Guest blog post

Private medical practice in the UK has long existed in the shadows of the NHS. For many clinicians, it remains something of a mystery – rarely discussed during training and often treated as an awkward or even taboo topic. Yet the reality is that private practice is simply another legitimate way to deliver excellent patient care while exercising professional autonomy.

Like many colleagues, my own journey into private practice began cautiously. There was no formal training in the business side of medicine and very little accessible advice. In response to this gap, I later created Private Practice UK , a free resource aimed at helping doctors understand some of the practicalities involved in building and running a private practice. The site is not a manual or business consultancy – it is essentially a synthesis of experience, observations, and lessons learned along the way.

For clinicians considering dipping their toes into the private sector, the key message is simple: it is entirely possible to build a professional, ethical, and sustainable private practice alongside NHS work, or as a full-time endeavour. Like anything worthwhile, it helps to understand both the benefits and the pitfalls.

Here are five good things about private practice – and five things I wish someone had told me before I started.

1. Professional autonomy

Perhaps the most obvious benefit of private practice is autonomy.

In the NHS, clinical work inevitably occurs within large organisational structures. In private practice, the consultant often has far greater control over how care is delivered – how long appointments last, what diagnostic tools are used, and how the patient experience is designed.

This autonomy can be profoundly satisfying. It allows clinicians to build a service that reflects their own values and standards. For example, at The Wye Clinic , the emphasis is on truly patient-centred, consultant-led care and personalised treatment pathways, allowing patients to be seen by experienced specialists without long waiting lists and with a tailored approach to treatment.

Many doctors find this ability to shape the patient journey, from first consultation to follow-up, one of the most rewarding aspects of private work.

2. The ability to innovate

Private practice often allows clinicians to adopt new techniques, technologies, and service models more rapidly than large healthcare systems.

In ophthalmology, for example, advances in cataract surgery and intraocular lens technology have transformed outcomes over the past three decades. Platforms such as The Cataract Specialist exist partly to help patients navigate this evolving landscape and identify surgeons with the relevant expertise and experience.

Private practice can create an environment where innovation thrives; provided it is done responsibly and always with patient safety at the forefront.

3. Direct relationships with patients

One of the great pleasures of private practice is the ability to build meaningful relationships with patients.

Longer consultations, continuity of care, and the opportunity to explain treatments in detail all contribute to a more personal style of medicine. Patients often value the ability to choose their surgeon and to be treated directly by an experienced consultant at every stage of their care.

These relationships are frequently deeply rewarding and remind us why we entered medicine in the first place.

4. Intellectual and entrepreneurial stimulation

Medicine is intellectually stimulating by nature, but running a private practice introduces a new set of challenges.

Understanding pricing structures, patient pathways, marketing, branding, and service design requires learning skills that are rarely taught in medical school. While not every doctor enjoys this aspect, many discover that the strategic and entrepreneurial elements of practice are surprisingly engaging.

Private practice can therefore provide an additional dimension to a clinical career: one that combines medicine with elements of leadership and business.

5. The opportunity to build something lasting

For some clinicians, private practice becomes more than simply an additional income stream. It evolves into something more meaningful: a professional legacy.

Whether that takes the form of a specialist clinic, an educational platform, or a collaborative network of clinicians, private practice offers the chance to build services that persist beyond individual careers.

The key is to approach this ambition thoughtfully and responsibly.

While private practice has many rewards, it also comes with responsibilities and complexities that are easy to underestimate.

Here are five things I wish I’d known when starting:

1. Nobody teaches you the business of medicine

Medical training in the UK provides extraordinary clinical education – but almost nothing about running a business.

Billing systems, tax structures, company formation, secretarial services, indemnity arrangements, and marketing are all things that clinicians often learn through trial and error.

This lack of guidance is one of the reasons resources like Private Practice UK were created: to encourage open discussion and share practical insights between colleagues.

2. Compliance matters more than you think

Private practice sits within a complex regulatory framework.

