Working in private practice - overview

Find out more about maintaining a private practice and read our guidance on recognition with private medical insurers.
Location: UK
Audience: Consultants SAS doctors GPs Junior doctors
Updated: Tuesday 26 October 2021
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There are an estimated seven million private general practice consultations a year in the UK, with 11 per cent of the population having some form of medical insurance.

As a private practice or practitioner, there are certain rules that must be followed to ensure your business is operating within the law. Here we look at registering with the Care Quality Commission (CQC) as a private practitioner and changes to the terms that private medical insurers AXA PPP healthcare and BUPA use to recognise private practitioners.

For more information on working in private practice, read our individual pages for consultants and SAS doctors.

 

Registering with CQC

The CQC (Care Quality Commission) was established by the Health and Social Care Act 2008 and its role includes regulating the independent healthcare sector in England.

Any service provider who carries out a regulated activity, must register with the CQC; however, there are certain exemptions that apply to independent medical practitioners.

Find out more about registering

Find out about exemptions

CQC advice for the nations

 

Recognition with private medical insurers

Many individuals who receive private treatment do so as a result of private health insurance schemes. PMIs (private medical insurers) - such as BUPA, AXA PPP, WPA and Aviva - will only reimburse patients for their specialist's fees if the consultant has been granted specialist recognition with the insurer.

Changes to terms of recognition – as in the case of AXA PPP healthcare and BUPA - can cause issues for consultants and private practices, so it’s important that you are aware of these changes before accepting the criteria.

 

AXA PPP healthcare

The PPC (private practice committee) has been closely monitoring members' concerns about the new terms of recognition as an approved specialist with AXA PPP Healthcare.

It is our understanding that if a consultant became recognised as an approved specialist by AXA PPP Healthcare prior to July 2008, then the consultant can charge patients at their own rate. The patient would then pick-up any shortfall that was not reimbursed by their insurance.

Consultants who were recognised after July 2008 would have signed up to the new terms. These terms say:

  • consultants must charge fees at the level outlined in the AXA PPP healthcare fee schedule
  • if charges are made above these values then the consultant will be de-recognised.

BMA advice

The BMA has worked with specialist solicitors and met with the Financial Ombudsman Service and senior officers of AXA PPP Healthcare to address members' concerns about the new terms.

Although the PPC is firmly against the introduction of these set fees, the law does not provide a remedy. From a competition law perspective, the terms are seen to be of benefit to consumers, and so outweigh any adverse financial impact on consultants.

Signing up to the new terms is a commercial matter between the consultant and AXA PPP Healthcare. In order to be recognised, consultants must accept the new terms and charge at the fee levels set by AXA PPP Healthcare.

We would advise members to:

  • consider the implications of signing up to the new terms
  • decide whether you are prepared to accept the fee levels offered by AXA PPP Healthcare
  • remember that you remain free to provide services elsewhere and to set your own charges.

We will continue to maintain contact with senior staff at AXA PPP Healthcare and raise our concerns, and the concerns of our members, at every opportunity.

If you have any further questions or concerns regarding the new terms, please email the private practice committee or contact a BMA adviser on 0300 123 123.

 

BUPA

The current BUPA consultant recognition process opened in June 2010. Consultants recognised by BUPA prior to this remain unaffected by the changes and can continue to charge patients at their own rate, with patients picking-up any shortfall not reimbursed by BUPA.

However, all consultants applying for recognition with BUPA from June 2010 onwards must accept the new terms for recognised consultants.

These terms say that:

  • consultants must agree consultation fees as part of the recognition process
  • all other fees must not exceed BUPA's Benefit Maxima
  • if charges are made above these values then the consultant will be de-recognised.

BMA advice

The PPC has sought external legal advice about whether these terms can be challenged through competition law, but we were told that BUPA would not be acting outside of the law when consumers benefit from lower costs.

We would advise members that agreeing to the terms as part of the new consultant recognition process is a commercial matter between the consultant and BUPA.

However, members should also:

  • consider the implications of signing up to the new terms
  • decide whether you are prepared to agree face-to-face consultation fees and accept the fee levels outlined in BUPA's Benefit Maxima
  • remember that you remain free to provide services elsewhere and to set your own charges.

When setting consultation fees, it is important to ensure that charges are representative of what is fair remuneration for services. You should consider conditions such as experience, effort, skills and resources applied.

If you need further advice about the BUPA recognition process or have any other questions or concerns regarding your private practice, do not hesitate to contact a BMA adviser on 0300 123 123.