What staff do you need to run a private general practice service?

It depends on how you work

If you consult in a private hospital outpatient department, or under practising privileges at a larger clinic, the host usually employs the receptionists, nurses and managers. You may need nothing more than your own secretary or booking service. See practising privileges.

If you set up your own service, you decide. Many private GPs start alone, with a booking system, a phone answering service and an accountant, and hire once there is enough work. See running a practice by yourself.

Roles the regulator requires

In England, the CQC registration rules decide some roles for you:

• Registered provider. You as an individual, a partnership or a company.
• Registered manager. Required where the provider is a company or other body, or where an individual provider is not fit to manage the service or is not in full-time day-to-day charge of it. A solo GP registered as an individual and running the service day to day may not need a separate one.
• Nominated individual. A company or other body that is not a partnership must name a director, manager or secretary who supervises the management of the regulated activity.

The same person can hold more than one of these roles in a small company, but each carries its own responsibilities. See registering with the CQC.

Named leads

The CQC expects clear responsibility for key areas. In a small service, one or two people cover them all, but write down who does what:

• safeguarding lead, trained to the right level for adults and children
• infection prevention and control lead
• resuscitation lead, who makes sure training and equipment checks happen
• complaints lead
• information governance or data protection lead
• health and safety and fire lead.

The core roles as you grow

Role	What they do	When to hire
Receptionist or administrator	Answers calls and messages, books appointments, takes payments, handles post, results and letters	Usually the first hire, often part-time
Practice manager	Runs operations, staff, compliance, finance and suppliers. Often the registered manager.	When admin and compliance take your clinical time. Often grows out of the administrator role.
Practice nurse	Vaccinations, travel health, cervical screening, wound care, health checks	When you add nurse-led services
Healthcare assistant or phlebotomist	Blood tests, observations, ECGs, chaperoning	When you offer screening or high blood test volumes
Additional GPs	More appointments and cover for your absence	When you are fully booked or need holiday cover. See recruiting GPs.

Chaperones

The CQC expects every patient to be offered a chaperone for intimate examinations, with the offer made clear before the appointment. Formal chaperones must be trained, and non-clinical staff doing chaperone duties may need a DBS check. If a patient wants a chaperone and none is available, they must be able to rebook within a reasonable time. Working alone makes this hard, so plan for it, for example by booking intimate examinations when a trained colleague is in.

What you can outsource

• bookkeeping, payroll and accounts
• IT support and cyber security
• HR advice, contracts and policies
• cleaning, clinical waste and couriers
• call handling and out-of-hours messages
• marketing and website.

Outsourcing does not move your regulatory responsibility. The CQC says providers remain responsible when they delegate to contractors, so check your suppliers' work. A good booking, payments and record system also reduces the admin a small team has to do by hand.

Planning for absence

A small team has little slack. Decide now who covers when you or a key member of staff is on holiday or off sick: who reads incoming results and messages, who handles urgent queries, and whether a locum GP or a neighbouring practice can see patients. Write this into your business continuity plan, which the CQC may ask to see when you register.

Checks for everyone

Regulation 19 applies to everyone who works in the service, including volunteers, contractors, agency and bank staff. For each person you need the Schedule 3 information, such as identity, relevant DBS check, qualifications, employment history and conduct in previous health or care roles. There is no general requirement for reception or administrative staff to have a DBS check, but you need a recorded rationale and risk assessment for your decision. See employment law when hiring staff and staff immunisations.

Scotland, Wales and Northern Ireland

Healthcare Improvement Scotland, Healthcare Inspectorate Wales and RQIA each have their own registration rules, including who must be named to manage the service. Check their guidance before you decide your structure.