A Guide to Private Practice in the UK

The NHS is the UK’s medical compass, guiding patients through some of the darkest times in their lives. However, its needle has been wavering under the strain of under-resourcing and insufficient planning, making it harder for patients and doctors to find their way through the system. It is no secret that an increasing number of doctors are experiencing burnout and are leaving the NHS, looking to be better supported, and valued for the commitment and effort they put into their role.

According to the BMA, over 3000 UK doctors said they were “very” or “fairly likely” to leave the country within the next year, as the pull-factor from overseas countries like Australia are undeniable with the better pay and reduced hours. However, relocating isn’t feasible nor desirable for everyone. Ties to family, friends, or the local community keeps many rooted in the UK. Private practice offers a tenable option that can benefit doctors and patients.

Whether you’re a newly qualified consultant or still in training and curious about your future options, this guide is for you. We’ve spoken with Mr Mallappa Kolar, a private consultant plastic surgeon at Kliniken.

🧐Why consider practicing privately?

Practicing privately offers a chance to reclaim autonomy, more efficient workflows, and tending to patients with fewer time pressures. The financial incentive is also significant, but it’s not just about money. It’s about delivering care on your own terms, escaping the burnout of the NHS bureaucracy, or having more time to spend on the non-clinical side of your life whether that is taking care of your health with friends or family, to developing a portfolio career and pursuing your hobbies.

Mr Kolar stressed how the non-clinical side to his life is what influenced his decision to leave the NHS, and how it was evident to his family from his mood to his stature the days he had worked privately in comparison to the days he worked for the NHS. During his time with the NHS, he felt his patients experienced significant injustice due to the limited time he could dedicate to each of them, and the extensive waiting times they faced (with many exceeding a year waiting for an appointment).

It is not just doctors too. There is a rising trend of patients pursuing private healthcare in the UK. The Independent Healthcare Providers Network (IHPN), found that at this time of record-high waiting times, 67% of the people surveyed would consider using private healthcare. Approximately, over 10% of the UK population has some form of medical insurance and this number is rising. The public is increasingly unwilling to gamble with their health by enduring ever-lengthening waiting times. Health should not be compromised by systemic delays and seeking private healthcare safeguards their conditions from deteriorating.

🩺How can I start to work privately?

To work independently in private practice in the UK, you typically need the following:

- GMC-registration with a full license

- Completed specialist training and passed the relevant exams to be a consultant. It is recommended to have experience working in the NHS as a consultant, as private hospitals may require this for insurance purposes and to prove credibility with patients.

- Appropriate insurance (indemnity insurance)

You can then join a Private Hospital Group such as Spire or Nuffield Health, where you will undergo vetting to then be listed on their consulting team for referrals. Private Hospitals usually handle admin, billing and marketing, so there will be a lower workload on yourself (but this comes at a cost).

There are also a few exceptions:

- GPs can enter private general practice immediately after they have their CCT

- Aesthetic and wellness work- this can be from Botox to health checks, which can be undertaken by doctors not yet on the specialist register. However, it is crucial to stay within your scope of practice and legal limits. You should be highly confident in your ability and undertaken suitable training courses

If you’re interested in setting up your own independent private practice, there are additional steps you have to handle yourself. This includes registering with the Care Quality Commission (CQC) alongside financial and legal considerations from taxation and financial projections to business considerations and marketing strategies. Mr Kolar undertook an iBsc in Health Science with Management that set the foundations for his passion for business and helped to carve his path into private practice. Although having an intercalated degree is not necessary to set up your own private practice, degrees similar to this can help to introduce you to management in the medical setting, which is not covered in the standard 5-year medicine curriculum.

🤔NHS vs Private Practice (What is the difference?)

Before diving in (or even dipping your toes into private work), it is essential to understand how NHS practice compares to working privately in terms of advantages and disadvantages…

✅Advantages of Private Work:

- Greater autonomy– as a private doctor, you can tailor treatment plans and deliver care to each of your patients needs without having to worry about the constraints of NHS policies or financial limitations.

- More time spent with patients– appointments typically last longer than the usual 10-20 minutes in the NHS, allowing you to build a deeper rapport with your patients

- Improved work-life balance– less tight schedules and night-shifts (unless you choose to do so)

- Less admin burden (unless you own a private practice and don’t delegate admin to others)

- Higher income– many doctors can significantly boost their income by even working one private clinic a week

❌Disadvantages of Private Work:

- Paid per consultation/procedure/session– the NHS has a fixed salary by the hour with you NHS banding, whereas at a Private Hospital, you’re essentially self-employed and have “Practicing Privileges” to use their facilities and treat patients

- While private hospitals may refer some patients to you, you’re also expected to bring your own, often via word-of-mouth or from your own prior NHS reputation

- Limited opportunities for training and research in comparison to the NHS

- No pension/sick leave- this has to be arranged by yourself independently

- Costs involved with insurance and registering with platforms; if you are setting up you own clinic, there will be fees for room hire , software subscriptions, equipment, and staff

⚖️What ethical considerations are there?

Regardless of the setting, the GMC’s Good Medical Practice guidelines and ethical principles are always applicable. You must always act with honesty, integrity, and place patient care and safety above any business interest or financial gain. Private healthcare environments often involve more patient engagement, so it is crucial to uphold clear professional boundaries. Even though these individuals may be perceived as “customers”, their care and well-being should always be the first priority.

Private healthcare, while it offers certain advantages, is not universally accessible in the UK due to financial constraints. This creates a situation where individuals with comparable health issues face unequal access to treatment based solely on their economic status. A growing private healthcare sector risks exacerbating social inequalities, granting preferential care to those who can afford it and leaves others behind.

🗣️Is there any stigma to working privately?

Historically, working privately has faced stigma due to its perceived conflict with the principles upon which the NHS was founded in 1948. However, this stigma is becoming less pronounced, as frustrations surrounding waiting times and quality of service grows for both patients and those who work at the NHS. Upon announcing his departure from the NHS, Mr Kolar noted that sadly his colleagues and patients expressed considerable support, a response attributed to the shared awareness of the prevailing difficulties and suboptimal working conditions in the NHS.

Newly-qualified doctors entering private practice may face criticism, but this often stems from a concern for patient safety and to avoid making mistakes that could jeopardise their reputation. Patients who choose to go private for their health have expectations a higher standard of care and results that justifies the cost.

🤔Final Thoughts

When considering private practice, you need to ask yourself and reflect:

- What aligns with my values and wellbeing?

- How do I want to practice medicine?

- What kind of lifestyle do I want?

Private practice is becoming an increasingly viable alternative or complement to NHS work. Whether you seek deeper connections with patients, more control over your time, or better pay, working privately can offer this without uprooting your life from the UK. Nonetheless, private practice isn’t the right path for everyone. The NHS offers stability in patient flow, and consultant positions on offer, as well as research opportunities, teaching roles, and roles beyond direct clinic duties. You have to reflect on you aspirations within and outside your career.