With NHS salaries at their lowest and staff morale hanging by a thread, the question on healthcare professionals' minds is 'where can I supplement my income?'
That's where private healthcare comes in.
Roughly 11% of patients in the UK have some form of private healthcare [1]. Patients receiving private healthcare in the UK tend to fall into two main groups: those with private medical insurance policies (which are usually chosen for them by their employers) and those who self-fund. Very few UK insurance policies offer maternity or mental health cover. None provide cover for accidents and emergency or for general practice.
There are many reasons why patients may opt for private healthcare in the UK at the moment. The most common ones are:
Waiting times. In the NHS, you can often have your appointment happen hours late, rescheduled, or cancelled completely. In private care, this is a rarer occurrence as it is typically one-to-one doctor-to-patient care. Patients are given an appointment and it is stuck to - this is particularly popular with surgical procedures.
Patients can choose their consultant and are more likely to be seen by the same consultant throughout their treatment - this continuity of care is currently poor in the NHS due to high staff turnover and rotas.
Facilities will include a private room, better food, and 1-1 nursing assistance.
Private patients may fund their treatment individually, or through claiming on their private medical insurance. The doctor's contract is always with the patient, meaning it’s the patient's responsibility to make sure that the doctor's terms and fees are met.
Can junior doctors practice privately?
Doctors with provisional or limited registration CANNOT practise without supervision (i.e. F1). Any doctor fully registered with the General Medical Council (GMC) is entitled to work in private medical practice (F2 and beyond) [2].
HOWEVER, due to the fact that private medical insurance companies do not have their own set standards for assessing the quality and suitability of doctors, they rely on specific benchmarks, including the need to be on the GMC’s Specialist Register [3] and to have successfully gone through an Advisory Appointments Committee (AAC), which are both parts of the NHS consultant appointment process. On the other hand, private hospitals, BY LAW, have to set very strict criteria for awarding practicing privileges to doctors before they can use their facilities. A combination of these benchmarks and the criteria doctors need to meet in order to work for a private hospital, helps ensure patients are being seen by the appropriate experienced and fully-trained registered specialists.
Therefore, it is a LOT less likely that you can do private work as an F2 - you might be able to pick up a few shifts to do things like admin and be an extra pair of hands. But to enter private work and be seeing patients, you'd likely be an ST3 on a specialist training program, a GP*, or a consultant.
*It is important to note that private practice is significantly restricted for GPs because most people in the UK will be registered with an NHS GP already. Patients who are registered with an NHS GP cannot be charged for any 'General Medicine' services. In addition, GP practices cannot offer or advertise - during NHS working time or on NHS-funded property - ANY of their private primary medical services to anyone (whether the patient is registered or not). This means that if a GP practice provides an NHS service, they cannot then charge for (or host) that same service during NHS working hours or on their practice premises [4].
Doctors registered with the GMC do not need to tell the council that they will be undertaking private work, but they may be expected to declare their private work to their NHS trust if also undertaking NHS work (as there are specific rules touched on later in this post).
There are also some extra requirements you have to fulfil before you can work privately:
Register with the CQC
By law, any person (individual, partnership, or organisation) who provides regulated activity in England must be registered with the Care Quality Commission. However, there were recent changes to this so that if you are working for a private practice that is registered with the CQC already, YOU as a physician (NOT a surgeon) do not need to individually register. You need to register if the private practice is NOT already registered with the CQC or you are performing surgical procedures [5].
Be recognised by private medical insurers (specialists and consultants)
Most patients who receive private treatment do so as part of their private health insurance plans. Therefore, in order for them to be reimbursed for their specialist's fees, their doctor must be recognised by these insurers. Some popular insurers you've probably heard of are: BUPA, AXA PPP, WPA and Aviva. An overview of their rules can be found in the BMJ article on working in private practice. Malpractice will lead to de-recognition.
Are there restrictions on private practice for NHS doctors?
Yes, and these restrictions will depend on your stage of training.
Consultants are permitted to carry out private practice subject to the terms of their contract and job plan. Other staff are permitted to undertake private practice providing that it is not undertaken within their time contracted to the Trust and follows the rules for outside employment.
There may, however, be specific restrictions on time. For example, junior doctors in Cambridge may engage in private medical practice for no more than the equivalent of one NHS session (one half day) each working week [6].
Each NHS Trust should have their own policy on Undertaking Private Practice and Fee Paying Work on their intranet. Most NHS Trusts may ask you to fill out a form to declare your private work and as a trainee, may require you to meet certain conditions such as:
The work undertaken complies with the European Working Time Directive / Working Time Regulations (now referred to as EWTD) and the requirements stipulated in your employment contract and the terms and conditions of your employment. i.e., you must not work more than a total of 48 hrs a week (or 60 hrs a week if you opted out of the EWTD).
The work is not undertaken during periods of leave of absence for study or sickness.
Trainees must not work at a level above their competency.
Undertaking the work will not impact on meeting educational goals.
The work must be approved by the clinical / educational supervisor in the host organisation including GP Practice, if in primary care, and the training programme director or head of school if in secondary care.
