Can I work as a private GP and in the NHS as a GP?
The rules for partners, salaried GPs and locums who add private sessions, and what changes for indemnity, appraisal and pension.
- England
The short answer
Yes, many GPs combine NHS and private work, and it is often the easiest way to start. The main rules are that an NHS practice cannot charge its own registered patients, private work should not happen in your NHS time or premises unless agreed, and you need separate indemnity for the private work. Your annual appraisal covers both, and private income is not NHS-pensionable.
Key points
- Combining NHS and private work is allowed and common.
- An NHS practice cannot charge its own registered patients for treatment, so see people registered elsewhere.
- The BMA model salaried contract allows private work that does not conflict with your job plan or contracted hours.
- CNSGP in England covers NHS work only. Private work needs its own indemnity.
- One appraisal covers your whole practice, and private income does not count towards your NHS pension.
Yes, and most private GPs do
Nothing in GMC registration or the NHS contracts stops a GP from working in both sectors. Many private GPs keep NHS sessions for a steady income, their NHS pension and their clinical breadth, and add private work one session at a time. For the routes into private work, see the different types of private GP.
The rules that matter depend on your NHS role. This article describes the NHS rules in England. They are mostly about keeping the two kinds of work separate: separate patients, separate time, separate premises and separate cover.
What applies to you
| Your NHS role | The main rules to check |
|---|---|
| Partner in a GMS or PMS practice | The practice must not charge its own registered patients for treatment. Private work for others must be outside contracted hours and not in NHS-funded premises. Your partnership agreement may also restrict outside work. |
| Salaried GP | Your employment contract. The BMA model contract allows private or other work as long as it does not conflict with your job plan and, unless agreed, is not done in contracted hours. |
| Locum GP | Fewest restrictions. Check each practice’s terms, and do not see a practice’s own patients privately. |
The contractor rules are covered in detail in the restrictions on seeing private patients in NHS practices. If you are a partner, take advice before you set anything up.
Salaried GPs: your contract
Clause 14 of the BMA model salaried GP contract says practitioners may undertake private practice or other work, provided it does not conflict with their job plan and, unless agreed, is not done during contracted hours. If you use practice facilities for private work, the model contract expects part of the fee to go to the practice.
The model terms are written for GMS practices, which should offer terms no less favourable. Other employers may use different wording. Read your own contract and tell your employer about your private work, even if you do not need their permission.
Keep patients and time separate
- Do not offer private care to patients registered at the NHS practice you work in.
- Do not promote your private service during NHS consultations or in NHS premises and materials.
- Do not do private work in NHS time unless your employer has agreed.
- Keep separate records, and write to the patient’s NHS GP after private care.
The ethics of offering private care to people you also see in the NHS are covered in transitioning NHS patients to private care.
Indemnity: two kinds of cover
In England, the state-backed Clinical Negligence Scheme for General Practice (CNSGP) covers clinical negligence claims from NHS GP work only. NHS Resolution recommends cover from a medical defence organisation or other provider for matters outside it, such as non-NHS work. Wales has its own state-backed scheme for NHS GP work. In Scotland and Northern Ireland your MDO membership covers NHS claims, and private work is added to it.
Tell your indemnity provider exactly what private work you do. See whether you need different indemnity and where to get it.
One appraisal for all your work
You have one GMC licence and one revalidation, so your annual appraisal must cover your whole scope of practice, including private sessions. If you keep NHS work in England, you stay on the NHS performers list and NHS England is usually your designated body. Bring evidence from your private work, such as patient feedback, significant events and audit, to your NHS appraisal.
If you stop NHS work entirely, NHS England may remove you from the performers list if you cannot show you have performed NHS services in the preceding 12 months. You then need another route to appraisal. See appraisal and revalidation as a private GP.
Pension and tax
- Pension. NHS Business Services Authority guidance says GP practitioners’ pensionable earnings exclude non-NHS income. Private work does not add to your NHS pension, so plan for it separately.
- Tax. Private income is taxed whether you are employed by a clinic, self-employed or working through your own company. Keep records from day one and see the tax implications of private work.
Workload and safety
Private sessions on top of a full NHS week can leave you tired, and fatigue is a patient safety issue. Count your total hours across both jobs, protect rest between shifts, and do not squeeze private sessions into days you already find hard.
There is no minimum number of private hours. See minimum hours for private work.
Scotland, Wales and Northern Ireland
The GMC rules apply everywhere. The NHS contract rules, performers lists and indemnity arrangements differ in each nation, and private services are regulated by Healthcare Improvement Scotland, Healthcare Inspectorate Wales or RQIA instead of the CQC. Check the local rules, or ask your LMC or medical defence organisation.
Getting started
- Read your NHS contract or partnership agreement.
- Tell your NHS employer or partners.
- Arrange indemnity for the private work before your first session.
- Choose a route: sessions for an existing provider are the simplest. See sessional private GP work.
- Start collecting appraisal evidence from your private work straight away.
Frequently asked questions
Do I need my NHS employer’s permission to work privately?
Under the BMA model salaried contract you do not need consent if the work is outside contracted hours and fits your job plan. Other contracts may differ, so read yours and tell your employer anyway.
Can I see private patients in my NHS practice building?
Only with the practice’s agreement and within the NHS contract rules on premises. Many GPs rent rooms elsewhere to keep things simple.
Will doing private work affect my NHS appraisal?
It adds to what your appraisal must cover. Your appraiser will expect evidence from private sessions too, such as feedback and reflection on significant events.
Can I work privately while on a GP retainer or in training?
Check with your scheme or deanery first, because these posts often have their own conditions on outside work.
