrangement The document sets out the standards for all doctors within the Devon Partnership Trust about their conduct in relation to private practice (part 1) and fee paying work (part 2). This policy covers all private practice and fee paying work, whether undertaken in non-nhs or NHS facilities This document outlines Trust policy and arrangements to be followed in the provision of private practice and fee paying work. This policy is in line with Terms & Conditions of Service for Doctors, the Department of Health Code of Conduct for Private Practice and the British Medical Association Code of Conduct for Private Practice All doctors are expected to adopt and comply with this policy and the aforementioned Codes of Practice. Doctors will need to be compliant with this if they wish to be considered for Clinical Excellence Awards. 2. Purpose 2.1. This policy is based on the following key principles: The Trust and its doctors should work on a partnership basis to prevent any conflict of interest between private practice, fee paying work and contractual work for the Trust. It is also important to minimise the risk of any perceived conflict of interest; although no consultant should suffer any penalty simply because of a perception; The provision of services for private patients should not prejudice the interest of NHS patients or disrupt NHS services; With the exception of the need to provide emergency care; agreed NHS commitments should take precedence over private work. 3. Duties within the Organisation 3.1. Consultants are responsible for declaring any private practice or fee paying work to their line manager or supervising consultant and through their annual appraisal Consultants should also declare any such practice through the Annual Declaration of Interest Form in accordance with the Standards of Business Conduct Policy. The form then needs to be scanned and ed to: dpn-tr.esrsupport@nhs.net 4. Definitions 4.1. Private Practice Private practice is defined for consultants and other hospital doctors in both sets of terms and conditions as the diagnosis or treatment of patients by private arrangement Please refer to para 6.1 and 6.2.

4 4.2. Fee Paying Work Fee paying work is defined as any paid professional services, other than those falling within the definition of Private professional services (above), which a consultant carries out for a third party, or for the employing organisation, which are not part of, nor reasonably incidental to, contractual and consequential services. See Schedule 10 of the Consultant Contract for further definition Please refer to para 7.1 and Mental Health Act Assessments All Mental Health Act work is classed as Fee Paying Work in accordance with the above para 4.3, unless the individual is an inpatient under Devon Partnership NHS Trust s care. The Approved Place of Safety (APOS) is not considered an inpatient setting. 5. General Standards of Practice 5.1. Disclosure of Information about Private Practice and Fee Paying Work Doctors should declare any private practice or fee paying work, which may give rise to actual or perceived conflict of interest, or which is otherwise relevant to the practitioner s performance of his or her contractual duties As part of the annual Job Planning process, doctors should disclose details of regular private practice commitments and fee paying work, including the timing, location and broad type of activity, to facilitate effective planning of NHS work and out-of-hours cover. Where fee paying activities do not occur regularly, an annual assessment and declaration of activity is appropriate Under the appraisal guidelines agreed in 2001, consultants should be appraised on all aspects of their medical practice, including private practice. In line with the requirements of revalidation, consultants should submit evidence of private practice to their appraiser If private professional services are being offered the individual should discuss this with the appropriate representative within the Trust (or though the appraisal process) in relation to Schedule 6 of the Consultant Contract - Extra Programmed Activities and spare professional capacity, particularly with regard to pay thresholds Limits to Private Practice and Fee Paying Work In accordance with the above provisions, the Trust will aim to support individuals undertaking work in the above categories, provided that in the Trust s opinion this does not interfere with an individual s ability to discharge their contractual duties and does not breach the provisions and obligations of the employee and employer in relation to the European Working Time Directive Questions of excessive practice outside of contractual duties should be dealt with informally in the first instance, by the appropriate clinical manager. In the event of a disagreement between consultant and the manager the matter should be referred to the Associate Clinical Director Failure to follow the requirements of this policy may result in investigation and management action being taken as appropriate. This may include formal action in accordance with the Trust disciplinary or capability procedures; and other action in

5 relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary arrangement. Advice from Medical Personnel should be sought if formal action is being considered. 6. Part 1 - Private Practice 6.1. Definition Private Practice is defined for consultants and other hospital doctors in both sets of terms and conditions as the diagnosis or treatment of patients by private arrangement This excludes Schedule 10 work (please refer to para 7.1 and 7.2) Use of NHS Facilities Consultants may not use Trust facilities for the provision of private services Use of NHS Staff Trust secretarial support staff will not be used to support paid private activities Any work undertaken under this category for Consultants by medical secretaries must only be done in private agreement and must be undertaken outside of contractual hours Medical secretaries must however declare any work undertaken outside of their contractual hours in accordance with the Trust s Standards of Business Conduct Policy The Trust has no obligation or liabilities relating to any such arrangement. Consultants should be aware of their duty to inform their secretaries that any income related to this work is subject to taxation and must be declared to the Inland Revenue. It is strongly recommended that consultants maintain a record of such payments (see also paragraph 6.11 for Tax Liabilities) The consultant responsible for admitting a private patient to NHS facilities must ensure, in accordance with local procedures, that the responsible manager and any other staff assisting in providing services are aware of the patient s private status Medical Indemnity NHS indemnity does not cover private practice Doctors must ensure that any private practice is covered by their Medical Defence Organisation, taking out additional cover if necessary. The Trust will not be liable for any private practice Tax Liabilities It is the responsibility of the consultant to declare to the Inland Revenue all income in relation to private practice. The Trust has no such obligation in this respect Scheduling of Work and On-Call Duties In circumstances where there is or could be a conflict of interest, programmed Trust commitments should take precedence over private work. Consultants should ensure