Trainees training less than full-time should explore increasing their regular hours before undertaking locum activity.
Trainees must work in an approved practice setting.
Practitioners must not, during the course of their Programmed Activities, make arrangements to provide Private Professional or Fee Paying Services, nor ask any other member of staff to make such arrangements on their behalf [7].
Does private practice count towards training?
Good news: locum work and private practice can count towards training competencies!
But this requires you to be on top of your admin and you should be getting most of your competencies done from your NHS work.
All licensed UK doctors must meet the GMC’s requirements for revalidation. It is the doctor’s responsibility to make sure they meet the requirements to avoid their license being placed at risk. Their revalidation will be based on their annual appraisals. Appraisals are annual reviews of your work while a revalidation of your license happens usually every 5 years [8].
For all doctors, your “designated body” (normally the trust, company, or agency employing you) must support you to access an annual appraisal with an appropriate appraiser. The designated body must be an approved practice setting (up until your first revalidation so approx. 5 years of practicing medicine) and you can find an appropriate designated body on the GMC website [9].
What are the advantages of working in the private healthcare sector?
Reduced caseload & autonomy over your schedule
There are fewer patients with private healthcare = fewer people coming to private hospitals. This allows healthcare professionals to dedicate more time to each patient, providing them with a thorough service that gives each individual more than the minimum level of care required. Without the pressures of a heavy caseload, as a doctor, you are better able to ensure patients' needs are met and that their problems/illnesses are quickly resolved. Private work gives doctors a lot more freedom to decide when they want to work. Consultants tend to do 'NHS days' and 'private days' and see patients one day a week. Patients are given an appointment and it's stuck to.
In the NHS, resources are stretched and employees are overloaded with work, with patients on never-reducing waiting lists. One of the biggest issues facing the NHS is staff burnout – 76% of NHS staff experienced mental distress or ill health at work [10]. The private sector experiences a far lower rate of burnout.
Pay
What do private doctors get paid?
Contractually, you may need to fulfil a number of hours in the NHS and your extra time can be used for private practice. This is typically what specialist trainees and consultants do. Pay will depend on a few key things:
Specialty - surgeons tend make the most money, particularly cardiothoracic and orthopaedic surgeons (see graphs below of NHS waiting times for procedures in 2021 and the common procedures done in private practice with their costs - full BBC article here).
Stage of training - consultants are top earners.
Your credibility - how well-known you are / accolades and titles (clients specifically want YOU), high positions you've held e.g. VP or President of a Royal College, sometimes even social media (for you budding plastic surgeons).
Amount of time outside of NHS hours dedicated to private work - consultants can opt to go private full-time because they've completed their NHS training. But most work less than full time and make up the hours with private practice. This is because higher salaries incur progressively higher rates of income tax and the NHS has a great pension scheme and some added benefits with regard to training resources and assistance.
Therefore, the 'average' pay of a private doctor is impossible to determine. You'll hear anything from consultants being completely unable to find private work to making millions per year. Private work in the UK is a wild west.
Ballpark figures suggest that surgeons earn the most from the private sector (upwards of £100,000 per annum), whereas physicians and anaesthetists hover around the £60,000 mark. Nevertheless, I wouldn't base your decision to work privately on a specific number whatsoever due to the circumstantial factors listed above. [11, 12]
Employee benefits
There are a number of employee benefits and perks available in the private healthcare sector, though it does depend on which company you’re employed by. These can include regular health screenings, private health insurance (for you AND your family), life insurance, gym memberships, free meals, coffees, and parking among other things. These can result in you actually saving a large amount of money too [13].
More responsive workplace
Private healthcare institutions tend to be more independent than the NHS - they're smaller and less bureaucratic. Private hospitals allow for a much more hands-on, responsive approach to complaints and ideas for improvement from their employees and patients. This means changes are implemented quicker. Think: QIP on steroids!
Diversify your experience
Working in the private healthcare sector broadens your medical experience. Despite your clinical skills being used, you will also take responsibility for positions you wouldn’t otherwise occupy. For instance, senior doctors in the private sector won’t just be responsible for their patients, but for staff management, sourcing and ordering supplies, and the general day-to-day running of their department. This creates and shapes well-rounded healthcare professionals, tying in your people skills with business and management.
What are the disadvantages?
A decrease in the entitlement of annual leave and loss of current terms for maternity leave and sick leave (which could affect the pay you get if you fall ill or pregnant).
Erosion of protected time for continuing professional development.
Increased work hours (if still doing NHS work to maintain NHS benefits and training).
Possible loss of any financial support given for professional fees.
Doctors who leave the NHS to work for a private provider should be aware that they will lose the benefits of the NHS pension scheme [14].
References:
The CQC - Registration exemption for independent medical practitioners in private practice
Cambridge University Human Resources - School of Clinical Medicine: Private Practice.
GMC approved practice settings and finding a designated body
Team24 - What are the advantages of working in the private healthcare sector?
BMJ Careers - Working as a GP in the private sector. BMJ 2008;336:s169
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