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Independent Practitioner – July/August 2012 “Take risks and work hard to realise them”

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During the years of study and training leading to qualification, medical professionals quite rightly focus on medicine. Yet when building a career in private medicine, one needs to develop business skills and adopt a more entrepreneurial outlook. Dr Harry Brünjes, Group Medical Director of Capita and Non Executive Director at The Good Care Group, details his own journey from GP to business leader and shares his tips for success.

It is a short walk from Guy’s Hospital in London to The City, but it took me 25 years to get there. After working in the NHS for several years, I realised that private practice offered greater earning potential. As a private GP, I found – and fulfilled – gaps in the market for private healthcare provision, building up a company – Premier Medical – that was sold to Capita for £60millionin 2010. Currently Group Medical Director of Capita and Chairman of Premier Medical, my passion for new business remains strong, so I am also a Non-Executive Director of home care provider The Good Care Group and founder of a new medical fund, Woodsta, for pioneering healthcare companies in need of cash.

What drives me is the knowledge that there is always an opportunity to create profitable businesses whilst delivering service excellence – if only people take the risk and expend the effort to make it work. So what advice would I give to those who are starting out or want to grow their own private practice or small business?

What are you willing to do to achieve success?

Medical professionals can earn a perfectly good salary by staying within the NHS or building a modest clientele as an individual private practitioner. Taking earnings to the next level requires much more ambition about what you want to achieve and the effort you are willing to expend. Most people simply cannot take time out of their working day so it is essential to work outside normal hours, in the evenings and at weekends, as a matter of course. I made myself available when it suited my clients and so they kept coming back. Starting out I was my own PA on top of my medical role, taking care to answer the telephone politely, prepare well-crafted letters, manage the diary and make sure my premises were well-presented, to create and maintain the right impression. Even as my business grew and I could afford support, I kept an eye on everything to protect my brand.

The other thing to consider is how you could diversify your activities or expand your client base in order to exploit growth opportunities, but adopting a wider business model requires a change in mindset. The focus moves from being a Doctor treating a patient and sending a bill, to thinking in business terms – what else can I do with my skills or my client base? Location is key, too. In wealthy niche areas there may be an under-provision of private GP’s – providing opportunities for those willing to relocate. Private GPs can also undertake training to provide specific services for a set portion of their time. For example, Dr Newman’s Clinic has a network of private GPs who work one day a week, having undertaken their course on thread vein removal.

Spotting market opportunities

Awareness of the marketplace is critical. In 1995, I noticed a growing demand for medical reports for pre-employment medicals, workplace accidents or insurance cases. I started to provide this service as a private GP – and that was the foundation of Premier Medical. There is a huge demand for these reports – generating over quarter of a million appointments a year for Premier Medical alone and this ensured the growth of the business.

Sometimes, new business ideas come from personal experience. A decade ago, I moved my elderly parents into residential care. It soon became clear this did not suit them, so I arranged for them to be cared for at home instead. Everyone was much more comfortable with this solution, but the experience also sparked an interest in elderly care that has informed some recent business decisions. Of course, we all know that the UK has an aging population, but few are considering the potential business opportunities. At a recent conference, I heard that 50 percent of all UK hospital admissions are aged over 80. Once admitted, many of these elderly patients (through no fault of their own) have nowhere else to go to receive care and effectively end up bed-blocking. An elderly person who takes a bad fall often ends up staying in bed, losing their confidence and mobility to receive perhaps half an hour of physiotherapy a day. This is a personal, financial and logistical crisis that will only worsen as social demographics continue to change. In my opinion, we will need to find new business models to reduce avoidable long-term hospital stays.

This could present new opportunities for private practitioners to provide additional services to patients at home, which would be substantially more cost-effective than a lengthy hospital stay – and better for the patient. There are obvious opportunities to provide a range of branded care solutions for the elderly, but this could apply to other medical conditions, too. What if a business could provide chemotherapy or physiotherapy in the patient’s own home, at a time that is convenient to them? In effect, virtual wards could be established outside physical hospitals – but this challenges medicine’s traditional model of care provision.

Until then, it is worth considering lateral business opportunities that match your client base. It may be possible to offer nursing, domiciliary or respite care services – or partner with another provider to do so. A private GP could develop a business to provide medical equipment to meet patients’ needs in the home. In effect, it’s about thinking like a business – maximising returns through patient models (groups needing similar services) rather than simple patient numbers.

Attracting and retaining business

Word of mouth recommendation is still the best generator of new business and delivering on your promises the best retention strategy, but it is worth undertaking marketing PR. In branded networks, doctors can advertise themselves under that recognised brand. In addition, it is worthwhile exploiting opportunities to speak at local events and conferences, undertaking webinars and participating in social networks like LinkedIn. Each of these activities can help to generate business.

I invested time and energy in networking – and still do – to build the right connections. As a small business owner you can join local business and medical networks, which can be a rich source of patients and recommendations. These badges of association also offer comfort and security to prospective clients. A major attraction for potential clients is flexibility and availability – but this must be followed through. If out of hours care is offered, a call must be answered day or night. Paying clients do not want to hear an answering machine at 12:30 because everyone is out for lunch, nor are they willing to hold for thirty rings until someone answers the phone. Similarly, you must be sufficiently proficient – or employ people who are – to deliver high quality care. As delivering medical services is a highly personal business, affability and politeness are critical attributes of key staff. I also find it essential to have good working practices with integrated checks and balances so nothing slips through the net, such as appointment reminders. I am careful to use best practice, have a team that is fit for purpose, and am able to rely upon an efficient and well-organised back office, all supported by good IT. It’s perfectly fine to outsource where necessary – as long as the service provider delivers to your service levels.

Scaling up the business

When staffing Premier Medical I turned first to my own personal network, so I knew each individual’s work ethic and ability matched my own. I also sought to free up front-line doctors with more support staff and efficient procedures. Premier Medical has 350 staff providing back office support for a network of doctors in 220 clinics across the UK. They source the necessary medical records and X-rays so the doctor has everything to hand. In addition, we use touch-screen systems so the customer completes pro-forma Q&A’s before seeing the doctor. This makes the most efficient use of the doctor’s time. Having the right people and processes can significantly improve performance and profitability.

In conclusion, becoming financially successful as a private practitioner is about much more than clinical excellence. Apart from the “Three A’s of Private Medicine” – availability, affability and ability – it requires a certain personality and drive to be more visionary and entrepreneurial. My mantra is “Sell what they need, not what you have”, acknowledging that it is impossible to make a significant amount of money without significant effort. Put simply, be clever enough to spot opportunities for growth, be brave enough to take the risk and work hard enough to make it happen.

Journal of Community Nursing – Sept/Oct 2012 “Optimising treatment and care for dementia patients” Geriatric Medicine – July 2012 “Achieving better care for dementia patients”
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