There are a variety of factors to consider when setting up in private practice.
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It is essential that all private practitioners have an adequate level of indemnity cover from one of the medical defence bodies, as the NHS indemnity schemes do not cover private work.
You can get appropriate cover from one of the following organisations:
Many individuals who receive private treatment do so as a result of private health insurance schemes. Private medical insurers (PMIs) - 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. Therefore, in order to be able to treat patients holding medical insurance, many practitioners choose to apply for specialist recognition.
The requirements to obtain specialist recognition vary between the insurers, but most grant recognition to individuals who are on the specialist register and hold, or have held, a substantive NHS consultant appointment. The recognition arrangements of the insurers do differ, however, and some may not require a formal recognition procedure. Get in contact with the health insurer directly to find out what their recognition criteria is and decide whether you agree to their terms.
There are many administrative, financial and legal implications that need to be addressed by doctors interested in setting up in private practice.
You will need to seek the specialist advice of accountants and lawyers when setting up a new business, particularly in relation to the more detailed aspects of business arrangements, such as the application of tax and accounting.
You may also wish to consider the help of other professionals including IT specialists, marketing agents and business consultants or advisers.
It is important to select an accountant and solicitor who is right for the business and has the experience of dealing with organisations in the same sector and of a similar size.
A few of the professional associations that can be contacted include:
It is important to register with HMRC that you are entering a fee charging practice within three months of starting practice, otherwise you could be subjected to a fine.
Check HMRC for more information.
In order to keep track of cash flow and taxation, all doctors in private practice will need to set up a separate business bank account and develop a form of book keeping that is easy to use and well organised.
It is advisable to employ an accountant at the end of the year to draw up a profit and loss account, balance sheet and calculate tax.
Terms of engagement set out organisational and financial arrangements, and highlight that doctors have a professional and contractual arrangement with their patients, rather than another third party.
To help, we have created a terms of engagement template that can be adapted to suit individual requirements.
Download the template
Doctors who carry out private practice are required to be registered with the Information Commission under the Data Protection Act .
This covers private doctors in the processing of all personal data relating to any private treatment.
Notification with the Information Commission is a statutory obligation for every organisation or individual who processes personal information electronically, unless they can rely on any of the exemptions in the Data Protection Act .
Complete the application form and pay the statutory annual fee on the Information Commission website or by contacting their helpline on 123 .
A register of data controllers is available for public inspection on the ICO's website.
The Disclosure and Barring Service (DBS) was established under the Protection of Freedoms Act () and merges the functions previously carried out by the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA).
The services provided by the DBS have not changed from those provided by the CRB and ISA, instead, they are now provided by one organisation.
With the introduction of the DBS there has been a change to the definition of 'regulated activity' in relation to safeguarding adults as defined in the Safeguarding Vulnerable Groups Act .
In this context 'regulated activity' does not have the same meaning as it does in the Health and Social Care Act of . Instead, for disclosure and barring purposes, a regulated activity is one involving close work with vulnerable groups including children.
Find out more about the changes.
In June , the DBS introduced the Update Service to reduce the number of applications individuals must make for a DBS check.
The DBS Update Service means that applicants will only have to apply for a DBS check once. Applicants will then be able to re-use their certificate if they require a further check of the same type.
Find out more about the DBS Update Service.
Read The Safeguarding Vulnerable Groups Act (Miscellaneous Provisions) Regulations .
Doctors working in private practice are not employees and are not covered by employment law. Therefore, it’s extremely important that you give due diligence to any contract for the provision of services, practising privileges policy, or any other commercial agreement, before signing.
Contract terms can often be negotiated and amended, and it might be worth seeking independent advice from an expert to highlight any pitfalls and risks that might result from signing the contract.
The CQC was established by the Health and Social Care Act 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.
One of the major issues to be addressed by practitioners creating a new practice is location.
There are three main options where consultants can practise privately: in rooms provided in a private or NHS hospital; in dedicated consulting rooms; or in a part of their own home. There is also a fourth option: purchasing an existing practice.
Similarly, for private GPs, they may choose to practice at home, in a purpose-built surgery, in rented rooms, or, occasionally, in consulting rooms in private hospitals.
There may be several advantages to practising in a private hospital. For example, the rental or lease may include the use of skilled ancillary staff, such as receptionists, secretaries and nurses, and usually includes most of the furniture and equipment.
Easy access to on-site facilities, such as pathology and radiology may also be a considerable advantage. It is worth researching the average cost per session for consulting in private hospitals in different regions, and, if the decision is made to consult in a private hospital, then an application for practising privileges at the hospital will need to be made.
