How Much Private Practice Do You Really Need to Replace Your NHS Income?

You’ve finished clinic.

You open your inbox.

There are another twenty-three ‘Advice and Guidance’ requests waiting for you. Urgh.

Your private practice surgical planning still needs doing. Tomorrow’s NHS list is a beast.
By the time you finally get home, you’re wondering, not for the first time, whether this is really how you want the next ten years to look.

Maybe you’d never dream of leaving the NHS.

Maybe you’d just like to get one day a week (and your life) back.

Maybe you’re wondering whether Private Practice could eventually give you the lifestyle and security your friends who work in the city have.

Whatever you’re thinking, it all comes down to one question.

If you reduced your NHS commitment tomorrow, how much Private Practice would it actually take to make the numbers work?

Most consultants can’t answer that.

Not because they’re bad with numbers. Quite the opposite. They know exactly how many clinics they’re doing, how many PAs they’re carrying and how much private work they’re squeezing into evenings and weekends.

What they don’t know is the one number that would tell them whether cutting back is actually possible.

And without that number, it’s incredibly difficult to make a confident decision.

So, most people don’t, and a few more years drift by like that. Not because they’ve consciously chosen to stay, but because they don’t know whether they could afford not to.

What’s really keeping you stuck?

I hear from clients, that when it comes considering reducing NHS hours or even leaving, it’s the pension, loyalty or even their appraisal, direct their reasoning.

Those things absolutely matter.

But in my experience, they aren’t really at the core of what keeps Consultants exactly where they are.

It’s the uncertainty.

The worry that if you reduced your NHS commitment, the private work wouldn’t fill the gap.

That fear feeds on vagueness, and when the numbers are fuzzy, staying where you are feels like the safest option. Of course it does. We’re humans and we all want an easier life.

Here’s the irony. Many ‘stuck’ Consultants are turning a blind eye – unconsciously sacrificing their quality of life, time with friends and family, and even their health, when all that they needed was clarity..

Once you know your number, you can make a proper decision.

You might decide to stay exactly where you are.

You might drop one or two PAs.

You might build your Private Practice more deliberately.

You might even decide it’s time to leave the NHS altogether.

The point isn’t what you choose.

The point is that you’re choosing from facts instead of fear.

Meet your Ninja Number

(Yes, it’s a cheesy name, but I do love a little alliteration).

It’s a number from a simple calculator that estimates how many outpatient hours of Private Practice you’d typically need to reach your income goal.

It’s important to understand what it is, and what it isn’t.

It’s not a financial forecast. Nope.. and it definitely won’t replace advice from your accountant or financial adviser. Obvs.

But it is a practical rule of thumb, or a ‘pulse-check’, built on more than a decade of working with hundreds of consultants across a wide range of specialties.

Its job is to answer two questions.

“Roughly what would this take, and am I on track?”

And it does that in about a minute.

How does it work?

The calculator starts with one number: your NHS take-home income – i.e. how much went into your bank account..

And then you add in two other bits of data:

How much revenue did your practice bring in, in the last twelve months (gross revenue)? How many hours of outpatient time did you spend in clinic?

If you have practice management software, you can usually pull out the data with not much effort.

Here’s an example from Carebit – a month’s revenue and the booked hours – aka outpatient hours:

From there, it estimates how many outpatient hours of Private Practice you’d typically need to replace it.

The assumptions are deliberately conservative.

Across hundreds of practices, I’ve found that a sensible rule of thumb is that around a third of the money your practice brings in eventually ends up in your pocket.

Why only a third?

Because your gross fees aren’t your income.

First, your practice has to pay its way. Secretarial support, consulting rooms, indemnity, software, accountancy, travel, conferences, professional subscriptions and all the other costs that come with running a successful practice. And let’s not forget buying that nice shiny Macbook Pro and stashing some pension dosh away, too…

Then HMRC takes its share.

By the time you’ve covered your overheads and paid your tax, roughly a third of your gross income is yours to keep.

Is that exact?

No.

In my experience, a few consultants keep a little less…

But many keep considerably more.

Let’s rather underestimate than over-promise. Then you’ll be pleasantly surprised.

If the calculator says the numbers work using cautious assumptions, there’s every chance your real-world position will be even better.

That’s exactly what a good rule of thumb should do. Give you enough clarity to make a better decision without pretending it can predict the future.

Four things your Ninja Number can tell you

1. Are you already on track?

If you’re already doing Private Practice, your Ninja Number becomes a benchmark.

Are your current hours and fees actually getting you where you want to go? If you look in the diary for next week, can you feel reassured?

2. Could you reduce your NHS commitment?

This is where many consultants get their biggest surprise.

One of my clients told me that ‘Advice and Guidance’ had become the straw that broke the camel’s back.

He’d finish clinic, open his inbox and find a tsunami of requests waiting for him.

Week after week.

It was effectively two extra clinics’ work ‘hidden’ inside renumeration of a single PA. About £10K of pre-tax NHS income for the whole year.

When we worked out his Ninja Number, he realised replacing that PA required far less Private Practice than he’d imagined. It was 2 hours per week of Private Practice.

That changed everything.

Let’s look at an example..

Let’s imagine he wanted to quit the NHS entirely, earn the same amount, but just work a lot less….?

3. Is Private Practice actually the right answer?

Sometimes the calculator tells people something they weren’t expecting.

For some consultants, Private Practice isn’t the right move yet.

That’s valuable information.

It’s far better to discover that in sixty seconds than after giving up two years of Saturday clinics.

4. What would leaving the NHS actually take?

For some consultants, this is the question they’ve quietly wanted answered for years.

Seeing the real figure, instead of the one your imagination has been inventing, is often the moment a scary idea becomes a practical plan.

One last thing

Your Ninja Number is driven by two things.

Outpatient of hours you work.

And what you earn per hour.

Most consultants assume the answer is simply to work more.

Usually it isn’t.

It’s smarter working- better positioning and attracting the right patients.

Those things all reduce your Ninja Number without adding another clinic.

That’s a conversation for another day.

Find your Ninja Number

It’s free.

It takes about a minute. Calculate your Ninja Number here →

For most consultants, the hardest part isn’t deciding what they want.

It’s knowing whether it’s actually possible.

Your Ninja Number won’t make the decision for you.

But it will replace guesswork with a bit more clarity.

And sometimes that’s all you need to stop drifting and start choosing.