Starting off in private practice – I’m a GP…but what next!?

This truly is one of the most frequent questions colleagues and I are asked by GPs – there has never been quite so much interest amongst UK GPs in working in some way in the independent or private sectors (it’s interesting to see how and why people use those two interchangeable terms – another article one day, Ed.).

I recently read a rather damming book about the prevalence of high-paying but low in societal value jobs…and the fact that usually one can index jobs that have measurably positive impact on people's lives, such as teachers, nurses, care workers and cleaning staff against salaries towards the bottom of the scale. This is not the place to enter such contentious territory, but to say that doctors and GPs, are very much a rightly lauded exception – enormously hard working, having undeniable positive impact at real scale, and compensated reasonably (I know, arguable too…but for now bear with me!).

All that said, there can be no doubt that GP working conditions have changed - worsened in the last 15 years. The reasons are manifold and complex, but the results are clear. A handful of examples here: GPs just 10 years into their career are leaving the NHS, younger GPs increasingly do not want to take on partnership roles, almost all qualifying GPs would not consider a ‘full time’, 9 or 10 session a week role to be viable.  

So, a large proportion of all GPs are actively considering portfolio roles with feet in both the NHS world that trained them, and the private sector where they rightly feel they may be able to manage their work life balance, and importantly, practice in a way that allows them the time and resources that align with their original aspirations for the role.  

Given all these pressures, and the real opportunities for GPs in the private sector, one would think that far more clinicians would be making that leap now – but time and time again we meet people for whom the looming shadows of regulation, documentation, indemnity, and commercial considerations have proven just too dark, too seemingly impenetrable.  

So, these excellent doctors stall. They put it off. They perhaps do a little work with a remote GP provider,  But I contend that this work is not a good representation of what Private GP work can be, should be, when run by an excellent clinician (or group of clinicians) focussed on the mutually compatible aims of a strong business and patient wellbeing.

So, let us point a torch into those shadows, say the nasty names of the things that sink our stomachs, and see them for the manageable tasks they truly are:

You are a GP – and so you know you need to be registered with the GMC, and that requires appraisal each year. As a private GP, things are the same – and if you are working in both eh NHS and private worlds, well, your NHS appraisal works for both! GPs who work 100% in the private world also need that registration, under the same conditions, and so they will need to either pay for a private GP appraisal or do enough work in an NHS service that they qualify for a free NHS appraisal. An appraisal in the private sector costs around £1000 currently, so a consideration for your yearly costs.

Indemnity – Lots has changed in this bit of the industry in the last few years… and we foresee more change to come – and the good news is that while indemnity for private GPs is a considerable amount of money at present - it is not covered by the government as NHS indemnity costs for GPs are in the main. This cost is likely to reduce – this is due to the increase in the use of Private services by the wider public, and the increase in understanding of private GP work by the indemnity providers (a case in point, indemnity for remote GP work by private provides reduced in cost by almost 50% over the pandemic period as providers working with Remote GP employers learned about the risks – specifically they became less concerned about risk. And so, costs fell.

And the good news is that if you have a GMC registration and are covered for an appropriate amount of time and type of work by an indemnity provider… you are good to go as a private GP!

Well, that is if you are going to work for an existing GP Clinic or Group Practice… If you want to set up your own practice, we are going to have to use the C word I am afraid.

You will need, of course, to register with CQC. I do not believe that this is a thought to bring joy to anyone – but, quite genuinely, there could not be a better time to be doing this.

CQC is fundamentally changing the way it works with independent providers, learning form the changes it has been bringing in the public sector and after a great deal of criticism about its previous approach.

Regulation going forward will be much more proactive on the part of the provider – maintaining good systems and documentation (and The Private GP Forum has you more than covered there!) and submitting these to CQC at regular times, will be, as a rule, the apple a day that keeps CQC away. Of course they will and should do initial inspections for new services, you will need to prepare for this fully, but there are services and people who can help (#privateGPForum, #fasttrackGP)– but there is a real intention that the kind of punitive investigations carried out by a motley crew that we have all heard about or even experienced, are a thing of the past.

So, you are a registered GP, you have had an appraisal in the last year, you have registered with CQC. What next? Let's help you choose a medical record system.

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