It should also be kept in mind that the GMC states that where a doctor has a financial interest, they must disclose this information to the patient before making the arrangements for admission or treatment, and this includes any financial interest in a private hospital.
In order to use rooms in NHS hospitals, formal approval is needed from the hospital authorities.
The advantages include the use of furniture and equipment, but it is important to note that ancillary NHS staff cannot be used for free, and NHS secretaries or receptionists should not be asked to work privately without payment.
Any work that involves assisting with a doctor's private patients should be undertaken outside NHS working hours and with management permission if NHS facilities are to be used.
The use of dedicated private consulting rooms is an attractive option for many private doctors, but it can be costly.
Purchasing the freehold of a property will require a substantial capital outlay and is best achieved by practitioners coming together to form a company. In this way, practitioners may purchase the freehold or lease, together with the necessary equipment, and employ staff on a shared basis.
In larger cities, however, fully equipped consulting rooms are often available by lease or license.
Practising from home is another popular option for doctors in private practice. Practising from home will cut down travelling costs and bring entitlement to tax relief in respect of heating, lighting, décor etc. but it could be disruptive to the home routine.
Some specialities will clearly be more suited to practising at home, whereas for others it will not be practical. Any doctor thinking of practising at home will need to consult their accountant in order to determine what tax advantages are available. It is also worth checking with a solicitor that there are no restrictions on the use of the property for business purposes.
Another way to establish a private practice is to buy an existing one, for example from a retiring specialist or GP. This would include purchasing not just the equipment, facilities and the lease or freehold of a property, but also the 'goodwill' attached to an existing client base.
This may be an advantageous way of starting out in private practice, as the client base and reputation of the practice has already been established.
An accountant should be consulted to calculate the value of the goodwill attached to a practice.
The general factors to be considered in the valuation would include:
It is important to note that there are some restrictions on the sale of goodwill for GPs who also hold an NHS contract. Read more about the sale of goodwill relating to the restrictions on GPs.
Independent practice, whether consultant or general practice, consists of a variety of different working arrangements and, as such, the nature of the appraisal process is also varied.
For example, doctors may work wholly in private practice and hold practising privileges with one or more providers; work wholly in private practice but with no practising privileges; or they may hold an NHS contract and carry out part-time private practice.
In all cases, however, it is your responsibility as a doctor to ensure that you are appraised annually.
The appraisal system is central to revalidation and must be quality assured, follow defined frameworks set down by the GMC and include the principles outlined in the Good Medical Practice module. Good medical practice requires that information be provided in relation to: activity, complaints, incidents and issues of health, probity.
Doctors undertaking private practice, who also hold an NHS contract, will need to participate in whole practice appraisal within your NHS appraisal, to cover all elements of your practice.
Appraisal of this nature takes place in the NHS, using NHS appraisal forms, together with relevant data provided from the independent sector provider, and a certificate to confirm the renewal of practising privileges.
Where you have practising privileges with more than one independent provider, information will need to be provided from each independent hospital.
On completion of the annual appraisal, a copy of form 4, or a letter from the employing NHS trust’s medical director confirming satisfactory appraisal, should be sent to the chief executive of the NHS employer and the registered manager of the independent hospital.
Many doctors do not hold an NHS contract, and work purely in the independent sector, either with practising privileges at one or more independent hospitals, on a self-employed basis with no practising privileges; or are employed by an independent hospital.
All these doctors, regardless of working arrangements, are required to participate in appraisal in order to revalidate with the GMC.
Independent providers have responsibility through the National Minimum Standards from the Care Standards Act , to ensure clinicians are appropriately appraised.
Doctors can participate in an appraisal process via: the independent sector organisation in which you work, the relevant Royal College, the Independent Doctors Forum, or an independent appraiser.
As a doctor, it is your responsible officer (RO) who is required to ensure that they are satisfied that the appraiser and appraisal process meet the standards required for revalidation. In every case, the appraiser needs to be a registered medical practitioner who has been trained and approved through a quality approved scheme.
Doctors identify their responsible officer for the purposes of revalidation through their prescribed connection to a designated body.
For doctors working in the NHS and undertaking any amount of private practice - even if this constitutes most of your work - your designated body will be your main NHS employer.
For more information, please visit Hospital consulting room.
For doctors working wholly in private practice, your designated body will usually be the private hospital provider where you have practising privileges and where you undertake most of your work.
For doctors working in the independent sector with no practising privileges, there are several options available to you, although this will depend on the nature of your work and your relationship with other recognised designated bodies.
Further information about identifying an RO is available on the GMC website.
The right to undertake private practice is an essential part of the flexibility and freedom built into the national consultant contract.
