Private general practice can be rewarding and liberating. It frees you from much of the burden of NHS regulation and allows you to spend more time with patients. There are no targets to meet, no QOF (Quality and Outcomes Framework) points and less government interference.

You can build up relationships with consultants, whom you know will provide the best possible care for your patients, and, although the demands of private patients may be higher, job satisfaction could be greater.

Our guidance is aimed at doctors who are looking to set up in private practice as a private GP and includes some important considerations before making your decision.

It should be read alongside our general guidance on setting up in private practice, which provides further information on financial and legal considerations including CQC registration, DBS checks, registration under the Data Protection Act, and arrangements for appraisals/revalidation.

Demand for your service

Private general practice is a business, so you need to be sure you have a market for your product. Most private general practices are in affluent areas where there is a high enough density of people who can afford the service you will provide. Insurance companies do not cover GP services or investigations organised by them.

Remember also that private prescriptions can sometimes be cheaper, but often much more expensive than the NHS alternative, especially for chronic conditions.

Patients accessing your service will also expect a higher level of service, same-day appointments, longer time with the doctor, and greater access to that doctor. The old adage that private doctors need to be affable, available and able still holds, but it is becoming less about personalities and more about the service provided.

Business models

When setting up as a private GP, there are several different types of business structure that you may wish to consider, depending on your aims and needs.

Single-handed GP/sole trader

Single handed GPs are providers that practise without any other partners. There may be several advantages to practising in this way. It allows you to have autonomy and flexibility over your work – working when and how you please. Greater work flexibility means that you will be able to take more time with your patients and build relationships.

As with running any business, you will be responsible for:

• book-keeping
• providing adequate premises/infrastructure
• employing and training practice staff
• managing staff leave (such as sick and maternity leave).

You will need to seek specialist advice when setting up a new business, particularly in relation to tax and accounting. You may also want to consider the help of other professionals including IT specialists, marketing agents and business consultants.

Before setting up your business there are significant upfront costs that need to be covered, for example, medical equipment, IT hardware and software.

You may choose to practise at home, in a purpose-built surgery, in rented rooms, or you may be able to practise in consulting rooms in private hospitals. If you are renting the premises, you will need a standard commercial leasing agreement, which can be expensive, and you may have additional costs if the rooms need to be refurbished. Repairing leases can be very expensive and you’ll need legal advice.

All doctors who work in the private sector must ensure that they are appropriately appraised in order to revalidate with the GMC (General Medical Council). Working as a single-handed GP will carry a different risk, so indemnity cover may be more expensive.

There are also practical considerations to consider like setting up a merchant account and obtaining a card payment machine in order to accept payments by debit or credit card. Income may be unreliable, certainly initially, and, in exceptional circumstances, the services of a debt collector may be required to recover costs.

Salaried GP

Salaried GPs are fully qualified GPs who are employed by a practice. Some practitioners prefer working as a salaried GP as the income is regular and is not dependent on the number of patients. It is also a good way to focus on clinical work without the competing demands of running a practice. As an employee, you would also receive certain benefits such as holiday pay, sick pay or maternity pay.

If you are just starting out in private practice this may be a good way to network and build contacts with local consultants. Depending on your contract, benefits may also include study leave to attend courses. Indemnity fees, courses, appraisal and revalidation fees may also be covered by the employer.

However, as a salaried GP, you will have less autonomy as you will not have final say on how the practice is run. Depending on your contract, your appointment may also be of limited duration and, unless otherwise agreed, you would not receive a share of the profits. However, you would not have to invest financially in the practice or risk being held liable to any creditors or other claimants.

Read more about salaried GPs.

Limited liability partnership

Practitioners may prefer to set up as a limited liability partnership (LLP). There are several advantages to working in an LLP. Working as a sole trader may feel isolating, while working in partnership means there is support from colleagues. Shared care will be good for patients too, as cross-cover may be available if a partner is unwell or on leave.

On the other hand, members of an LLP will have less autonomy than working as a sole trader, as important decisions relating to the practice will need to be jointly made. You will have to be flexible when it comes to negotiating annual leave dates. There are also other personal costs to cover including indemnity fees, appraisal, and revalidation. Depending on the arrangements, you may need to be involved in staffing/employment issues.

LLPs are closer in concept to limited companies, but members are subject to broadly the same tax, national insurance and capital gains tax regimes as partners in a standard partnership arrangement. The main advantage of an LLP over a traditional partnership is that members’ liability is limited to the amount of money they have invested in the business and to any personal guarantees they have given to raise finance, except in cases of negligence of an individual partner.

Forming an LLP is more expensive and complicated than setting up a partnership and brings several extra running costs.

