30 FEATURE
private work in the NHS
How to nurture your
PPU
My earlier articles have looked
at the increasing trend for trust
hospitals to offer capacity to private patients and why this can be
a positive development for consultants, for patients and for trust
revenues.
In March’s edition, I suggested
the seven key steps that trusts
should take to establish a private
patient unit (PPU) on a sound
commercial footing. And, last
month, I identified areas of winwin that might encourage consultants to positively participate
in PPU planning and development.
This month, I set out the three
key steps that will result in the
successful ramp up and sustained
growth in activity and profitability through a new NHS PPU.
These three key steps will have
an impact across the whole trust
and not just on private patient
activity.
It is my view that a successful
PPU can deliver a range of positive
benefits to the trust as a whole,
and, for these reasons, should be
supported by consultants and by
management at all levels.
I have set these three key steps
out as a time series for trust action:
nWhat to do now/first;
nWhat to do next/second;
nWhat to do after that.
1
What comes first?
The first step to a successful
PPU is to maximise gains from
existing private activity, whatever
level that currently runs at: high
or low.
In the fourth of this series exploring issues for
consultants extending choice for their private
patients by providing services on NHS trust sites,
Philip Housden reveals the steps needed to make
a new private patient unit grow
This will be principally achieved
from the actions that flow from
an audit of how on-site private practice is currently
organised, specifically the
quality, volume, cost and
mix of that work.
This internal audit
should also include an
examination of present
processes – and this is
best achieved by tracking the patient journey
from referral and outpat
ient appointment through
to discharge. This should look
at the appropriateness and efficiency of staff resource and structures, insurer relations and tariffs
and the effectiveness of revenue
capture.
NHS
Speeding implementation
Such an audit should be led by
trust management and consultants working closely together – to
set the terms of reference, to input
to the review and to consider the
findings and recommendations.
In this way, the benefits of consultant participation throughout
will speed implementation of the
resulting remedial changes.
The audit is likely to identify
where quick wins can be achieved
by improving capacity, increasing
volumes and maximising
revenues.
The biggest constraint on capacity is usually access to theatres and
diagnostics. A review of theatre
and outpatient utilisation and
scheduling is therefore a key starting point.
The biggest
constraint on
capacity is
usually access
to theatres and
diagnostics
PPU
To maximise benefits of a scheduling review, this should include
consideration of the impact of
changes to consultants’ sessional
timetables on their wider NHS
contractual commitments, as well
as their opportunities for private
earnings.
Consultants will have a clear
idea of how best to schedule operating and diagnostic activities to
support their private practice
without negatively impacting
NHS patients, and should engage
in conversation with management about how best to balance
these matters.
As trusts increasingly are prepared to recognise the existence
and opportunities of the mixed
economy, senior management will
expect operational managers to
work with clinical divisions/
departments to ensure that PPU
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independent practitioner TODAY  may 2013
32 FEATURE
activities are included in utilisation and scheduling reviews
alongside core NHS requirements.
Maximising existing private
patient revenues also requires
close co-operation between consultants and trusts. My previous
article discussed the importance
of administration and the risks
inherent in a lack of a partnership
approach in these areas.
This starts with successful revenue capture, which, in turn, is
dependent on accurate data, coding and pre-authorisation. Coding
is a complex area, and of course,
CCSD insurance codes do not
always directly equate to NHS tariffs and vice-versa (see this magazine’s three features on coding,
starting in February).
In our experience, inaccurate
insurer billing and procedure coding is one of the most important
contributory factors to NHS trust
under-achievement in capturing
private patients’ revenue.
For this reason, it is important
for consultants to work closely
with trust administration staff to
ensure commonality of coding
and to support the development
of positive relationships with
insurance companies to achieve
network recognition or contract
agreement regarding tariff for a
range of procedures.
My previous article emphasised
the advantages that can be
accessed by aggregating these
internal skills sets within a private
patient office team. Other quick
wins can be gained by revising
private patient tariffs, and these
have often been neglected and
may be behind achievable benchmarked market levels.
