My Curriculum Vitae
Mr Hardy has contributed to a number of chapters in surgical texts:
Literature
Want to know more about a particular problem or solution to that problem?
Read about Mr Hardy's past experience in his C.V.
John was invited to appear on Dr Phil Hammond's Saturday Surgery "The only place where you can book a regular appointment with a GP on a Saturday!" 26th Feb 2011. He is regularly invited to teach Consultants from all over Europe on arthroscopic minimal acess skills.
Want to have an estimate of the charges likely to be part of the offer of contract between Mr Hardy and his patients?
Want to know your rights as a patient? Problems with your Private Medical Insurance?
Would you like a link to the organisations that Mr Hardy recommends like the GMC, BMA and FIPO?
Do you want to see a draft copy of the Surgical Fees Letter Mr Hardy's secretary sends to patients?
Please navigate the pages below and right to learn more.....
- C.V.
- Consultant Contract
- Private Medical Insurance
Mr Hardy maintains that his contract to provide medical care is with the patient.
Mr Hardy does not contract to undertake professional medical care for insurance companies clubs or thrid party organisations.
Private Medical Insurance
The costs of Private Medical Insurance (PMI) to customers by insurance business like BUPA and AXA have been rising above inflation. In spite of these annual rises since 1994 the benefits to their customers have been restricted annually.
Inflation on corporate health plan costs rose on average 5% in 2007 compared to an average of 3% in 2006 - the lowest it has been for more than two decades - according to analysis by Mercer Human Resource Consulting, the UK’s largest pay and benefit consultancy and services provider. Despite this drop, many insurers are still applying inflation rates of as much as 10% to the calculation of companies’ annual healthcare premiums. In 2010 this insurance business practice of increasing the cost of medical cover over medical inflation has not stopped (Pan-European Survey of Employer Health Benefits).
Many experienced doctors have been targeted by the insurance industry for increasing their fees in line with inflationary pressures. The insurance industry has been restricting benefits since 1994. This leads to a number of disadvantages for patients. Concerns over the conduct of health insurers are to be reported to the FSA by Lord Sassoon, the Commercial Secretary to the Treasury. Should a General Practitioner recommend a particular hospital or doctor to a patient then the patient's chosen insurer, depending on the level of cover may:
Restrict you from attending the hospital of your choice.
Apply a variable shortfall to your reimbursement against the fair and reasonable charges to be treated by the doctor of your choice.
Prevent you from seeing the doctor of your or your General Practitioner's choice in favour of a doctor chosen by the insurer.
Patient Choice
Mr Hardy regularly sees uninsured patients who prefer to self pay even if they thought they were comprehensively insured but find they have a restricted policy.
Mr Hardy is happy to see any insured patient and still is seeing PPP AXA insured patients. However, AXA PPP patients that come to see him for a consultation should be aware that his team was unable to acquiesce to AXA PPP's request in 2009 to reduce his fees back to reimbursement not seen since 1994. This appears to be a restriction applied to many of the more experienced Consultants in the UK. To avoid disappointment please check the restrictions of which hospitals and which consultants you are allowed to see in the policy you were issued with when you applied to PPP AXA for Private Medical Insurance.
Mr Hardy cannot advise on which insurance company offers the best value for money and which policies do not restrict where the patient is seen or which doctor they can see.
Please do not ask Mr Hardy or his secretary to recommend a cheaper doctor or surgeon.
Joints
Joint Pain
Keyhole Surgical Techniques
Cartilage Repair - Mosaicplasty
Cartilage Repair - ACI/MACI
Arthritis
Finger Joint Replacement
Gout
Prevention of Arthritis
Mini-incision surgery for Knee Replacement
Prevention of Infection
Knee Ligament Reconstruction
Minimally Invasive Surgery
Extra-corporeal Shockwave Lthotripsy for Calcific Tendonitis
Guidance on selection of hip prosthesis
Metal on Metal Hip Replacement
Hand Injury
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Dupuytrens Disease
Dupuytrens Disease - Needle fasciotomy
(Mr Hardy says that this is a good stopgap for those patients who present late with inoperabable contractures to prepare the hand for formal excision of the Dupuytrens fascia at a later date).