The terms and conditions of service for consultants does not limit consultants from undertaking private practice, where those services are defined as 'private professional services'.
Although there is no obligation for a consultant to undertake PAs (programmed activities) in excess of 10 per week, one of the criteria for achieving pay progression is that consultants should accept an extra paid PA in the NHS, if offered, before doing private work.
Any additional PAs must be offered fairly between all consultants in the specialty, and if a colleague takes up those sessions there would be no detriment to pay progression for other consultants.
If the employing organisation offers the option of undertaking an extra PA per week and the consultant chooses to reject the offer, then pay progression can be withheld for that year only. If consultants are already working 11 PAs (or equivalent) then there is no requirement to undertake any additional work.
Consultants should discuss any private practice commitments with their clinical manager and, where possible, the offer of additional PAs should be made at the annual job plan review. There should be a three-month minimum notice period for starting or terminating additional PAs on both sides.
Read more about consultants contracts.
Under the pre- national terms of service, there are certain restrictions on full-time consultants, including a limitation on private practice income.
In the terms of the contract, gross earnings from private practice for any financial year must not exceed 10 per cent of gross NHS salary.
Full-time consultants must show their employer at the end of each financial year that they have not exceeded the 10 per cent limit. Exceeding the limit in two consecutive years - and failing to show that effective steps have been taken to reduce private earnings - will result in consultants losing their full-time status.
In some exceptional circumstances, employers have offered full-time contracts with no limit on private practice earnings, sometimes with a condition that private work will take place on NHS premises.
Maximum part-time consultants can do unlimited private practice, subject to the requirement that they devote substantially the whole of their professional time to their NHS duties, but only receive 10/11ths of whole-time NHS salary.
Read more about consultants contracts.
As part of the contract negotiations, a code of conduct for private practice was drawn up to minimise the risk of a conflict between a consultant's private practice and their NHS commitments.
The terms and conditions of service also contain contractual provisions dealing with the relationship between NHS and private activity. The terms and conditions cover very similar points to those in the code of conduct, which sets out the standards of best practice. These include:
Find out more
Rules surrounding patient entitlement to NHS care, have frequently been an area of confusion.
The Department of Health published guidance stating that NHS provision should not be withdrawn for those wanting to top up single episodes of care with private treatment, but any private additions to NHS care will only be allowed when they can be delivered at a separate time and place.
Patients may therefore pay for additional private health care, while continuing to receive care from the NHS, or may have a private consultation for investigations and diagnosis, but then transfer to the NHS for any subsequent treatment.
This guidance applies to all secondary and specialist healthcare in England., and the key principles are:
Read Department of Health guidance on NHS patients who wish to pay for additional care.
Many consultants in private practice choose to work in a private hospital.
Admitting rights at a private hospital is a matter between the consultant and the hospital concerned, and are generally approved through the hospital's medical advisory committee (MAC).
The criteria and conditions under which consultants may be granted authorisation to treat patients in a private hospital are outlined in the hospital's practising privileges policy. For this reason, a licence to use the facilities of a private hospital is known as ’practising privileges’, and consultants are independent contractors of the hospital.
Although the criteria for granting practising privileges vary between hospitals, to be eligible, a consultant must:
If a consultant has not held a substantive consultant post, then they must be able to demonstrate experience of independent practice over a sustained period applicable to working in the independent sector.
Doctors on the GMC specialist register who hold a locum consultant post, may be granted practising privileges limited to the duration of their locum appointment.
Hospitals are required to review the practising privileges of each practitioner every two years. In order to maintain practising privileges, a satisfactory appraisal process must be carried out, and the collection of clinical data.
When agreeing to the conditions set out in the practising privileges policy, it is important that consultants are aware of the circumstances under which the hospital may restrict, suspend, withdraw or vary practising privileges.
For example, this may occur for reasons of health, fitness to practise, commercial conflict of interest, or failure to comply with the hospitals policies.
Consultants may hold practising privileges at more than one hospital. In this situation, one hospital is required to lead the process and should be named in the practitioner's personal file. The formal application process is required for each hospital applied to, and a record of the number of practising privileges should be held at each hospital.
If you’re a consultant working in the NHS, you are free to carry out private practice work in your non-NHS time, provided it is not viewed as competing with your main NHS employer.
In today's NHS, non-NHS bodies are increasingly competing for NHS work, so a consultant could end up carrying out work for an organisation that competes with their NHS employer. This has resulted in confusion over the extent to which a consultant's implied 'duty of fidelity' to their NHS employer might restrict them.