• You must make financial information about your business publicly available by sending a copy of your annual accounts to Companies House.
• You must submit an annual return giving key details of the LLP and its members.
• You must have the accounts audited (it is possible to be exempt from the audit requirement depending on the annual turnover, balance sheet and number of employees).
• You should have suitable professional indemnity insurance cover from a medical defence body.

Furthermore, banks and other financial institutions lending money to the partnership may still require personal guarantees from the members, as they frequently do with shareholders in a company.

An LLP should be based on a written agreement drawn up with specialist legal and accountancy advice. The agreement will set out:

• how the LLP will be run
• how profits are shared
• who needs to agree decisions
• members’ responsibilities
• how members can join or leave the LLP.

Find out more about LLP registration and legal obligations of LLP members.

Regulation

Registration with the CQC

Any new practice will need to be registered with the CQC (Care Quality Commission) and new applications can take three or more months to complete. Once registered, they will make regular inspections to ensure you are providing a safe service from safe premises.

The CQC have inspected private general practices for many years longer than their NHS colleagues and their inspections can be difficult. Their inspectors often have little knowledge of how the private sector works and expect the same levels of clinical governance and auditing as in the NHS. You will need to abide by all the usual health and safety and infection control legislation as any other practice. Training requirements are also the same for the private sector and can prove expensive.

Find out more about registering.

Find out about exemptions.

CQC advice for the nations

• Northern Ireland: Regulation and Quality Improvement Authority (RQIA).
• Scotland: Healthcare Improvement Scotland.
• Wales: Health Inspectorate Wales (HIW).

Appraisals

You will need to be appraised and revalidated in your role. While this happens automatically in the NHS, it can be more problematic (and expensive) in the private sector. Some GPs continue to do a few NHS sessions to retain their NHS appraisals. Other alternatives, such as the IDF (Independent Doctors’ Federation), can provide appraisal services and have their own responsible officer.

Patients

Patient care

Patients who are entitled to NHS-funded treatment may opt into or out of NHS care at any stage. Patients may pay for additional private health care while continuing to receive care from the NHS; however, private and NHS treatment should be carried out at a different time and place.

Some patients may wish to keep their NHS GP and you must communicate with that GP if the patient agrees to this. Some patients will have no NHS GP, so you will be solely responsible for their medical care.

If you look after babies and children, then you need to provide the full range of child assessment services and schedule of vaccines. Complex elderly and social care tends to remain the remit of the NHS, as this can prove to be expensive privately and there aren’t the same services and multidisciplinary teams available.

Contracts with patients

You should always make sure you have a formal agreement with your patients. They may pay an annual membership fee covering some (or even all) the services you provide, or just pay for each consultation as they attend.

A contract or letter of engagement for private patients should clarify:

• what the fees are and exactly what they cover
• who will be involved in patient care (ie any other doctors and health professionals)
• terms of business, such as payment methods, when payment is required, interest charges on late payments (for example, where payment is not made within two months), and the clinic’s cancellation policy.
• The patient should confirm that they are happy for information to be shared with their NHS GP.

To help, we have created a terms of engagement template that can be adapted to suit individual requirements.

Out of hours cover

As an NHS GP you have no contractual obligation to provide out of hours services to your patients. You can also choose what level of care you provide privately.

Complaints procedure

All private GP practices that are CQC registered are required to have a complaints policy in place. Patients need to be made aware of this policy at the time of registration and leaflets should be made available at reception detailing the complaints policy of the practice.

The complaint should be made to the GP in the first instance. Depending on the nature of the complaint, patients may complain to the GMC or the Care Quality Commission if they feel that the standard of care is far below what might have been expected. Alternatively, the patient may go to court to sue the practice if they feel they have been damaged by negligent treatment.

If a GP is aware of a potential complaint, they should consult their medical defence organisation and the BMA.

Finances

The point of running any business is to make a profit so you can pay yourself an income. In the private sector, time is money and you only get paid for the service you provide (unlike in the NHS). You will need enough income to cover set up costs, premises, staffing and their tax requirements, as well as paying yourself a decent salary. This may not happen overnight and there will probably be a deficit, which you will have to cover in the first few months.

There is always the risk that the practice does not succeed, so you may need to keep your options open with the NHS. The perception of private doctors earning large sums of money is generally not true and is certainly not the reason to set up a private general practice.

It’s also important to remember that you will not be able to continue with your NHS superannuated pension and you will need to make private arrangements for your retirement. This is a very important consideration depending on what stage of your career you start a private practice.

The pitfalls

The grass is not always greener, and the security of the NHS has a lot to be said for it.

Private patients can be more challenging; their needs often cannot be accommodated by the NHS, their expectations are understandably higher, and they will often let you know when they don’t feel they have received the level of service they expected.

Credit control can also be a problem for many practices, as patients are invoiced after their appointment. Many practices employ debt collection services to chase unpaid fees.