Trigger Thumb
Trigger Finger
Joint replacement for CMCJ Thumb - NICE guidelines
Sports Injuries
Quadriceps Tendon Rupture This is a new radiological sign to prevent Quadripceps Tendon Rupture being missed by inexperienced A&E officers.
Patella Dislocation in Athletes 5% of all patella dislocation are associated with an osteochondral fracture that is easy to miss on x-ray to the detriment of the athlete as early repair has a good prognosis and late recognition a bad one.
Extracorporeal Shockwave Therapy for Tendonopathy such as Tennis Elbow (NICE).
The Footballers Fracture A demographic study of the largest series of fractures in footballers managed by Mr Hardy ever published with a commentary by Steve Bollen editor of the British Journal of Sports Medicine.
Trauma
Dynamisation of Tibial Fractures When a patient needs to be treated with an External Fixator dynamisation results in beneficial changes in both cyclic movement progressive closure.
Fracture Stiffness Measurement This is one of the only two objective measures of fracture healing that Orthopaedic and Trauma surgeons have to assess when a patient has healed and is match fit.
Quantitative measurement of fracture healing is more accurate than qualitative measurement as long as the technique is performed properly.
Callus Index and NSAIDS A small prospective randomised study that suggests but does not prove that NSAIDS have a beneficial effect on intramembranous fracture healing.
Salvaging Stripped Drive Connections This is a technique to get an Orthopaedic and Trauma Surgeon out of trouble when removing metal ware.
Tibial Fracture Stability This research looks at the influence of fixator type on the amount of micromovement at the fracture site.
Tibial Fracture Movement During Normal Activity
This research looked at the micromovement that was taking place at the fracture site with normal patient activity.
Why does your surgeon loosen your fixator after 6 weeks? You have broken you shin in a football match and the surgeon has recommended one of the new lightweight disposable fixators. At about 6 weeks the surgeon will loosen part of the fixator to speed up healing. Here is the science behind why.
Bone Grafting Your surgeon has recommended you have a bone graft procedure. 
This may be part of a bigger operation. It may also be one of a number of types of bone graft:
1.Autograft: This means the bone that comes from another part of yourself and be used on you to strengthen your own bone.
2.Allograft: This means that the bone will come from another patient to be used to strengthen your own bone.
3.Xenograft: This is graft from another species that is used to strengthen your own bone.
Management
Anaesthesia Many operations are usually carried out under general anaesthesia as a day-case procedure. 
As a team Dr Coates, Consultant Anaesthetist and Mr Hardy, Consultant Orthopaedic and Trauma Surgeon offer an appropriate anaesthetic and good pain relief.
Smoking Patients who smoke do not just risk lung diseases and cancer. There is plenty of evidence that smoking delays fracture healing following scaphoid fracture, open tibial fracture, compound fractures, osteotomy of the forearm and shin bone fractures. Happily, if you stop smoking then fracture healing is improved according to a Finnish study. So if you are a smoker and are about to undergo Orthopaedic or Trauma Surgery then stop at least 2 weeks before surgery and use the excuse to give up or accept the increase risk of complications.
NHS Waiting Lists Many studies have shown patients choose convienience over quality. This is because it is difficult for a layperson to recognise quality of care. However, given the finite resources in the NHS 83% of patients would prefer to see a Consultant and go on a waiting list than wait to see a Consultant but have the opportunity to be operated on rapidly.
Copying Letters to Patients Mr Hardy subscribes to these good Practice Guidelines. Mr Hardy dictates his letters in front of his patients. This allows patients to decline a copy to their preferred address, correct perceived or actual mistakes and think of anything that might be included in the consultation. A copy of every letter he sends to a General Practitioner is also sent to the patient following consultation. As a result of this policy Mr Hardy believes he and his patients are rewarded with improved consultations, better understanding of treatment options and the chance to correct genuine mistakes in health records.