2
What is next?
After the initial work to
review and maximise existing private patient activity to achieve the
above ‘quick wins’, consultants will
be interested in the level to which
their trust can demonstrate ongoing commitment to ensure that
private patient activity becomes
part of ‘business as usual’.
Trusts that have been successful
in developing and sustaining private patient earnings ensure it is
included in long strategic planning and modelling.
Periodic reviews and updates of
strategy, working with the trust
medical society and private prac-
Inaccurate
insurer billing
and procedure
coding is one
of the most
important
contributory
factors to NHS
trust underachievement
in capturing
private
patients’
revenue
tice medical advisory committees
and their chairmen, will provide
opportunities for consultants to
raise the importance of private
patients so that this minority
activity achieves and retains
mainstream status.
Alongside strategy is the development of branding. This is much
more than just a label or logo,
although the specific name(s) chosen for private patient services will,
of course, be important in terms of
establishing service identity and
an association with quality.
In our experience, the private
patient service image needs to ‘fit’
with the overarching trust brand.
This should emphasise patient
safety, specialist expertise, as well
as the sense of place and local
geography. Many local people are
proud of their hospital and a sense
of ‘buying in’ to that legacy of
goodwill may encourage some
business growth.
Regional chambers
Consultants are increasingly
working together to promote and
enhance their range of skills and
services and pool overheads.
Chambers may have a range of
forms from limited companies to
limited liability partnerships.
They might be single or multispeciality and may include just
some or all consultants in a
department. Increasingly, we are
starting to see groups that federate in some way across traditional
single trust catchments, and this
might be the beginning of
regional or national chamber
brands.
This interesting development
will be explored in our next article
in more detail, but what is important here is to recognise that the
relationship between the chamber
and the trust management team
and board can have a substantial
impact on the success of a PPU.
We urge any chambers to consider
the opportunities of the trust PPU
as a key element in their own
commercial plans.
3
And after that?
To enjoy the benefits of a
sustained period of growth and
success, there are challenges for a
trust PPU. Consultants can support the hospital in addressing
these challenges. NHS PPU incremental growth requires the meas-
Many local
people are
proud of their
hospital and a
sense of
‘buying in’ to
that legacy of
goodwill may
encourage
some business
growth
urement and maintenance of a
high level of customer service.
In the previous article, we
explored how the success of a PPU
is dependent on all trust staff –
not just those with a direct
involvement – having an appreciation of the importance of supporting private patient activity.
To achieve this, staff should be
kept informed of the valuable
financial contribution of the service and, where possible, should
play some part in agreeing how
PPU profits are re-invested.
Meeting and exceeding private
patient expectations can have a
knock-on beneficial effect on NHS
customer care and satisfaction by
raising the bar for optimum personalised patient care. In this way,
the trust can enhance their reputation through all staff-patient
contact.
To develop a successful PPU,
management should also focus on
profitability and not just revenue
capture. One way to encourage a
focus on profitability is to create
internal service-level agreements
to enable co-payment for services
between departments as reward
for delivery of a clearly documented level of quality. This
approach will also enhance an
understanding of the principles of
commercial management: that
excellence has a measurable value
and benefit.
So, in summary, this threestepped approach provides a forward plan to achieve private
patient growth that is sustainable
over the longer term.
Viewing the PPU as an integral
part of trust business will help to
foster a trust culture that supports
a focus on patient satisfaction,
effective processes, accurate data
capture, interdepartmental cooperation and good relations with
funders and suppliers. These are
all key to a symbiotic, mutually
beneficial relationship between
private patients and NHS patients
services.
To accelerate these benefits,
consultants should engage with
trust management to work
together in these areas. n
Philip Housden (left) is a director of
Housden Group management consultancy, which specialises in commercial support across the healthcare
sector
independent practitioner TODAY  may 2013