For many Doctors Private Medical Practice is actually something often hidden from view. You dont really want your colleagues to know, it is seen as a negative aspect of your professional life. You are seen as greedy, money driven, and betraying not only your NHS trust but also ordinary patients. In this blog I am going to outline why private medical practice is a positive and productive part of your medical career and not a secret that you have to hide from your colleagues.

 I will highlight three key misconceptions that I think you should consider and I will explain how these misconceptions act as barriers to being successful in private practice. For each of these I’m going to give you simple practical tips and advice to overcome these barriers and avoid the common pitfalls that result from them.  

The first common misconception is that you don't have enough time and I felt exactly that way for years. This to me is the number one perceived barrier that doesn’t actually exist. You assume that private practice will entail significant time, typically evening clinics and Saturdays and that you’re chained to a job plan at your NHS Trust which you can not control or negotiate. This is not true.

Many Doctors also make the mistake when they start casting their net too widely initially running around to two or three private Hospitals or clinics. It often stems from bad preparation right from the beginning of their career. You are so excited to be appointed as a Consultant and to be honest grateful that the race is over that you do not stop and pause and think: what have I actually signed up for? , what is my actual job plan not the one cobbled together for the advert, can I negotiate? will I seem ungrateful?. Once you start it is pretty hard to change anything in the NHS and before too long, you start to dream of perhaps doing a little private practice, just a little. It soon becomes obvious the only time you have and the only clinic any Private Hospital wants you offer you (because after all you are a very” junior consultant “ is Friday evening. So what happens? You try and open as many clinics in different places as you can thinking that one will “bite” and then you can drop the rest. Except you are too busy to actually prepare or plan anything. 

 After a long day in clinic you set off to see the one or two patients who “want to go private” from the 100 NHS patients you have seen that week.  Arriving late to an evening clinic, shattered from the days NHS work is the quickest way to ensure that any patient you see never chooses to see you again. You don’t really want to be there and  neither do your patients. You will resent having to drive in the rain at night to see two patients on a Friday evening I can guarantee it. You have to work smartly and spend your precious time very very efficiently. Keep it simple to start with and choose one place to work and get it right there.

Let me give you an example to help bring this to life. An endocrinologist with a new Research Interest in Diabetes works in Hogwarts Hospital and would like to spend a half day a week in  private practice and also working with a company developing a new test and kit for glucose monitoring. This programmed activity  is not currently recognised or supported in their Job Plan. The result – evenings and weekends meeting the lab team and writing papers in order to pursue this. 

Why does this happen? An NHS trust is like any other organisation –  they want value and productivity from you . So you have to give it to them. They don't care about your ambitions and dreams, they care about you seeing 20 patients every clinic. In fact you actually want to do this because you are passionate about the NHS and you care for your patients?. You have to remember you are in control of your time and you have choices. You are choosing to follow a work pattern according to this Job Plan. However. it is not set in stone, and you have the choice to change it.

So, what could our Endocrinologist do then ? They  could ask for a job plan review, and present a solution to the problem, not complain about how unfair it is. But how can they deliver productivity for the NHS while still making time for their private practice? They  have to think smartly.  Is there an effective R&D Lead? Could they form a collaborative link from the company to the Hospital?. Could they set up an Innovation hub in the hospital? Are there grants that they could apply for to fund the job plan change? Is there a business case for a specialist nurse to take up some of the routine work? Positive engagement, being honest and transparent about your aims and creating space around yourself, goes a long, long way. You need to push back in your Trust and deliver your NHS Commitment effectively and efficiently and probably differently if you want to create the space and time for private practice. If you really want to reduce your NHS PA commitment you need to be honest and open and come to the table with a plan for your NHS Department which maintains productivity. By taking control of the conversation, presenting solutions not complaints, and working smartly you can release the time you want to develop your Private Practice. 

The Second Misconception is that it will cost too much to set up your private practice, for example employing a secretary, advertising and marketing etc. Again it is simply not true. It still amazes me that many of my colleagues still employ a full time or shared secretary who is poised by a phone, often a mobile phone. Patients will ring a number and often leave a message only to play a game of telephone tennis over the course of the day. That same secretary will be spending most of the day typing letters and invoices on beautiful conqueror cream paper, while your patients have no way of rapidly booking an appointment.  The world I’m afraid has changed. Cloudphone technology, Chatbots, virtual PA’s services, practice management software, the list goes on. You can have an 8am-8pm service for a few hundred pounds per month if you are prepared to spend a little at the beginning setting up the flows and processes. Technology does not want Friday off, Christmas off and really doesn't mind if they get replaced - so use it. In the course we will show you exactly how to do this. 

The third and final misconception is that it’s not worth starting a private practice as the fees you will receive are so low now that it simply doesn’t add up. Insurance companies are paying less and less and in General Practice a patient can see an online GP from one of the big providers for £35. How do you compete with that?

Trust me, it can be profitable. Many consultants, particularly surgeons pride themselves on refusing to engage with the major insurers in order to protect their Initial Consultation, follow up and surgical fees and don’t bother to maintain for example their BUPA Finder Profile. This is a huge opportunity for  you because BUPA Finder works by prioritising fee assured specialists. These Consultants will see a lot of new patients and that results in a lot of fees, simple as that.

Let me give you a quick example of this in action. As a Consultant it is far better to see 8 new patients in a tightly and efficiently run clinic running from 8am-12pm that is always fully booked than it is to see 5 patients with gaps at a slightly higher rate. The conversion to surgery will be higher because you are seeing more patients.  You will then start to  have a predictable income as your clinics become full and you can then develop business plans, models and plans for your family knowing that there will be a predictable cash flow in your business. Those new patients will also come back to you for the rest of your career and that overall value is far greater than a one off higher charge. Engaging with insurance providers, providing consistent high quality care with feedback is far better than being an outlier. Patients want to see busy Doctors. Would you prefer to see a Doctor who has a full clinic or one you see reading the paper when you arrive? Think about that. 

Similarly on the other side of the fence many GP’s simply undervalue themselves and charge fees comparable to seeing a physiotherapist or Nutritionist and feel that they have to immediately refer patients on to a specialist. 

For GP’s in private practice you need to think about what value you are giving. A patient with a simple urine infection who needs a urine test and a prescription should be seen quickly and pay the bare minimum – with a great experience they will be your patient for life. That same patient will then come back and undertake a detailed health assessment, have a full medical and embark on a journey with you to reach their health goals. That overall package of care is worth far more than the initial cheaper episode of care. By creating a lifelong patient you are creating an asset of significant value.

You also need  to look beyond the consultation charge and own the whole pathway particularly the tests such as blood tests, vaccinations, smears and so on. The analogy would be a restaurant, where the profit is made on the wine list not the food. 

Do not overcharge for simple care or undercharge for complex care.  

So to recap: Private practice can be a rewarding, exciting and productive part of your medical career, which does not need to take up your evenings and weekends. You make time by working with your NHS trust, providing solutions to job planning not complaints and being efficient and organised with your time. Upfront set up costs are not as high as you think and you can start up cheaply and effectively using technology to reduce administration and cost and to automate large parts of your practice. And finally it can be very financially rewarding providing you spend your time effectively, understand the value of that time and focus on where your profits are really made.