Surgery in the city is just what the doctor ordered . .

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"I’LL be a bit late tomorrow - I’ve got a doctor’s appointment." It’s a common cry in any office, and usually means a good chunk of the day taken up by coming in late after an appointment at the doctor’s surgery near to home, or leaving mid afternoon to make it back in time for an evening appointment.

What if workers in Edinburgh city centre could visit a doctor close to work, so that it only takes a quick dash across town and back?

That was the theory - or one of them - behind the establishment of private medical practice Healthcare Now in Stafford Street, central Edinburgh.

The company had also seen gaps in NHS healthcare provision in the city and realised it could provide services that people need and want enough to pay for themselves, chief executive Neil Cunningham says.

"The Edinburgh clinic was set up by our medical director, Gordon Wishart, because he realised that there was an opportunity for a diagnostic service at the affordable end of the market," Mr Cunningham says. The clinic, established in December 2003, also provides a GP service for workers in the city. Patients do not have to transfer their medical details, as the Stafford Street clinic will communicate details of any treatment to their registered doctor.

Edinburgh born and educated, Mr Wishart is one of the UK’s leading consultant breast and endocrine surgeons. He currently practises from Addenbrookes Hospital in Cambridge, which is one of the reasons Healthcare Now set up its second clinic in Cambridge last month.

"There are lots of things that the NHS do well, and others that they do less well. The idea is to augment what the NHS provides," Mr Cunningham says.

In bone density scanning, for example, the NHS doesn’t have the resources available in Scotland. While other private clinics in Edinburgh offer a similar service, "where we differ is that ours is very affordable," Mr Cunningham says. A standard consultation costs 160 to 200, but Healthcare Now will charge 95, he says.

Bone density scanning is big news because of recent scares about the safety of hormone replacement therapy, resident GP Alison Holloway says. "Reports of the dangers of taking HRT have scared a lot of women, but they know HRT protects against osteoporosis. They want to know about bone density and their risk factors. But at the moment there just isn’t the provision on the NHS," she says.

Osteoporosis is likely to affect one in three women and one in 12 men, Dr Holloway says, "Fractures kill a lot of people," she says, and people are prepared to pay the 95 to find out how strong their bones are before making any decision on HRT, she says.

The clinic also offers the private GP service, with two GPs including Dr Holloway available at 35 per 15 minutes, general health screening and cardio-vascular risk assessment, plus fertility screening, Dr Holloway says.

Healthcare Now is Scotland’s leading centre for nuchal fold scanning, a screen for Down’s Syndrome using ultrasound and blood tests. The NHS recognises that nuchal fold scanning should be offered to expectant women, but isn’t able to offer it yet. It should be available on the NHS in Scotland by 2006, but many women are prepared to pay for it in the meantime. The scans can be done much earlier than amniocentesis and are less invasive, with less danger of damage to the baby, Dr Holloway says. It will give women an idea of how high-risk they are, and they can then choose a further amniocentesis test if they feel it is needed.

"It’s widely available down south" but regional variations in funding mean it’s hard to get the scan done in Scotland, Dr Holloway says. Healthcare Now is now performing 15 to 20 nuchal fold scans a week, she says.

The Edinburgh clinic will also offer mammograms within the year, she says.

On the GP side, while getting a GP in Edinburgh is not difficult, getting access to them isn’t always easy, Dr Holloway says.

"It can take a while to get an appointment, and then lots of people work in the centre of town and don’t want to have to take time off work to go home to Livingston or wherever they live. We hope to let people come in to see us, save time and fit it around their working pattern. We keep up links with their home doctor - this is a complementary service," she says. The patient chooses how long they want to spend with the doctor, and pays for each 15 minutes they book.

In Cambridge, the clinic has three GPs and is further out of town. It is twice the size of the Edinburgh facility, but offers the same services. Both clinics have been set up with room to offer serviced consulting rooms for consultants from nearby hospitals.

"There’s a national lack of quality consulting space and mostly it’s a case of waiting on dead men’s shoes. If you want to run a private practice you ask the hospital for space, and you’ll get a couple of hours at an awkward time. For the prime slots you’re waiting for someone to die or retire," Mr Cunningham says.

Healthcare Now has three rooms in Edinburgh and four in Cambridge that it makes available "for a very modest room rental" on a time basis. Secretarial and other support can also be paid for as consultants need it.

"It means it’s a one-stop shop for the patients, too. If they need ultrasound, for instance, we can provide it on the spot instead of sending them off to the hospital and making a new appointment for them to come back after it’s been done," he says.

The out-of-town location in Cambridge was chosen because of the city’s traffic problems, Mr Cunningham said.

"The difficulties of driving and parking mean a city centre location wouldn’t work in Cambridge. So we identified a site five minutes drive from the hospital, and two minutes from the motorway, with its own car park. We have to find the right site for the market in each city," he says. The Edinburgh clinic is already breaking even financially, as is Cambridge "as we expected after a month," Mr Cunningham says. The company has been funded by private investors "and we may get to the stage where we expand and look for outside funding," he says.

The aim is to grow Healthcare Now into a nationwide chain, Mr Cunningham says, and agents are already looking for an appropriate property for its third clinic.

"The idea is to bed down these two and get the mammogram service into Edinburgh, and then the plan is to open two clinics a year for the next four or five years. It’s a question of demographics, and of the distribution of other service providers," he says. Leeds and Bristol are the most likely next sites of for clinics.

The downside of all this? People will have to find new excuses for coming in to work late.

Founder and inspiration

EDINBURGH-BORN and educated Gordon Wishart, founder and medical director of Healthcare Now, is one of the UK's leading consultant breast & endocrine surgeons.

He is one of four consultants practising from Addenbrookes Hospital in Cambridge.

"Five or six years ago, the breast service at Addenbrookes wasn’t great, and so Gordon and another Scottish surgeon, Arnie Purushotham were brought in to sort it out," Healthcare Now chief executive Neil Cunningham says.

The Cambridge Breast Unit, a purpose-built breast cancer care centre, was set up in 2000 at a cost of 756,000, bringing all of Cambridge’s breast services under one roof.

"It’s now generally recognised as a beacon of excellence," Mr Cunningham says.

Mr Wishart is heavily involved in Healthcare Now, and regularly sees his outpatient patients at the Healthcare Now clinic in Cambridge. "He takes the clinical lead across the whole of Healthcare Now’s business," Mr Cunningham says.

Mr Cunningham was brought in in May of this year to take some of the work off Mr Wishart’s shoulders, running the core business side of the business, he says.

"Everything that needed to be attended to, to free up Gordon’s time," he says.

The company has also hired an imaging specialist, Alan Wallace, to take the lead in running its imaging services. Mr Wallace is a Paisley-based consultant radiologist, Mr Cunningham says.

Before moving to Addenbrookes, Mr Wishart was a consultant based in Haywards Heath, Sussex.