Leaving the NHS is one of the biggest decisions a clinician can make. For some, it is years in the making. For others, it comes after one particularly difficult week when something just shifts. Either way, it deserves proper thought and proper preparation.

The private healthcare sector in the UK is growing, with a growing number of patients choosing to pay for faster access and longer appointments. The demand is there. What you need is a clear picture of what the transition actually involves.

Private practice is not just the NHS without the waiting lists. It is a different way of working, and it is worth being clear-eyed about both sides of that.

On the upside, you get control. Over your hours, your caseload, your fees, and how you structure your working day. Many clinicians find that seeing fewer patients with more time per session leads to better outcomes and a much more sustainable pace of work.

On the other side, you are running a business. That means managing income that varies month to month, handling your own admin, marketing your services, and building a client base from scratch. None of this is insurmountable, but going in with realistic expectations makes the adjustment much smoother.

Before you treat a single private patient, two things need to be in place.

Your professional registration. If you are registered with the HCPC, you need to keep that registration active whether you are working in the NHS or privately. Your registration does not automatically transfer or change when you move sector, but you are responsible for maintaining it and keeping your CPD up to date.

Professional indemnity insurance. In NHS employment, your employer's indemnity cover protects you. In private practice, that cover disappears the moment you leave. You need your own professional indemnity insurance in place before you start seeing private patients — for HCPC registrants, this is a mandatory condition of registration. Most professional bodies, including the CSP and BACP, offer indemnity schemes for members. Make sure your cover reflects the work you are actually doing, including any home visits or telehealth sessions.

You may also need public liability insurance if clients will be coming to a clinic space, and employers' liability cover if you take on any staff.

This is the part that catches many clinicians off guard.

When you leave NHS employment, your NHS pension does not disappear, but it does stop growing through new contributions. If you have more than two years of service, your benefits will be preserved and increase each year in line with CPI — less than the CPI plus 1.5% revaluation active members receive, which is worth understanding before you hand in your notice. You will also lose benefits that come with active membership, including death in service cover and enhanced ill-health retirement protections. Replacing these through life insurance and income protection policies is worth doing before you leave.

On the private income side, you will need to set up your own pension arrangements. Personal pensions and SIPPs are both options. If you are incorporating as a limited company, pension contributions through the company can be a tax-efficient approach. Get advice from someone who understands clinician income rather than a generalist.

Not everyone goes fully private in one move, and there is a lot to be said for a phased approach. Working part-time in the NHS while building a private caseload gives you a financial safety net while you find your feet. It also keeps you connected to a clinical team and CPD opportunities that some clinicians miss more than they expected.

If you plan to take on private work alongside NHS employment, check your contract carefully. Many NHS trusts have restrictions on outside work, and you may need to notify your employer and seek formal approval.

Going fully private from the start is possible, but you should have at least three to six months of living costs available as a buffer. New practices take time to build.

A place to work. Renting a room in an existing clinic is often the lowest-risk way to start — it keeps fixed costs low while you build your client base. Some clinicians begin with home visits or Telehealth-only practices, which reduces overheads significantly. If you are planning a fixed premises, factor in rent, rates, and the time it takes to build a full diary before committing to a lease.

A practice management system. The admin burden in private practice is real. Trying to manage appointments, notes, invoicing, and client communication manually while also seeing patients is a fast route to burnout. A system like splose handles all of this from day one — and if you want to understand what practice management software actually does, that is a good place to start.

ICO registration. Most private practitioners need to register with the Information Commissioner's Office as a data controller. It is a legal requirement if you are holding sensitive patient data, and costs a small annual fee. Use the ICO's self-assessment tool if you are unsure whether it applies to you.

A business bank account. Keep your personal and practice finances separate from the start. It makes bookkeeping far simpler and is essential if you are operating as a limited company.

Building a client base is an active process, and this is the part that feels most alien to clinicians coming from the NHS.

GP relationships remain one of the most valuable referral sources. Introducing yourself to local surgeries and making it easy for them to refer is time well spent. A simple one-page referral sheet is often enough — and reducing no-shows once those clients are booked is equally important.

Getting listed on directories early also pays off. Psychology Today, the BACP therapist directory, and the CSP's Physio2u tool can generate steady enquiry volume once your profile is set up. A basic website that explains who you are, what you treat, and how to get in touch will do more for your visibility than word-of-mouth alone.

Think about whether you want to work with health insurers too. Becoming recognised with BUPA, AXA Health, or Aviva can open up a significant referral stream, though application processes take time and reimbursement rates are set by the insurer.

Even well-prepared clinicians find the first few months harder than they anticipated — not clinically, but emotionally and logistically.

The isolation can surprise people. Going from a busy department to working alone is a real shift. Building peer networks and staying connected to your professional community become things you have to be intentional about rather than things that happen automatically. The splose community is one place where private practitioners share experiences and advice.

Income will fluctuate, particularly early on. Cancellations hit harder as a sole practitioner, and holidays or illness mean no income rather than paid leave. A financial buffer and conservative projections for the first year are the most protective things you can have in place.

They wish they had sorted the admin infrastructure earlier. They are glad they did not rush the move. They found the autonomy more energising than expected once they got through the adjustment period. And most say it was worth it.

The NHS gave them their clinical foundation. Private practice lets them use it on their own terms.

splose is practice management software built specifically for private healthcare professionals in the UK. With splose you can manage online bookings, automate appointment reminders, write and store progress notes, send invoices, and track your finances — all in one place. The AI features mean that note-writing and client correspondence take a fraction of the time they otherwise would.

If you are planning your move, or already there and finding the admin harder than expected, splose offers a free trial so you can see how it fits before committing.

Ready to see what splose can do for your private practice? Explore splose features or read our guide to setting up a successful private practice.

This article is intended as a general guide for healthcare professionals considering or making the move to private practice in the UK. It does not constitute financial, legal, or professional advice. Always seek guidance from qualified advisers for decisions specific to your circumstances.