Leaving the NHS for Private Practice? Nine Excuses Keeping You Stuck

Every Consultant I coach has a reason why they can’t reduce their NHS sessions yet. Or why they can’t grow their Private Practice properly. Or why full time Private Practice is something other people do. 

Maybe you’re on ten, eleven, twelve PAs. Working a maximum job plan, quietly killing yourself – and still too nervous to drop a single one. 

You’re not alone in wanting out. GMC polling has found that around a third of doctors want to cut their hours. The desire is everywhere. What’s rare is the plan. 

The reasons vary. The staying stuck doesn’t. And after a decade of coaching Clinicians through this exact decision, I can tell you that most of these reasons aren’t barriers at all. They’re symptoms – and the underlying condition is uncertainty. 

So let’s do what we’d do in clinic. Let’s take a proper history. 

Can I reduce my NHS hours if my Trust says no? 

Yes – just not the way you’ve been thinking about it. 

This is the excuse I hear most often. “I asked about dropping sessions and they said no. It’s full time or nothing.” 

Your Trust may well refuse to change your job plan. That part can be true. But notice what your brain does next. It turns “the Trust said no to a job plan change” into “therefore I can never work less in the NHS.” Those are not the same statement. 

You don’t need the NHS’s permission to build a springboard. 

Consultants make this move all the time. They build a robust part time Private Practice alongside their NHS role. Steady clinics. Reliable referral sources. A patient base that grows month on month. And then, when the numbers work, they don’t cut their hours. They resign their NHS post entirely, or drop to a bare minimum contract, and step across. 

With planning, that step is not a leap of faith. It’s a well rehearsed transfer from one solid platform to another. The all or nothing framing belongs to your Trust’s HR department. It doesn’t have to belong to you. 

Can I still get appraised and revalidate outside the NHS? 

Yes. Easily. And I’ll admit this excuse gobsmacks me every time. 

Talented, senior Clinicians genuinely worry that if they step away from the NHS, they won’t be able to find an appraiser. Of course you’ll be able to find an appraiser. Even if you’re not working in a hospital environment, there are independent organisations whose whole purpose is to appraise doctors like you. 

You can still do audits. You can even still do research, if that’s what you want. Your professional development doesn’t stop at the NHS car park barrier. 

Is the paperwork tedious? Yes. It’s tedious for everybody, everywhere, in every version of your career. It doesn’t need to be the thing that decides your future. 

Please don’t let this piddling little administrative task be the one thing standing between you and the working life you actually want. I say that with love. And a slight smile. 

Do I need CQC registration for Private Practice? 

For most Consultants working in hospital, probably not. And even if you do, help exists. 

I understand why this one feels daunting. It sounds official, legal, and heavy. But the majority of Clinicians never need to go anywhere near their own CQC registration, because most people work under practising privileges at a private hospital, and the hospital holds the registration. 

If you’re one of the ones who does need it, two things are true. First, you must be compliant, because otherwise you’re breaking the law. Second, there are now specialist companies who will do the vast majority of the heavy lifting for you. 

Will you need to do some work? Yes. Will they make it manageable? Yes. Will you need to pay for it? Also, yes. But don’t worry. You’ll learn lots in Private Practice – and getting comfortable with buying in expertise is lesson one. 

Will I lose my NHS pension if I leave? 

Let’s take this one seriously, because it sounds like the most rational fear on the list. 

The typical advice from financial advisers runs along these lines: stay as long as possible, because your NHS pension depends on multiples of your salary. This advice isn’t work, but the problem is, it’s entirely about what you’d be giving up. It says nothing at all about what you stand to gain. 

Then there’s the quieter fear underneath it. What if I get sick? What if I’m permanently injured? The truth: the NHS isn’t going to pay you indefinitely either. And in Private Practice you can put policies in place – income protection, critical illness cover, key person insurance. Yes, these a cost. Of course they are. Private Practice is a business. But the numbers you get to play with are thankfully much bigger. 

Let’s retire that “job for life” myth too. For the first time, we’re seeing that NHS job security isn’t guaranteed. Trusts merge. Hospitals shut. Departments get reconfigured. A boss who doesn’t rate you can make your position very, very uncomfortable indeed. The “safe” option is not as safe as it feels. 

So absolutely speak to your financial adviser. That’s non-negotiable. But before you do, use our free Ninja Number calculator to see what your Private Practice could realistically earn. For many Consultants, that number easily more than covers the pension question – and suddenly the conversation with your adviser gets a lot more interesting. 

What if the patients don’t come? 

Now we’re at the heart of it. You want freedom. But you also want the certainty that you can get there.

Let’s deal with the worst case first, because that’s what your brain is chewing on at 3am. What if it all falls flat and you end up without a job? Well – there are plenty of NHS roles out there. Worst case, you travel a bit and do some locuming while you regroup.

Have I ever actually seen this happen to anyone I’ve coached or known? Er, nope. Not ever. Not a single sausage.

Now for the real diagnosis. Most Clinicians who carry this fear are running on unsound marketing. They’re overly reliant on word of mouth, a couple of referrers, and an insurer (who might blackball them) sending them people. When your patient flow belongs to someone else, no wonder you’re terrified of losing it. That fear is entirely rational.

The answer isn’t courage. It’s skills and clarity. When you know how to attract self-funding patients yourself, when you can reliably track exactly where every patient comes from, and when your systems and processes deliver an amazing patient experience, everything changes. Patients seek you out for your niche skill. And your problem becomes overwork – not empty clinics.

Will I be lonely in Private Practice? 