6 that, except in emergencies, private commitments do not conflict with Trust activities included in their job plan It is recognised that occasionally a private patient may suddenly deteriorate and require review by their Consultant. If this occurs during a NHS Programmed Activity, the Consultant must ensure that the NHS patients being cared for are safe prior to leaving the hospital. The time involved must be declared on a monthly basis and the Consultant will make himself or herself available for additional NHS work up to the same duration without additional payment Where there is or could be a conflict of interest, programmed NHS commitments should take precedence over private work Consultants should ensure that: i. Private commitments, including on-call duties, are not scheduled during times at which they are scheduled to be working for the NHS. ii. 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 Where the Trust proposes changes to the scheduling of NHS work, reasonable notice will be given to Consultants in order to rearrange private sessions and commitments NHS Facilities and Private Patients Except with the Trust s prior agreement, a Consultant may not use NHS facilities or staff for the provision of private practice Private procedures should take place at a time that does not impact on normal service for NHS patients. Private patients should not be booked on routine, elective NHS operating or other procedure lists. Private patients should normally be seen separately from scheduled NHS patients Consultants may only see patients privately within Trust facilities with the explicit agreement of the Trust. It is for the Trust to decide to what extent, if any, their facilities, staff and equipment may be used for private patient services and to ensure that any such services do not interfere with the organisation s obligations to NHS patients. This must be discussed and approved with the relevant Clinical Director or Co-Medical Director Information for NHS Patients about Private Treatment In the course of their NHS duties and responsibilities consultants should not initiate discussions about providing private services for NHS patients, nor should they ask other NHS staff to initiate such discussions on their behalf Where a NHS patient seeks information about the availability of, or waiting times for, NHS and/or private services, consultants should ensure that any information provided by them, is accurate and up-to-date and conforms with any local guidelines Except where immediate care is justified on clinical grounds, consultants should not, in the course of their NHS duties and responsibilities, make arrangements to provide private services, nor should they ask any other NHS staff to make such

7 arrangements on their behalf unless the patient is to be treated as a private patient of the NHS facility concerned. 7. Part 2 Fee Paying Work (Schedule 10 Work) Fee Paying Services are services that are not part of Contractual or Consequential Services and not reasonably incidental to them Fee paying is defined as work that arises when individuals, employers, courts or the Department of Work and Pensions (DWP) request medical examinations, reports and associated diagnostic services from practitioners directly e.g. court reports, DVLA reports, Court of Protection Orders, DOL s Assessments, LPA Assessments, MHA Assessments, Insurance Reports See Schedule 10 of the consultant contract for full definition Timeshifting One of the key principles of the consultant contract is that an individual cannot be paid twice for the same work Timeshifting occurs when fee-paying work is undertaken in place of scheduled Clinical Care activities. When this happens, the equivalent amount of Direct Clinical Care activity is built back into the job plan and undertaken without additional payment Timeshifting arrangements will be subject to regular review and can be changed by either party subject to reasonable notice Use of NHS Facilities & NHS Staff Consultants may use Trust facilities for the provision of fee paying work categorised under Schedule 10 of the consultant contract Trust secretarial staff may be used for work that falls within this category. This is contained within the job description and contractual duties of a Trust Medical Secretary. 8. Acknowledgements Terms & Conditions of Service for Doctors Department of Health Code of Conduct for Private Practice British Medical Association Code of Conduct for Private Practice 9. Workforce Planning & Development Considerations 9.1. The committee/group responsible for the development of this policy will work with staff from the Workforce Planning and Development service to support the development/maintenance of the competences required by staff in various roles throughout the organisation/service to ensure that the policy can be implemented safely and effectively to enable high quality delivery of services To enable this happens, the committee/group responsible (or their nominee) will work with member(s) of the Workforce Planning and Development service to ensure that the processes identified and fully described in the Learning and Development Policy (reference HR50) section 15 are undertaken. These will include:

8 Identification of the competences required by the various types of staff affected by this policy Development of a competence framework for the levels of knowledge and skills required to ensure effective implementation of the policy Training needs analysis to identify the numbers of staff who will require the different levels of competence Identification of the ways in which these levels of competence may be acquired by staff (including a range of learning methods) Development of a business case, where required, to identify options for delivery of learning and the associated costs Development of action plan(s) for the implementation of training Systems to review the efficacy of the training Systems to monitor that staff have undertaken the training Signed (on behalf of the Trust) Date Signed (on behalf of the LNC) Date