Moving From Being a ‘Sole Practitioner’ to a ‘Clinic’

06 January 2017 by Petra Erving

I have worked on a self-employed basis for the past 8 years. Even though I worked in Ealing Hospital and in London Bridge Plastic Surgery, I was there on a contract basis, so not technically an employee but, I saw patients who came to these clinics, rather than those patients coming specifically to see me. I left both places of work in August 2015 and then November 2015 respectively to take the plunge of being completely self-employed. My aim was to get a clinic near to Harley Street established. I wanted to provide patients with a more holistic approach to treatment. To incorporate exercise and nutrition advice into treatment packages. However, I didn’t know where to start. A previous patient of mine, who was a very successful businessman, suggested I start writing a business plan. He said that if it doesn’t come to fruition, it will at least ‘focus your mind and give you some direction’. So, I started the very lengthy process of writing a plan. It wasn’t at all easy. You think you know what you want to do, but putting it on to paper to sound like a feasible, viable business is completely different. There was a lot of fact finding and research to do. All extremely time consuming. I spent hours writing and rewriting the various sections of the plan. My patient and I discussed it during his treatment sessions and he gave expert advice. Since then, things have changed and evolved. The clinic that I started to build up in Harley Street came to an end in January 2016. I had worked hard to establish contacts with Consultant Oncologists, Breast Surgeons, Breast Care Nurses and Plastic Surgeons in reputable private hospitals like The London Clinic and private clinics like The LOC (London Oncology Clinic) and The London Breast Clinic. At the same time, a colleague of mine who worked in an NHS clinic in Windsor retired and hadn’t been replaced. I was contacted to see if I could help them out until they filled the post, which I of course, said yes to. That was in July 2015 and since then I’ve had approximately 250 referrals of patients with Breast Cancer Related lymphoedema and since word has spread that there is now a lymphoedema specialist in the area, there has been a steady increase in primary and other secondary forms of lymphoedema patient referred. The past 12 - 18 months have been a whirlwind, to say the least. From seeing the occasional extra patient during evenings and weekends, my patient numbers have grown to the extent that I had to, pretty quickly, make a decision on whether to continue with Harley Street, or Maidenhead. When I spoke to anyone about it, they simply said it was a ‘no-brainer’. Give up Harley Street and concentrate on Maidenhead. That meant no more commuting – YAY! But, I had worked hard to become established in Harley Street. I had arranged meetings with various consultants and surgeons at lots of different clinics; oncology centres, plastic surgeries and private hospitals and had started to build a reputation. So, I was somewhat reluctant to give up Harley Street. Maidenhead had kind of fallen on my lap. But, it was a no-brainer really. Why would I continue the commute up to London when I could see patients at home? So, from being a sole-trading, private practitioner, I suddenly found that I was technically running my own clinic. I’ve learnt a massive amount about how the NHS works in the background i.e.: CCG (clinical commissioning groups) and how they commission services and who they fund. I’ve learned how much is spent per CCG when lymphoedema is left untreated and what issues can occur, e.g.: the cost of one patient being hospitalised due to infection (cellulitis), a common occurrence in those with (untreated or badly treated) lymphoedema. I have had to put proposals together and present them to people who don’t really want to use a ‘private practitioner’ and I am constantly fighting to know how long I will continue seeing NHS patients. I don’t have a contract at present, but they’ll offer me a 6 month contract with a 3 month notice period. Now, I have built my clinic to furnish seeing/treating all these patients. My patient numbers currently stand at approx. 300 – 250ish of those are NHS. I have taken on staff to help me so that I have some sort of life outside of work – as it is, I start work at 7/8am and work weekends on top of seeing patients during the week so that I can complete all the admin involved. I have now taken on renting premises that are ‘fit for purpose’, clinical and accessible. A massive commitment, which the NHS are aware of. However, they cannot commit to offering a longer contract, nor a longer notice period because “– unfortunately we do not know the long-term future of the commissioning arrangements”. So, if given 3 months-notice, I could find that I have to let any staff I’ve taken on go, and find myself out of a job. Not particularly secure. In the meantime, my clinic continues to grow. ‘My’ patients are now getting a service they didn’t have before. Those that need treatment are getting it. They have regular follow ups. I am gradually putting procedures and protocols into place. I now have a fantastic clinic management system, that once I have migrated all the patient data over, will be incredibly helpful and eventually save A LOT of time spent making appointments, sending out letters and invoicing. I will be able to produce reports from it to measure the outcomes of treatment so that anyone that needs to know, will be able to see how successful and beneficial treatment is to this complex patient group. However, at present, while all this data migration is being done, I find there are simply not enough hours in the day. I feel tired all the time and, have regular moments when I think ‘is it all worth it?’ Particularly when it could all be pulled away from me with a measly 3 months-notice! But, I wouldn’t have it any other way. My idea of having a clinic that provides a holistic approach to treatment is coming to fruition. I have a wonderful small team of people: Nicola who is an MLD Therapist, Sam who is a personal trainer with a nursing background who has now completed the CanRahab specialist training and Julia, who helps with admin. Medical Therapies now runs exercise classes for our Cancer and Lymphoedema patients twice weekly, taken by Sam. Sam also puts bespoke exercise plans in place for anyone who wants them. Next on my list is to get a nutritionist involved. With all these different facets, I believe patients will get the best outcomes from their treatment. At present the ‘to do’ list is long. Keeping on top of everything is difficult. I’m constantly juggling physical work with admin and trying hard to keep time for my daughter and my wonderful husband-to-be. None of this would be possible without the support and understanding of my family, particularly Jason, who is incredibly supportive and tolerates the fact that I am nearly always working weekends and exhausted every evening. But, I know it won’t be like this for ever and, fingers crossed it will all be worth it in the end.

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