How to go private as a consultant in the UK

Private practice for NHS consultants: what your contract allows

In England the rules sit in the 2003 consultant terms and conditions and the Code of Conduct for Private Practice. Scotland, Wales and Northern Ireland have their own versions, so check the BMA guidance for your nation.

The first offer of an extra session

Before you take on private practice, your employer has the right to offer you one additional programmed activity (PA) a week on top of your standard commitment. If you already work 11 PAs, you have met this. If you turn down an offered PA and no colleague in your department takes it, your employer can defer your pay progression for that year if you go ahead with private work. If a colleague picks it up, or nothing is offered, there is no penalty.

When and where you can do it

• Declare it. Tell your clinical manager about regular private commitments: where, when and the broad type of work. Most trusts collect this through job planning, and it belongs in the scope of practice you declare at appraisal.
• Not in NHS time. No private work during scheduled NHS sessions, except emergencies or by prior agreement, such as time shifting a session back into your job plan.
• Not with NHS resources. No NHS facilities or staff, including your NHS secretary, without the trust's agreement.
• Protect on call. Only book private work that still lets you get back to the NHS site quickly.
• No touting. Don't start conversations about private treatment with NHS patients during NHS work.

Your trust's own private practice policy builds on these terms. Read it before your first clinic.

GMC registration, indemnity and practising privileges

GMC registration and the Specialist Register

You need full GMC registration with a licence to practise, and private hospitals and insurers expect you to be on the Specialist Register for the specialty you will practise. If you hold a substantive NHS consultant post you already are, because the post requires it. Private work also becomes part of the scope of practice you bring to appraisal.

Indemnity for private work

NHS indemnity covers your NHS duties only. The GMC's indemnity guidance says any private practice needs its own adequate and appropriate cover, even on NHS premises. Most consultants arrange it through a medical defence organisation such as the MDU, MPS or MDDUS, or an insurer. Check the procedures you plan to do are covered, whether it is discretionary indemnity or an insurance policy, and what happens to claims after you retire or switch. Cost varies a lot by specialty, so get quotes for your own scope of practice.

Practising privileges

To see patients at a private hospital you need practising privileges there, usually approved by the hospital's medical advisory committee (MAC). At HCA Healthcare UK, you send your CV and proposed scope of practice to the consultant liaison office, meet the chief executive's team, then the MAC decides. Spire, Circle and Nuffield hospitals each have their own policy, so ask for it. Expect to provide:

• GMC registration and Specialist Register entry
• Your NHS post (some hospitals, such as the Cromwell, ask for a substantive NHS appointment within the last five years)
• Evidence of indemnity, and your latest appraisal
• References, usually a DBS check, and the procedures you plan to do there

Start with the hospital your local GPs and colleagues already refer to, or your trust's own private patient unit.

Insurer recognition, fees and the PHIN rules

Recognition with the insurers

Insurers such as Bupa, AXA Health, Aviva and WPA only pay specialist fees to consultants they recognise. Bupa's criteria include a current or previous NHS consultant post, Specialist Register entry, indemnity and practising privileges at a hospital it recognises. Recognition comes with fee terms: the BMA notes that consultants recognised by AXA since July 2008, and by Bupa since June 2010, must keep within the insurer's fee levels or risk losing recognition. Our guide to getting recognised by Bupa and AXA covers the applications.

Setting your self-pay fees

For self-pay patients you set a new consultation fee, a follow-up fee and a price for each common procedure, ideally as a package agreed with the hospital. Check what colleagues in your specialty charge locally.

What the CMA order and PHIN require

The CMA's Private Healthcare Market Investigation Order 2014 applies to every consultant doing private work, including in NHS private patient units:

• Submit your fees to PHIN: your typical fees for initial and follow-up consultations and common procedures, through its portal.
• Check your data. PHIN publishes activity data hospitals send in about you, and lets you review it first.
• Write to patients first. Before an outpatient consultation, patients get written information on the estimated cost and any potential conflicts of interest, on a CMA-approved template from your hospital. Before further tests or treatment, they get the reasons and a cost estimate.

