Starting private practice

Author: Ian Tongue, Sandison Easson

It is never too early to be thinking of whether you will undertake private work when you have secured your substantive consultant post. Check out this first article in a six-part guide, taking you through tips and advice to stating private practice helping you to hit the ground running when the time comes.

What is private practice?

Private practice is working outside your NHS salaried role. It can take several forms with the most common being:

• Patients with private health insurance
• Self-paying patients
• NHS work carried out in the private sector
• Medicolegal work.

Each of these sources of income have their own nuances and the mix of these will have an influence on many aspects of your private practice including how much profit is earned as each source carries varying degrees of profitability. Often a combination of income streams are undertaken and it is always good to have a spread of work in case a source reduces or dries up completely, as we have recently seen with the effect of COVID on the medical sector. 

The basics

To carry out work in the private hospitals you must obtain ‘admitting rights’ for private hospital in question. Most of the private hospitals have consultant liaison teams whose job it is to attract new consultants and retain their existing ones. A consultant generating a lot of activity for the hospital is a valuable commodity and will be treated as such by these teams.

The income earned from private work can be modest or significant and the key considerations here are work-life balance as well as availability of work. Private medicine is a very different way of interacting with the patient and it is important that you are able to wear your ‘private’ hat separately from your ‘NHS’ hat. Whilst the care and skill provided is no doubt the same, with private practice you are running a business rather than undertaking the work as part of your employment. This means that you need to promote yourself at the hospital, with GPs and the patients themselves.

The three As

A well-used phrase for a successful private practice is to follow the 3 As which are Availability, Affability, and Ability.

Availability is really the key factor for a successful practice. You must be able to spend time with patients and offer treatment and follow ups within a relative short period of time and be accessible by phone, email, or other modes of communication.

Affability for patients is essentially your bedside manner and the general ability to make the patient feel at ease, and with the additional time you have with patients when carrying out private practice you can build relationships with them. This will be readily portable from your NHS practice.

Ability should be a given with all the hard work and dedication that you have put in until now. Patients won’t necessarily know how good you are and that is why you need to be successful at the first two As before your ability comes into play.

Selling yourself

As mentioned above, many of the private hospitals have consultant liaison teams that help you get up and running but it is important that you take time to ensure your profile is best placed on the website of the hospital, your own website and social media channels which can be essential for some specialties.

When it comes to private medicine, often the first person that can be involved in you obtaining work is a GP when it comes to clinical work and solicitors when it comes to medicolegal work. Work such as NHS contracts in the private sector are often private hospital specific where you agree to carry out clinics and work with these patients is supplied by the private hospital. This type of work can be less profitable as a result.

Some specialties require significant marketing and advertising to be undertaken and the first port of call is to look at your colleagues and see what they are doing. In the modern world of private medicine, it is essential that patients can research you before treatment and the internet is usually the first place they will look.

Getting the right team behind you

Building a successful private practice can be greatly accelerated by having the right team behind you from the outset. The consistent message from those with successful private practices is to engage a strong secretary who can ensure that the practice is run efficiently and that you are getting paid for all of the work undertaken.

It may seem that preparing accounts and tax returns is not too complicated but there are many nuances to the medical profession and having an accountant who is able to advise you on private practice as well as tax planning is extremely important. Unlike the medical profession, anyone can call themselves an accountant but at the unregulated end of the market you can often receive basic or in many cases incorrect advice that makes using these firms a false economy. Always engage an accountant that is a member of a professional body and has experience of acting for doctors.

Another key relationship is with your provider of medical defence and being a member of Medical Protection ensures that you have the support you require to safely grow your private practice into a successful business.

Income sources

It is common when starting out to target a particular source of income and as the practice grows change the mix of income. A good example of this is NHS work in the private sector or waiting list initiatives (outside your payroll) as these can generate lower profits and historically have been less attractive to those who have alternative sources of private income with higher profit margins.

Medicolegal work is common, particularly in certain specialties such as Orthopaedics, but during the COVID pandemic there have been more consultants undertaking this work, so competition has increased. It is also important to understand that undertaking medicolegal work carries certain cash flow risks and it is common to not be paid for many months which can result in tax being paid in advance of you being paid.

The above is an overview of the environment in which private practice takes place and provides a flavour of the options to carry out private work once you have secured a substantive post. The next articles in the series will explore key financial and taxation decisions to be made as well as offering practical guidance for building a successful private practice.

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