Only if you design it that way. And let’s start with an uncomfortable truth: you can be lonely in the NHS too. Surrounded by people, and lonely. Or worse still, surrounded by lots of people you really don’t like. 

What Private Practice gives you that the NHS rarely does is choice. You choose which hospital you work in. You choose the way to get to work. You can even choose your own staff. And in the same vein, you choose your patients – I want to see these people, and not those. 

The people who end up lonely in Private Practice turn up, sit in their room, see their patients, and go home.  

If you want your Private Practice to succeed, you’re going to need to network anyway – talk to the people working in the same hospital environment as you. And if you’re somewhere you don’t see other Clinicians, you can reach out and foster relationships with like-minded private practice clinicians to meet up with. Why not build proper private MDTs, rather than trying to sort out your private patients in the last five minutes of an NHS MDT. 

The NHS gives you a lot of people around you – and a lot of noise and hassle from those same people. In Private Practice, there’s no annoying manager. No obstructive gatekeeper. No chorus of people whose default answer is no, no, no. Some of the crowd you lose is crowd you’ll be glad to lose. 

How do I deal with the guilt of leaving the NHS? 

This is the deepest one, so it deserves a straight answer.

You trained in the NHS. Colleagues invested in you. Patients need you. And somewhere along the line, that gratitude got twisted into a belief that you owe the institution your wellbeing, indefinitely, whatever it costs you.

For many Consultants it goes further. You built a beautiful service. It’s your baby. You’re terrified that if you leave, there’s nobody to fill the gap and the whole thing falls over. And you feel like you’d be letting your colleagues down.

Gently: the gap is not your problem to solve. Workforce planning is the job of an entire national institution, not one Consultant’s conscience.

There’s a bittersweet truth almost everyone discovers here. Consultants who leave, or reduce their hours, are usually astonished by how fast the NHS moves on without them. The service you built survives, adapts, or changes – because it belongs to the system, not to you. That cuts both ways. It means it was never yours to carry, either.

As I like to remind clients: it doesn’t benefit anyone for you to die on a sacrificial altar, propping up a system that won’t look after you in return.

I’m not a self-promoter – do I really have to market myself?

You have to market your practice. And when we dig into this fear, it’s rarely about patients at all.

It’s about peers. You don’t want colleagues thinking you’re cocky. “Look at him with his fancy website. Look at her all over LinkedIn.” It’s the tall poppy fear – the worry that if you put your head above the parapet, someone will take a swing at it. Maybe a colleague calling you out on social media, claiming your content is bogus.

One principle dissolves all of it. Make your marketing for the patient, about the patient, and grounded in your experience – and on the whole, you really can’t go wrong. Ethically, professionally, or reputationally. Good medical marketing isn’t self-promotion. It’s making sure the patients already searching for help with your exact condition can find you, trust you, and book you.

So it’s not about you. And it’s definitely not about what your peers think. The vast majority of the time they’re far too busy to notice anyway.

And if one or two of them are a little jealous of your thriving practice? Well. I’ll leave that thought with you. Let ‘em.

Nobody taught me to run a business – can I really do this?

This is the quiet excuse underneath all the others. And yes, you can – because business is learnable in a way that medicine’s entry requirements never were. I had to do this. In a hurry. You can too.

Med school taught you how to be a Clinician. It certainly didn’t teach you how to run a business. Even the Consultants who are naturally good at the businessy side – when we unpick things together, there are almost always huge gains to be made in their systems and processes.

If you started as an F1 (that’s a ‘house officer’ to my medical generation) at twenty-three and you’re now in your forties or fifties, you’ve spent your entire working life inside one organisation. You’ve been properly institutionalised, through no fault of your own, with barely a chance to peek over the fence at how the other side works.

So naturally you worry. Your clinics aren’t full enough yet, so how could you possibly find the time and energy to build them up to the point where you can reduce your hours or go full time?

That’s where I come in. This is exactly what I do, and I’ve been doing it for over a decade. In all that time, I’ve never had a single client who went full time, or significantly reduced their NHS hours, and then went back.

A client sent me this message recently:

“Full-time Private Practice is amazing. I work on average twenty hours a week. The rest of my week is spent enjoying my freedom in life – sleep, mental health, relationships. Everything is better. It’s a pleasure to be doing good work and being paid my worth. I’ll never go back. Could not have done it without you. I’ll be eternally grateful.” 

That’s not a special case. That’s what the other side of this decision looks like. 

One last thing – I’m not here to get you to leave the NHS 

I mean that. I love the NHS. I hope to God it survives! 

Here’s the irony that surprises people. Some of my clients are very happily still in the NHS. They’re earning serious money in Private Practice, and that’s exactly what lets them keep up a bit of NHS work on their own terms – where before, they were burning out and getting really, really resentful. 

That’s the whole point. This was never about NHS or Private Practice. It’s about choice. When your Private Practice can stand on its own, staying in the NHS becomes a choice. And it’s remarkable how much easier the NHS is to love when you’re there by choice. 

The real diagnosis 

None of these excuses survive contact with a plan. That’s the pattern. Admin problems dissolve into sequences. Money fears dissolve into numbers. Identity fears dissolve into skills you can learn. 

What’s left is uncertainty. And uncertainty is treatable. 

So ask yourself the question I ask every Clinician who’s stuck: what exactly are you protecting by staying? 

If you’re ready to swap your excuses for a plan, book a  FREE DISCOVERY CALL We’ll look at where you are, what’s actually holding you back, and what your springboard could look like. No pressure, just a proper diagnosis