Depending on the nature of your work, you may need to consider:

• Indemnity arrangements
• Registration with PHIN
• CQC registration, especially if you are keen to create your own facility
• Data protection and information governance
• Contracts with insurers
• Billing transparency
• Professional conflicts of interest

None of these things are insurmountable, but they must be addressed properly from the outset. Private practice is not the Wild West; it operates within clear legal and ethical boundaries.

As I often emphasise to colleagues: stay legal, stay insured, and stay transparent.

3. Reputation is everything

In private medicine, reputation is your most valuable asset.

Patients often choose consultants based on trust, recommendations, and visible expertise. A strong professional reputation built through years of clinical excellence is the foundation of a successful practice.

No amount of marketing can compensate for poor outcomes or questionable ethics.

Fortunately, the inverse is also true: clinicians who consistently deliver excellent care tend to build strong referral networks naturally.

4. Administration is bigger than you expect

Many doctors initially assume that private practice is simply about seeing patients outside the NHS.

In reality, administration plays a substantial role. Appointment scheduling, patient communication, billing, insurance queries, and follow-up processes all require systems and staff. Remember that the very first interaction that potential patients have with your team will be crucial in deciding if they would like to proceed under your care, or not. If this interaction is handled by a generic private hospital team, who have perhaps never even met you, the consequences may be very negative for your fledgling business.

A good secretary or administrative support team can make an enormous difference to the smooth running of a practice.

Without that infrastructure, even a clinically brilliant service can quickly become chaotic.

5. Be careful about 'managed' private practice models

One issue that is increasingly relevant for new consultants entering private practice is the growth of large corporate healthcare providers offering employment-style roles within private settings.

At first glance, these arrangements can appear attractive. The organisation provides the facilities, the administration, the patient flow, and the billing infrastructure. For a clinician starting out, this can feel like a convenient shortcut into private practice.

However, there is an important distinction between building a private practice and working within someone else’s managed care system.

In many such models the financial structure, pricing, patient pathway, and sometimes even clinical protocols are largely controlled by the organisation rather than the consultant. While this may reduce administrative burden, it can also lead to a substantial loss of professional autonomy. The consultant effectively becomes a salaried or sessional worker within a corporate system – a 'worker bee' – with limited influence over how the service is designed or delivered.

This arrangement can feel surprisingly similar to NHS employment, but without the same professional structures, governance traditions, or long-term security. You will need to consider carefully if this is why you entered private practice…

Why autonomy still matters

True private practice allows clinicians to develop their own professional identity, build direct relationships with patients, and maintain control over the standards of care they provide. It also allows consultants to build their own reputation and brand over time.

When those elements are removed, the advantages of private practice can quickly diminish. Instead of creating something personally meaningful and professionally independent, clinicians may find themselves functioning simply as another component within a larger corporate machine.

For that reason, I often encourage colleagues to think carefully about the difference between short-term convenience and long-term professional independence .

Starting your own practice, even on a very small scale, can be slower and requires more effort initially. But it allows you to retain control over your professional standards, your reputation, and ultimately your career.

In the long run, those things matter enormously.

Encouraging the next generation

Private medicine in the UK is evolving rapidly. Rising demand, longer waiting lists, and technological innovation are creating new opportunities for clinicians who wish to explore this area of practice.

For younger consultants and newly appointed specialists, the idea of private practice can seem daunting. Yet with careful planning, appropriate advice, and a strong ethical framework, it can become a rewarding and intellectually stimulating part of a medical career.

Learn from others. Ask questions. Seek professional advice when necessary. And always place patient welfare at the centre of everything you do.

Private practice is not about replacing the NHS. For many clinicians, it sits alongside NHS work, complementing it and offering additional ways to deliver high-quality care.

Handled responsibly, it can be a powerful force for professional fulfilment, and for better patient outcomes.

About the author

Mr Simon Madge is a consultant ophthalmologist and founder of The Wye Clinic and Border Health Alliance , independent healthcare facilities delivering consultant-led care in the UK. His specialist clinical work in cataract and lens surgery is outlined on these websites.

He also created Private Practice UK , a resource designed to help doctors understand the practicalities of establishing and running a private practice. Through this platform he provides mentoring for consultants who are new to private practice.

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