Accuracy of Digital Image Analysis Digital image analysis of radiographs is 20 time more accurate than the human eye.
Shaving with Static Electricity Mr Hardy has used this is a simple technique for reducing the risk of postoperative wound infection in the operating theatres for years.
Fracture Reduction - Technical Tips Mr Hardy says that this is the technique he teaches on the Basic Surgical Skills courses he runs in Bristol and London for surgical trainees in Surgical Training years 1-2.
Medical Fees
Mr Hardy is happy to see both insured patients and those who choose to pay for their own treatment.
Those patients with medical insurance can be assured that Mr Hardy is an independant private medical practioner not contracted to provide care by any one insurance company. Patients are recommended to check their insurance policy prior to proceeding with any treatment to verify that they are covered under their own private medical insurance scheme, and to check if they are liable for an excess payment under the terms of their policy.
Patients choosing to pay for their own treatment will be expected to settle their consultation fees on receipt of an invoice from Mr Hardy’s office.
Should any of Mr Hardy’s patients require surgery payment will be required prior to the date of surgery. Mr Hardy’s secretary will contact you by letter and telephone to arrange this with you.
Outpatient Fees:
For more information on our outpatient fees please check our Surgical & Anaesthetic Fees for 2012.
Inpatient Fees:
There are a number of ways to manage the cost of your treatment:
- Paying for treatment directly through one of our hospital self pay schemes.
- Private Medical Insurance (Personal or company paid medical insurance policy e.g.WPA).
- Cash Plans (Cash plans pay out contributions towards hospital treatment). Details of cash plan schemes can be found on the British Health Care Association (BHCA) website, the trade body for the majority of health cash plans and associated plans).
- Employer Assisted Schemes: (Employer Assisted Schemes are used by employers who recognise that in certain circumstances it is more economical for them to fund private hospital treatment, than to fund your sick pay and pay someone else to do your job, whilst you are awaiting publicly funded hospital treatment).
NHS, Private Medical Insurance and Self Pay Health Care
There are at present three levels of Medical Care a patient can expect. There should be only one standard.
The quality of care depends not on the government in power, health minister, department of health, practice premises, hospital premises, administrative staff or even nursing staff. It depends on the doctors. It is the responsibility of the doctor to manage your diagnosis and treatment and that means the doctor should be safely managing the resources available to him or her.
A doctors most valuable resource is their time. Any doctor cajoled into managing too many patients for a defined resource will not be able to provide proper management. The Best Doctor is the one that allocates the time needed to provide the patient infront of them with a gold standard of care.
Private Medical Insurance vs Self Pay Health Private medical insurance is a mine field. Insurance Companies have not substantially increased customer reimbursment for the last 17years. Many insurers are restricting access to Consultants in the top of their profession and Hospitals with international reputations.
The growth of Private Medical Care is now in the self pay market.
The professional organisation for Orthopaedic and Trauma Surgeons in the UK the British Orthopaedic Association have recently addressed the attempts by BUPA insurance to regulate knee arthroscopy and prevent some of their customers from receiving reimbursment against arthroscopic surgery. Read the latest correspondence between our President and The BUPA Medical Advisory Panel:
Letter to Professor Sir John Tooke & BUPA Medical Advisory Panel 21/7/11
Professor Sir John Tooke reply letter 5/8/11
BOA Letter to Professor Sir John Tooke 9/8/11
The BOA have recommended the following advice to Knee Surgeons and their patients (based on the response rate of 87.1% of surgeons who thought that this new pre-authorisation process would
disadvantage patients):
"At a meeting of the BOA Patient Liaison Group on the 20th June 2011 the Group discussed the BUPA initiative on arthroscopy and expressed the opinion that BUPA is putting at risk the integrity of the doctor/patient relationship by proposing a 'distant' review scheme. The Group further feels that a system of reviewing a course of treatment recommended by a qualified surgeon on the basis of the patient's medical needs by someone who has no knowledge of the patient and his/her particular situation is not in line with best clinical practice". Good Medical Practice "sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action. The guidance is addressed to doctors, but it is also intended to let the public know what they can expect from doctors" is elucidated by the GMC.