The consultant contract does not limit consultants from undertaking private practice on behalf of other parties. BMA legal opinion has interpreted the contract as restricting private practice work that could diminish overall NHS services, rather than those of a single employer.
The contract anticipates that there may be a conflict with the employer's business activities, but it does not attempt to limit the private practice work that consultants can undertake.
Some private hospitals state that the consultant who uses their consulting rooms and facilities will admit the patient to that private hospital for treatment. If, however, the consultant has not formally agreed to this with the hospital then they are entitled to send patients to the facilities of their choice.
The consultant has an overriding professional duty to treat patients in a hospital with the appropriate facilities and equipment.
Hospital beds play a crucial role in patient care and comfort, providing a supportive and adjustable surface for individuals in medical facilities. Whether for short-term or long-term use, selecting the right hospital bed is vital. In this comprehensive guide, we will explore the various uses, key features, and important buying considerations for hospital beds.
Hospital beds are specialized beds designed to meet the specific needs of patients in medical settings. These beds offer adjustable features to enhance comfort, aid in medical treatments, and provide support during recovery.
Manual Hospital Beds
Manual beds are operated through manual mechanisms and adjustments. They are cost-effective options and suitable for patients requiring basic positioning changes.
Semi-electric beds combine manual and electric features, allowing for easier adjustments of the head and foot sections with the help of electric controls.
Fully electric beds offer complete electric operation, providing convenient adjustments for the bed height, head and foot sections, and additional features like bed exit alarms.
Hospital beds offer essential support and comfort for patients, aiding in proper rest and alleviating pressure points. They allow for convenient positioning changes to prevent bedsores and enhance overall well-being.
Hospital beds are instrumental in various medical treatments and procedures, providing a stable platform for surgeries, examinations, and other interventions. Their adjustable features assist healthcare professionals in delivering efficient and effective care.
During rehabilitation and recovery, hospital beds assist patients in regaining mobility and independence. They allow for safe and controlled movements, providing support for physical therapy exercises and aiding in the recovery process.
Adjustable Height
Hospital beds with adjustable heights ensure ergonomic positioning for patients and caregivers, allowing for easy transfers and reducing the risk of strain or injuries.
The ability to adjust the backrest and leg rest angles provides personalized support and comfort. It enables patients to find optimal positions for activities such as eating, reading, or watching TV.
Hospital beds often come with side rails to prevent accidental falls. These rails can be easily raised or lowered as needed, ensuring patient safety while allowing for easy access when required.
Some hospital beds feature wheels or casters, enabling easy movement within the healthcare facility. This mobility facilitates patient transfers and efficient use of space.
High-quality mattresses designed for hospital beds promote pressure redistribution, reducing the risk of pressure ulcers. Features like air-filled or foam overlays enhance patient comfort and ensure adequate airflow.
Understanding the specific needs of the patient, such as mobility limitations or medical conditions, is essential in selecting the appropriate bed type and features.
Consider the dimensions and weight capacity of the hospital bed to ensure it accommodates the patient comfortably and safely.
Opt for hospital beds constructed with durable materials that can withstand daily use in a medical setting. Quality craftsmanship ensures longevity and reliability.
Choose a hospital bed that is user-friendly, with intuitive controls and accessible mechanisms for adjustments. Additionally, consider the ease of maintenance and availability of replacement parts.
While considering the features and quality, it's important to align the selection with the budgetary constraints of the healthcare facility or individual purchasing the bed.
Seek advice from healthcare professionals, including doctors, nurses, or therapists, to gain insights and recommendations based on the patient's specific needs.
Explore different brands and models of hospital beds, considering their reputation, customer reviews, and available features to make an informed decision.
Reading user reviews and ratings can provide valuable feedback on the performance, durability, and overall satisfaction of specific hospital bed models.
If feasible, try to test-drive the hospital bed to evaluate its functionality, comfort, and ease of use firsthand.
Follow proper cleaning and disinfection protocols provided by the manufacturer to maintain a hygienic environment for patients.
Perform routine inspections and maintenance checks on the hospital bed, ensuring that all mechanisms are functioning correctly and addressing any issues promptly.
Educate patients and caregivers about the safe operation of the hospital bed, including using side rails, operating controls, and taking necessary precautions during transfers.
Hospital beds are versatile tools that enhance patient care, assist in medical treatments and aid in rehabilitation and recovery. Their adjustable features, including height, backrest, and leg rest adjustments, along with safety measures, contribute to overall comfort and well-being.
When purchasing a hospital bed, considering patient needs, bed features, quality, and budget is crucial. By following the outlined tips and conducting thorough research, healthcare facilities and individuals can make informed decisions to provide optimal care and support for patients.
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