‘Independent Practice’ and ‘Private Practice’ are synonymous terms meaning practicing medicine out with the umbrella of the NHS. Private practice existed long before the creation of the NHS, and it continues today in parallel with the NHS.
Private practice does allow surgeons to practice more independently of NHS targets and diktats. Private Practice allows more direct one-to-one care for patients, without a need to rush. Private practice can indeed be greatly rewarding, both emotionally and professionally, but like most worthwhile things, it does require hard work and commitment.
Patients receiving private healthcare fall into two groups: those with private medical insurance policies (about 80% of patients) and those who self fund (about 20%).
Of those doctors undertaking private practice, the large majority also work in NHS Consultant posts, doing their private work in their spare time, outside of and on top of their NHS commitments. A small proportion of doctors work in full time private practice only.
The amount of private practice varies considerably across the country, with the greatest density being around London and the South-East.
Entering Private Practice
Any registered medical practitioner can, in theory, undertake work privately. However, in reality, there are a number of practical barriers.
First, private medical insurance companies do not have their own mechanisms for assessing quality and suitability of doctors for being recognised as specialists. They therefore rely on specific benchmarks, including the need to be on the GMC’s Specialist Register and to have successfully gone through an Advisory Appointments Committee (AAC), which is part of the NHS Consultant appointment process. Second, by law, private hospitals have very strict criteria for awarding practicing privileges to doctors using their facilities. These help assure patients that they are being seen by experienced and fully trained registered specialists.
Balancing Private and NHS work
Whether a surgeon decides to undertake work in the private sector is a personal decision, which can be influenced by many factors.
Under the new consultant contract, there are rules governing how you balance NHS work with private practice. If you do not have 11 or more programmed activities in your job plan, you are expected to offer the first portion of any spare time to the NHS in preference to any private work.
There is a Code of Conduct for Private Practice, jointly agreed by the DH and BMA (downloadable from the DH site). This code ensures that your private work does not disadvantage NHS patients.
When a surgeon has patients under their care within the NHS, the patients tend to be looked after by a large team, including a variety of grades of trainees. Care in the private sector is generally delivered entirely by the consultant. Private practice is therefore a significant commitment, which has to be handled effectively on top of all the many commitments of the busy NHS Consultant.
Factors such as geography and specialty can also influence a surgeon’s decision to undertake private practice. Some specialties have relatively low rates of private practice whilst others, such as cosmetic surgery, feature very strongly.
There is a perception that those doctors (and particularly surgeons) undertaking private practice are very generously remunerated financially. The reality, however, is that most surgeons do only relatively small volumes of private practice on top of their NHS commitments.
To give this issue some perspective, a surgeon undertaking private practice and receiving £100,000 remuneration a year, will be paying practice costs (secretary, room hire, stationery, I.T. costs etc) of anything up to 40%, i.e. £40,000. It is compulsory for the surgeon to have medical negligence Insurance or indemnity cover. This may well cost as much as £20,000 per annum. This leaves a net income of £40,000 from the original £100,000 invoiced. This £40,000 will be subject to income tax of 40%. Thus, the initially attractive appearing sum of £100,000 actually equates to a real income of about £20,000.
It should therefore be emphasised that the number of surgeons actually earning significant incomes from private practice is, in reality, very small.
For further information about the private medical sector and some of the current issues facing it, please see the website of The Federation of Independent Practitioners Organisations.
Appraisal for Private Practice
The Independent Healthcare Forum (IHF) has issued guidance and forms for NHS doctors with a private practice. This guidance should be used in conjunction with NHS appraisal. The arrangements have been agreed between the IHF, the DH, the GMC and the BMA. The IHF has issued separate guidance for those doctors working wholly in the independent sector.
Your Trust should implement a 'whole practice' appraisal for you if you undertake private work during the period being appraised. Please see the guidance document.