Mr Hardy recommends that if you are insured with an insurer that is not fufilling the contract that you agreed with them then you should always contact the Financial Ombudsman. Please read the BOA advice on how to contact them in case of a dispute in your contract: Patient Information Sheet for BUPA Insured Patients Only
The British Orthopaedic Association the professional body for Orthopaedic Surgery have updated their good advice on the BUPA Arthroscopy review and included the General Medical Council advice on the dangers of the distant clinical review proposed by BUPA insurance.
The BOA consider that BUPA Arthroscopy Review has put BUPA insured patients at a big disadvantage as many patients will be forced into distant review and later second opinions and with other surgeons that neither the patient nor their General Practitioner wanted to consider. For some patients, with knee problems requiring arthroscopy, delay could cause further harm. Referral by your insurance to a surgeon not experienced in knee arthroscopy could leave you with permanent injury.
Mr Hardy considers his contract is with each patient he is asked to see for his professional opinion and not with their insurer.
Mr Hardy has a poor opinion of most insurers and their motives regarding forming referral contracts with health care professionals.
BUPA have recently had a problem with trying to direct care for corporate insurance schemes which does not appear to be popular with the big companies or their employees. Mr Hardy believes that it is a patient's General Practitioner who has assessed the patient clinically and should be able to decide using local knowledge where to refer patients.
Many patients in the situation of finding themselves in an uninsured position have asked Mr Hardy or his staff to advise on the most comprehensive insurance available. Mr Hardy and his staff arenot in the position of being able to offer financial advice of this nature. Mr Hardy has inclusive private medical insurance with WPA
Surgical & Anaesthetic Fees Mr Hardy follows best practice in that his contract of duty of care is with his patients (and not with any third party insurer selling Private Medical Insurance "PMI"). Click on the link above for his fair and reasonable fees for 2011. The table is based on the OPCS-4.5 classification which was mandated for implementation on 1 April 2009 by the NHS and system suppliers.
These fees have increased in line with the same inflationary pressures that have guided the subscriptions for PMI noted above. Having discussed treatment options with Mr Hardy please telephone for a date for surgery and a letter confirming the fees. His secretary will send you a Surgical Fees Letter.
Please check whether there is a difference between the amount you will receive from your insurer according to the policy you have taken out and the surgical and anaesthetic fees quoted. Many policies have not increased their fees in line with inflation OVER THE LAST 19 YEARS according to the BMA and leave the insured with large shortfalls they are not expecting.
Prevention of Infection
Mr Hardy has recently contributed as faculty member to the very successful Molnlycke Draping Forum 2001. In this study day, that takes place in the University College London Education Centre, theatre staff in the NHS spend a day learning about surgical site infection risk, infectiuon risk reduction, the legal aspects of draping and they participate in draping workshops.Click on the image below to read all about the 2011 forum or read the Operating Theatre Journal...
With governments clamouring to reduce the impact of bacterial infections like MRSA and 
Clostridium difficel
e on expenditure and the increasing risk of cross infection of blood born virus Mr Hardy is pleased
to announce a development in the measurement of how drapes control bacteria and an invention for the reduction of risk of cross infection in surgery that will make a 
difference.
There are many things a surgeon and his theatre team can do to reduce the risk of infection to below 1% like care when scrubbing to prevent bacterial contamination of surgical gloves.
Please read the scientific work so far....
Showering With Sutures Many of John Hardy's patients ask about showering after surgery with sutures in the wound. Mr Hardy has reviewed the evidence and recommends that there is no additional risk of infection after his operations if you choose to shower. NICE guidelines on prevention of Surgical Site Infection recommend patients can shower after 48 hours. Mr Hardy recommends that the dry dressing can be removed for showering once you have gone 24 hours with a dry dressing and no further ooze.
Mr Hardy's publications, including the references of some of the literature above, can be found on the Sports Injury Clinic website.