Is the grass really greener? Moving from the NHS to private practice

Moving into the private sector after years in the NHS has been an eye-opener for physio Liz Cowan.


Frustration led physio Liz Cowan to move from the NHS to private practice

Thinking of private practice?

It was one of those typical days at work – loads of patients waiting to be seen, time wasted by those who didn’t turn up, and the ones you do the most for on the phone constantly saying you weren’t doing enough.

Frustrating. Clinical pressures of work, combined with the worry of re-banding. Then the final straw, an unfair letter of complaint.  
I flicked through the job adverts in Frontline. A private practice was trying to recruit. I love the NHS, I was trained by the NHS. I don’t want to leave the NHS. What NHS?
I gave the company a ring. The boss spoke so enthusiastically about what her practice could offer me, and what we could offer the clients, that I decided to put in an application form – after all, I would have to interview for my own job in time anyway so I might as well get my CV up to date. Then I was offered an interview: all good practice, I told myself, nothing lost.  
I was in a good bargaining position in the interview. I was currently in a good job just miles from home, with top annual leave, pension, and all the benefits that goes with having been somewhere for ten years.

I took a list of four things I was going to get out of a job offer, or I wasn’t going to accept. I was offered the job. The boss wasn’t giving into my four requests (that’s why she has a successful business) – take it or leave it.

No improvement in pay; payment based on how busy you are; less annual leave; poor sickness policy; much less job security; longer journey to work. 
I took it, such was my frustration with the NHS.

Private practice: what have I learned?

So, after 18 months in private practice, what have I learned? Did my expectations match reality?
I thought that clients would be wealthy. I imagined that if people were willing to pay for physiotherapy that they actually wanted it, and might carry out recommendations. Not so. I have entered into the world of clinical compensation awards, and case managers.
Many of the clients have been awarded compensation for an injury that has occurred to them. They have a fund of money to pay for the therapy. They come from all walks of life. Yes, I still go to houses where I have to wipe my feet on the way out.
Not every client wants your input, they are no more likely to do their home programme than if they weren’t paying. If anything, there is an expectation that the service will be better, because they are paying for it, and that you will do everything for them, because they are paying for it. And if they don’t like you, they will pay for it from someone else. 
I thought private physiotherapists were much better paid. My hourly pay is less than in the NHS. The practice charges a lot more, but this covers all the overheads that go with running a private practice, including marketing and promotion.
I get paid the same hourly rate when I am treating a client as when I am in the car travelling to a client, or writing a report for a client. If I don’t see any clients I don’t get paid. If they cancel because they are ill on the day, I don’t get paid.



Private practice means becoming a business within a business

I get the opportunity to see clients as often as I think they should be seen, based on clinical need, not waiting list pressures. Where clients may have had their input reduced under the NHS I can keep providing input.

All is measured by goals set every three months. If my input is not effective and they don’t reach their goal I have to explain myself.

There is more pressure to set meaningful, measureable goals as my caseload and thus my livelihood depends on it.

It is a challenge, but an exciting opportunity – not only for me, but for the profession. Have you asked yourself: ‘How much could this client achieve if I could see them as often as I want?’ Well, in the private world there are opportunities to really prove that physiotherapy works.

If we do it well, and shout about our results, the word will get to those who we wish would listen and NHS services may be better funded.
Paperwork needs to be kept up to date. Each contact with a client is invoicable, each telephone call, each email, each activity you do on their behalf. If you want to send them a bill you have to have an entry in your notes to record that it happened.

Many of the clients are going through legal procedures, so there is a high chance that your notes may be used in court.

A business head

I have taken ownership of my future as a physiotherapist. I am a part of a private practice, but really I am a business within a business.  If I do my job well, and word gets about, then I get more business – more clients, means more hours, means more pay. 
Every contact is a potential business opportunity. Networking matters. Getting to know your market matters. Know your case managers and solicitors. Tweet – yes, get dragged into this century. I recently took part in my first Twitter chat on my Tweetdeck.

There are many private physiotherapists out there; I need my name and the name of the practice to be on the lips of the case managers as they source what the clients need. My elevator pitch is constantly being rehearsed and updated.
Family life has changed since I went into private practice. To some extent, I can manage my own diary. For me, this means I get to drop off the kids at school. Conversely, if a client is paying for therapy they expect it at a time that suits them; so careful diary management is needed to keep everybody happy.

Report writing can be done at a time that suits me. I will often see my clients, then have some quality time with the kids, then do some reports later in the evening. On the downside, I am a slave to my phone – I don’t tend to clock off. I need to work on that. I am still learning that my work-life balance has to suit us as a family.
I think about the value of the service that I offer much more than I did when I was with the NHS. Then the cost was a distant factor, managed by someone else. And unfortunately I think it was regarded in the same way by the patients.

Now I am aware of how much the clients are paying, and I put myself under more pressure to make every session count. Not that I was shabby before, I just didn’t consider it.

Loads of love, not money

Private physiotherapy does not equate to physios taking lots of money for treatment sessions that are not really needed.  Professional firms will give treatment plans documenting what they are going to do, and how they are going to do it.
They will then be measured on whether they have achieved that, using SMART (specific, measurable, attainable, relevant and time-related) goals.  For me it is about giving the best service I can, to get the best out of my clients.  
I welcome the opportunity to work with NHS colleagues – think of me as another pair of hands, aiming towards the same goals, not a threat to your job. 
I have discovered that I love my work all over again. I really love working with children with disabilities. I love being part of the physiotherapy community, and want to do all I can not only to further my career; but also to enhance the good name of my employer; and the good name of the physiotherapy profession.
  • Liz Cowan is a physiotherapist with Susan Pattison Therapy Services, which is based in Bury
  • Twitter: @sp_neurophysio
  • Website:

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