Hospitals must make this a condition of your practising privileges. PHIN also lets you add a profile with your training and interests.

Setting up private practice: consultant admin, billing and tax

A medical secretary

Many consultants start with a self-employed medical secretary who works for several consultants, or a practice management company, and take on their own secretary as the list grows. They handle bookings, letters, insurer pre-authorisation, invoicing and chasing. Agree in writing what they do and how they handle patient data.

Billing and Healthcode

Most UK health insurers take invoices electronically through Healthcode, and some, such as Aviva, only accept new practitioners registered on Healthcode's Private Practice Register. Register early, then set up with each insurer. Practice software such as Meddbase can send invoices through Healthcode. Insurers set invoicing deadlines (Bupa expects invoices within six months of first treatment), so chase unpaid claims monthly.

Limited company or sole trader

Many consultants start as sole traders and some later move private income into a limited company. It depends on your income, pension and who else works in the business. Take accountancy advice before you invoice your first patient.

Data protection and CQC

You will hold your own patient records, so you will normally need to pay the ICO data protection fee (see our guide to GDPR for private practices). In a registered private hospital you work under its CQC registration. If you open your own consulting rooms in England, an exemption covers NHS-employed doctors treating patients in a consulting room, but not sedation, intravenous medicines, endoscopy or imaging. Our CQC registration guide explains.

Your consultant website and online profiles

A GP, colleague or insurer gives patients your name, then they look you up. What they find decides whether they book.

Do you need your own website?

Your hospital profile page is a reasonable start, but it covers one site and you control little on it. A simple site in your name works across every hospital you use and stays yours when you change secretary. It should show:

• Your name, specialty, GMC number and the hospitals where you practise
• The conditions and procedures you treat, each with its own page if you want them found in search
• The insurers that recognise you, and your self-pay consultation fee
• One clear way to book through your secretary, and a real photograph of you

Doctify, Top Doctors and PHIN

Patients and GPs also check third-party profiles. Claim your Doctify and Top Doctors profiles, keep the details identical to your website, and complete your PHIN profile.

Google Business Profile

Google allows profiles for individual practitioners, so reviews can collect in your name rather than only the hospital's. Our guide to Google Business Profile for practices covers the set-up.

Getting referrals from GPs and colleagues

For most new consultants, referrals do more in the first year than anything online.

• Tell your colleagues in your specialty and neighbouring ones what you see privately. Those who don't do private work, or your subspecialty, will refer.
• Get known by local GPs. Many insurers still want a GP referral. Hospital GP evenings and a short, useful letter to local practices help. Keep it educational.
• Make referring easy: one phone number and email, a reasonable wait, and a clear letter back after every consultation.
• Work with your hospital, which markets consultants to GPs and runs an enquiry line. Make sure its team knows what you treat.

Search matters once you want self-pay patients who search for a condition and a town rather than a name. That is where condition pages help and, for a faster start, Google Ads for doctors. Medical clicks can be expensive, so get your booking process ready first.

Your first 90 days in private practice

Privileges and insurer recognition take weeks, so start those first.

Month one: permissions

• Read your trust's private practice policy and agree timings with your clinical manager
• Arrange indemnity and apply for practising privileges
• Register with Healthcode and start insurer recognition
• Talk to an accountant

Month two: set up

• Agree a secretary and your booking and billing systems
• Pay the ICO fee and publish a privacy notice
• Set your fees and submit them to PHIN
• Get your website live and claim your Doctify, Top Doctors and PHIN profiles

Month three: open

• Send the hospital's fee letter before every new appointment
• Tell colleagues and local GPs you are open
• Ask your first patients for reviews
• Check invoices are being paid, and review whether your clinic day and place are right